Difference Between Occupational Therapy and Physical Therapy: The Pediatric Edition

Written by: Karly Nadolski, PT, DPT & Cecilia Williford, MSOT, OTR/L

Introduction

There have been many times that parents have asked the question “what is the difference between occupational and physical therapy anyway?” As healthcare professionals, we often have to explain to pediatricians, parents, or others in the community, what we do in our respective field versus the other. Many people summarize it as OT addresses the upper body or fine motor skills and PT addresses the lower body or gross motor skills. That description barely brushes the surface of what each therapist can provide for your child. These two types of therapists can function independently, but work best through collaboration as a team. Within this document, together we , a physical therapist (PT) and an occupational therapist (OT),  will discuss the differences and similarities between these two types of therapies within the pediatric world.

Similarities

Both occupational and physical therapy help improve the lives and functional ability of children. These children may experience a wide range of congenital and acquired conditions, or may simply have some developmental delay. We work very closely with parents. This is because children who work on skills at home, in addition to at the clinic with the therapist, have greater opportunities for improvement.

Occupational Therapy

An occupational therapist’s ultimate goal is to increase independence and participation in the meaningful occupations of a person’s life. Play is a child’s main occupation and it is  utilized during intervention to promote progress. Therefore, the focus is on play and self-care skills and how to improve participation in these occupations at home and within their community environments. A pediatric occupational therapist offers a holistic approach to the evaluation, assessment, and treatment of babies, toddlers, and school-aged children and youth.

Physical Therapy

Pediatric physical therapists are considered musculoskeletal and movement specialists, seeing children between the ages of birth to 18 years old. A physical therapist’s goal is to increase function and independence with a person. Physical therapists treat various neurological, orthopedic, and developmental conditions. Overall, our focus is for children to be as independent as possible. 

These therapists work on the following: 

Physical TherapyOccupational Therapy
Gross Motor Skills and Development
— These movements require large muscle activation including rolling, crawling, cruising, walking, jumping, running, stair climbing, etc.
— Using efficient strategies for movement
— Effective transitions from one position to another
— Gross motor skills training
— Global strength
— Overall, progressing any developmental delays
Fine Motor Skills and Development
— Finger isolation
— Separation of sides of hand (i.e. lateral versus medial, and palmar versus back of hand)
— Hand dominance
— Grasp precision (Grasp, Release, Rotation)
— Pincer grasp (lateral pinch grip, 3 jaw chuck pinch grip,tip to tip grip, lateral grip)
— Gross hand strength and grasp
— Thumb function: flexion & opposition
— Palmar arches
— Handwriting
— Precision/hand control
— Integration
— Manual Dexterity in hand manipulation (Finger to palm, Palm to finger, Shift, Simple rotation, Complex rotation)
— Bilateral coordination
— Wrist/hand development
Strength and Endurance
— Upper body
— Core (Proximal stability is important for distal mobility)
— Lower body
— Endurance in large motor skills
Strength
— Upper body
— Core (Proximal stability is important for distal mobility)
— Positioning (Adaptive equipment)
Motor Control, Motor Planning, and Body Awareness
— Following steps to complete a motor pattern
— Understanding where the body is in space to improve motor control during functional mobility in play
Motor Control, Motor Planning, and Body Awareness
— Following steps to complete a motor pattern
— Understanding where the body is in space to improve motor control during functional mobility in play
Balance and Coordination
— Static Balance (Varying base of support, including single leg)
— Dynamic balance (Focusing on maintaining balance while performing multiple movement tasks)
— Coordination of various body parts moving together with fluidity (Upper body versus lower body movement, Bilateral coordination of Left versus Right side of body)
Self-care routines
— Feeding (utensils use, meal preparation, adaptive equipment, adaptive techniques)
— Grooming (hand washing, brushing teeth, brushing hair)
— Bathing (sequencing, safety awareness, hygiene awareness) — Dressing  upper and lower body (putting on and taking off clothing, orientation of clothing, fastener manipulation, shoe tying)
— Toileting (Sequencing, Hygiene awareness, Dressing to complete toileting)
Flexibility and Full Range of Motion
— Muscle tightness and lack of motion (Often found with torticollis, toe walking, etc.)
— Assessing joint and muscular restrictions
— Assessing muscle tone (Normal muscle tone is the right amount of tension that a resting muscle in order to move on command with the appropriate amount of force. Hypotonia is low muscle tone. Hypertonia is high muscle tone, and can occur with or without spasticity)
— Posture assessment and modification based on impairments or range of motion needs
Visual motor skills
— Processing: how the eyes move and collect information (Visual tracking, Convergence, Saccades, Visual fixation, Visual attention)
— Perception: the ability to understand what you see and navigate within the world; reading, writing, manipulation of objects (Visual memory, Visual closure, Form constancy, Visual spatial relations, Visual discrimination, Visual attention, Visual sequential memory, Visual ground closure)
— Hand-eye coordination: using visual input effectively and efficiently with the hands to use and manage objects (Allows for the collection of visual information and putting it into action. Requires dexterity, strength, shoulder stability, core stability, etc.)
Gait Mechanics
— Lower extremity, posture, and ankle alignment assessments
–Teaching a child to walk
–Efficient heel-toe reciprocal pattern is optimal
Sensory processing
— The nervous system’s ability to register input from our senses, interpret that information, and create an appropriate motor response
— Seeking, avoidance, sensitivity, & registration
— Auditory, visual, tactile, movement, proprioception, oral
— Registration
— Modulation/self-calming/”just right” arousal
— Attention and tolerance
— Sensory diets for carryover into home and community environments
— Emotional regulation
— Self-regulation
— Body Awareness
Orthosis Training (i.e. special braces that encompass the foot and as high up as the hip)
— Lower extremity and ankle alignment assessments
— For parents and children as needed to learn how to use an orthosis properly
Executive functioning
— Planning and organizing
— Time management
— Working memory
— Self-control/impulse control
— Attention
— Flexibility
— Perseverance
— Transitioning
— Problem solving
Pain Relief 

References (AMA)

About the authors:

Karly Nadolski, PT, DPT graduated from Georgia Southern University with her Bachelor of Science in Kinesiology in 2015 and her Doctorate of Physical Therapy in 2019. (An Eagle for life!!) She maintains her membership to the American Physical Therapy Association (APTA), and continues to grow her skill set by staying up to date with research and participating in continuing education.

Karly’s hobbies includes working out, reading, spending time with family and friends, traveling, and cheering on the Georgia Southern Eagles and the Atlanta Braves.

Karly loves being a pediatric physical therapist because she gets to help people learn new skills or improve the skills they already have.  She feels very blessed to be a part of The Therapy SPOT team and looks forward to meeting you and working with your child!  

Cecilia Williford, MSOT, OTR/L, graduated with her Bachelor of Science in Kinesiology from Georgia Southern University (GO EAGLES!). She went on to earn her Master of Science in Occupational Therapy from Brenau University. Cecilia currently maintains her National Board Certification in Occupational Therapy and is licensed to practice in the state of Georgia. She also maintains her membership to the American Occupational Therapy Association (AOTA) as well at the Georgia Occupational Therapy Association (GOTA). Her clinical experience included a focus on early intervention, sensory integration, and adult inpatient/outpatient rehabilitation.

She enjoys working with children of a variety of ages and diagnoses including Sensory Processing Disorder, Autism, Fine Motor Delays, Developmental Delays, ADD/ADHD, etc. Using play as a primary therapeutic tool, Cecilia works with children to strengthen and improve their sensory processing skills, fine motor skills, upper extremities and core, bilateral coordination, executive functioning skills, body awareness, visual motor integration, and visual perception. Cecilia is extremely passionate about the development and well-being of children and the empowerment of their families. She believes in the importance of a holistic approach by working as a team with the family as well as fellow Therapy SPOT therapists to develop a plan of care as well as activities and therapy goals that best suit the child and their family needs.

Cecilia is happily married to her husband, Seth, and has three beagles, Paulson, Beau and Duke. Outside of OT, she enjoys working out, reading, baking, working in the yard, spending time with family and friends, and cheering on the Georgia Southern Eagles.

The Therapy S.P.O.T. – Speech, Physical, and Occupational Therapy

www.jasonhurstphotography.com ©Jason Hurst Photography 2014-2015

Our multidisciplinary therapy center was established in 2007, and is committed to providing quality therapy services in a fun, family and child centered environment. We provide pediatric speech, feeding, physical, and occupational therapy as well as adult speech and swallowing therapy.  Our therapists have unique and specialized skills and training, and we strive to pair our patients with the therapists who will best meet their specific needs.  You can learn more about our services at therapyspotstatesboro.com.  Questions or concerns?  Call us at (912) 681-7768 for a consultation.

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