Any school-based occupational therapist can attest to the popularity of tracing worksheets as a classroom tool to aid developing writers and struggling writers. But how effective is tracing, really? We know that learning to write is a complex task. Children have to use their visual skills to recognize that a drawing or symbol represents a letter, recognize that letter in its many different forms in text, create a mental picture of the letter in their memory, make a motor plan of how to form it themselves, and coordinate their brains and hands to execute that motor plan.
Recent studies have used functional magnetic resonance imaging (fMRI) to better understand which parts of the brain are most used during a specific task. Studies that have looked at tasks related to reading or writing indicate clear differences in brain activation. Specifically, studies have used fMRI to study what is occurring in the brain when children see, type, or trace a letter, compared to when they free write a letter. When children free write letters, the areas of the brain responsible for reading and writing are highly activated (lit up). In contrast, when children see, type, or trace letters, these areas are not activated.
When tracing, children tend to focus on the individual letter segments and on their ability to adhere to the lines, instead of focusing on the letter as a whole. They often start tracing at different points on the letter, and may not start at the same place each time. For these reasons, the act of tracing does not help children develop a mental representation of a letter, or develop form constancy, which is the understanding that a letter stays the same, even when it changes size, font, or case, in the way that free writing does. When free writing, children learn that their letter “A" may not look exactly alike each time they write it, and may not look exactly like the model, but it is still an “A." Furthermore, tracing a letter does not allow a child to develop a motor plan for the letter as a whole, which is important for writing with automaticity and fluency. Most children can overcome the limitations of tracing and learn to write fluently; however, children with poor visual-motor skills are likely to struggle, and may produce letters that are slow and labored, choppy, and drawn with various starting points.
Finally, tracing worksheets are generally used as independent work activities; however, research indicates that learning handwriting should not be an independent process. Effective teaching includes guided practice that incorporates feedback from the teacher as well as the child's self-assessment.
There are several compelling reasons for occupational therapists and teachers to abandon tracing activities in lieu of other, more effective methods of learning to write. Children benefit from explicit instruction in how to form letters along with guidance and feedback provided as they practice free writing. Children should be given frequent opportunities to practice writing letters and words in an environment that favors process over product.
Here are a few resources on tracing that may be helpful!
The effects of handwriting experience on functional brain development in pre-literate children (iu.edu)
Why tracing is a very bad idea | Skills for Action
To Trace or Not to Trace? - The Learning Professor
By Janine Calmes, PT, MS and Amy Collins, OTR, MOT
At TxSpot, we receive a lot of questions about dismissing a student from occupational therapy or physical therapy services in the school setting.
So…let's look at some of the questions and answers about this topic!
Is a reevaluation required to dismiss a student from occupational therapy or physical therapy services in Texas?
Texas physical therapists must be aware that a discharge summary is required by Texas Physical Therapy licensure rules before a client can be dismissed from service:
The PT must provide final documentation for discharge of a patient, including patient response to treatment at the time of discharge and any necessary follow-up plan. A PTA may participate in the discharge summary by providing subjective and objective patient information to the supervising physical therapist. Texas Board of Physical Therapy Examiners RULES March 2022 §322.1.(e)(4)
The PT must provide final documentation for discharge of a patient, including patient response to treatment at the time of discharge and any necessary follow-up plan. A PTA may participate in the discharge summary by providing subjective and objective patient information to the supervising physical therapist.
Texas Board of Physical Therapy Examiners RULES March 2022 §322.1.(e)(4)
Can a student be dismissed from services at an annual ARD/IEP meeting or only at a REED or 3-year reevaluation meeting?
The decision to dismiss services for a student can be made in any convened ARD/IEP meeting.
What are some considerations for dismissing a student from occupational therapy or physical therapy services at school?
Some guidelines for considering dismissal of services:
by Denice Tucker, OTR & Amy Collins, MOT, OTR
Manager, School-Based Therapy Services, HCDE
The American Occupational Therapy Association is offering COVID-19 & OT courses for free to members and to non-members through the AOTA Store, including the following:
From Onsite to Online: Addressing Students' Needs Through a Telehealth Service Delivery Model.
Online Continuing Education Series
AOTA is also offering an online continuing education series. Participants can earn up to 1.5 contact hours per session. Webinars will be live-tweeted using #COVID19andOT and available on the AOTA Store within 24 hours of the live event.
Registration for the series is now open! Check AOTA's COVID-19 & OT Online CE Series page for detailed information and updates.
COVID-19 & OT | An Online CE Series
Update on the Coronavirus Aid, Relief, and Economic Security (CARES) Act Wednesday, April 8 • 12:30 p.m.–2:00 p.m. ET FREE
Shortening the Distance: A Panel Discussion on Telehealth and Occupational Therapy with Children, Youth, and Adults
Thursday, April 9 • 12:30 p.m.–2:00 p.m. ET
Friday, April 10 • 2:00 p.m.–3:00 p.m. ET
Providing Pediatric Outpatient OT Using Telehealth Technologies: Case Study of a Hospital-Based Institution
Monday, April 13 • 1:00 p.m.–2:30 p.m. ET
State Advocacy Update: Ensuring Access to OT During a Pandemic Tuesday, April 14 • 11:00 a.m.–12:30 p.m. ET
Earn up to 1.5 contact hours per session. Webinars will be live-tweeted using #COVID19andOT and available on the AOTA Store within 24 hours of the live event.
Registration now open! Check AOTA's COVID-19 & OT Online CE Series page for updates.
Other OT Resources for COVID-19
New Telehealth Resources on the AOTA Coronavirus Resource Center include a free webinar focused on Telehealth Resources for Occupational Therapy hosted by the American Congress of Rehabilitative Medicine featuring AOTA Member Tammy Richmond and AOTA's Monica Wright, and the “Delivering Services Through Telehealth" chapter of The Occupational Therapy Manager (6th ed.) ($19.95 for members, $24.95 for nonmembers). Also available is the Telehealth Demystified CE, focused on the benefits of telehealth and how to incorporate it into an existing practice.
The APTA is offering online courses related to telehealth and school-based therapy. Some are FREE and open to non-members; others are open for free to members and at nominal cost to non-members. Links are listed below:
Open FREE to Non-Members and Members:
Implementing Telehealth in Your Practice STAT: Practical Guidance From Experienced Telehealth PTs NEW | FREE to all; no CEUs
HIPAA and Telehealth – FREE to all
Interprofessional Practices (IPP) in School-based Setting: Why It's important – NEW | FREE to all
Well-Being: Your Career Depends on It ‒ FREE to all
Courses that are FREE to Members and at nominal cost to Non-members:
Digital Telehealth Practice - Connect for Best Practice, Compliance, and Healthcare – NEW | FREE to members April 7 | 2-3 p.m. ET Flipped classroom format; prerecording will be available on April 3 for review.
Increasing Physical Therapist Acceptance of Telehealth – NEW | FREE to members
For access to more courses, go to APTA Learning Center
“There is no defined or correct method to adequately and equitably meet the need s of all students in an unprecedented event such as the current COVID 19 pandemic response. LEAs need to be flexible and consider employing a variety of delivery options as they make reasonable efforts to provide services to students with disabilities." (from TEA, https://tea.texas.gov/sites/default/files/covid19_special_education_qa_updated_march_20.pdf)
School districts will each determine how to best provide education to all students during this confusing and rapidly changing climate. There is probably no option that does not come with advantages and disadvantages. Districts must consider access to instruction, equality, efficiency, competence with technology and more; many will want to follow the guidance of their attorney. It has been made clear that as soon as districts begin to provide instruction to students, all the mandates from the Individuals with Disabilities Education Act (IDEA) are in effect, including timelines for initial evaluations and implementation of Individual Education Programs (IEPs). As related service providers, school-based occupational therapists and physical therapists need to work closely with district leaders to determine how to assist the district to meet its obligations. In many districts, this will be your Special Ed Director or Coordinator.
As you move forward, here are some things you'll want to consider:
As many school districts are scrambling to problem-solve how to deliver educationally-relevant related services to students, there has been much discussion around the use of telehealth services. There are many things OTs and PTs should consider when planning to use telehealth as a service delivery model. Therapists must be informed on what their state licensure rules say, as well as ethical considerations, FERPA compliance, access, reimbursement, and logistics. Here is what Texas OT and PT Rules require, along with some helpful resources.
OT RULES (December 2019)
(39) Telehealth--A mode of service delivery for the provision of occupational therapy services delivered by an occupational therapy practitioner to a client at a different physical location using telecommunications or information technology. Telehealth refers only to the practice of occupational therapy by occupational therapy practitioners who are licensed by this Board with clients who are located in Texas at the time of the provision of occupational therapy services. Also may be known as other terms including but not limited to telepractice, telecare, telerehabilitation, and e-health services.
(3) The occupational therapist is responsible for determining whether any aspect of the evaluation may be conducted via telehealth or must be conducted in person.
(4) The occupational therapist must have contact with the client during the evaluation via telehealth using synchronous audiovisual technology or in person. Other Texas Board of Occupational Therapy Examiners December 2019 37 telecommunications or information technology may be used to aid in the evaluation but may not be the primary means of contact or communication.
(f) Plan of Care.
(7) Except where otherwise restricted by rule, the occupational therapy practitioner is responsible for determining whether any aspect of the intervention session may be conducted via telehealth or must be conducted in person. (8) The occupational therapy practitioners must have contact with the client during the intervention session via telehealth using synchronous audiovisual technology or in person. Other telecommunications or information technology may be used to aid in the intervention session but may not be the primary means of contact or communication.
(9) Devices that are in sustained skin contact with the client (including but not limited to wheelchair positioning devices, splints, hot/cold packs, or therapeutic tape) require the on-site and attending presence of the occupational therapy practitioner for any initial applications. The occupational therapy practitioner is responsible for determining the need to be on-site and attending for subsequent applications or modifications.
(10) Except where otherwise restricted by rule, the supervising occupational therapist may only delegate to an occupational therapy assistant or temporary licensee tasks that they both agree are within the competency level of that occupational therapy assistant or temporary licensee.
PT RULES (March 2020)
§322.5. Telehealth (a) When used in the rules of the Texas Board of Physical Therapy Examiners, telehealth is the use of telecommunications or information technology to provide physical therapy services to a patient who is physically located at a site in Texas other than the site where the physical therapist or physical therapist assistant is located, whether or not in Texas. (b) Physical therapy telehealth services must be provided by a physical therapist or physical therapist assistant under the supervision of the physical therapist who possesses a current: (1) unrestricted Texas license; or (2) Compact Privilege to practice in Texas. (c)The provision of physical therapy services via telehealth requires synchronous audiovisual or audio interaction between the physical therapist or physical therapist assistant and the patient/client, which may be accompanied by the use of asynchronous store and forward technology. (d) Standard of Care. A physical therapist or physical therapist assistant that provides telehealth services: (1) is subject to the same standard of care that would apply to the provision of the same physical therapy service in an in-person setting; and (2) the physical therapist is responsible for determining whether an evaluation or intervention may be conducted via telehealth or must be conducted in an in-person setting. (e) Informed Consent. A physical therapist that provides telehealth services must obtain and maintain the informed consent of the patient, or of another individual authorized to make health care treatment decisions for the patient, prior to the provision of telehealth services. (f) Confidentiality. A physical therapist or physical therapist assistant that provides telehealth services must ensure that the privacy and confidentiality of the patient's medical information is maintained during and following the provision of telehealth services, including compliance with HIPAA regulations and other federal and state law. (g) The failure of a physical therapist or physical therapist assistant to comply with this section shall constitute detrimental practice and could subject the licensee to disciplinary action by the Board. (h) Telehealth is a mode for providing one-on-one physical therapy services to a patient/client and is not a means for supervision of physical therapy aides.
INFORMATION ON TELEHEALTH
https://ptot.texas.gov/wp-content/uploads/PTrules_2022.03.pdf (Chapter 322.5)
https://ptot.texas.gov/faq/ (PT Practice FAQs - Telehealth)
https://ptot.texas.gov/wp-content/uploads/2022/06/OT-Rules-June-2022.pdf (Chapter 372.1)
STUDENT PRIVACY AND ONLINE SERVICES
Respecting Student Privacy while using online educational services
VIDEO CONFERENCING PLATFORMS
https://zoom.us/ (free to create account and time limit on free use waived currently)
The following are some words of wisdom from Laurie Ray, School-based Physical Therapy Special Interest Group of the Academy of Pediatric Physical Therapy:
"While (these)* resources are provided for your information, EVERYONE must comply with their LEA, district, state and federal regulation, policy and directive! Please do not begin any practice without consideration of legal and ethical principles AND approval from your administration and supervisors! This is not a time to problem-solve on your own…lone rangers, dismount! Work within your school district/LEA and administrative structures to ensure compliant, thoughtful, reasoned action or inaction.
Each student, IEP, situation and intervention must be thoughtfully considered with applied clinical reasoning, there is no single 'answer' to all."
Best regards and be well,
Laurie Ray, PT, MPT, PhD
*("These" resources does not refer to those listed in this article, but the thoughts apply.)
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OTs and OTAs – Thank you
for all you do to make students’ lives better!!
out helpful (and some fun) links below:
Therapy in School Settings
School-Based OT Fact Sheets
Tip Sheets - Children and Youth
and Youth - Evidence-Based Practice Resources
Competency Assessment Platform
Handwriting in the 21st Century (Why handwriting belongs in the classroom)
Successful Participaton at School: Stategies for All Students - (TxSpot March 2018 Resource of the
Online Resources for
Keyboarding Practice (including games)
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To Consult or Not
to Consult: That is the Question.
by Janine Calmes, PT, MS
What do recent studies say about the use of tracing worksheets? Read this article to find out and to learn the most effective methods for learning to write.
Answering some frequently asked questions about dismissing a student from school-based occupational therapy or physical therapy services.
Tips for steps to take to start the school year
AOTA offering FREE COVID-19 and OT courses to members and non-members
Preliminary Telehealth Guidelines
Happy National Occupational Therapy
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Happy National Physical Therapy
Month! Enjoy some helpful links.
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How to determine if missed visits
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Ideas to help establish yourself as
part of the team.
Tips to get organized at the start
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Update on the Sunset Review process
for the Texas OT and PT Licensing Board.
What to expect; Some differences
between school-based therapy and clinic-based therapy.
Wrapping up your school year: Making
sure your documentation is complete for the next year or the next
Evaluation tools for Adapted
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Points to consider when a parent
brings an advocate or lawyer to an ARD meeting.
Explains the focus on literacy in
Handwriting referrals to school
OTs related to STAAR and STAAR-A tests.
When is it time to dismiss a student
from therapy services?
The academic benefits of physical
Transitioning from caseload to
Screening for sleep deprivation.
Questioning the "why" behind lack of
motivation at school.
When to use standardized assessment