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Q&A: Structured OT Therapy Sessions?


How would you create structured OT therapy sessions with a 22-month-old child, who presents with the following:

  • Jumps up and down and flaps his arms and hands when excited
  • Requires a great deal of motivation to get engaged in purposeful play for more than a few minutes
  • Enjoys movement-based or repetitive play

Currently, I spend most of his session time trying to engage and redirect him. 


A great way to design structured OT therapy sessions would be to create a visual schedule using BrainWorks picture cards. Since he is little, I would keep it fairly short—maybe five pictures for a 45-minute session. Here’s how I would run the therapy session.

Choice 1

When he enters the therapy room, hold up two picture cards of whole-body movement activities. Good ones would be ball bath, platform swing, or jumping into a crash pad. He can then put the choice onto your visual schedule. This can be a strip of cardstock with five pieces of Velcro on it.

Choices 2-3

While he is engaged in a whole-body activity, assist him in creating the rest of the schedule for the session. Choices 2 and 3 should be “green arrow” activities to help him reach the threshold of input he appears to be seeking (I think he is a sensory seeker). Stick with these “green arrow” activities until you start seeing some adaptive responses (better communication, better eye contact, less hand flapping, etc.).

Choices 4-5

Choice 4 should be a “yellow arrow” activity that requires pretty intense heavy work (prone on a scooter while being pulled by a rope maybe). This activity should help slow him down a little. Activity number 5 might be your choice—probably an objective you want to address (ADLs or a specific motor skill). Then you could reward him at the end by letting him choose any activity he wants (I would still have him select from 4 or 5 picture cards, so he begins to use this as an effective choice system).


For activities 1–4, you are letting him make limited choices. For example, hold up two green-arrow picture cards, he chooses one of them and puts it in the right spot on the schedule. At his age, I would offer no more than 2 choices. If he attempts to disengage or leave the area of the chosen activity, use the visual schedule to redirect him. After completing each activity, make a big deal about it and let him take the picture card off to indicate that activity is “all done.” Let him see a reward card at the bottom of the schedule for motivation.

While engaging in each activity, you can feel free to bring other motivational toys into the picture. For example, if he chooses to jump from the mini-trampoline into a crash pad, you could extend the interest in the game by having him “chase” a toy frog. You make the frog jump onto the “lily pad” then ask him to try to “catch it!” Make him repeat the activity several times before allowing the frog to be caught.

Let me know if you need any more ideas for structured OT therapy sessions!

Best Wishes,