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Occupational Therapy Case Study

Nicholas is four years old and has autism and intellectual disability. You will see him in his early intervention program where he spends three days with a small number of other children who have various physical and developmental disabilities.  You will also see his early intervention teacher and a early education assistant who is sitting behind him. Nicholas is non-verbal and has no signing or formal alternative communication methods established.  He is largely toilet trained and eats independently when food is given to him.
The preschool has sought the advice of a consultant occupational therapist (you) about what they could do to best prepare him for more formal learning, for example engagement in tasks such as colour, cut, paste, blocks, puzzles, toys, painting as well as outdoor play and formal group language and story time.
One short term early intervention goal is for Nicholas to use play objects (e.g. toys, blocks, puzzles) and tools (paint brush, crayon) in preparation for formal instruction in school skills.  You will see one of the classroom assistants trying to teach Nicholas how to engage in group story time.
The assignment is in two parts.
PART A (25 marks):  Observe Nicholas during school time.
Assess the quality of his instruction relative to the six principles of systematic instruction covered in this UOS:
•    Occupational cue
•    Goal
•    Instruction (cues and prompts Nicholas can process in general (leading to incidental learning), and those that are purposefully used by the instructor).
•    Practice
•    Variability
•    Feedback

PART B (35 marks):
Develop an instruction plan to suit the situation that can be carried out by the early intervention teachers.
1.    Identify the learning needs in the situation (who needs to learn what?) using the M.A.T.C.H. mnemonic presented in this UOS.
2.    Based on your analysis, construct a learning plan for both Nicholas and the assistant using the six principles of instruction.
•    Occupational cue:  (what materials/tasks would you suggest the assistant uses and why)
•    Goal: (what do you specifically hope is achieved by Nicholas and the assistant at the conclusion of your consultation)
•    Instruction: (what cues and prompts should be applied to Nicholas’s instruction and why:  what instruction are you going to suggest the assistant use for the activity you have chosen)
•    Practice:  (what practice schedules are you going to suggest be used with Nicholas and why:  how will you apply the concept of practice schedules to your teaching of the assistant)
•    Variation: (how much variation should be introduced and why?)
•    Feedback: (how do you suggest the assistance use feedback to enhance Nicholas’s learning: how will you utilise feedback to reinforce what you have taught the assistant).
3.    How will you measure the effectiveness of your intervention?

Observation from the video: Task- clapping hands

Physical prompts:
•    Singing songs and clap hands
•    Nicolas is touching his nose and not focusing on the songs
•    Attempt to touch the spoon and not pay attention to the task

Verbal cues:
Clap your____? Lets sing.
Teacher pick up a spoon and asks the kids “what spoon is it, happy spoon or sad spoon?”
Other kids can response the questions but he couldn’t.
If you are happy and you know how to clap your hands
1.    singing cue (physical prompts by teacher) to clap your hands
2.    attention problem (try to grab the board)
3.    if you are sad and you know you will cry
4.    This is a spoon, what do we see on the spoon, is this a happy spoon or sad spoon. (show the spoon to Nicholas) Watching, is the spoon still happy? Sad!!! How can you tell? Distracted by other student. Oh, sad now. So sad.

Environment: childcare centre; other kids around him have cerebral palsy.

Points to consider:
•    too much help from the teacher
•    Massed, blocked practice to clap hands
•    Distractive environment, Nicholas did not respond to teacher’s answers
•    Sitting on the chair with belts when asked for doing the task


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