Client’s Initials and Age: DV, 4 Time allotted for session: 25 min Date implemented:

Diagnosis and any Precautions: (1) developmental delay 10/24/2018

Goal(s) being addressed: (1) Improved FMC (grip, writing, cutting) and visual perception
Activity Demands (setting,
Specific Objectives for this Modifications (provided during the
Intervention Activities materials, and social
activity (list 2-3) activity and planned for next
(5) requirements)
(5) session) (5)
(5)
Environmental Setup: Sitting at
For this activity, the child started in prone
child-sized table in supportive
to increase the stability challenge and
chair. Basket placed in front of
add a postural component. The child
child on table with tweezers
remained in this position for 75% of the
placed to the right of the child.
activity, and then switched to a seated
Door closed to reduce
position for the remaining portion to
distractions. The child’s talker will
decrease fatigue. The motor planning
be placed to the side of the child
component of this activity was a
to promote use to ask for help
challenge for the child so I decreased the
and to make requests.
Child will participate in spider amount of webbing to decrease the
Materials: Spider web basket, 15
web fine motor activity while challenge of maneuvering past this
spiders, tweezers, table, chair
sitting supported at table. Using barrier. The child also used longer
Social Requirements: This
tweezers, child will pinch spider tweezers that offered less resistance
1. Child will retrieve 10/15 activity will require child to remain
from bottom of basket. Child will than the shorter ones, adding to the
spiders on the first try with seated and act in socially
retrieve spider past “web”. Child manipulation challenge but decreasing
verbal cueing as needed appropriate manner despite
will repeat this task 15 times to the strength need. This task took much
for strategy and grasp. challenge. Additionally, child will
retrieve all spiders. This activity longer than I anticipated, so I decreased
2. Child will complete need to communicate need for
will challenge the child’s fine the number of spiders the child had to
activity in 8 minutes. assistance to therapist if
motor control, accuracy, pinch retrieve from 15 to 11. The next session
encountered (a current challenge
strength, motor planning, and will address motor planning and hand
for this child).
visual perception to improve strength as these were the primary
Grading: To grade this task up,
performance in writing activities. challenges the child encountered during
the child could use longer
this activity. The child was able to
tweezers or tweezers with more
successfully use his talker, given
resistance, I could increase the
prompting, to request help and a change
amount of spider webbing to
in position when needed, which was a
increase motor planning
fantastic accomplishment. To better
difficulty, or the child could
support the child’s performance, this
perform this activity while in
activity should be completed sitting at
prone on ground. To grade this
the table as originally planned, with less
task down, the child could use
spider webbing, and with items with
smaller tweezers to decrease

Child will participate in paint
writing activity to promote grip,
FMC, open web space, and
letter/shape formation accuracy.
Child will write pre-writing shapes
(O, X, +) using q-tip on paint-filled
Ziploc bag, provided a visual
model. Child will also write name
in correct case using same
manner as above. This activity
will challenge the child’s pincer
grasp, accuracy, radial/ulnar
separation, and promote an open
web space.
stabilization challenge, I could more grip (spiders were flimsy and
decrease the amount of spider difficult to grasp).
webbing to decrease motor
planning need, the child could
perform this task standing to
decrease angle needed to
position hand through webbing,
or I could decrease the number of
spiders the child needs to
retrieve.
Environmental Setup: The child
will lie in prone on ground with
paint-filled bag placed directly in
front. The child will use q-tip in
tripod grasp to copy letters and
name from paper model. The
door will remain closed to
promote attention. After using this activity with another
Materials: Q-tip, alternate writing child, I realized that the paint bag did not
utensils, Ziploc bags, washable work for this activity. Thus, I had to
paint, paper models largely change this activity to allow for
Social Requirements: The child the best performance from the child. I
1. Child will correctly form will need to appropriately attempt used a tabletop white board and a fat dry
O, X, and + when given to copy the shapes/letters erase marker for the child to write the
model with no more than modeled for them. The child also pre-writing shapes with another white
1 verbal prompt. needs to be aware and have the board in front of child with a model. The
2. Child will copy first name initiation to request help when child then wrote his name on a sheet of
in correct title case with needed or correct mistakes. paper given a model with a q-tip dipped
top-to-bottom formation Grading: To grade down the in paint. Given the change in activity,
80% of the time. task, the child may use a these tasks were performed sitting
larger/fatter writing utensil (such supported at a child-sized table. To
as a wooden dowel or fat crayon) better support the child’s performance,
to facilitate an easier grasp. this activity could be completed standing
Additionally, this may be at a wall to promote proper grip and wrist
completed with bag hung on wall stability.
and child standing to promote
proper grasp and letter formation
if prone is too difficult. The child
may also use a gallon bag (as
opposed to the quart bag) to
make the writing space larger.
Last, the child may imitate

Child will create pumpkin out of
construction paper. Child will cut
simple pumpkin shape (1/2
sheet of paper), two triangles for
eyes, a half-moon for mouth, 1
rectangle for stem, and 6
rectangles for teeth when given
traced shape. Child will then
glue pieces on pumpkin with
provided model. This activity will
address FMC, correct
positioning of scissors in hand,
bilateral coordination, motor
planning, finger strength, and
visual motor integration.
shape/letter formation after
therapist forms rather than
having an already created model.
To grade up the task, this may be
completed on a smaller bag or
the child may write shapes/name
without model provided.
Additionally, the child may write
with q-tip cut in half to require a
more precise grasp.
1. Child cuts within 1/4” of Environmental Setup: Child will This activity went very well, although
line for 75% of cutting sit at child-height table with part will be completed in the next
tasks. supportive chair and child-sized session. The child successfully cut out
2. Child will complete task scissors. Child will be given the the pumpkin shape with no assistance.
with no more than 5 half-sheet of paper with a The child properly manipulated the
physical cues. pumpkin shape traced on to cut paper, stayed within ¼” for 95% of the
out. Once that has been cut, the pumpkin. He did require cuing for
child will be given the eyes to cut scissor positioning, which we will
out, then the mouth, then the address in the next session. I only had
rectangles until all items are cut. to change the amount of this task we
Then the child will be given completed this day, otherwise he
brush-on glue to complete completed the task as written. To better
project. support the child’s performance, I will
Materials: Table, chair, orange make the line he cuts on thicker for the
construction paper (pumpkin), next cutting task, and use less-resistive
black construction paper scissors to make the task easier for him
(eyes/mouth), white paper to position and remain in that position.
(teeth), green paper (stem), child
scissors, and glue.
Social Requirements: Child
needs to listen to and
appropriately apply directions to
create pumpkin. Child needs to
be able to appropriately control
any frustration created, and
acknowledge a need for help, as
appropriate.
Grading: To grade this task
down, the child may only cut the
straight lines on the shapes, use
adapted scissors (self-
 opening/easi-grip), and use a
glue stick. To grade this task up,
the child may make cut smaller
shapes (requiring more
precision), cut shapes out of
larger sheet (requiring better
manipulation), or use
squeezable glue to promote
hand strength and insight on
appropriate amount of glue to
use.

S/OT name: Samantha Develli

Citation:
Valvano, J. (2004). Activity-Focused Motor Interventions for Children with Neurological Conditions. Physical and Occupational Therapy in
Pediatrics, 24(1-2), 79-107. doi:10.1300/J006v24n01_04

Abstract:
“This article presents a model to guide activity-focused physical therapy and occupational therapy interventions for children with neurological
conditions. Activity-focused interventions involve structured practice and repetition of functional actions and are directed toward the learning of
motor tasks that will increase independence and participation in daily routines. According to this model, the pediatric therapist: (1) develops activity-
related goals in collaboration with the child and the family; (2) plans activity-focused interventions by adapting knowledge of motor learning to the
child’s individual learning strengths and needs; and (3) integrates impairment-focused intervention with activity-focused intervention.”

Support for Intervention:

In the school setting, school participation is the primary occupation addressed. In the preschool setting, this typically focuses on writing, cutting, and
other manipulation tasks required in this setting. The FMC required for the above tasks were addressed in the above interventions. The above
interventions focused on activities common to the child’s school day, and fostered practice and repetition of those activities, and their component
actions, to improve the child’s ability to participate in his educational setting. The motor learning facilitated by the above interventions was
developed with the child in mind, and adapted to that child’s specific challenges to promote functional improvements. Thus the above article
supports my plan for intervention.

Total: 27 points