Occupational Therapy Services
OTA The Koomar Center offers the highest quality evaluation and treatment to children within the fields of Occupational Therapy and Speech and Language Therapy. This page describes the different types of evaluations that are offered at OTA The Koomar Center. Which evaluation you receive depends on the unique needs of the child. On this page you will also find information describing individual Occupational Therapy and Speech and Language Therapy as well as the variety of specialized areas in which many of our therapists have expertise that complement individual therapy. At OTA experienced therapists are available to discuss with you which type of evaluation and treatment approach is appropriate. Click here to find out how to get started.
Comprehensive OT Evaluation
Most children require a full, comprehensive evaluation in order to begin occupational intervention services. Our comprehensive evaluation requires 12 hours of therapist time. This evaluation will give you a complete picture of your child’s sensory processing and motor needs along with recommendations for services and accommodations. It includes 2 1/2 to 4 hours of direct assessment, a comprehensive detailed written report, and an evaluation feedback meeting. The assessment tools used for this evaluation vary depending on the child’s age, abilities and needs but may include the Sensory Integration and Praxis Tests (SIPT), the Miller Assessment for Preschoolers (MAP), the OTA-Watertown Sensory Modulation and Discrimination Evaluation, the Bruininks-Oseretesky Test of Motor Proficiency, or a number of other assessment tools.
Abridged OT Evaluation
Clients whose evaluation is covered by Harvard Pilgrim Health Care (HPHC) insurance plans only are eligible for our abridged evaluation. This evaluation requires 45 minutes to 1 hour of assessment and parent feedback and includes a brief two page written report. An evaluation feedback/goal-setting meeting is strongly encouraged but not covered by this insurance plan and must be paid for out-of-pocket if desired. This evaluation is not comprehensive but is sufficient to determine eligibility for occupational therapy services.
Specialty OT Evaluation
On occasion children may require a detailed evaluation that is focused on a specific need area such as fine motor/handwriting skills, oral motor skills, listening, visual-vestibular integration, or Interactive Metronome. These specialty evaluations are tailored to meet the needs of the child. They are most appropriate for examining, in depth, specific problems that may have been identified in another evaluation, emerged as particularly problematic during therapy services or appear to be an isolated difficulty identified by yourself or your child’s school.
Occupational Therapy Screening
In rare instances, an occupational therapy screening for a specific treatment area may be appropriate. This screening is most often used when clients are receiving other services at The Koomar Center, such as speech therapy, and believe there may be other sensory-based problems or wish to determine if an adjunctive service such as craniosacral therapy or listening intervention may be appropriate. At times it is unclear from an initial intake if a client has sensory integration difficulties and a screening may be recommended as a first step instead of a comprehensive evaluation. A comprehensive evaluation may be recommended if indicated by the screening. A screening consists of one hour of assessment, and a feedback checklist is provided at the end of the screening.
Occupational Therapy Intervention
Individual Occupational Therapy Intervention
Therapy is based on the unique needs of each child and can address difficulties with self-regulation, sensory processing, body awareness, motor planning, and development of gross motor and fine motor skills. The first therapy session will be focused on building a rapport between the child and therapist. Some children require their parents to be present during this session while other children will perform better without their parents watching. Your therapist will happily discuss with you which option will be most appropriate for your child.
Your therapist may decide initially to work with your child in a smaller, quieter room to support engagement in appropriate activities and may then move to a larger room where peers may also be working one-on-one with therapists. When appropriate, children are encouraged to interact with peers to promote problem solving, negotiation and social skills.
Therapy is playful and follows a child led, adult guided approach where the therapist encourages the child to participate in fun but purposeful activities that stimulate sensory systems that may not be working as effectively as they should be. Therapy is fun for the child and is skillfully managed by the therapist to ensure it is appropriate for the child and is set to the “just right challenge,” where the activity is not too difficult so that the child no longer wants to play but is not too easy so they lose interest quickly. It is this “just-right challenge” that ensures the child forms an adaptive response that will develop the functions in which the child is having problems.
No one can organize a child’s brain for him. He has to do it himself. Though a therapy session looks like casual play, both therapist and child are in fact working very hard. All of the activities that your child will engage in during the therapy session are purposeful; they are all directed toward a goal of self-development and self-organization.
The development of specific therapy objectives for each child 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 goals and objectives that will be measured by improvement in day-to-day skills and activities.
Our occupational therapy services treat a variety of pediatric diagnosis including:
Autistic Spectrum Disorders
Attention deficit disorder
Fine and gross motor coordination disorders
Other psychological and neurological conditions
And a variety of challenges including:
Difficulty paying attention in class
Difficulty carrying out daily activities such as getting dressed
Avoidance of playground activities
Frequent tumbles and falls
Difficulty engaging at birthday parties or play dates
Needing to be constantly on the move
Heavy handed with toys and peers
Poor sleep patterns
Sensitive to clothing or becoming upset at bath time
Easily frustrated with new activities
Specialty Occupational Therapy Interventions
The use of auditory interventions as a therapeutic tool (also called sound therapy) has grown significantly in recent times. 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, visual motor skills, handwriting and reading.
Music based sound stimulation programs originated 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 the principles and theories of Tomatis provide the foundation for other auditory stimulation programs.
Currently OTA offers three different types of auditory intervention: Integrated Listening Systems (ILS) The Listening Program (TLP) and Therapeutic Listening. All programs utilize specially modified music 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.
OTA offers 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, which 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. In school, it is estimated that at least 75% of classroom learning occurs through visual pathways. 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.
Children with visual-vestibular coordination difficulties may:
Crave constant physical support from adults, such as being held, rocked, guided, etc.
Have difficulty with going up or down stairs
Get car sick frequently or generally dislike rides in the car
Avoid swings or playground equipment
Experience delays with reading and writing
Have difficulty with gross motor skills such as riding a bike, ball skills, running, or jumping
Stumble or fall frequently
Not seem to get dizzy even after spinning for a long time
Seem to enjoy fast movement like swinging
Visual vestibular intensives at OTA are typically of a three-week duration where the individual attends for 3 to 4 sessions a week working one-on-one with a therapist. Following the three-week intensive the therapist will discuss the recommended course of action. This may include discharge from therapy, continued therapy once a week, or a break from therapy to allow for the information to be integrated before continuing with more therapy. Click here for more information on Visual Vestibular integration.
The FOCUS Program – Oral Motor/Feeding Intervention
Many children/adolescents 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. Our Occupational Therapists have specialized training to work with clients who have eating and mealtime challenges as part of our FOCUS Institute for Mealtime Success. This whole-body, systematic approach was developed here at OTA The Koomar Center. Eating is a complex and multi-system skill, so 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. Wondering if you or someone you know would benefit from support in this area? Click here to find out. For more information about our therapy services, please click here.
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. One of the most common therapies used at OTA is craniosacral therapy. This gentle, hands on intervention is designed to support the rhythmic flow of the cerebral spinal fluid throughout the craniosacral system (the area surrounding the brain and spinal cord). By maintaining a balance in this system, functions of the central nervous system such as reaction to sensations, emotional responses, and development of motor skills can be facilitated.
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 the regularly scheduled sensory integration sessions, depending upon the client’s tolerance. Parents are encouraged to remain with children during manual therapy sessions (at least initially) in order to observe the techniques and their effects. Click here for more information.
The Interactive Metronome (IM) is an adjunct program to the sensory integration services provided at OTA. It is most appropriate for children who have reached a plateau or end in their sensory integration services, or who have mild motor coordination difficulties. Other children with excellent coordination skills can use the program to attain peak performance in specific sports activities.
The Interactive Metronome (IM) is a computer-based program that uses a patented auditory guidance system plus interactive exercises to improve the foundational neural mechanisms necessary for motor planning, sequencing, and rythmicity. This involves clapping or tapping triggers in time to the metronome beat. The computer program measures the child’s response time in milliseconds and provides auditory feedback as to whether the child’s timing is too fast, too slow, or just right in response to the metronome beat.
Functional changes that are seen after completing an Interactive Metronome program are variable with each child, but most often include improvements in timing, reciprocal social interactions, rhythm, motor coordination, sports skills, attention and impulsivity, fluidity with reading and writing and language processing. For more information click here.
Under the best circumstances, mastering the art of bike riding can be difficult for many children. For those who have sensorimotor issues, the task can be even more daunting. Learning to ride a bide requires many foundation skills including good body awareness, balance, postural stability, visual skills, bilateral skills and motor planning. Children may also be anxious and appear unmotivated if they have not been able to master riding their bike with the same ease as peers and siblings. At OTA individual bike-riding instruction is given to children who are not yet riding their bikes or have limited skills. Taught by experienced OTA therapists, these lessons are tailored to meet the needs of each child. A bike lesson typically starts off with activities within the clinic and then moves to direct practice on the bike. The number of sessions required depends on the child’s skill level. Don’t forget to bring your bike and helmet to the lesson! Just fill out a Bike Intake Form, and we’ll contact you. Click here for a Bike Intake Form.