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4/12/2018
1
Working Together: How
OTs, PTs, and SLPs Can
Collaborate
Kenzie Davis, MS CCC-SLP
Jane Weedon, MS PT
Alyssa Fagan, OTD, OTR/L
Please no video or audio
recordings during the
presentation to protect the
confidentiality of the children
in our case studies.
● Participants will understand how OT, PT, and ST can
collaborate to achieve therapeutic goals and learning
objectives.
● Participants will learn developmental milestones for
PT, OT, and ST. Participants will also identify
characteristics of language processing and sensory
processing disorders.
● Participants will identify when to refer children for ST
and OT evaluations along with special instruction
services, play therapy, and neuropsychological
evaluations.
Learning Objectives
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● Participants will understand how PT interventions
can help with global delays and improve ST and OT
goals along with school learning objectives.
● Participants will learn how to integrate some
language processing, speech production, and
sensory integration/regulation techniques to help
facilitate PT goals and outcomes.
● Participants will learn “red flags” when children are
not meeting developmental milestones for PT, OT,
and ST.
Learning Objectives (cont.)
● Key Aspects of ST, OT & PT
● Collaboration Definition & Trends
● Interdisciplinary Overlap
● Case Studies
● Implications for PT Intervention
● Red Flags
● Questions or Comments?
Outline for Today
Speech-language pathologists (SLPs) work to
prevent, assess, diagnose, and treat speech,
language, social communication, cognitive-
communication, and swallowing disorders in
children and adults.(American Speech-Language Hearing Association, 2018)
Role of a Speech-Language
Pathologist
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● Joint Attention
● Receptive Language
● Expressive Language
● Pragmatic Language
● Speech Production (Articulation, Phonology)
● Oral Motor Skills
● Feeding & Swallowing
● Fluency (Stuttering)
● Voice
Speech Therapy Goal Areas
Occupational therapists (OTs) use daily
activities or “occupations” to promote health,
wellness, and the improvement or
enhancement of participation in roles, habits
and routines for individuals and groups in
various contexts. (American Occupational Therapy Association, 2014)
Role of an Occupational
Therapist
● Upper Body/Core Strength and Endurance
● Bilateral Coordination
● Eye-Hand Coordination
● Sensory Processing
● Fine Motor Skills
● Visual Perception
● Visual Motor Integration
● Self-care or Activities of Daily Living (ADL’s)
Occupational Therapy Goal Areas
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Sensory Modulation
Sensory Overresponsivity, Sensory
Underresponsivity,
Sensory Craving
Sensory-Based Motor Disorders
Dyspraxia, Postural Disorders
Sensory Discrimination Disorder
Visual, Auditory, Tactile, Vestibular,
Proprioception, Taste/Smell,
Interoception
(Miller, Anzalone, Lane, Cermak & Osten, 2007)
Proposed Nosology of Sensory Processing Disorder
● Strength
● Endurance (Muscular and Cardiovascular)
● Motor Coordination
● Balance
● Body/Safety Awareness
● Gross Motor Skills
● Tone, Reflexes
● Motor Learning
● Joint Range of Motion, Posture
Physical Therapy Goal Areas
CPSE- Committee on Preschool Special Education
- Funded by NYC Department of Education
- Provides evaluations and therapy for children ages 3-5
CSE- Committee on Special Education
- Funded by NYC Department of Education
- Provides evaluations and therapy for school-aged
children over age 5
EI- Early Intervention
- Funded by the NYS Department of Health
- Provides evaluations and therapy for children 0-3
DOE- New York City Department of Education
General Acronyms
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“Collaborative practice happens when
multiple health workers from different
professional backgrounds work together with
patients, families, carers and communities to
deliver the highest quality of care.”
World Health Organization, 2010, p. 7
Increased area of importance based on complex
needs in early intervention and school-based
settings
More recent research and professional
accrediting bodies in support of formal
Interprofessional Education (IPE)
Del Rossi et al. 2017; Kerfeld, Pitonyak, and Jirikowic, 2017; Teeters Myers and Peganoff
O’Brien, 2015
Interprofessional Collaboration
● Understanding professional roles
● Communication
● Trust & Teamwork
● Problem-solving
● Belief in & advocacy for collaboration
(Del Rossi, Kientz, Padden, McGinnis, and Pawlowska, 2017; Peabody & Demanchick, 2016)
Interprofessional Collaboration
Requirements
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● Increased demands in kindergarten
classrooms since late 1990s:
○ Teacher expectations
○ Curricular content
○ Fewer activity/play centers
○ Use of standardized testing (Bassok, Latham, & Rorem, 2016)
● Therapies sought for skill enrichment (Harris, 2015)
Trends
● Child Factors: Shifts in diagnoses,
increased premature survival rates,
increased rare genetic dx, global
processing delays, increased anxiety, ADD,
ADHD, ASD
● Contextual influences: Later
diagnosis, starting school earlier, over-
scheduled, influence of technology,
caregiver stressors, urban stressors
Anecdotal Trends
● Task Breakdown: “Stand up, Put on Your
Shoes & Line Up”
● Venn Diagram
● Video Case Studies
Interdisciplinary Overlap
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1. Stand up from yoga mat
1. Locate shoes in classroom & navigate
getting to shoes
1. Sitting and putting on shoes amidst
peers
1. Standing up and forming a line with
peers
“Stand up, Put on Your Shoes & Line Up”
Task Analysis/Discipline Overlap
(Task: “Stand up, put your shoes on and line up”)
ST
OT
PT
- Distinguish
directions amidst
classroom stimuli.
- Visually locate shoes.
- Have spatial awareness so
can sit down amidst peers.
- Pair shoe with correct
foot.- Tying the laces with
adequate dexterity.
- Awareness
to stand in
personal
space.
- Comprehend and follow 3-
step commands.
- Know where shoes are kept.
- Know where to line up.
- Vocabulary associated with
shoe fastening. - Remember and recall
sequence in correct order.
- Maintain focus without
getting distracted.- Understand spatial
concepts such as “in
front”, “next to”,
“behind” and motor
plan body movements
accordingly.
- Navigate classroom
without bumping into
peers and furniture.
- Use bilateral hand
skills to fasten shoe.
- Fasten shoe with
adequate tightness.
- Exhibit co-contraction and mid-
range muscle control to stabilize
core; push with lower leg; pull with
bilateral hands.
- Sit down in controlled
manner.
Zeke Shoes Video
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What did you see?
● 3-year, 6-month old male
● Receives ST, OT and SEIT
● Dx sensory processing disorder
● Emerging expressive language and play skills
● Reduced attention to language and tasks
● Reduced ability to follow directives
● Impulsivity
● Difficulty peer interactions
● Decreased body awareness
Case Study #1: Zeke
ST: Zeke will follow familiar 3-step verbal
command given visual cues and minimal
clinician repetition of the instructions in a
variety of settings in 4 of 5 attempts.
OT: With minimal verbal prompting, Zeke
will don his shoes with competing visual
sensory stimuli present (i.e. another peer)
in 3 consecutive sessions.
Sample Therapeutic Goals
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● Overall strengthening activities
especially torso
● Endurance activities
● Oppositional alternating movement
activities
● Crossing midline and trunk rotation
activities
● Motor planning activities
● Movement sequencing activities
● Balance activities
PT Intervention
● Plan with speech
therapist specific
words/phrases to
use
● Repetition of
established language
each session
● Use picture board
for sequencing,
motor planning
PT Intervention
ST
OT● Minimize visual
distractions in PT gym
● Minimize number of
other people in PT gym
● Minimize external sound
in PT gym
● Visual stimuli slowly
added to build up
tolerance
● Proprioceptive input
● Tactile tapping of: shoe,
foot, hand to bring gaze
to task
● Move chair to face wall
Review Zeke Shoes Video
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Shoes
Talking
Dexter Videos
What did you see?
Case Study #2: Dexter
● 4-year, 2-month old male
● Receives ST and PT
● Strong expressive language and play skills
● Overall low tone
● Reduced speech intelligibility
● Lateralization of fricative sounds
● Nasality
● Reduced attention to listener
● Decreased gradation of movement
● Decreased proprioception
● Decreased body and safety awareness
● Decreased balance and stability
● Decreased protective reactions
● Decreased endurance
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ST: Given verbal prompts, Dexter will
exhibit a closed mouth posture for up to 5
minutes when engaging in a structured play
task in the therapy room in 4 of 5
attempts.
OT: Dexter will demonstrate spontaneous
midline crossing during self-care and
structured play tasks in 4 of 5 attempts.
Sample ST & OT Therapeutic Goals
● Cues to close mouth,
tongue inside mouth:
verbal/tactile
● Torso strengthening
for good alignment
of head, jaw, tongue
● Endurance for breath
control
PT Intervention
ST
OT
● Cues and toys that
require bilateral hand
coordination
● Activities that require
reaching across midline
● Torso strengthening
along with trunk
rotation activities
● Raising the surface level
● Providing visual cue on
floor for maintaining
position
● Manual facilitation
Shoes
Talking
Dexter Videos
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● Providing modeling of directives
● Using simplified language
● Breaking down each step of a multi-step
command
● Providing visual supports
Language Processing
Considerations for PT Intervention
● Forward head posture
● Low torso strength/posture
● Midrange motor control of muscles
that support breath/jaw control
● Difficulty with sustained phonation
● Reduced ability to dissociate tongue
movement from jaw
Speech Production Considerations
for PT Intervention
Sensory Modulation
Sensory Overresponsivity, Sensory
Underresponsivity,
Sensory Craving
Sensory-Based Motor Disorders
Dyspraxia, Postural Disorders
Sensory Discrimination Disorder
Visual, Auditory, Tactile, Vestibular,
Proprioception, Taste/Smell,
(Miller, Anzalone, Lane, Cermak & Osten, 2007)
Proposed Nosology of Sensory Processing Disorder
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○ What is it?
○ Think THRESHOLDS
○ Environmental considerations
Sensory Processing Considerations for
PT Intervention
Calming Techniques:
Rhythmic breathing,
rhythmic rocking, heavy
work, reduced
auditory/visual stimuli
Alerting Techniques:
Oscillatory or arrhythmic
movement, heavy work,
increased auditory/visual
stimuli
Sensory
Modulation
Sensory Processing Considerations
for PT Intervention
● Readiness for PT
● Understand child’s sensory triggers
● Modify environment to help with sensory
triggers
● Provide proprioceptive input
Visual Tracking & Perceptual
Considerations for PT Intervention
● Visual tracking/scanning and gross
motor skills
● Postural control
● Midline crossing
● Depth perception
● Figure ground
● Timing
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● Frequent tripping and falling
● Frequent leaning
● Excessive muscle tone (low or high)
● Bumping or crashing into objects or
people
● Avoidance of certain activities
● Favors one-side of body
● Fatigues quickly/sits down during gross
motor activities
PT Red FlagsWhen to Make a Referral
PT Red Flags (cont.)When to Make a Referral
● Awkward movements
● Ball handling decreased (throwing,
kicking, catching)
● Difficulty on the playground
● Difficulty riding a tricycle or bicycle
● Holding or fixing postures
● Can’t keep up with peers
● Doesn’t obtain new motor skills
● Consistently avoidant of a physical skill
ST Red FlagsWhen to Make a Referral
Infant/Early Toddler
● Reduced eye contact
● Not pointing
● Reduced joint attention
● No babbling
● Can’t follow one-step commands by 1-year
● No words by 1-year
● Less than 50 words by 2-years
● Reduced ability to use words for more than just
labeling
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ST Red Flags (cont.)When to Make a Referral
Preschool
● Difficulty following multi-step commands
● Difficulty using multi-word sentences to respond to
wh-questions
● Reduced ability to comment spontaneously
● Difficulty engaging in conversation
● Difficulty logically recalling events/telling a story
● Difficulty playing interactively with peers
● Decreased speech intelligibility
OT Red Flags When to Make a Referral
Difficulty engaging in age-appropriate occupations
● Achieving pre-academic skills: engaging with
different materials in various contexts, varying
demands
● Gaining independence with self-care skills:
eating, dressing, toileting
● Engaging in play: interacting with manipulatives
and play equipment, peer interactions, self-
regulation
● Manipulating clothing,
shoes
● Managing utensils, cups
● Puzzles and shape
sorters
● Grasp on crayons, paint
brushes
● Drops things frequently
● Visually tracking objects
OT Red Flags (cont.)Difficulty with:
● Drawing shapes, writing
name
● Attention to task
● Textures (eating,
playing, dressing)
● Movement (playground,
stairs)
● Frequent tantrums
● Social interactions
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Other Red Flags
Play Therapy
● Trauma
● Mental disorders
● Learning and
social issues
● Play scenarios &
themes
● Distinguishing
between play and
reality
● Regression in play
Special Instruction
● Developmental
delay
● Physical
● Cognitive
● Communication
● Social-Emotional
● Self-help
Neuropsychology
● Learning
● Attention &
Memory
● Language
Processing
● Visuospatial
● Executive
Functions
● Emotional
Functions
Dexter: One year later...
Questions or
Comments?
4/12/2018
17
Contact Information
Kenzie Davis: [email protected]
Jane Weedon: [email protected]
Alyssa Fagan: [email protected]
Biel, L., & Peske, N. (2005). Raising a sensory smart child: The definitive
handbook for helping your child with sensory integration issues. New
York, NY: Penguin Books.
Bly, L. (1983). The components of normal movement during the first year
of life and abnormal motor development. Laguna Beach, CA: Neuro-
Developmental Treatment Association, Inc.
Cheatum, B. A., & Hammond, A. A. (1999). Physical activities for
improving children’s learning and behavior: A guide to sensory motor
development. Champaign, IL: Human Kinetics.
Hanft, B., & Shepherd, J. (2016). Collaborating for student success: A
guide for school-based occupational therapy (2nd ed.). Bethesda,
MD: AOTA Press.
Resources
Henry, D., Kane-Wineland, M., & Swindeman, S. (2007). Tools for tots:
Sensory strategies for toddlers and preschoolers. Flagstaff, AZ: Henry
OT Services.
Linder, T. (1990). Transdisciplinary play-based assessment: A functional
approach to working with young children. Baltimore, MD: Brookes
Publishing Company.
Stock-Kranowitz, C. (2005). The out of sync child. New York, NY: Penguin
Group.
Weiss, D., Tilin, F., & Morgan, M. (2014). The interprofessional healthcare
team. Burlington, MA: Jones and Bartlett Learning.
Resources (cont.)
4/12/2018
18
American Occupational Therapy Association. (2014). Occupational therapy practice
framework: Domain and process (3rd ed.). American Journal of Occupational Therapy,
68(Suppl. 1), S1-S48.
Bassok, D., Latham, S., & Rorem, A. (2016). Is kindergarten the new first grade? AERA Open,
1(4), 1-31.
Del Rossi, L., Kientz, M., Padden, M. McGinnis, P., & Pawlowska, M. (2017). A novel
approach to pediatric education using interprofessional collaboration. Journal of
Physical Therapy Education, 31(2), 119-129.
Kerfeld, C. I., Pitonyak, J. S., & Jirikowic, T. (2017). Enhancing student interprofessional
teamwork and collaboration through pediatric therapy learning experiences. Journal of
Physical Therapy Education, 31(3), 114-120.
Miller, L.J., Anzalone, M.E., Lane, S.J., Cermak, S.A., & Osten, E.T. (2007). Concept
evolution in sensory integration: A proposed nosology for diagnosis. American Journal
of Occupational Therapy, 61, 135-140.
Peabody, M.A., & Demanchick, S.P. (2016). Interprofessional opportunities: Understanding
roles in collaborative practice. International Journal of Play Therapy, 25(2), 102-111.
Teeters Myers, C., & Peganoff O’Brien, S. (2015). Teaching interprofessional collaboration:
Using online education across institutions. Occupational Therapy in Health Care, 29(2),
178-185.
World Health Organization. (2010). Framework for Action on Interprofessional Education
and Collaborative Practice. Geneva: WHO Press. Retrieved from
http://apps.who.int/iris/bitstream/handle/10665/70185/WHO_HRH_HPN_10.3_eng.pd
f;jsessionid=F6C8C6E14261051CABBA855D8C54A307?sequence=1
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