DU​ ​Students​ ​Names:​ ​Sara​ ​Weigand​ ​&​ ​Mackenzie​ ​Rodgers

Client​ ​Name:​ ​Jacob

Diagnosis:​ ​Down​ ​syndrome,​ ​ADHD,​ ​PDD

Part​ ​II
Goal​ ​for​ ​the​ ​session:​ ​ ​Jacob​ ​will​ ​be​ ​able​ ​to​ ​copy​ ​one​ ​sentence​ ​from​ ​a​ ​premade​ ​card​ ​on​ ​a​ ​blank​ ​card​ ​with​ ​tri-lines​ ​and​ ​sign​ ​his​ ​first​ ​and
last​ ​name​ ​using​ ​upper​ ​and​ ​lower​ ​case​ ​letters,​ ​with​ ​75%​ ​accuracy​ ​and​ ​no​ ​more​ ​than​ ​5​ ​verbal​ ​and​ ​physical​ ​cues​ ​in​ ​order​ ​to​ ​complete​ ​a
Thanksgiving​ ​card​ ​for​ ​his​ ​teacher.

​Barriers​ ​to​ ​be​ ​Addressed​ ​in​ ​the​ ​Session ​Intervention​ ​Plan/Techniques

● Decreased​ ​postural​ ​stability Upon​ ​first​ ​entering​ ​the​ ​therapy​ ​room,​ ​the​ ​therapist​ ​will​ ​show
● Decreased​ ​visual​ ​attention
Jacob​ ​a​ ​visual​ ​schedule​ ​of​ ​the​ ​session​ ​that​ ​includes​ ​3​ ​pictures:
● Alignment​ ​of​ ​letters​ ​in​ ​handwriting
● Spacing​ ​of​ ​letters​ ​in​ ​handwriting one​ ​of​ ​a​ ​therapy​ ​ball,​ ​one​ ​of​ ​a​ ​card​ ​and​ ​crayons/markers,​ ​and​ ​one
● Spatial​ ​organization
of​ ​a​ ​school​ ​bus​ ​to​ ​represent​ ​going​ ​home.​ ​The​ ​schedule​ ​will​ ​serve
as​ ​a​ ​method​ ​to​ ​keep​ ​Jacob​ ​on​ ​task​ ​and​ ​motivated​ ​throughout​ ​the
session,​ ​as​ ​going​ ​home​ ​as​ ​previously​ ​proven​ ​to​ ​be​ ​one​ ​of​ ​his
biggest​ ​motivators.​ ​The​ ​therapists​ ​will​ ​cover​ ​whichever​ ​tasks
Jacob​ ​is​ ​not​ ​currently​ ​on​ ​with​ ​sticky​ ​notes,​ ​and​ ​only​ ​leave​ ​the
current​ ​task​ ​uncovered​ ​so​ ​Jacob​ ​knows​ ​that​ ​is​ ​what​ ​he​ ​has​ ​to
focus​ ​on​ ​right​ ​now.
To​ ​begin​ ​the​ ​session,​ ​Jacob​ ​will​ ​participate​ ​in​ ​facilitative​ ​trunk
exercises​ ​on​ ​a​ ​large​ ​therapy​ ​ball.​ ​Taylor​ ​Swift​ ​music​ ​will​ ​be
played​ ​in​ ​the​ ​background​ ​since​ ​he​ ​seems​ ​to​ ​enjoy​ ​this​ ​addition​ ​and
it​ ​will​ ​keep​ ​him​ ​motivated​ ​and​ ​alert.​ ​If​ ​the​ ​music​ ​becomes​ ​too
much​ ​of​ ​a​ ​distraction​ ​for​ ​him,​ ​the​ ​therapists​ ​will​ ​turn​ ​off​ ​the​ ​music
and​ ​talk​ ​to​ ​him​ ​about​ ​his​ ​plans​ ​for​ ​Thanksgiving,​ ​instead.​ ​The
therapists​ ​will​ ​stabilize​ ​Jacob's​ ​base​ ​of​ ​support​ ​while​ ​he​ ​sits​ ​on​ ​top
of​ ​the​ ​ball​ ​and​ ​cause​ ​him​ ​to​ ​sit​ ​upright​ ​by​ ​using​ ​their​ ​hands​ ​to
activate​ ​his​ ​lower​ ​back​ ​and​ ​spinal​ ​muscles.​ ​They​ ​will​ ​displace
Jacob's​ ​center​ ​of​ ​gravity​ ​by​ ​rolling​ ​him​ ​back-and-forth,
side-to-side​ ​and​ ​diagonally.​ ​Jacob​ ​can​ ​participate​ ​in​ ​this​ ​prep
activity​ ​for​ ​about​ ​10​ ​minutes​ ​or​ ​less,​ ​but​ ​until​ ​there​ ​is​ ​a​ ​noticeable
improvement​ ​in​ ​his​ ​posture.​ ​These​ ​motions​ ​will​ ​activate​ ​Jacob's
trunk​ ​muscles​ ​to​ ​help​ ​improve​ ​his​ ​postural​ ​stability​ ​for​ ​the​ ​rest​ ​of
the​ ​session.​ ​Jacob​ ​will​ ​be​ ​able​ ​to​ ​sit​ ​upright​ ​in​ ​his​ ​chair,​ ​creating​ ​a
source​ ​of​ ​proximal​ ​stability​ ​in​ ​order​ ​for​ ​him​ ​to​ ​have​ ​distal
mobility​ ​as​ ​he​ ​engages​ ​in​ ​handwriting​ ​activities​ ​and​ ​occupations
in​ ​the​ ​session.​ ​In​ ​this​ ​preparatory​ ​activity,​ ​the​ ​therapists​ ​will​ ​use
knowledge​ ​of​ ​performance​ ​(KP)​ ​feedback​ ​to​ ​encourage​ ​and
correct​ ​Jacob​ ​through​ ​verbal​ ​and​ ​physical​ ​cues.​ ​Jacob​ ​will​ ​also
utilize​ ​procedural​ ​knowledge​ ​from​ ​his​ ​long​ ​term​ ​memory​ ​storage
for​ ​this​ ​task.​ ​Since​ ​Jacob​ ​has​ ​done​ ​this​ ​prep​ ​activity​ ​with​ ​the
therapist​ ​in​ ​the​ ​past,​ ​he​ ​will​ ​remember​ ​that​ ​he​ ​has​ ​to​ ​sit​ ​up​ ​on​ ​the
ball​ ​and​ ​maintain​ ​his​ ​balance.
Next,​ ​Jacob​ ​will​ ​be​ ​guided​ ​over​ ​to​ ​a​ ​desk​ ​and​ ​will​ ​sit​ ​so​ ​that​ ​his
posture​ ​is​ ​upright​ ​with​ ​his​ ​feet​ ​placed​ ​on​ ​the​ ​floor.​ ​If​ ​Jacob​ ​begins
to​ ​slouch,​ ​the​ ​therapist​ ​will​ ​provide​ ​physical​ ​cues​ ​and​ ​gentle
pressure​ ​to​ ​the​ ​small​ ​of​ ​his​ ​back​ ​to​ ​maintain​ ​his​ ​upright​ ​posture
throughout​ ​the​ ​session,​ ​so​ ​that​ ​he​ ​can​ ​better​ ​use​ ​his​ ​hands​ ​for​ ​the
activity.​ ​The​ ​therapist​ ​will​ ​then​ ​provide​ ​Jacob​ ​with​ ​a​ ​pre-made
Thanksgiving​ ​card​ ​with​ ​a​ ​colored-in​ ​and​ ​pasted-on​ ​turkey​ ​on​ ​the
front,​ ​and​ ​a​ ​short​ ​one-sentence​ ​phrase​ ​on​ ​the​ ​inside​ ​saying​ ​“I​ ​am
thankful​ ​for​ ​all​ ​the​ ​help​ ​you​ ​give​ ​me​ ​at​ ​school”.​ ​The​ ​therapist​ ​will
then​ ​explain​ ​to​ ​Jacob​ ​that​ ​since​ ​Thanksgiving​ ​is​ ​coming​ ​up,​ ​we
will​ ​be​ ​making​ ​a​ ​card​ ​to​ ​give​ ​to​ ​his​ ​teacher,​ ​as​ ​pleasing​ ​his​ ​teacher
seems​ ​to​ ​be​ ​a​ ​huge​ ​motivator​ ​for​ ​him.​ ​The​ ​therapist​ ​will​ ​then
provide​ ​Jacob​ ​with​ ​a​ ​similar​ ​card,​ ​but​ ​one​ ​that​ ​only​ ​has​ ​lines​ ​for
writing​ ​on​ ​the​ ​inside​ ​and​ ​no​ ​turkey​ ​yet​ ​on​ ​the​ ​front.​ ​The​ ​therapist
will​ ​set​ ​the​ ​premade​ ​card​ ​right​ ​above​ ​Jacob’s​ ​card​ ​on​ ​the​ ​desk,
and​ ​ask​ ​him​ ​to​ ​copy​ ​the​ ​sentence​ ​onto​ ​the​ ​lines​ ​as​ ​he​ ​sees​ ​it.​ ​Jacob
will​ ​have​ ​to​ ​retrieve​ ​from​ ​his​ ​long​ ​term​ ​procedural​ ​memory​ ​to
remember​ ​how​ ​to​ ​form​ ​letters​ ​and​ ​copy​ ​words.​ ​He​ ​will​ ​need​ ​to​ ​use
visual​ ​spacial​ ​relationships​ ​to​ ​properly​ ​space​ ​letters​ ​and​ ​words
apart.​ ​He​ ​will​ ​also​ ​have​ ​to​ ​orient​ ​the​ ​words​ ​properly​ ​on​ ​the​ ​lines
provided.​ ​The​ ​therapist​ ​can​ ​also​ ​cover​ ​up​ ​the​ ​rest​ ​of​ ​the​ ​paper​ ​if​ ​it
seems​ ​to​ ​be​ ​too​ ​visually​ ​stimulating​ ​for​ ​him,​ ​so​ ​that​ ​he​ ​is​ ​only
focusing​ ​on​ ​the​ ​lines​ ​to​ ​write​ ​on.​ ​They​ ​can​ ​also​ ​highlight​ ​the​ ​text
on​ ​the​ ​copy​ ​so​ ​it​ ​is​ ​apparent​ ​to​ ​him​ ​what​ ​to​ ​copy.​ ​They​ ​may​ ​have
to​ ​walk​ ​Jacob​ ​through​ ​letter​ ​by​ ​letter,​ ​if​ ​needed.​ ​If​ ​Jacob​ ​seems​ ​to
get​ ​frustrated​ ​by​ ​this,​ ​the​ ​therapist​ ​will​ ​bring​ ​out​ ​the​ ​blank
drawing​ ​of​ ​a​ ​turkey​ ​and​ ​remind​ ​Jacob​ ​that​ ​he​ ​will​ ​get​ ​to​ ​color​ ​in
the​ ​turkey​ ​after​ ​he​ ​finishes​ ​writing,​ ​since​ ​he​ ​has​ ​shown​ ​to​ ​greatly
enjoy​ ​coloring.​ ​If​ ​this​ ​task​ ​seems​ ​too​ ​difficult​ ​for​ ​Jacob,​ ​the
therapists​ ​will​ ​provide​ ​a​ ​similar​ ​card,​ ​but​ ​with​ ​dotted​ ​letters​ ​for
the​ ​words,​ ​which​ ​he​ ​will​ ​have​ ​to​ ​trace.​ ​The​ ​therapist​ ​can​ ​also
assist​ ​him​ ​by​ ​providing​ ​hand-over-hand​ ​assistance​ ​and​ ​providing
additional​ ​scaffolding.​ ​Jacob​ ​may​ ​require​ ​many​ ​different​ ​forms​ ​of
assistance​ ​and​ ​feedback​ ​in​ ​order​ ​to​ ​achieve​ ​his​ ​goal.​ ​If​ ​this​ ​task
seems​ ​too​ ​easy​ ​for​ ​Jacob,​ ​the​ ​therapist​ ​will​ ​write​ ​another​ ​sentence
on​ ​the​ ​premade​ ​card​ ​and​ ​ask​ ​Jacob​ ​to​ ​copy​ ​that​ ​as​ ​well.​ ​The​ ​task
of​ ​copying​ ​will​ ​require​ ​Jacob​ ​to​ ​look​ ​between​ ​two​ ​items​ ​and
therefore​ ​it​ ​is​ ​not​ ​only​ ​further​ ​developing​ ​his​ ​handwriting​ ​skills​ ​by
copying​ ​letters​ ​as​ ​they​ ​should​ ​be​ ​made​ ​to​ ​form​ ​words,​ ​but​ ​also​ ​it
is​ ​helping​ ​to​ ​improve​ ​his​ ​visual​ ​attention​ ​and​ ​near-point​ ​copying
abilities.
Once​ ​Jacob​ ​completes​ ​copying​ ​the​ ​sentence,​ ​the​ ​therapist​ ​will
provide​ ​Jacob​ ​with​ ​the​ ​blank​ ​turkey​ ​drawing​ ​and​ ​crayons/markers
and​ ​allow​ ​him​ ​the​ ​opportunity​ ​to​ ​color​ ​it​ ​in​ ​as​ ​he​ ​pleases.​ ​Since
Jacob​ ​tends​ ​to​ ​become​ ​overstimulated​ ​rather​ ​easily,​ ​the​ ​therapist
will​ ​also​ ​utilize​ ​this​ ​time​ ​as​ ​a​ ​calming,​ ​quiet​ ​break​ ​for​ ​Jacob​ ​to
ensure​ ​he​ ​does​ ​not​ ​become​ ​so​ ​stimulated​ ​he​ ​shuts​ ​down.
Once​ ​Jacob​ ​determines​ ​that​ ​he​ ​is​ ​finished​ ​coloring​ ​the​ ​turkey,​ ​the
therapist​ ​will​ ​help​ ​Jacob​ ​paste​ ​the​ ​cutout​ ​of​ ​the​ ​turkey​ ​to​ ​the​ ​front
of​ ​the​ ​card.​ ​Finally,​ ​the​ ​therapist​ ​will​ ​ask​ ​Jacob​ ​to​ ​write​ ​his​ ​first
and​ ​last​ ​name​ ​on​ ​the​ ​inside​ ​of​ ​the​ ​card​ ​underneath​ ​the​ ​sentence​ ​he
copied​ ​earlier,​ ​where​ ​there​ ​will​ ​also​ ​be​ ​lines​ ​to​ ​guide​ ​his
handwriting.
If​ ​there​ ​is​ ​time​ ​at​ ​the​ ​end,​ ​the​ ​therapist​ ​will​ ​allow​ ​Jacob​ ​to​ ​do
something​ ​in​ ​the​ ​room​ ​of​ ​his​ ​choosing​ ​for​ ​a​ ​few​ ​moments,​ ​to
reward​ ​him​ ​for​ ​working​ ​so​ ​hard​ ​and​ ​to​ ​get​ ​him​ ​in​ ​a​ ​neutral,​ ​happy
state​ ​before​ ​getting​ ​on​ ​the​ ​bus​ ​to​ ​go​ ​home.​ ​Otherwise,​ ​the
therapist​ ​will​ ​announce​ ​to​ ​Jacob​ ​that​ ​it​ ​is​ ​time​ ​to​ ​go​ ​home,​ ​and​ ​the
therapist​ ​will​ ​motivate​ ​him​ ​to​ ​walk​ ​back​ ​to​ ​class​ ​by​ ​reminding
 him​ ​that​ ​he​ ​has​ ​something​ ​to​ ​give​ ​to​ ​his​ ​teacher.

Practice​ ​FOR​ ​&​ ​Rationale

In​ ​this​ ​treatment​ ​session,​ ​the​ ​visual​ ​perceptual​ ​and​ ​cognitive​ ​frames​ ​of​ ​reference​ ​are​ ​used.​ ​Visual​ ​perception​ ​is​ ​“the​ ​ability​ ​to​ ​make
sense​ ​of​ ​sensory​ ​stimuli​ ​and​ ​involves​ ​cognition​ ​and​ ​sensory​ ​awareness”​ ​(Case-Smith​ ​&​ ​O’Brien,​ ​2015,​ ​p.​ ​199).​ ​Because​ ​of​ ​Jacob’s
diagnoses,​ ​he​ ​has​ ​difficulty​ ​maintaining​ ​sensory​ ​awareness​ ​of​ ​certain​ ​things,​ ​therefore​ ​impacting​ ​his​ ​ability​ ​to​ ​interpret​ ​and​ ​react​ ​to
incoming​ ​information.​ ​This​ ​concept​ ​of​ ​visual​ ​perception​ ​considers​ ​ideas​ ​like​ ​visual​ ​closure,​ ​figure-ground,​ ​shape​ ​recognition​ ​and
depth​ ​perception​ ​(Case-Smith​ ​&​ ​O’Brien,​ ​2015,​ ​p.​ ​199).​ ​Upon​ ​seeing​ ​these​ ​visual​ ​stimuli,​ ​the​ ​brain’s​ ​process​ ​for​ ​memory​ ​begins.
The​ ​input,​ ​or​ ​visual​ ​stimuli,​ ​is​ ​sent​ ​to​ ​short​ ​term​ ​sensory​ ​storage,​ ​where​ ​the​ ​brain​ ​either​ ​discards​ ​the​ ​information​ ​or​ ​decides​ ​to​ ​work
with​ ​it.​ ​If​ ​the​ ​person​ ​selectively​ ​attends​ ​to​ ​this​ ​information,​ ​it​ ​is​ ​transmitted​ ​to​ ​short​ ​term​ ​working​ ​memory​ ​which​ ​can​ ​manipulate
around​ ​seven​ ​items​ ​at​ ​one​ ​time.​ ​Here,​ ​the​ ​brain​ ​decides​ ​to​ ​either​ ​react​ ​to​ ​the​ ​information​ ​and​ ​generate​ ​an​ ​output​ ​or​ ​send​ ​this
information​ ​to​ ​long​ ​term​ ​memory​ ​storage​ ​via​ ​rehearsal.​ ​If​ ​a​ ​person​ ​retrieves​ ​knowledge​ ​from​ ​long​ ​term​ ​memory​ ​storage,​ ​a
movement​ ​output​ ​can​ ​be​ ​produced.​ ​This​ ​knowledge​ ​can​ ​be​ ​declarative​ ​or​ ​procedural,​ ​or​ ​a​ ​person​ ​can​ ​exhibit​ ​metacognition,
knowing​ ​that​ ​they​ ​know​ ​something​ ​in​ ​order​ ​to​ ​use​ ​transfer​ ​and​ ​generalization​ ​skills​ ​(Case-Smith​ ​&​ ​O’Brien,​ ​2015,​ ​p.​ ​304).​ ​Some
children​ ​have​ ​trouble​ ​with​ ​this​ ​process,​ ​either​ ​putting​ ​information​ ​into​ ​long​ ​term​ ​memory​ ​or​ ​with​ ​retrieving​ ​it.​ ​Some​ ​are​ ​challenged
with​ ​visual​ ​discrimination​ ​(finding​ ​the​ ​differences​ ​between​ ​items),​ ​visual​ ​spacial​ ​relationships​ ​(orienting​ ​items​ ​in​ ​space),​ ​or​ ​figure
ground​ ​(finding​ ​an​ ​item​ ​in​ ​a​ ​cluttered​ ​background)​ ​(“Perception,”,​ ​n.d.,​ ​n.p.).​ ​Difficulty​ ​in​ ​these​ ​areas​ ​may​ ​impact​ ​a​ ​child’s
functional​ ​engagement​ ​in​ ​occupations,​ ​including​ ​school​ ​work​ ​and​ ​handwriting.​ ​Jacob​ ​may​ ​experience​ ​challenges​ ​with​ ​one​ ​or​ ​more
of​ ​these​ ​areas.​ ​Based​ ​on​ ​previous​ ​observations,​ ​Jacob​ ​may​ ​have​ ​difficulty​ ​with​ ​storing​ ​in​ ​or​ ​retrieving​ ​from​ ​long​ ​term​ ​memories.
With​ ​intervention,​ ​the​ ​therapist​ ​may​ ​utilize​ ​scaffolding​ ​by​ ​providing​ ​the​ ​child​ ​with​ ​a​ ​reference​ ​of​ ​correctness​ ​or​ ​via​ ​discovery
learning,​ ​in​ ​which​ ​the​ ​child​ ​arrives​ ​at​ ​solutions​ ​themselves.​ ​The​ ​therapist​ ​may​ ​also​ ​choose​ ​to​ ​utilize​ ​a​ ​CO-OP​ ​approach,​ ​in​ ​which
the​ ​focus​ ​is​ ​on​ ​correcting​ ​the​ ​child’s​ ​performance​ ​by​ ​providing​ ​feedback​ ​of​ ​knowledge​ ​of​ ​results​ ​and​ ​of​ ​performance​ ​(Case-Smith​ ​&
O’Brien,​ ​2015,​ ​p.​ ​306).

We​ ​will​ ​also​ ​utilize​ ​a​ ​Neurodevelopmental​ ​Treatment​ ​approach,​ ​with​ ​use​ ​of​ ​the​ ​therapy​ ​ball.​ ​The​ ​therapist​ ​will​ ​“provide​ ​input​ ​to​ ​the
child​ ​to​ ​help​ ​‘normalize’​ ​muscle​ ​tone”​ ​(Case-Smith​ ​&​ ​O’Brien,​ ​2015,​ ​p.​ ​196).​ ​By​ ​using​ ​handling​ ​techniques​ ​and​ ​stabilizing​ ​key
points​ ​of​ ​control​ ​while​ ​Jacob​ ​is​ ​on​ ​the​ ​ball,​ ​his​ ​postural​ ​tone​ ​will​ ​be​ ​facilitated​ ​to​ ​help​ ​prepare​ ​him​ ​for​ ​proximal​ ​stability​ ​to​ ​support
distal​ ​mobility​ ​in​ ​the​ ​session.

Database​ ​Searched Search​ ​Terms Limits​ ​used

Scopus Handwriting​ ​AND​ ​“Down​ ​syndrome” None
Academic​ ​Search​ ​Elite Handwriting​ ​and​ ​intervention Full​ ​Text
Google​ ​Scholar Handwriting​ ​and​ ​occupational​ ​therapy Do​ ​not​ ​include​ ​patents
ProQuest Handwriting​ ​and​ ​children None

Current​ ​Evidence​ ​to​ ​Support​ ​the​ ​Plan

“Specifically,​ ​they​ ​chose​ ​to​ ​explore​ ​the​ ​question​ ​suggested​ ​by​ ​Askov,​ ​Otto,​ ​and​ ​Askov​ ​(1)​ ​as​ ​to​ ​whether​ ​copying​ ​or​ ​tracing​ ​practice
would​ ​produce​ ​superior​ ​learning”
“​ ​Inspection​ ​of​ ​the​ ​results​ ​reveals​ ​a​ ​clear​ ​advantage​ ​of​ ​the​ ​copying​ ​group​ ​over​ ​the​ ​tracing​ ​group​ ​at​ ​all​ ​grade​ ​levels​ ​involved”​ ​-
(Askov​ ​&​ ​Greff,​ ​1975,​ ​n.p.)​ ​Jacob​ ​will​ ​be​ ​given​ ​a​ ​model​ ​in​ ​which​ ​he​ ​can​ ​copy​ ​to​ ​make​ ​his​ ​own.​ ​If​ ​necessary,​ ​we​ ​can​ ​write​ ​his​ ​name
on​ ​a​ ​separate​ ​sheet​ ​so​ ​that​ ​he​ ​can​ ​write​ ​it​ ​himself​ ​on​ ​his​ ​card.

“Instructional​ ​approaches​ ​of​ ​handwriting​ ​intervention​ ​programs​ ​vary​ ​but​ ​tend​ ​to​ ​comprise​ ​a​ ​combination​ ​of​ ​sequential​ ​techniques
including​ ​modeling,​ ​copying,​ ​stimulus​ ​fading,​ ​composing,​ ​and​ ​self-monitoring”
“(Child​ ​first​ ​learns​ ​individual​ ​letters)...Next,​ ​the​ ​child​ ​proceeds​ ​to​ ​copying​ ​letters​ ​and​ ​words​ ​from​ ​a​ ​model​ ​and​ ​then​ ​to​ ​writing​ ​letters
and​ ​words​ ​from​ ​memory​ ​as​ ​they​ ​are​ ​dictated”
“Handwriting​ ​problem:​ ​near-point​ ​copying;​ ​handwriting​ ​solution:​ ​highlight​ ​the​ ​text​ ​to​ ​be​ ​copied,​ ​teach​ ​student​ ​to​ ​copy​ ​two​ ​or​ ​three
letters​ ​at​ ​a​ ​time”​ ​-​ ​(Case-Smith​ ​&​ ​O’Brien,​ ​2015,​ ​n.p.)​ ​Jacob​ ​may​ ​require​ ​several​ ​different​ ​varieties​ ​of​ ​assistance​ ​in​ ​order​ ​to
complete​ ​the​ ​task​ ​in​ ​this​ ​session.
“Vestibular​ ​stimulation​ ​was​ ​applied​ ​to​ ​the​ ​second​ ​group.​ ​These​ ​included:​ ​activities​ ​on​ ​therapy​ ​ball​ ​in​ ​prone​ ​position​,​ ​active
maintenance​ ​of​ ​balance​ ​on​ ​stairs​ ​and​ ​ramps;​ ​Reducing​ ​gravitational​ ​insecurity:​ ​Self-initiated​ ​linear​ ​vestibular​ ​stimulation​ ​in
non-threatening​ ​positions​ ​with​ ​speeds​ ​and​ ​durations​ ​tolerable​ ​to​ ​the​ ​children...In​ ​the​ ​second​ ​group​ ​(sensory​ ​integrative​ ​therapy​ ​and
vestibular​ ​stimulation),​ ​significant​ ​improvements​ ​were​ ​observed​ ​in​ ​sensory​ ​integrative​ ​subtests,​ ​vestibular​ ​system,​ ​fine​ ​hand​ ​skills,
reflex​ ​development​ ​and​ ​gravitational​ ​insecurity"​ ​(Uyanik​ ​et​ ​al.,​ ​2003,​ ​p.​ ​71)​ ​ ​By​ ​putting​ ​Jacob​ ​on​ ​the​ ​ball​ ​as​ ​a​ ​prep​ ​activity,​ ​his​ ​fine
motor​ ​skills​ ​should​ ​improve​ ​due​ ​to​ ​his​ ​facilitated​ ​proximal​ ​stability.

“In​ ​the​ ​studies​ ​with​ ​handwriting​ ​practice​ ​using​ ​a​ ​cognitive​ ​focus,​ ​students​ ​received​ ​instruction​ ​to​ ​help​ ​them​ ​think​ ​their​ ​way​ ​through
letter​ ​formation​ ​and​ ​self-correction”​ ​(Hoy,​ ​Egan,​ ​&​ ​Feder,​ ​2011,​ ​p.​ ​19).​ ​These​ ​findings​ ​support​ ​the​ ​idea​ ​of​ ​a​ ​CO-OP​ ​approach​ ​and
discovery​ ​learning,​ ​allowing​ ​the​ ​child​ ​to​ ​think​ ​about​ ​the​ ​solutions​ ​that​ ​could​ ​affect​ ​and​ ​improve​ ​his​ ​performance.

What​ ​I​ ​liked What​ ​I​ ​didn’t​ ​like

MR:​ ​I​ ​thought​ ​we​ ​did​ ​a​ ​good​ ​job​ ​at​ ​trying​ ​different​ ​tactics​ ​on
how​ ​to​ ​get​ ​Jacob​ ​engaged.​ ​Aside​ ​from​ ​changing​ ​the​ ​focus​ ​of​ ​the
session​ ​entirely​ ​and​ ​doing​ ​whatever​ ​he​ ​wanted,​ ​I​ ​think​ ​we​ ​tried
many​ ​ways​ ​to​ ​help​ ​him​ ​succeed.​ ​We​ ​started​ ​with​ ​facilitation​ ​by
bouncing​ ​on​ ​the​ ​ball,​ ​gave​ ​him​ ​options​ ​throughout,​ ​graded​ ​the
task​ ​down,​ ​limited​ ​visual​ ​stimuli​ ​by​ ​covering​ ​up​ ​everything
other​ ​than​ ​what​ ​he​ ​needed​ ​to​ ​copy,​ ​providing​ ​more​ ​stimulation
on​ ​the​ ​ball,​ ​changed​ ​his​ ​seating​ ​arrangement,​ ​changed​ ​his
position​ ​in​ ​the​ ​room,​ ​and​ ​gave​ ​him​ ​motivators.​ ​I​ ​am​ ​happy​ ​with
how​ ​we​ ​worked​ ​with​ ​him​ ​to​ ​see​ ​if​ ​any​ ​of​ ​these​ ​options​ ​appealed
to​ ​him.
SW:​ ​I​ ​really​ ​liked​ ​the​ ​strategies​ ​we​ ​used​ ​to​ ​try​ ​to​ ​get​ ​Jacob​ ​to
participate.​ ​Though​ ​they​ ​were​ ​mostly​ ​unsuccessful,​ ​it​ ​felt​ ​good
to​ ​ ​be​ ​in​ ​a​ ​situation,​ ​remember​ ​a​ ​technique​ ​we​ ​learned​ ​in​ ​class,
MR:​ ​It​ ​is​ ​frustrating​ ​when​ ​we​ ​have​ ​continuously​ ​tried​ ​to​ ​make​ ​a
connection​ ​with​ ​Jacob​ ​and​ ​plan​ ​things​ ​hoping​ ​they​ ​will​ ​appeal​ ​to
him,​ ​but​ ​he​ ​shows​ ​no​ ​interest​ ​in​ ​participating.​ ​It​ ​has​ ​been​ ​a
challenge​ ​dealing​ ​with​ ​his​ ​behaviors​ ​while​ ​trying​ ​to​ ​engage​ ​and
motivate​ ​him.
SW:​ ​I​ ​felt​ ​very​ ​frustrated​ ​after​ ​this​ ​session​ ​because​ ​this​ ​is​ ​the
third​ ​time​ ​now​ ​that​ ​Jacob​ ​has​ ​been​ ​unsuccessful​ ​in​ ​meeting​ ​the
intended​ ​outcome​ ​for​ ​the​ ​session.​ ​It​ ​is​ ​very​ ​difficult​ ​to​ ​get​ ​him​ ​to
cooperate,​ ​and​ ​even​ ​though​ ​we​ ​have​ ​used​ ​every​ ​motivator​ ​we
know​ ​of​ ​for​ ​him,​ ​it​ ​still​ ​has​ ​not​ ​seemed​ ​to​ ​increase​ ​his
participation​ ​at​ ​all.
and​ ​use​ ​it​ ​in​ ​the​ ​moment.​ ​Also,​ ​I​ ​liked​ ​how​ ​although​ ​it​ ​would
have​ ​been​ ​easy​ ​to​ ​give​ ​up,​ ​we​ ​continued​ ​to​ ​try​ ​different​ ​things​ ​to
get​ ​Jacob​ ​to​ ​participate​ ​until​ ​the​ ​very​ ​end​ ​of​ ​the​ ​session.

Progress​ ​Note

In​ ​this​ ​session,​ ​Jacob​ ​was​ ​mostly​ ​unsuccessful​ ​in​ ​achieving​ ​the​ ​goal​ ​of​ ​copying​ ​a​ ​sentence​ ​onto​ ​a​ ​piece​ ​of​ ​paper​ ​in​ ​order​ ​to​ ​make​ ​a
Thanksgiving​ ​card​ ​for​ ​his​ ​teacher.​ ​Even​ ​though​ ​Jacob​ ​had​ ​time​ ​on​ ​the​ ​ball​ ​at​ ​the​ ​beginning​ ​of​ ​the​ ​session​ ​to​ ​help​ ​increase​ ​his
postural​ ​stability​ ​during​ ​the​ ​session,​ ​he​ ​continued​ ​to​ ​keep​ ​his​ ​head​ ​down​ ​and​ ​his​ ​back​ ​hunched​ ​over​ ​throughout​ ​the​ ​session,​ ​making
handwriting​ ​increasingly​ ​more​ ​challenging​ ​to​ ​initiate.​ ​The​ ​therapists​ ​brought​ ​two​ ​copies​ ​of​ ​the​ ​card​ ​Jacob​ ​could​ ​have​ ​potentially
used​ ​-​ ​one​ ​with​ ​just​ ​the​ ​tri-lines,​ ​and​ ​one​ ​with​ ​the​ ​tri-lines​ ​and​ ​the​ ​sentence​ ​dotted​ ​onto​ ​the​ ​lines​ ​in​ ​an​ ​effort​ ​to​ ​grade​ ​down​ ​the​ ​task.
Jacob​ ​needed​ ​to​ ​use​ ​the​ ​copy​ ​with​ ​the​ ​dotted​ ​sentence​ ​on​ ​the​ ​lines,​ ​because​ ​he​ ​did​ ​not​ ​seem​ ​to​ ​understand​ ​the​ ​task​ ​with​ ​just​ ​the
pre-made​ ​card​ ​he​ ​was​ ​supposed​ ​to​ ​copy​ ​and​ ​the​ ​blank​ ​tri-lines​ ​on​ ​his​ ​card,​ ​as​ ​evident​ ​by​ ​his​ ​lack​ ​of​ ​response​ ​even​ ​when​ ​verbally
and​ ​physically​ ​prompted​ ​multiple​ ​times.​ ​When​ ​Jacob​ ​was​ ​presented​ ​with​ ​the​ ​dotted​ ​sentence​ ​card​ ​instead,​ ​he​ ​still​ ​did​ ​not​ ​choose​ ​to
participate.​ ​The​ ​therapists​ ​gave​ ​him​ ​choices​ ​about​ ​the​ ​type​ ​of​ ​writing​ ​utensil​ ​he​ ​wanted​ ​to​ ​use​ ​and​ ​what​ ​color,​ ​and​ ​even​ ​after​ ​he
chose​ ​a​ ​marker,​ ​he​ ​would​ ​not​ ​hold​ ​the​ ​marker​ ​independently​ ​and​ ​continued​ ​to​ ​drop​ ​it​ ​on​ ​the​ ​floor.​ ​The​ ​therapists​ ​then​ ​resorted​ ​to
utilizing​ ​hand-over-hand​ ​to​ ​complete​ ​writing​ ​the​ ​sentence,​ ​but​ ​Jacob​ ​refused​ ​to​ ​grasp​ ​the​ ​marker​ ​on​ ​his​ ​own,​ ​so​ ​the​ ​therapist​ ​did
most​ ​of​ ​the​ ​work.​ ​In​ ​past​ ​sessions,​ ​Jacob​ ​has​ ​been​ ​very​ ​motivated​ ​by​ ​coloring,​ ​so​ ​the​ ​therapists​ ​had​ ​added​ ​a​ ​blank​ ​turkey​ ​on​ ​the
front​ ​that​ ​he​ ​could​ ​color​ ​after​ ​he​ ​was​ ​done​ ​writing.​ ​However,​ ​when​ ​this​ ​was​ ​offered​ ​to​ ​him,​ ​he​ ​showed​ ​no​ ​response​ ​and​ ​continued​ ​to
sit​ ​in​ ​the​ ​chair​ ​hunched​ ​over​ ​and​ ​looking​ ​down.​ ​The​ ​therapists​ ​asked​ ​Jacob​ ​to​ ​at​ ​least​ ​write​ ​his​ ​name​ ​on​ ​the​ ​bottom​ ​of​ ​the​ ​card​ ​so
his​ ​teacher​ ​could​ ​know​ ​it​ ​came​ ​from​ ​him,​ ​and​ ​he​ ​again​ ​chose​ ​to​ ​show​ ​no​ ​response​ ​to​ ​either​ ​verbal​ ​or​ ​tactile​ ​cues.​ ​At​ ​the​ ​end​ ​of​ ​the
session​ ​when​ ​the​ ​therapists​ ​walked​ ​Jacob​ ​back​ ​to​ ​his​ ​classroom,​ ​his​ ​teacher​ ​reported​ ​that​ ​Jacob​ ​had​ ​been​ ​having​ ​a​ ​very
noncompliant​ ​day.

References:
Askov,​ ​E.,​ ​&​ ​Greff,​ ​K.​ ​(1975).​ ​Handwriting:​ ​Copying​ ​versus​ ​Tracing​ ​as​ ​the​ ​Most​ ​Effective​ ​Type​ ​of​ ​Practice.​ ​The​ ​Journal​ ​of

Educational​ ​Research,​ ​69​(3),​ ​96-98.​ ​Retrieved​ ​from​ ​http://www.jstor.org/stable/27536837

Case-Smith,​ ​J.,​ ​&​ ​O’Brien,​ ​J.​ ​(2015).​ ​Occupational​ ​Therapy​ ​for​ ​Children​ ​and​ ​Adolescents​ ​(7th​ ​ed.).​ ​St.​ ​Louis,​ ​MO:​ ​Elsevier.

Hoy,​ ​M.,​ ​Egan,​ ​M.,​ ​&​ ​Feder,​ ​K.​ ​(2011).​ ​A​ ​systematic​ ​review​ ​of​ ​interventions​ ​to​ ​improve​ ​handwriting.​ ​The​ ​Canadian​ ​Journal​ ​of

Occupational​ ​Therapy,​ ​78​(1),​ ​13-25.​ ​Retrieved​ ​from

https://search-proquest-com.authenticate.library.duq.edu/docview/859014480?accountid=10610​.

Perception.​ ​(n.d.).​ ​Retrieved​ ​November​ ​04,​ ​2017,​ ​from​ ​http://eyecanlearn.com/​.

Uyanik,​ ​M.,​ ​Bumin,​ ​G.​ ​and​ ​Kayihan,​ ​H.​ ​(2003),​ ​Comparison​ ​of​ ​different​ ​therapy​ ​approaches​ ​in​ ​children​ ​with​ ​Down​ ​syndrome.

Pediatrics​ ​International​,​ ​45​:​ ​68–73.​ ​doi:10.1046/j.1442-200X.2003.01670.