Week 10 - Interventions

Discuss how evidence based practice is used to support client interventions in this setting. In APA format, list one article you used to support evidence based practice.

At Wolfson’s Children’s Outpatient Rehabilitation they focus their interventions a lot on evidenced based practice. The therapists treating that this facility perform independent research along with continuing education classes to aide in their ability to individualize each child’s care.

The Wilbarger Brushing protocol or as they call it at Wolfson’s deep touch/pressure protocol is a way to improve attention and decrease impulsiveness prior to the beginning of a therapy session. I had never heard of this protocol prior to this clinical but I have seen results from the use of brushing before therapy tasks. We also provide families with training on this protocol for them to use at home. The majority of the families that we have taught in my 10 weeks have reported that they have noticed improvement in behavior and attention at home along with improved ability to fall asleep at night.

Wolfson’s also uses Handwriting Without Tears for those children that are having difficulty with handwriting. This is used in many ways including the manuscript and cursive books with worksheets along with the chalkboards and sticks used to form letters.

With many of the children at Wolfson’s that have been diagnosed ADHA along with a few other diagnoses, we use a weighted compression vest following the use of deep pressure/ touch protocol in order to improve participation and interest in therapy tasks. The vest provides sensorimotor input to the child adding the sensory stimulation that they seek out. Lin et al., performed a study to examine the effectiveness of using weighted vest for improving attention, impulse control, and on-task behavior in children with ADHD. They performed a randomized, two-period crossover design trial with 110 children participating. They use the Conners’ Continuous Performance Test-II (CPT-II) to measure. As a result of the study performed, they determined that the use of weighted vests for children with ADHD showed significant improvement in all three attentional variables of the CPT-II tasks which includes inattention, speed of processing and responding, consistency of executive management. The children wearing the vest also showed significant improvement in off task behavior, out of seat, and fidgeting. The study did not find improvements in impulse control and automatic vocalizations. In conclusion, the researcher’s state that wearing a weighted vest is not a cure all strategy which is something that we remind parents at Wolfson’s when they purchase a vest for home.

Lin, H., Lee, P., Chang, W., & Hong, F. (2014). Effects of Weighted Vests on Attention, Impulse Control, and On-Task Behavior in Children With Attention Deficit Hyperactivity Disorder. The American Journal of Occupational Therapy. (68)2: 149-158. doi: 10.5014/ajot.2014.009365