Emi is a truly remarkable 4-year-old who has made incredible strides in a short amount of time. Her progression includes certain skills that were initially completed at a 9-month age equivalency to mastering many age-appropriate skills.
At the time of the initial referral Emi’s pediatrician and mother had concerns with delayed self-care skills requiring maximum assistance in all basic ADL routines. She presented with significant delays in fine motor skills and visual motor integration skills such as the inability to lace, stack items, manage scissors, or complete puzzles. She demonstrated delayed grasping skills including using a pincer grasp or maintaining grasp on markers or crayons to color or copy simple lines and shapes. Emi demonstrated significant difficulty with emotional regulation, delayed social skills, and play skills presenting challenging behaviors around peers and siblings. She also had a strong aversion to tactile input with her hands and feet limiting play and self-care routine participation. She struggled with attention, following directions, and problem-solving skills, leading her to become very frustrated and scream or have prolonged meltdowns.
Occupational therapy addressed the functional limitations by focusing on foundational fine motor and visual motor integration skills, bilateral upper extremity strengthening and coordination, sensory regulation activities through a sensory diet, and engaging in immersive floor play. The OT also incorporated sensory feeding strategies to increase her food repertoire as well as tactile sensory play with hands and feet. Additionally, OT enabled Emi to drastically increase emotional regulation and social coping skills. Emi’s family actively participated in various home exercise programs and rarely missed a visit, which increased the speed of Emi’s progress. Emi has responded very well to occupational therapy through teletherapy service provision. She has made monumental gains in all areas of self-care, play, social skills, cognitive skills, sensory regulation, and emotional regulation. Emi is now able to use a spoon, fork, and small open cup during mealtimes. She has increased her food repertoire. In addition, she has improved self-regulation and sensory regulation skills significantly, which have helped her to tolerate washing her face, brushing her hair, as well as being able to brush her teeth without tantrums. Emi has progressed to using a pincer grasp with small items, lace beads, use scissors, and grasp a marker to copy all developmentally appropriate pre-writing lines and shapes. Emi is more independent with all aspects of dressing, making her morning and nighttime dressing routines less stressful and time consuming for the family. Her mother reported Emi plays and interacts more with other children including her siblings. She tolerates public places and family functions with a significant decrease in meltdowns and follows directions with significantly less prompting.
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