This case study is part of our collection of resources and training materials for online occupational therapy. If you are an allied health professional see our free online therapy training course for more resources. If you are a family or provider wanting to know more about our online occupational therapy services see our frequently asked questions.
Poorani Balasundaram, Occupational Therapist
Leo is a 5-year-old boy from rural NSW who was referred to telehealth Occupational Therapy and Speech Therapy services at Umbo for needs around emotional regulation, motor and communication skills. Leo lives at home with his parents, his brother and his extended family. Leo is funded by the NDIS program and has a supportive support coordinator, Mary, who is also his key worker in his therapy. Given that both of Leo’s parents worked fulltime, telehealth sessions were completed at Leo’s school with Mary present.
Leo experienced difficulty verbally expressing himself and when he did, his speech lacked clarity. He had also been reported to appear clumsy, restless and accident prone. His parents reported that he experienced difficulty writing or using a pair of scissors effectively and that he sometimes had temper tantrums that were difficult to manage.
The Occupational Therapist completed several assessments and information gathering interviews with Leo and his family to understand his needs and performance capacity. These assessments included an initial assessment with Leo’s parents, a visual motor integration assessment, sensory assessment, dynamic assessment* and informal observations of Leo. The assessment results indicated that Leo had difficulty maintaining attention, mild delays in motor coordination, poor motor endurance which caused him to fatigue easily, difficulty following 1-2 step instructions and sensory processing difficulties around auditory processing and movement processing.
Following this, using evidence-based practice, the Occupational Therapist provided interventions to Leo that targeted these areas of need. One such intervention was around fine motor skills and pencil grasp. Leo had a keen interest in art and the cartoon character Pikachu. Utilising a strengths-based approach to encourage motivation and success in outcomes, the Occupational Therapist taught Leo correct pencil grasp and to strengthen his fine motor muscles by painting on different modalities, using paint brushes of different sizes and colouring and completing fine motor activities with a Pikachu theme. In addition, the Occupational Therapist also used a coaching approach to coach Mary and Leo’s parents to implement the strategies recommended for Leo in the school and home environments. Equipment such as a seating discs and pencil grips were also used during sessions as needed.
The Occupational Therapist collaborated with the Speech Therapist regularly to co-implement communication strategies and recommendations in each session.
- After 1.5 years of receiving online therapy, Leo achieved the following outcomes:
- Leo was able to follow 2 step instructions most of the time.
- Leo was able to maintain his attention for a period of 10-12 minutes at a time.
- Leo was able to maintain good pencil grasp and he was able to complete handwriting tasks with minimal errors.
- Leo’s cutting skills improved with some minimal prompting as needed.
- The frequency of Leo’s temper tantrums had significantly reduced.
Leo continues to receive Occupational Therapy and Speech Therapy services from Umbo.
* Dynamic assessment Dynamic assessment here refers to a systematic process that involves task manipulation and modification of a client’s functional level during the assessment procedure. In other words, this form of assessment uses a ‘test-teach-retest’ model to assess and build on the existing skills of the client.
** Motor Coordination refers to the sequenced movement of multiple body parts as required to accomplish intended actions, like jumping and hopping