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OT Occupational Therapy

Occupational Therapy (OT) is an evidence-based practice that is deeply rooted in science. Practitioners use a holistic approach wherein the focus is on adapting the environment and/or task to fit the individual through sensory integration. 
Sensory Integration (SI) is the process by which we receive information through our senses, organize the information and use it to participate in everyday activities. SI involves many neuro-motor systems working together, when sensory receptors receive information from the body and take those messages through the brain stem cortex and back, with instructions on how the body should respond.
When children fail to get the early nurturing needed for proper development or have a stressful pre-birth or early life experiences, their sensory and motor systems are often under-developed, immature, or “wired” wrong. This can cause glitches in the “sensory-response loop”. Dysfunctional or immature motor, emotional & behavioral skills and dysregulation are the results. Challenges can occur with any sensory system and any part of the “sensory loop”.
Trauma can heighten sensory awareness, making it difficult to make sense of the messages received & respond appropriately to the world. For children of trauma, pairing OT with Trauma Focused Cognitive Therapy  or other mental health interventions can lead to significant improvements in emotional regulation and behavior.
While it may be a long process, the body can “change the score” and “re-wiring” is possible.
Behaviors & Skills indicative of underlying Neuro-Motor Issues that are appropriate for OT intervention are:
  1. Personal Space Issues: Bumping into things & people; getting into people’s personal space or requiring a large “personal bubble”; etc.
  2. Difficulty with Grading Pressure: Crushing delicate things when picking them up, writing too darkly or too lightly, holding pencil very tightly. Breaking crayons because of too much pressure, slamming cupboard doors, walking like an elephant, etc.
  3. Clumsy & Uncoordinated Gross Motor Skills: Difficulty with balance activities such as riding a bike, hopping on one foot, skipping, jumping rope, poor ball skills, etc.
  4. Poor Directional Sense: Difficulty copying movement or learning a new motor skill, left-right confusion, no clear dominance pattern, or mixed dominance, etc. Sometimes oppositional defiance stems from a difficulty with motor planning.
  5. Atypical Awareness of Bodily Needs: Decreased or increased response of pain or illness. Decreased or absent sense of food satiation - in extreme cases overeats until vomiting; OR requires reminders & imposed motivation to eat. Picky eater - limited to certain textures or tastes. Difficulty with incontinence well past the typical age without a medical reason.
  6. Poor or Under-Developed Fine Motor Skills: Immature or unusual pencil grasp, difficulty with self-care tasks involving tying or fasteners; awkward or under-developed cutting skills, etc.
  7. Movement in Space Issues: Extra or under sensitive to touch, sights, sound, movement, smell or taste; Picky eater.
  8. Under or Over Responsiveness to Sensations: Fear of feet leaving the ground, for example, on playground equipment, fear of moving surfaces such as escalators & elevators, frequent motion sickness, etc.
  9. Hypervigilance: Nearly always on high alert, does not tolerate “busy” sensory situations, i.e., too much noise, too much light or visual “business”, sensitivity to smell or taste. Does not seem to have a sensory gating mechanism to screen & sort out what is incoming. This results in feelings of sensory bombardment. Emotionally over-reactive, misinterprets facial expression, body language, or conversation reacting defensively– everything seems to be a “safety” threat. Acts as the local “F.B.I.” - knows everything that is going on around them. Is attuned to & becomes involved in other's conversations in other rooms not involving them. Very controlling, very ridged & compulsive, sometimes suspicious. Picky eater.
  10. Inability to organize one’s self or tasks: Inability to accomplish simple tasks, struggles to carry out daily routines, never quite remembers the plan or is able to carry it out without a lot of coaching or assistance. This may indicate a problem with motor planning—the process of having an idea, creating a plan, & executing that plan– the underpinnings of sequencing & other executive unction skills.
For All: There is frequent frustration with these tasks beyond what is age appropriate.
Major Components of Function /Dysfunction Involving Neuro-Motor Development & Sensory Integration
  • Body & Spatial Awareness - #1-8: Incoming information is used to help us establish a physical sense of self and where we stand (literally) in relation to the world.
  • Sensory Discrimination Vs. Sensory Protection - #5, 8 & 9: Incoming information is used to help us identify & learn from our environment OR incoming information is used to alert us to danger.
  • Early Reflexes - #1-9: Frequently unintegrated early pre-birth and early infant reflexes are still present or have re-emerged in children & adults who have had traumatic experiences. These interfere with many of the motor development, sensory integration & emotional regulation issues listed in #’s 6-10. Two of the most commonly occurring unintegrated reflexes in those with PTSD are Fear Paralysis which is an in-utero “freeze” reflex, and Moro, or Startle reflex seen in early infancy. These are foundational neuro-motor building blocks for the development of higher-level skills. When these and other reflexes become integrated major changes can occur motorically, behaviorally & emotionally.


We have had the in-home Occupational Therapy services for over 4 months for our daughter, Annie. She has significant trauma-related challenges regulating her emotions, developing properly attached relationships and being appropriate in social situations. On a weekly basis, our OT was in our home teaching both Annie and I rhythmic movement exercises and providing us with sensory tools to address Annie’s challenges. Through our weekly therapy sessions and subsequent support from our OT, my education as a foster parent around the importance of reflex integration and how it can lead to improved daily functioning for our child has been extremely helpful. Annie’s achievement of her occupational therapy goals thus far has been significant.Learning & practicing the neurodevelopmental, rhythmic exercises have become a very powerful tool to facilitate bonding, emotionalrelease and regulation. While we have much more work to do, Annie is experiencing an increase in her ability to function, regulate her emotions and attach. We are so excited as we see the progress! With gratitude

- Laura F

Services provided by Cheryl Hunt:
  • Attachment, Attention, Executive Functioning, Adaptive and Regulatory struggles
  • Developmental Delays
  • Dyslexia tutoring utilizing Foundation in Sounds or The Barton System both of which are Orton -Gillingham based.
  • Fine Motor & Handwriting challenges
  • Gross Motor – balance & coordination issues
  • Neurodevelopmental challenges including Sensory Processing & Reflex Integration
  • Visual Motor, Tracking, & Visual Perception challenges

Dean Healthcare is accepted

6716 Stone Glen Drive
Suite A
Middleton, WI 53562
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