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Transcript of -introduce intervention
Cueing during dressing
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St. Louis, MO: Mosby.
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Lancioni, G. E., & O’Reilly, M. F. (2001). Self-management of instruction cues for occupation: review of studies with people with severe and profound developmental disabilities. Research In Developmental Disabilities, 2241-65. doi:10.1016/S0891-4222(00)00063-9
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Mailloux, Z., May-Benson, T. A., Summers, C.A, Miller, L. J., Brett-Green, B., Burke, J. P., … Schoen, S. A. (2007). Goal attainment scaling as a measure of meaningful outcomes for children with sensory integration disorders. American Journal of Occupational Therapy, 61(2): 254-259.
Reynhout, G. & Carter, M. (2006). Social stories for children with disabilities. Journal of Autism and Developmental Disorders, 36 (4), 445-469. Doi: 10.1007/s10803-006-0086-1
Interventions used for ADL tasks
Developing a Bedtime Routine Using Social Stories
Toileting and Goal Attainment Scales!
Least amount necessary
Begin with simplest form
Provide more cueing as needed
Let's Talk About Tooth Brushing And Video Modeling!
What might be tooth brushing challenges for a 7 year old diagnosed with:
*Hint: Think physical, emotional, sensory, environmental
Factors to Think About for Tooth Brushing:
Sensory Sensitivities Or Obsessions:
-Tooth Brushing Experiences
-Knowledge of Tooth brushing
-Ability to Plan the motor movements
-How does the child best learn?
THE POWER OF CHOICE!
The Intervention: VIDEO MODELING
Utilize Video Modeling
Grading This Activity
Cueing and Independence
Physical and verbal
type of toothbrush/toothpaste
Changing video model
Evidence Based Practice supports Cueing as an intervention...
-Using Goal Attainment Scale to measure progress with toileting.
-Dynamic Systems Theory- multiple systems of the person, task, and environment work together.
Reese and Snell completed a study that used graduated guidance (graded cueing) during a dressing activity and found significant results at the end of the study as well as at the 2 year follow up
Lancioni and O'Reilly completed a systematic review of 25 articles that looked at different types of cueing and its effectiveness. Overall, the cues used were effective and motivating
Lower Extremity Dressing
Upper Extremity Dressing
What types of cueing are provided in the videos?
How would you grade this cueing for a child who is higher functioning?
How would you grade cueing for a child who is lower functioning
I had a
I had a really hard time.
It was just right.
I did a good job!
Grading Up: Have the client complete the full detailed scale. It is important to give the parents the more detailed Goal Attainment Scale to fill out when toileting is done at home.
Where I would start with my client:
What are components of toileting that may be difficult for this client that you can work on during a session?
Client: A 7 year old boy with Down Syndrome who has decreased fine motor coordination, decreased strength, and sensory processing
Client: A 7 year old boy with Down Syndrome who has decreased fine motor coordination and decreased strength and sensory processing disorder?
Think about the environment, the skills/limitations of the client, and the prerequisites involved in toileting
Clara is a 7 year-old who has cerebral palsy. She has decreased fine motor skills and high spasticity. One of her OT goals is to dress and undress independently
*These videos were filmed and will be used for educational purposes only with parental consent
-Social Learning Theory (Bandura, 1977)
5 minutes- snack time
5 minutes- Making Playdoh Tooothbrushes
Swinging on the platform swing collecting paper tooth brushes and
going in the ballpit to
find stuffed animals
that need to
"brush their teeth"
explain to the child that they will be brushing their teeth. Allow them to explore the toothbrush.
Tell the child they will now try.
Pick a familiar song to sing while brushing teeth.
When finished, congratulate the child. Give them a reward such as a token, a sticker, or letting the them watch the movie again.
5 minutes- Give the family a home program and resources while letting the child pick a closing activity
Show the child the video you are using to model. Again let them explore the tooth brush and watch the video for a second time.
- Create supports within the family's environment
- Promote opportunities for the child to be independent
- Establish a bedtime routine
Preparing client for the session
-Setting up the picture
*Make sure to agree on a goal for the session!*
and Strengthening Activities
-Child will chose clothing
for Mr. Bear to wear to
Hand Washing Skills
-Client will clean up the
play dough, wash the
plates, and dry them
Goal Attainment Scale
-Remind the client of
-Ask them to rate their
Intervention Session- A Day in the Life of Mr. Bear!
15 min: Making a social story
- Choose relevant tasks to include in the story
- Use a social story app on an iPad to take pictures of the child completing the bedtime routine
10 min: Introduce social stories
- Read a social story about a bedtime routine with the child
- Ask three comprehension questions about the story
Let's Put It All Together!
- Cueing Hierarchy
-Goal Attainment Scales
Greet the client and family/ caregiver and provide a schedule
Facilitate dressing related play
(10 minutes) encourage the child to participate in a play activity with a doll or action figure.
(10 minutes) Perform preparatory techniques, stretch the client or have a snack
Let the child choose clothing!
10 min: Assist the child in constructing sentences for the story
- Provide sample sentences that follow Gray's Social Story format (descriptive, directive, perspective, affirmative, cooperative, and control)
5 min: Wrap up
- Review child's session with the parent
- Answer questions about handouts and questionnaire or provide contact information to address further questions
10 min: Role-play the social story
-As the therapist, my role would be the parent
- The child will practice the bedtime routine
Bring Clothing Options...
Wrapping it up
(5 minutes) Provide detailed home program
As the child's ADL's skills improve, less cues are needed.
In order to progress the child to become more independent, use the least amount of cueing necessary.
Goal: The child will read a social story with a parent prior to starting the bedtime routine in order to develop a consistent routine and reduce sleep disturbances.
Target age: 7-9 years
10 min: Preparation activities
- Parent/child interview about sleep habits and routines
- Quiet activity for the child during the interview
- Give screening questionnaire and handouts to parent
- Change method of story delivery
- Task breakdown
Components of Skilled OT
What other strategies may be helpful for developing a routine?
Bedtime routines using social stories
Tooth brushing using video modeling
Dressing using cueing
Toileting with Goal Attainment Scales
Giving the right amount of cueing, not too much, not too little!
Keeping the child safe
Understanding and adjusting for emotional insecurities
This approach is used to establish and restore ADL skills
Cues may be given by the therapist or environmental or task cues may occur naturally
Grading This Activity
Type of Toothbrush/Toothpaste
Cueing and Independence
Evidence to support
Goal Attainment Scales
What is a Goal Attainment Scale?
-Intervention Session: working on
components of toileting that are
challenging for the client.
-GAS were originally used in mental health OT settings
-Measure progress towards a goal with a -2 (much less than expected) to +2 scale (greatly exceeds expected level) with 0 being the goal for the client
-See your sheet for an example!
- Evidence supports the use of GAS as a valid, reliable, and sensitive measure to capture improvement in hard to measure goals.
-Clients and parents also report that they appreciate the individualized goals that are formed when making a GAS!
-Therapeutic use of Self
-Cueing (Verbal, Tactile, Hand over Hand)
-Grading of tasks
-Just right challenge
-Progressing the client
Title: Social Stories for Children with Disabilities
- Level I systematic review of 16 studies examining the effectiveness of using social story interventions for children with disabilities
- Participants ranged from age 3 to 15 years old
- Range of diagnoses and behavioral problems included in the studies
Bottom line: Social Stories may have a positive effect on improving a child's behavior, but the effects are highly variable.
Progressing the Client
-Dressing bear to dressing self
-Decreasing the number of cues
-Progressing from play dough
to preparing a small snack
-Progressing from toileting to learning about privacy and appropriate behavior in public restrooms
- Fading the social story as the child becomes familiar with the bedtime routine
-Make food for dinner with play dough
Goal: Eating 2 bites of cereal with a spoon!
-Therapeutic Use of Self
- Using Cueing
-Type of feedback given
-Type of video modeling given
-Sensory input for the child
-Making the environment prepared-thinking ahead
-Being playful and on the child's level
Visually Cued Instruction
- Therapeutic use of self
Pediatric Interventions for ADLs
By: Anja Saksa, Taylor Al-Qadhi, Jordyn Nikunen, and Leah Schminkey
-Two meta analyses: Showed that video modeling is effective in learning, retaining, and transferring skills.