Occupational Therapy

A young girl who has limited use of her hands begins to develop the ability to grasp using an elastic board.
A young girl who has limited use of her hands begins to develop the ability to grasp using an elastic board.

Much like physical therapy provided in a school setting, occupational therapy is tied to access and participation in a child’s educational program as part of special education services. Many children with significant developmental delays functioning at a developmental level of under 48 months, especially those with vision and/or hearing loss require these services. Occupational therapy focuses on fine motor movement such as use of the hands, fingers, sensory efficiency, self-care skills, and transition/work skills.

Role of the OT

School-based occupational therapy practitioners are 0ccupational therapists (OTs) and occupational therapy assistants (OTAs) who use meaningful activities (occupations) to help children and youth participate in what they need and/or want to do in order to promote physical and mental health and well-being. Occupational therapy addresses the physical, cognitive, psychosocial and sensory components of performance. In schools, occupational therapy practitioners focus on academics, play and leisure, social participation, self-care skills (ADLs or Activities of Daily Living), and transition/ work skills. Occupational therapy’s expertise includes activity and environmental analysis and modification with a goal of reducing the barriers to participation.

What is the Role of the School-Based Occupational Therapy Practitioner?

American Occupational Therapy Association (AOTA)


In addition to contributing to the full initial evaluation for special education services, the OT will complete assessment to help in the development of the IEP. They will focus on these types of concerns:

      • Organization skills
      • Sensory regulation strategies
      • Balance & coordination
      • Anxiety management
      • Self care issues (e.g. eating, dressing)
      • Handwriting

When a child is visually impaired they should work in collaboration with the teacher of students with visual impairments and the orientation and mobility instructor. If the child is deaf, they should collaborate with the teacher of the deaf and hard of hearing, especially around issues related to balance and coordination. Children who are deafblind need the collaborative support of both of these professionals and/or a teacher of students who are deafblind when it comes to assessment.

When completing the Functional Scheme as a part of the educational team, the OT may work with others to complete these sections:

      • Fine motor
      • Mouth movements
      • Haptic-tactile perception
      • Smell & taste (Olfactory and gustatory perception)
      • Perception thru play & activity
      • Undressing & dressing
      • Eating skills

Providing Therapy and Supporting Programming

The OT may provide direct therapy to the child and/or they may provide services in consultation with others such as a OTA, paraprofessional, or classroom teacher. After assessing the student, they will contribute to the development of IEP goals that guide instruction and should be involved in documenting progress of the the student.

We often see the OT who works with children who are significantly developmentally delayed consulting on issues related to sensory integration, hand use for eating, dressing, experimenting and exploring objects, developing the ability to use hands and mouth, and organizing materials for use.

They may help develop activities and environments that utilize an Active Learning approach. For example, when designing a Position Board, the OT can help select materials that are appropriate for the skills the child demonstrates with his hands and mouth. They may also be able to suggest activities and strategies that help the child develop better sensory integration skills and address specific aversions or preferences related to sensory information.

Documenting Progress

The OT is responsible for documenting progress on IEP goals that are written related to fine motor movements and perhaps sensory issues. They may choose to do this directly and/or utilize various Active Learning forms that others can help complete to document progress. 

They will also re-evaluate skills to determine 1) if their services continue to be needed and 2) what should be the focus of new IEP goals.


Below are some videos showing Active Learning activities that support the development of fine movement, self-care, and sensory efficiency.

Zain Exploring Kinetic Sand on a Mirror Tray to Develop Grasp

Description: This boy with cerebral palsy uses a raking motion to explore the objects in the kinetic sand in front of him. As an adult moves the objects, notice the slight changes in the way he uses his hands and fingers. The kinetic sand on the mirror tray allows the objects to stay in place, so that he can more easily find the objects.


Jervarius with the Rain Stick and Steel Drum

This video we see that the boy demonstrates difficulty rotating his wrist in order to activate the rain stick. In the second part of the video, notice how he compares the sound of dropping the beads in the steel drum versus the ping pong balls, and eventually puts the beads down to engage both hands in dropping ping pong balls in the steel drum.


Oral Motor- Exploration of Chime

Description: In this video of a young boy, notice the protrusion of his tongue. He is unable to eat liquid or food by mouth and receives his nutrition from a gastro-tube. The chime activity allows him to gain head control and allows for exploration with the mouth.

Downloads: Transcript (txt)

Skye Eating Applesauce

In this video you will see Skye exploring some quack sticks that have been coated with apple sauce. She was just learning to eat from a utensil, and we were having her practice bringing her utensils to her mouth. But you can see during this play activity, she’s feeding herself apple sauce from a quack stick, which was one of her favorite toys.

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Before children learn to put clothes on, they learn to take clothes off. Taking off is always easier than putting on. Let your child have the opportunity to be active during dressing in anyway they can. If you have a shirt pulled mostly off the child’s head, can he pull it the remainder of the way off? Can she bend the leg or pull the foot to remove the shoe or sock while you hold on to it? Any little bit of action on their part is the goal. In this video you can see that Patty Obrzut, OTR, has placed a Velcro strap of bells on Rylan’s feet. This encourages Rylan to kick his legs and feet. 

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As you can see in this video, the button holes are very large to make it easier for the child to practice putting items through the holes. Attaching some of the buttons on elastic, keeps the buttons accessible.  Remember a child needs to repeat and practice putting a button or other small objects inside slots many times before he or she masters this skill. This skill is also needed for activities like using a vending machine.

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