What Kinds of Goals and Strategies are Most Important in Occupational Therapy?

Goals and strategies may need to be developed in a variety of areas for children and adults with fragile X syndrome. The characteristics described (hyperarousal, hypoarousal, tactile defensiveness, and fine motor disorders) may all need to be addressed, particularly with boys and men. Occupational therapists (OTs) may design goals for: calming, movement, fine motor development, and oral motor development. They may also provide a number of strategies for altering the environment of the home, school, or workplace, in order to decrease sensory overload.

Occupational therapists may design goals using neurodevelopmental therapy (working with muscle tone) or sensory integration therapy (SI). SI therapy is designed to help the individual gradually respond more appropriately to sensory input. This involves input to all of the five senses, plus proprioceptive (the sense of one's body in space) and vestibular (the sense of gravity and motion) input.

Calming activities may need to be written into each day's plans with young children. These may include a variety of physical inputs, such as rocking or swinging the child, applying deep pressure, or brushing the child's skin with a therapeutic brush. These may also include breaks in the day, where a child can go to a quiet space and calm himself through playing a computer game or listening to music or a story on headphones.

Environmental changes are often essential for the person with fragile X syndrome to perform at his or her optimum level. The occupational therapist may make suggestions about lighting, including using as much natural light as possible. She or he may design goals that help the child or adult gradually tolerate more visual information or brighter lighting.

Sound levels may also need to be adjusted. Earphones for listening to soothing music or tapes of books may be helpful to some people. Goals and strategies may be designed to help the person with fragile X to gradually tolerate more sound. While loud situations may never be the choice of a male with fragile X, he may be able to tolerate more auditory input, such that he can sit through school assemblies, big screen movies, and noisy restaurants.

Seating adaptations may need to be made to help the child maintain an upright posture and focus. School desks and chairs may not provide enough feedback to the body about where the child is in space. Donut shaped cushions may be helpful, but may draw too much attention to a child in an inclusion setting. Young children may be able to sit on foam wedges rather than carpet squares during "circle time".

Movement therapy is important to help the child with fragile X to have a good sense of his body in space. Balance and muscle tone can be worked on through a variety of physical activities: dance, martial arts, sports, and physical play.

In addition to these goals and strategies using sensory integration therapy, more functional therapy may be designed with goals for daily living skills and fine motor and oral motor development.

Fine motor goals may include improvements in writing and drawing, as well as using eating utensils, scissors, and other tools. Fine motor goals might also include computer usage, as keyboarding may provide a more legible output for persons with poor handwriting skills.

Most boys with fragile X syndrome require oral-motor assessment and goals on their Individual Family Service Plans (IFSP) or Individual Educational Plans (IEP). This assessment and the writing of goals might be carried out jointly by an occupational therapist and a speech-language pathologist.

There are many activities that occupational therapists can use to help increase tolerance to touch around the face, neck, and mouth, and thus to improve chewing, swallowing, and speaking. Speech pathologists may work jointly with occupational therapists to design oral motor activities appropriate for a child. These may include physical activities that begin away from the mouth, but that gradually allow the child to build up tolerance around the face and mouth.

Both foods and toys can be used in oral-motor activities in order to provide incentives. Blow toys, whistles, and straws can be used to help build up oral-motor strength and functioning. Occupational therapists and speech pathologists may recommend a variety of foods to help with chewing and oral-motor strength. These might include crunchy and chewy foods, such as fruit snacks, celery, bagels, and gum. In addition to helping with speech and language, such oral stimulation may help prevent the child's chewing on clothing, straps, or skin.

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