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SLI-Sen Learning Institute Individualized Educational Plan Occupational Therapy Name: Ahil IEP Duration: December 2021-May,2022 Date: DOB: INTRODUCTION: Ahil joined Sen Learning Institute, Lahore in December, 2021 as a regular student. He has been taking Occupational Therapy services since then. STUDENT’S PRIORITIES & NEEDS: Improve his concentration, eye contact, social and emotional skills. Develop his self-help/ADL skills. Practice of fine motor precision along with fine motor integration. Improve play activities and gross motors activities. Develop his eye hand coordination skills. ASSESSMENT AND EVALUATION: An Occupational Therapy Assessment looks at the sensory, motor and cognitive skills that contribute to a child’s participation in play, learning and daily living tasks. A blend of standardized testing and clinical observations are used for the assessment and evaluation of sensory processing, self-help, fine and gross motor skills. Review of all file information Clinical observation Sensory profile by Winnie Dunn parent questionnaire CLINICAL OBSERVATION: She has immature tripod pencil grip. She has poor attention span, which hinders in her performance. Moreover, her fine and gross motor skills are not age appropriate. SENSORY PROFILE PARENT QUESTIONNAIRE: Sensory processing is a term that refers to the way the nervous system receives messages from the various senses (touch, movement, smell, taste, vision and hearing) and turns them into appropriate motor and behavioral responses. It is a complex set of actions that enables the brain to understand what is going on both, inside your own body and in the world around you. The Sensory Profile was administered as part of a comprehensive assessment. It was to determine whether aspects of sensory processing might be contributing to performance challenges in Hassan’s daily life. In Sensory Profile Items are grouped by sensory processing, modulation, and behavioral and emotional responses. The nine factor groupings characterize children by their responsiveness to sensory input including, Sensory seeking, Emotional reactive, Low endurance/tone, Oral sensory sensitivity, Inattention/distractibility, Poor registration, Sensory sensitivity, Sedentary, and Fine motor/perceptual. A classification system based on means is used to rate the child’s responses in comparison to a normative sample of children. The Sensory Profile is basically a measure of children’s response to sensory events in daily life. Children who have difficulties in sensory processing will have difficulties in regulating their attention control, activity level and interactive behavior and also developing foundation abilities for motor organization, learning and organization of behavior. Results from the Sensory Profile completed by mother and the clinical observations reveals that Hassan appears to have sensory processing difficulties which are impacting on his day-to-day functioning. The sensory profile Questionnaire by Dr. Gaurav Thawali, measures the way a child is processing sensory information. The items on the questionnaire describe different responses a child might have to sensory experiences. Scores are recorded as falling into one of three categories: Typical performance Probable difference (an area of questionable ability) Definite difference SECTION SCORE SUMMARY Sensory processing areas Typical performance Probable difference Definite difference A Auditory processing ✓ B Visual processing ✓ C Vestibular processing ✓ D Touch processing ✓ E Multisensory processing ✓ F Oral sensory processing ✓ Modulation G Sensory processing related to endurance/ tone ✓ H Modulation related to body position & movement ✓ I Modulation of movement affecting activity level ✓ J Modulation of sensory input affecting emotional response ✓ K Modulation of visual input affecting emotional response & activity level ✓ Behavior and emotional response L Emotional and social response ✓ M Behavior outcome of sensory processing ✓ N Items indicating thresholds for response ✓ DISCUSSION OF RESULTS: In this section Ahil scored the probable/definite difference in following: Auditory Processing Vestibular Processing Visual Processing Multisensory Processing Oral sensory processing Sensory processing related to endurance/ tone Modulation related to body position & movement Modulation of movement affecting activity Modulation of visual input affecting emotional response & activity level Behavioral outcome of sensory processing Items indicating thresholds for response Auditory Processing Auditory processing refers to the ability to make sense and process information which is taken through ears. Difficulties with auditory processing affect the child's ability to respond to instructions and filter out background information. Vestibular Processing: The vestibular system processes information about sense of balance, spatial orientation and head position in space. The vestibular system together with the proprioceptive system, are necessary to make fine postural adjustments necessary for balance and coordinated movements. Difficulties with vestibular processing can result in poor postural control, bilateral integration and motor planning activities. Multisensory Processing: This section measures the child’s responses to activities that contain a combined sensory experience. Minahil scored definite difference in multi-sensory processing. Modulation Modulation is the ability to regulate/maintain arousal level so that you can orient, focus attention on meaningful sensory events, and maintain an alert but relaxed state. It is the optimum level of arousal which allows us to function meaningfully within our environment. When children have sensory modulation difficulties, they can be over or under aroused by the sensory input. If they have a low threshold, it means they will be overwhelmed quickly by the sensory input and will need less stimulation in order to maintain a calm alert state. However, if the threshold is too high, they will need intense input to meet their needs. The sensory profile indicated that Ahil has difficulties in the following areas: Modulation of movement affecting activity level measures the child’s demonstration of activity. Ahil scored probable difference in Modulation of movement processing. Modulation of Sensory Input Affecting Emotional Responses measures the child’s ability to use body senses to generate emotional responses. Modulation of visual input affecting emotional response & activity level Measures the child’s ability to use body sense to generate appropriate emotional response. Behavioral Outcomes of Sensory Processing items indicate the child’s ability to meet performance demands. Ahil has poor writing skills. NOTE: The areas mentioned above are most likely to provide challenges for Minahil. When children have difficulty in a sensory system, it means that this form of sensory input is confusing, upsetting, or not meaningful to the child. In any case, difficulty with sensory input can interfere with child’s ability to complete important activities as successfully as other children of her age do. The team will need to conduct additional observations to determine the contribution of these areas to her performance challenges. Goals of treatment: Improve functional strength. Improve oral motor muscle strength. Improve attending skills. Improve eye hand coordination. Improve sensory processing system. Improve fine and gross motors skills. INTERVENTION IMPLEMENTATION Areas for focus for future intervention would include: Increase attention span Explore objects in sensory bins. Strengthening exercises to improve muscle strength To develop some sensory strategies to incorporate into his daily routine to assist with his difficulties with sensory processing. Fine motor skills by demonstration of his hand manipulation. Walking on stepping stones. Activities involved hand movements like hand pushes and hand presses. Improve socialization by daily greeting with maximum persons. Controlled sustained jumping, swinging, rocking and bouncing. Jumping on trampoline 20 jumps. Bouncing on gym ball, 20 repetitions two times a day. Occupational Therapist Sana Shafique (B.Sc Hons.CH,ICH UHS, POTA) Sensory Enrichment Therapist