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Excelling in Out Patient Therapy Services

Say What?


Moshe could not function in his 5th grade classroom. Whenever his teacher issued instructions like, “Take out your pencil and start working on your worksheet, ” Moshe appeared “spaced out” and seemed to ignore the instructions completely. Moshe’s apparent disregard for his teacher’s instructions lead to a breakdown in the classroom environment as the teacher was forced to repeat instructions and call his name to get his attention. Moshe’s teacher also expressed concern over the fact that Moshe could not take notes during class.


After a thorough and careful evaluation, the therapist concluded that Moshe was suffered from APD, auditory processing disorder. Although Moshe can hear perfectly, his brain does not process the sounds of spoken language properly. Although he heard the sounds of speech properly, his mind cannot adequately interpret the meaning of the sounds.

Due to his APD, Moshe has difficulty with reading, with receptive language and with expressive language. When the therapist showed Moshe a cow, he was able to identify it. When asked what sound the cow makes, Moshe replied, “Moo.” Then the therapist asked moshe to walk like a cow  and asked, “What sound does that  animal make?” The task of processing both parts of the question (walk like an animal it is and what sound it makes) was too much for Moshe and he shut down. He could identify these elements separately, but not simultaneously.

Moshe’s APD makes it difficult for him to process multi-step or two-step directions. Note-taking is impossible, as it requires him to process the teacher’s verbal lesson and simultaneously write it down. His trouble processing language makes it impossible for him to follow multi-step directions such as, “Take out your pencil and begin your worksheet.”


To remediate Moshe’s APD, we needed to build neural networks to help him process multi step directions. Neural networks are built through repetition. We helped Moshe engage in multi-step actions, such as marching in place while clapping. At first the therapist had to help Moshe standing nearby and moving his hands and feet in the necessary motions (“hand over hand”), but as Moshe progressed he no longer needed that level of assistance and the therapist began using verbal cues and visual cues exclusively.

The therapist also utilized a computer-based specialty program called neuronet. This program guided Moshe through a set of increasingly complex exercises that combine different physical activities. Eventually Moshe was able to hear, process, and perform more and more of the these activities simultaneously. After several months of therapy, Moshe was able to participate in class, complete his classwork, and did not stand out in any way from his peers.

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Names and details have been changed. This case study may be amalgamation of different patients or symptoms. The purpose of this article is to educate about conditions that may be treated with occupational therapy.