S (SOAP Notes)
-Subjective information that cannot be verified or measured
-Statement is relevant to the clients condition or treatment
-Concise this section should only be a few statements
(Ch 7)
Ex. Claire stated “my hand hurts and just gets tired when writing
Ex. Noahs mothers reported improvement with attention to task when utilizing sensory strategies during tabletop
O (SOAP Notes)
-Objective direct observations throughout the session
-Record all relevant objective data
-Always begins with length setting and purpose
-Focus on occupation purpose and function
-Include assist level (no min mod max) will mostly be numbers
-Can be written chronologically or by categories
-Professional concise and specific
(Ch 8)
Ex. Noah was seen for a 45 min ot session in a telehealth setting to address sensory processing skills required for attention and engagement in classroom activities.
Ex. Noah required 3 verbal prompts for redirection from sensory seeking behaviors to complete a 5-min tabletop task
A (SOAP Notes)
-Assessment analysis interpretation of your s and o
-Do not add in new info here
-This is where you will demonstrate your clinical reasoning skills
-These statements should be written as problem progress or potential statements
-Should always end with child would benefit from
(Ch 9)
Ex. Noah’s difficulty processing vestibular and proprioceptive input impacts his ability to attend and complete classroom work
Ex. Noah’s ability to maintain attention to a 5 min tabletop task indicated improved sensory regulation skills required for educational participation
P (SOAP Notes)
-Plan this is your plan of what happens next
-Includes frequency duration and purpose and specific interventions
-Needs to relate to your o and a
-Frequency and duration will depend on the setting
(Ch 10)
Ex. Noah will continue to be seen 30 min a week until the annual IEP meeting to improve sensory processing skills for increased educational performance. OT sessions to address proprioceptive and vestibular strategies and sensory regulation techniques within the classroom.
What is play
- Spontaneous
- Fun
- Intrinsically motivated
- Internally controlled
- Emphasis on process rather than product
- Pretend or as if component
4 characteristics of play
- Framing
- Relative intrinsic motivation
- Relative internal control
- Relative freedom from some constraints of reality
Contexts and interactions are more or less…
Playful depending upon the balance between perception of source of control source of motivation and suspension of reality
Framing
- Players give cues to one another that define an activity or interaction as play this is not real
- Define the boundaries of play with cues
- Cues are exaggerated and easier to learn/notice
- Frames last only as long as players cues support it
- Frames break for negotiation of rules
Relative Internal Control
- Child acts on his intrinsic motivation by deciding who what to play with and how where to play
- Supports a safe environment to play
- Child can choose activities that are appealing and provide a just right challenge
- Not running the show
- Shared control through negotiation and collaboration
Relative Intrinsic Motivation
- Motivation that comes from inside of an individual
- Participating in the activity itself provides its own reward
- How do we know: Intense engagement, Ignoring things that are not of play, Persistence
Relative freedom from constraints of reality
- Ability to pretend and engage in fantasy play
- Reduction or suspension of consequences that might be associated with the activity in real life
TUOS and pediatric therapy: the art therapy
- Establishing trust
- Setting a playful atmosphere
- Tapping motivation and inner drive
- Reading and responding to childs cues and behavior
- Adjusting the challenge and flow of therapeutic activities and interactions
Settings that support play in OT intervention
- Respects bulbs on childs intrinsic motivation
- Allows for object exploration/experimentation
- Supports play through verbal nonvernal messages
- May include social or imaginative play
- May use fantasy play
- May follow the childs lead by structuring or expanding on child initiated ideas
Research related to therapist child relationship in Ped OT
- Task orientation
- Positive emotional atmosphere
- Playfulness
- Joint managemet of challenge
- Joint decision making
- these are all around therapeutic relationship*
Playful Use of Self
- The adoption of a playful attitude in interpersonal relating with the child
- Two questions:
1. How do we use ourselves therapeutically to communicate a playful backdrop for intervention
2. How do we playfully and intentionally interact with clients in the establishment and maintenance of a positive therapeutic alliance
TUOS in creation of a playful context for intervention
- Suspend adults assumptions
- Level power differences
- Look for impact of adult presence
- Assume behavior actions are communications
- Engage together in co-occupations
Communicating Playfulness Non-Verbally
- Eye gaze
- Facial expressions
- Body language
- Voice and vocalization
Communicating playfulness verbally
- Match the childs language
- Give words to the childs actions and vocalizations
- Direct instruct playfully: Invite, Use rhythm, Fun sounds effects, Use kid words
Look listen and feel for child feedback
- How do you know your message about play is being received
- When a playful message comes across to the child the child is usually agreeable to the task
- Cues to understand the message of play like laughing and smiling
- Cues that message is not received is withdrawal pushing away ignorin
Therapeutic modes
- Advocating
- Encouraging
- Instructing
- Empathizing
- Collaborating
- Problem solving
Empathizing mode
- Tone of voice
- Mirroring emotions and actions of the child
- Personify objects to mirror the child emotions
- Give voice to the childs feelings and reactions
- Play with the child as a partner or in parallel
- Communicate empathy through touch as appropriate
- Share control
Collaborating Mode
- Offer choice in activities play schemes sequence
- Join childs play schemes
- Share control
- Look to teh childs behavior to communicate feedback about interest comfort level and enjoyment of play activities
- Follow the childs directions
Grading collaboration
- Overuse of the mode may communicate a lack of understanding
- For some asking to take lead may feel unsafe if they need direction
- Grading communicates understanding respect whil allowing some self direction
Instructing mode
- Provide directions in playful ways (Song, Personification of toys and body parts)
- Demonstration (Talking through, Taking turns with the child)
- Playful and firm limits (Ooops this way is closed you need to find another way)
