Sometimes it's tough choice - determining if OT is appropriate for certain kids.

Pediatric OT is exciting because we get to see improvement. In addition to the help that we and other team members provide, children are in a constant state of skill development. Sometimes, though, we are thrown a curve ball.
I am currently dealing with a couple of kiddos that have tricky conditions. It is my job to make recommendations to the team regarding whether or not OT is appropriate for these students. Keep in mind that it does not take the skill of an occupational therapist to monitor conditions or to implement a daily practice regimen. However, the role becomes blurry in certain situations. Let me share the two issues with which I am currently dealing.
1. A girl on my caseload has been receiving OT on a weekly basis for many years. She now has beautiful handwriting and her sensory processing is definitely functional for her special day class setting. Her motor planning, visual motor skill, etc. are fine. She appears to be a typical 4th grader with autism. But she has Rett Syndrome, see http://www.rettsyndrome.org/index.php?option=com_content&task=view&id=16&Itemid=375. Although in the 9 months I have known her, she has appeared to be stable in her skills, her speech therapist says that indeed, she has lost many communication skills over the past cople of years. It can soon be expected that she will lose meaningful use of her hands. Although there is no direct need for OT now, I want to stay on the team to support the teacher when these changes do occur. I have chosen to stay on in the consultant role.
2. A 1st grade boy is receiving chemo for a brain tumor. He has been referred to me for an assessment. I have known him for a while because I work with other students in his class. His affect, motivation, and skills vary from day-to-day because of his health conditions. His visual motor, sensory processing, and functional classroom skills were commensurate with intellectual functioning prior to this round of chemo (looking at his IEP goals, he was performing uniformly at a kindergarten level and, therefore, was not demonstrating the need for additional support in these areas). I don't know what his prognosis for functioning when he is done with chemo. Outside of school, he also receives OT to address his medical issues. (he has had this ongoing OT to address issues with his Erb's Palsy (see http://www.erbspalsy.net/erbspalsy.cfm), which completely unrelated to the tumor and does not hinder his school functioning). I haven't decided what my recommendations to the team will be. I'll keep you posted.