British Association and College of Occupational Therapists Member - Click to visit their Website Registered with the Health and Care Professions Council - click to visit their website Member of the Physio First Organisation - click to visit their website member of the Association of Speech and Language Therapists in Independent Practice - click to visit their website Nick Smith, INPP Licentiate - click to visit the INPP website

Functional Evaluations

Occupational Therapy/ Functional Assessment:

Occupational Therapy, by its very nature, focuses on enabling individuals to engage in meaningful occupations, which keeps us happy and healthy. We have three main categories of occupations;

Self-Care: being able to look after ourselves at an ability-appropriate level, making sure we can be clean, healthy, attending to our hygiene needs, eating and drinking.

Productivity/ Learning: as human beings, we are deigned to be motivated towards achievement and mastery of skills, whether this be the skill of tying a shoelace, or the skill of landing an aeroplane. Whatever our abilities, we need access the 'just-right challenge'. This is a task that is challenging enough to be motivational, but not so difficult that we experience failure.

Leisure: our leisure occupations stem from playing in early childhood, and develop in accordance with our interests and passions, into sports, music, travelling, dancing, singing....anything!

We need to achieve a balance across these three main occupation categories I'm order to support health and well-being. For a child or young person, a deficit in one or more areas of occupations can lead to reduced satisfaction. Often the reason for difficulties can be linked to specific deficits. For example, finding handwriting difficult impedes on learning in school; finding tying shoelaces difficult impedes on our opportunities to go and play football; finding fine motor manipulation difficult impedes our ability to clean ourselves after going to the toilet.

This assessment looks at functional deficits, and may use measures such as the AMPS (Assessment of Motor and Process Skills) to identify and target specific skill development to enhance engagement in meaningful occupations.

Environmental Assessment:

Whether we have specific needs that relate to physical difficulties, behavioural or emotional difficulties, our environment forms a dynamic part of our lives; it is more than the 'setting' that we might find ourselves in, but can inhibit or facilitate our ability to engage in the occupations that are meaningful to us.

It is challenging in the community to adapt environments to suit the individual needs of a child or young person. However at home, school, respite, or college, everybody has the right to feel safe in an environment which caters to their needs. This may consider;

Feeding and Drinking Assessments:

In order to gain an understanding of difficulties that a child or young person may have relating to feeding and drinking, ranging from being a picky eater through to being unable to consume food or drink orally.

Recommendations for Physical Difficulties or Disabilities

  • Floor plan recommendations for maximal functional use of space
  • Specialist equipment or furniture to enable independence in all areas of functioning
  • Adaptation recommendations to existing properties in order to maximise functional use


Recommendations for Emotional or Behavioural Difficulties or Disabilities

  • Designing a space to allow for self-regulation, including specialist equipment
  • Designing a space to allow for co-regulation and shared activities with valued family members
  • Designing a space for learning and productivity


Feeding and Drinking Assessment

We support a range of children with eating and drinking difficulties, from those who have to be fed via a gastrostomy tube, right through to those who are picky eaters.

Feeding and drinking difficulties can be due to a range of underlying deficits. If investigations have been conducted and the child or young person has been deemed to have a safe swallow, other reasons may include;

  • Structural deficits
  • Acid Reflux
  • Dysphagia
  • Poor core stability
  • Early feeding difficulties/ 'failure to thrive'
  • Sensory processing difficulties, and particular sensory dysfunction in the mouth and on the face
  • Anxiety
  • Oral motor and praxis difficulties around organising the mouth in an effective and safe way for swallowing and digesting food
  • Poor strength of the muscles and joints in and around the mouth
  • Poor positioning, making swallowing and digesting food uncomfortable
  • Sensory sensitivities relating to the sensory qualities of food or drink

Associated difficulties may include;

  • Mouthing objects and/ or fingers
  • Aversion to tooth brushing
  • 'Pouching' edible or non-edible food items
  • Licking, biting or chewing furniture and or objects in the environment

Methods to try and 'push through' the above difficulties will at best yield limited results, and at worst may traumatise the child and produce increasing 'barriers' to functional feeding, drinking, and tooth brushing.

By accurately assessing the underlying difficulties, and using the correct approach to re mediating this, the child or young person may begin to develop skills and mastery in eating, drinking and tooth brushing without even realising it! Approaches may include;

  • A sensory and environmental preparation and debriefing programme
  • An oral desensitisation programme
  • An oral-motor and/ or oral-a placement programme to support the development of skills for the jaw, lips, cheeks and tongue
  • A positioning programme to support comfort and safety
  • A food-based game repertoire to remove anxieties around food
  • Graded exposure to the 'just-right' challenge for feeding
  • Access to 'Food School!', a social and fun way of exploring and playing with different foods with no pressure, but tons of fun with our friends!

Please see our TalkTools® information and Food School information for just some of the approaches which may be used

Please Click Here For More Information On TalkTools®

Please Click Here For More Information On Food School

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