Terminology Related to Occupational Therapy & Services Provided at Pride Pediatric Therapy
Occupational Therapy: Therapeutic use of everyday life activities (occupations) with individuals or groups for the purpose of enhancing or enabling participation in roles, habits, routines, and rituals in home, school, workplace, community, and other settings.
Occupation: Daily life activities in which people engage. Occupations are anything that “occupy” your time and have meaning, purpose, or importance to the client. Occupations can be categorized as activities of daily living, instrumental activities of daily living, rest and sleep, education, work, play, leisure, and social participation.
ADLs: Activities of daily living (ADLs) are oriented toward taking care of one’s own body and are fundamental to living. These activities include dressing, bathing/showering, toileting, eating/feeding, functional mobility, and personal hygiene/grooming.
IADLs: Instrumental Activities of Daily Living (IADLs) are activities that support daily life at home and in the community. These activities include caring for others/pets, health management, financial management, home maintenance, meal preparation, safety, and shopping.
Self-regulation: The ability to achieve the preferred state of alertness for the given situation. This includes regulating one’s body’s needs as well as one’s emotions.
Sensory Diet: the multi-sensory experiences that one normally seeks on a daily basis to satisfy one’s sensory needs; a planned and scheduled activity program that an occupational therapist develops to help a person become more self-regulated.
Sensory Integration: The normal neurological process taking in information from one’s body and environment through the senses, of organizing and unifying this information, and using it to plan and execute adaptive responses to different challenges in order to learn and function smoothly in daily life.
Reflex integration: the disappearance of reflexes that are replaced with purposeful movements. Babies and children need movement throughout development to explore the environment and to strengthen muscles. If a baby does not complete movement progression they may experience difficulties later in life.
Fine Motor Skills: The skilled use of one’s hands. It is the ability to move the hands and fingers in a smooth, precise and controlled manner. Fine motor control is essential for efficient handling of classroom tools and materials. It may also be referred to as dexterity. Gross Motor Skills: Coordinated body movements involving the large muscle groups. A few activities requiring this skill include running, walking, hopping, climbing, throwing and jumping.
Visual Motor Skills: the ability to visually take in information, process it and be able to coordinate your physical movement in relation to what has been viewed. It involves the combination of visual perception and motor coordination. Difficulty with visual motor skills can result in inaccurate reaching, pointing and grasping of objects, as well as difficulty with copying, drawing, tracing and cutting.
Visual-Spatial Processing Skills: perceptions based on sensory information received through the eyes and body as one interacts with the environment and moves one’s body through space. Including: Depth perception, directionality, form constancy, position in space, spatial awareness, visual discrimination, visual figure-ground.
Bilateral Coordination: The ability to use both sides of the body together in a smooth, simultaneous, and coordinated manner.
Proprioception: The unconscious awareness of sensations coming from one’s joints, muscles, tendons, and ligaments; the “position sense.” Vestibular Sense: The sensory system that responds to changes in head position and to body movement through space, and that coordinates movements of the eyes, head and body. Receptors are in the inner ear.
The Zones: A concept used to help students learn how to self-regulate. The Zones of Regulation creates a system to categorize how the body feels and emotions into four colored zones with which the students can easily identify.
● Blue Zone: Used to describe a low state of alertness. The Blue Zone is used to describe when one feels sad, tired, sick, or bored.
● Green Zone: Used to describe the ideal state of alertness. A person may be described as calm, happy, focused, or content when he or she is in the Green Zone. The student feels a strong sense of internal control when in the Green Zone.
● Yellow Zone: Used to describe a heightened state of alertness. A person may be experiencing stress, frustration, anxiety, excitement, silliness, or fear when in the Yellow Zone. The student’s energy is elevated yet he or she feels some sense of internal control in the Yellow Zone.
● Red Zone: Used to describe an extremely heightened state of alertness. A person may be experiencing anger, rage, explosive behavior, panic, extreme grief, terror, or elation when in the Red Zone and feels a loss of control.
Big Problems: Problems that many people share that have no quick, easy, or pleasant solution.
Medium Problems: Problems some people share that are able to be resolved in an hour or couple of days.
Little Problems: Problems that only affect one to two people and can be ignored or solved in a matter of minutes.
Insurance/Payment Terminology:
In-network and out-of-network are terms used to describe health care providers in relation to a health insurance plan:
● In-network
A provider that has a contract with a health plan to provide services at a discounted rate. In-network providers are also known as network providers.
● Out-of-network
A provider that does not have a contract with a health plan and can charge the full price for their services
Referral: A written order from your primary care doctor for you to see a specialist or get certain medical services. In many Health Maintenance Organizations (HMOs), you need to get a referral before you can get medical care from anyone except your primary care doctor. If you don’t get a referral first, the plan may not pay for the services.
Allowed Amount: The maximum amount a plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”
Deductible: The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.
Co-Insurance: The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.
Example:
● Let's say your health insurance plan's allowed amount for an office visit is $100 and your coinsurance is 20%.
● If you've paid your deductible: You pay 20% of $100, or $20. The insurance company pays the rest.
● If you haven't met your deductible: You pay the full allowed amount, $100.
Copayment: A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible.
Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
Preferred Provider Organization (PPO): A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
Prior Auth/Preauthorization: A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.