In Bangalore, a diagnosis of autism, PDD-NOS, or ADHD translates into occupational therapy
(OT) services for sensory integration (SI). There is no denying that sensory
integration is mostly practiced by occupational therapists throughout the
world. However, many physiotherapists (PT) like myself also choose to train in SI.
In most Western
countries, there is a distinct division
of services between OT and PT. The PT
provides services that focus on gross motor activities, address the larger muscles
of the body, and mostly the trunk and legs. The OT works on fine motor, smaller
muscles of the body, and mostly the trunk and arms. Inevitably, there is an
overlap between both services; it is not unusual to see an OT and PT working
together to treat a patient and address different goals during the same
session.
The concrete reason for my preceding explanation is that
fine motor progress cannot be achieved without first addressing the larger
muscles of the body that include the trunk. Our trunk forms the foundation for
working of the arms and the legs. Weakness of abdominals and/or the back
extensors results into an array of problems in posture, postural control,
balance, coordination, and fine motor tasks such as writing/cutting/coloring.
We need a good core strength of the trunk to stay upright, alert, and ready for movement
skills such as throwing/catching/kicking a ball. Core strength also plays an
important role in climbing playground equipment and keeping balance on uneven
terrain. Good postural control is required for all activities ranging from
reaching for an object on a shelf to writing efficiently on paper.
Without adequate abdominal muscle strength, speech and
respiration are compromised. In my clinical practice, I have observed improved
speech, relief of constipation if any, and increase in stamina due to emphasis
on improving abdominal tone and strength.
Activities designed to improve upper
body strength result into better writing skills and coordinated use of both
arms and hands.
In summary, gross motor precedes fine motor.
