Thick descriptions of occupational therapy ADL intervention: A case study.

The context for this entry is that there has been some debating lately about what constitutes occupational therapy and if it can be represented by symbols or even words. So file this entry under: "An example of when the story probably works a little better than the image."

Caleb is thirteen years old and he lives in a shack on the east side of the city. His father abandoned the family long ago and his mother has been on disability payments for as long as she can remember. It's a little difficult understanding the full story because all of her teeth are missing and her articulation isn't particularly clear. That could be part of the reason why Caleb has speech delays - because the voice that he has heard since infancy, although loving, is like listening to marbles rolling over white noise.

Caleb has a moderate degree of mental retardation for which there is no specific cause. It could be genetics and it could be environmental but it is likely both. He relies on the school bus to get to his special education program - but now his transportation is in jeopardy. The problem is that the family bathtub is used to store newspapers, garbage, and his now-dead grandfather's bath transfer bench - so he doesn't have access to using it for hygiene purposes. Caleb also has some difficulties with encopresis and enuresis, which has recently caused upset on the bus because it is getting to the point where the other pre-teens are making fun of him and no one wants to sit near him while riding to school.

The bus company's solution to this is to 'write him up' which means that he is given a slip of paper that identifies the offending behavior and the potential consequences of not solving the problem. The slip of paper states that Caleb has a "Loud Body Odor" and other children are making fun of him. He will be not be allowed to ride the bus again if he does not correct this problem.

I pray to God frequently and today I can tell you that I thanked Him for the fact that Caleb can't read very well.

When we first met him the initial occupational therapy evaluation that was provided concluded that Caleb's fine motor skills were functional and that he did not qualify for school based services. The report stated that although there were some ADL concerns that these did not rise to the level of educational relevance. We wrote up a new evaluation that stated he required occupational therapy. No one questioned the new recommendation, and I remember feeling badly that these decisions that impact the lives of children are sometimes arrived at so whimsically.

The COTA working with Caleb brought in some of her husband's old clothes and gave them to Caleb. Although it amused her to see her husband's clothing on this child, at least Caleb had something clean to wear in case he had an 'accident' in school. We also got him some Axe deodorant and body spray because we thought it might help with some of the odor problem. Plus, kids think that Axe is cool. Once a week the COTA marches him down to the physical education locker rooms and has him take a shower. In between all of this Caleb is very gently coached and educated about personal hygiene and why it is important for a young man to begin taking care of his own body.

The COTA called me the other day, her voice choking a bit. She said that Caleb was walking down the hallway to the OT room and she was walking behind him - but he didn't know it. Caleb walked up to the OT door, wearing loosely frumpled clothing that used to belong to her husband, and his body odor and a slight hint of Axe trailed in the hallway behind him. But just as he got to the door, he reached around into his back pocket, took out a small plastic comb, and with an uncoordinated and misdirected swipe attempted to mash his hair down onto his head. He smiled, placed the comb back into his pocket, and pushed his way into the room.

Now I don't know where that comb came from - but when the COTA saw it she cried. I don't know if Caleb's progress will occur rapidly enough for the bus company. I don't know if the other children's teasing will subside. God knows we haven't even touched the issue of talking to the mom about using the bathtub at home yet.

But today Caleb tried to comb his own hair.


Anonymous said…
What a poignant story. Thanks for posting it (I linked to it from As a 'might-have-been' OT, I've just applied (with a certain amount of regret/resignation)to an OTA program. So it's nice to hear a story that shows an OTA's positive impact(especially in a school-based setting). Thanks again.
Rinto said…
greeting from Indonesian Occupational Therapist

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