The TARGET is a comprehensive format for collecting and organizing assessment data from tests, observations, histories and questionnaires. This format helps the therapist see the relationships between original concerns and underlying causes, prioritize areas that need addressing in treatment and plan the sequence of treatment. Goals can then be generated together and progress tracked together. The TARGET is composed of 4 pages, each of which is a category of like areas of function. They are titled:
Case Example
E is a 6.9 year old beautiful little girl with a smile on her face most of the time. Her history includes an unremarkable pregnancy and delivery at term. There were no major issues other than difficulty attaching to and remaining attached to the breast. This was reportedly difficult until she weaned herself at 8 months and switched to a sippee cup. No particular problems were noted until her preschool teachers told the parents they had some concerns about her language organization and some speech concerns. They also noted her motor skills were a bit awkward and she avoided the slide, climber and swings on the playground. Peer interaction was minimal (her preference was to play or sit in class by herself) but all thought that was because of her speech and language issues.
By the first grade these concerns remained and an OT consult was recommended which was followed by assessment and recommendation for a treatment intensive. A speech and language evaluation was also recommended and she began receiving services about the same time an OT intensive was scheduled.
- Page 1 is Modulation
- Page 2 is Postural Development and Outcomes
- Page 3 is Learning how to Learn and Remember
- Page 4 is Integrated Brain Activity, Emergent Processes and End Products.
Case Example
E is a 6.9 year old beautiful little girl with a smile on her face most of the time. Her history includes an unremarkable pregnancy and delivery at term. There were no major issues other than difficulty attaching to and remaining attached to the breast. This was reportedly difficult until she weaned herself at 8 months and switched to a sippee cup. No particular problems were noted until her preschool teachers told the parents they had some concerns about her language organization and some speech concerns. They also noted her motor skills were a bit awkward and she avoided the slide, climber and swings on the playground. Peer interaction was minimal (her preference was to play or sit in class by herself) but all thought that was because of her speech and language issues.
By the first grade these concerns remained and an OT consult was recommended which was followed by assessment and recommendation for a treatment intensive. A speech and language evaluation was also recommended and she began receiving services about the same time an OT intensive was scheduled.
Primary concerns to be addressed in the intensive were severe sensory defensiveness (shut down), very high palate, very weak and arrhythmic suck and poor suck, swallow, breathe synchrony. Her jaw was retracted and fixed allowing minimal excursion and her cheeks were retracted as well. The result was the ever present smile, and difficulty getting her lips together to produce labial sounds (p,b,m). Her food preferences were limited due to difficulty managing them. Postural concerns included low normal muscle tone, poor head/neck alignment (head forward and extended to interfere with neck elongation and freedom of movement of the head), shoulder girdle fixed and not supporting distal development of the hand, rib cage high and tight resulting in a rapid and shallow breathing pattern regardless of activity level. Fixing of the diaphragm was noted during gross motor activity and any eye hand skilled activity. Binocular vision seemed difficult for her both near and far. Motor acts (oral, fine and gross motor) were disordered and primitive motor patterns (reflexes) prevailed. She avoided all activities presented that looked to her like they might require problem solving (praxis) or anything that might require head down or backwards space. Swings of any kind were also avoided.
Treatment was done in the following progression over 5 days in 2 ½ hour sessions. The first 2 days involved work done to release the connective tissue around the jaw, neck, shoulder girdle, spine, diaphragm and pelvic girdle. Every day the Therapressure protocol was used every 2 hours (parents were diligent at home) and Therapeutic Listening (modulated music) was used to address the defensiveness, vestibular and language issues.
Day 2 marked oral motor emphasis on bite/tug, resistive suck and soft chew. All activities were chosen with the intensity of taste she liked and could use to support the motor outcomes we wanted. The last portion of day 2 E chose climbing the ramp to jump into the cloud swing (6 layers of 5’ x 9’ sheets of 4 way stretch lycra). Once in the lycra she wanted to be intensely swung and bounced. She repeated this activity many times and began laughing and talking about the experience. That day she chatted all the way home and asked many questions about what she was seeing out the window. Mom reported the next day that she never talks in the car and neither she or Grandma could remember her ever asking a question. Also noted was a remarkable increase in both her articulation accuracies and her organization of language.
Mary Kawar’s Space Tornado was used beginning on day 3 and the Astronaut Program was introduced. E was very cooperative and enjoyed movement done in this precise way. These programs became part of her sensory diet as did suck, blow, bite, intense flavors and textures at meals and snack times. Specific mouth and cheek massages to help with the tightness in her jaw, cheeks and lips were included. By day 4, E was ready to create her own activities to challenge the postural control now accessible and praxis emerged.
This case was chosen because the presenting issues are so familiar to us all. This child needed a multipronged OT approach with strategies designed for their intensity. The sensory defensiveness needed to be addressed first as did the suck/swallow/breathe issues. That allowed the work done from a more traditional SI framework (plus the Therapeutic Listening) to have a more profound effect on postural and practic development. Her comment on Day 4 says it all. She said, with a full, natural smile, “The fog has lifted!” Her dad remarked on day 5 that he had never seen her really play and that the joy in her was astounding.
Treatment was done in the following progression over 5 days in 2 ½ hour sessions. The first 2 days involved work done to release the connective tissue around the jaw, neck, shoulder girdle, spine, diaphragm and pelvic girdle. Every day the Therapressure protocol was used every 2 hours (parents were diligent at home) and Therapeutic Listening (modulated music) was used to address the defensiveness, vestibular and language issues.
Day 2 marked oral motor emphasis on bite/tug, resistive suck and soft chew. All activities were chosen with the intensity of taste she liked and could use to support the motor outcomes we wanted. The last portion of day 2 E chose climbing the ramp to jump into the cloud swing (6 layers of 5’ x 9’ sheets of 4 way stretch lycra). Once in the lycra she wanted to be intensely swung and bounced. She repeated this activity many times and began laughing and talking about the experience. That day she chatted all the way home and asked many questions about what she was seeing out the window. Mom reported the next day that she never talks in the car and neither she or Grandma could remember her ever asking a question. Also noted was a remarkable increase in both her articulation accuracies and her organization of language.
Mary Kawar’s Space Tornado was used beginning on day 3 and the Astronaut Program was introduced. E was very cooperative and enjoyed movement done in this precise way. These programs became part of her sensory diet as did suck, blow, bite, intense flavors and textures at meals and snack times. Specific mouth and cheek massages to help with the tightness in her jaw, cheeks and lips were included. By day 4, E was ready to create her own activities to challenge the postural control now accessible and praxis emerged.
This case was chosen because the presenting issues are so familiar to us all. This child needed a multipronged OT approach with strategies designed for their intensity. The sensory defensiveness needed to be addressed first as did the suck/swallow/breathe issues. That allowed the work done from a more traditional SI framework (plus the Therapeutic Listening) to have a more profound effect on postural and practic development. Her comment on Day 4 says it all. She said, with a full, natural smile, “The fog has lifted!” Her dad remarked on day 5 that he had never seen her really play and that the joy in her was astounding.
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