Adult Occupational Therapy Services

Adults and Sensory Integration

Many adults have sensory processing disorders that make daily activities challenging or even impossible. For example, auditory sensitivities may interfere with the ability to work, ride public transportation, and participate in family activities. Tactile defensiveness often creates difficulties with intimacy with a spouse or significant other and frequently affects interpersonal relationships with friends, co-workers, and family. Difficulties processing vestibular input (movement) can affect the ability to drive, ride in airplanes, and engage in daily activities such as descending stairs, riding a bike, walking on uneven surfaces (e.g., when hiking), and navigating terrain such as icy sidewalks (Kinnealey, Oliver, & Wilbarger, 1995). Adults with sensory processing challenges, especially those with sensory defensiveness, often present to others as being controlling, picky, and overly sensitive (Oliver, 1990). They often report high levels of anxiety and depression, commonly have a history of post-traumatic stress disorder (PTSD) or trauma (Kinnealey & Fuiek, 1999), and may have tried years of counseling and medication before arriving at occupational therapy.

OTA The Koomar Center offers the highest quality services to adults within the fields of Occupational Therapy and Speech and Language Therapy. This page describes the different types of Occupational Therapy evaluations that are offered at OTA as well as information on our intervention approaches.

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Occupational Therapy Evaluation

We strive to tailor our approach to meet the unique needs of adults seeking services at OTA. During the evaluation process, your therapist may consider using structured assessment tools, interview, and exploration of responses to different types of sensory input as part of the evaluation session. They will collaborate with you to determine the best approach to utilize during the evaluation session in order to determine your sensory and motor profile and how those abilities impact your participation, occupations, and social-emotional state.

Comprehensive OT Evaluation

This evaluation will give you a complete picture of your sensory processing and motor profile along with recommendations for services and accommodations. It includes 3 to 4 hours of time with a therapist for assessment, interview, and exploration of sensory strategies. It includes a detailed written report and an evaluation feedback meeting.

Specialty OT Evaluation

On occasion adults may benefit from a detailed evaluation that is focused on a specific area such as fine motor/handwriting skills, eating and mealtime performance, listening or visual-vestibular integration. OTA’s specialty evaluations are helpful for examining a specific area of function in an in-depth way to effectively guide intervention. These are recommended when an individual is experiencing an isolated area of difficulty or when an area is identified in another evaluation or over the course of therapy indicates the need for additional assessment. Our specialty evaluations include 1.5-2 hours of assessment, a written report, and an evaluation feedback meeting.

Abriged OT Evaluation

Individuals whose evaluation is covered by Harvard Pilgrim Health Care (HPHC) insurance plans are eligible for our abridged evaluations. This evaluation includes 45 minutes to 1 hour of assessment and interview; it includes a brief two-page written report. An evaluation feedback meeting is strongly encouraged to understand the results of the evaluation and our approach to intervention. These meetings are not covered by this insurance plan but are offered at a discounted rate. This evaluation is not comprehensive, but it is sufficient to determine eligibility for occupational therapy services.

OT Screening

In rare instances, an occupational therapy screening may be recommended. For individuals who currently receive services at OTA The Koomar Center, a screening might be recommended to begin to explore the potential benefit of other services. This might include screening sensory motor capacities or determining if an adjunctive service such as cranio-sacral therapy or listening intervention may be appropriate.

For individuals who are new to OTA, an occupational therapy screening might be recommended during the intake process if it is unclear if the reported concerns are sensory related. In this case, a screening can take place as a first step instead of a comprehensive evaluation. The results of the screening will guide if a comprehensive evaluation is recommended.

A screening consists of a 1-hour screening session; a feedback checklist is provided at the end of the screening.

Occupational Therapy Intervention

Individual Occupational Therapy Intervention

The occupational therapy intervention provided at OTA is tailored to meet the unique needs of everyone we work with. During therapy sessions with adults, therapists use the core tenants of sensory integration to address specific sensory motor areas to improve functional capacities. This includes providing enhanced and targeted sensory input at the “just right” level to promote an organized and developed nervous system; working in the context of meaningful activities and goals that are motivating and engaging; establishing a collaborative therapeutic relationship that allows for growth in a physically and emotionally safe environment. Utilizing these tenants, you will work together alongside your therapist to improve the sensory motor foundations needed to improve a range of functional skills including:

Completion of daily activities, routines, and roles
Organization and planning skills
Participation in social and work settings
Sleep and eating patterns
Engaging in new activities more comfortably
Accepting everyday sensations including clothing and noisy environments

Sessions take shape based on each person’s unique needs and learning style. They can include remediation-based sensory activities, development of home programs and accommodations, and education. Your therapist will be thoughtful about what other factors might need to be considered to support your individual needs, including room set up and environment. Your therapist will also consider and utilize a range of approaches during therapy to support your unique needs including listening programs, oral motor techniques, manual therapies, and visual vestibular modalities.

Our hour-long therapy sessions encompass direct care, education, and recommendations for support in functional settings. Additional supplemental services, including collaboration and meeting with family and team members, are also available to comprehensively provide support to meet their ongoing needs. The development of functional goals and objectives for everyone who receives services at OTA is a very important part of the treatment planning process. We look forward to meeting with you during the first month of therapy to establish functional goals that will be measured by improvement in day-to-day skills and activities.

Specialty Occupational Therapy Interventions

The FOCUS Program – Oral Motor/Feeding Intervention

Many adults experience eating difficulties brought on by physical, sensory and psychosocial factors. Restrictive eating patterns negatively impact an individual’s social, emotional, and dietary well-being. Occupational Therapists at the FOCUS Institute for Mealtime Success have specialized training and utilize the FOCUS Program, a whole-body, systematic approach developed to address the complex and multifaceted needs of clients who experience challenges around mealtime. Eating is a complex and multisystem skill, therefore, FOCUS practitioners believe it is not helpful to target treatments solely on the individual’s mouth, but to consider the individual’s whole body and all environmental, contextual, physical, and psychological causes as part of a collaborative and systematic approach to treatment. Click here to learn if you would benefit from our services. For more information about the FOCUS Program, click here.

Listening Interventions

The use of auditory interventions as a therapeutic tool (also called sound therapy) has grown significantly in the past years. These music-based programs facilitate sensory processing by impacting the auditory and vestibular sensory systems. Clinical outcomes following a sound therapy program can include improved self-regulation, attention, communication, temporal-spatial organization, motor control and visual motor skills. Music-based sound stimulation programs find their origins in the work of Dr. Alfred Tomatis, MD, a French ear, nose and throat specialist. In the 1950s Dr. Tomatis developed the first auditory training program called the Tomatis Method. Generally Tomatis’ principles and theories provide the foundation for other auditory intervention programs. Currently OTA The Koomar Center offers three different types of auditory intervention: Integrated Listening Systems (ILS), The Listening Program (TLP), and Therapeutic Listening. The programs utilize specially modified CDs which can be used within treatment sessions and carried over in a home program. They differ in the structure of the program implementation. For more information describing the listening interventions at OTA click here.

Visual Vestibular Intervention

We offer specialized intervention to support visual-vestibular coordination. The visual and vestibular systems share an inseparable neurological and functional connection. Together they provide the foundation for skillful and comfortable movement through space and time as well as for efficient intake of visual information for learning. The vestibular system is often referred to as the movement or balance system. The receptors are located within the inner ear and respond to gravity and detect motion and change of head position. They tell us where we are in relationship to gravity, if we are moving or at rest, and our speed and direction of movement. The vestibular system is a powerful integrator that interacts with all other sensory systems. It most noticeably impacts our posture, balance, muscle tone, and bilateral coordination. The visual system is more than just eyesight, or the ability to see clearly–it is also our ability to understand what we see. If an individual is experiencing any visual difficulties, learning will most likely be impacted. For efficient oculomotor function, complex integration of many sensory systems must occur. According to Josephine Moore, the vestibular system is like a tripod stand that holds a camera, in that it helps hold the head stable so that the eyes can focus on an object. It contributes to bilateral integration which is important for simultaneous functioning of the two eyes together and smooth eye movements across the visual midline. Proprioceptors in the neck, eyes, and body help to coordinate movements to orient the head to the task at hand. All of these inputs together, especially the coordination between the visual and vestibular systems, are important in providing a foundation for the timing and spatial orientation of our movements and for security and comfort to navigate across environments. Adults that have problems with visual-vestibular coordination may exhibit:

Difficulty driving (reading road signs, merging on the highway)
A dislike of flying in airplanes
Difficulty “getting it together” throughout each day
Motion sickness in cars, airplanes or boats
Needing to spend a lot of time and energy getting organized
Discomfort if not in front seat while riding in a car
Fear of heights
Loss of balance when a bus or subway stops quickly
Difficulty navigating through grocery store, department store or mall
Difficulty with maps and directions

Click here for more information on visual-vestibular integration.

Manual Therapies

Occupational therapists and other health care practitioners use manual therapies to help the body utilize its own healing abilities to balance body functions. Several types of manual therapies are used at The Koomar Center as part of an individual’s intervention program. These techniques include but are not limited to craniosacral therapy, myofascial release, and massage. These gentle, hands on interventions are designed to support the nervous system’s functional responses to sensations and emotions and to facilitate the development of motor and other functional skills.

Many therapists at The Koomar Center specialize in manual therapies and routinely use these techniques as an integral part of therapy sessions. Sessions specifically devoted to manual therapy are also offered. These sessions may precede or follow regularly scheduled sensory integration sessions, depending upon the individual’s tolerance. Click here for more information.