Scaffolding in Occupational Therapy

Scaffolding in Occupational Therapy

Scaffolding may be a term you are not familiar with in a therapy setting, but it is most likely a technique you are using in some capacity. While scaffolding is most commonly used in reference to pediatric occupational therapy, scaffolding techniques have a wide range of uses and can benefit just about anyone. What is scaffolding in occupational therapy? How can you use scaffolding in OT to facilitate progress towards therapeutic goals? How can scaffolding be most effective?

What is Scaffolding?

From a construction perspective, scaffolding is the temporary structure that you see on the outside of buildings that allows workers to get safe and easy access to elevated or incomplete areas. Scaffolding is usually set up as minimally as necessary and then systematically removed as work is completed.

In the same way, scaffolding in OT is the use of temporary support “structures” to help patients reach their goals. Over time, those supports are gradually removed to allow your patient to achieve the greatest level of independence possible. Scaffolding is similar to the principles of chaining.

scaffolding in ot

The concept of adding temporary, minimal support systems so that your patient can achieve the greatest improvement is nothing new to OT. Even if we don’t think in terms of scaffolding, we are always using the principles of minimal support. Whether it is waiting 20 minutes for your patient to put their shoes on, walking your student through the process of scheduling their night time routine, or simply providing verbal cues instead of physically correcting their performance, we all use scaffolding in occupational therapy.

If it’s already something that we all use, why is it important for us to go over the principles of scaffolding in OT? Simply put, the more we think about these specific practices, the more likely we are to implement them and continually progress our patients.

How to Use Scaffolding in Occupational Therapy

So from the sound of it, scaffolding is a great concept that will help our patients get to the point that they can achieve their goals and take care of themselves more independently. But how exactly are we supposed to do it?

Scaffolding in occupational therapy is not a protocol that can be followed for each and every patient in the same way, but like occupational therapy in general, it is individualized to the patient’s needs. The exact nature of the scaffolding structures provided will vary from person to person and case to case.

Below are a few examples of scaffolding techniques that can prove effective.

When approaching a child with sensory processing disorder, scaffolding can be utilized by stripping away elements of a challenging situation and working on them in pieces. For example, many children with sensory processing disorder have trouble attending loud, rowdy school rallies.

At first glance, the easiest solution might be to have the child avoid these types of activities in general. But by using scaffolding, we can provide the child with support and see how we can deal with each aspect of the event. A school rally can include a crowded group of people, unfamiliar people, unfamiliar locations, loud noises, bright lights, and even physical stimulation as children bump into one another. Instead of completely removing the child from the situation, try placing them in a circumstance that simulates just one of these aspects.

scaffolding OT intervention

Maybe start by going to the location where the assembly may be held, then add in loud music, then add in lights, and so on and so forth until we can identify potential weak spots. Once we know exactly what a child is struggling with the most, we can help remove those obstacles. In this example, if the child is comfortable in crowded spaces but uncomfortable with loud noises, the simple act of giving the child earplugs may be enough to allow them to enjoy this. Over time, they may enjoy these assemblies enough that they are comfortable removing their ear plugs.

Another example of how we can use temporary supports is in completing an ADL routine with a patient who is recovering from a stroke. Even when dealing with hemiplegia, much can be accomplished by allowing the patient to work on their own.

At first, we may need to demonstrate one-handed dressing techniques. Then, we can provide verbal cues to remind them to implement those techniques. If they continue to require cues, we can help them make a visual cue such as a sign or a note to self that will help them remember to utilize the adaptive techniques we have provided. The most important part of this process is ensuring that we continually grade the level of the activity to the patient’s needs.

Teaching Scaffolding to Others

After reading over these examples of how we can implement scaffolding techniques into our occupational therapy practice, you probably see that providing temporary supports that give exactly what is needed is pretty fundamental to occupational therapy. As we have seen, though, not everyone thinks like an OT. Too many times we have seen well-meaning family members or caregivers provide too much support and actually take away independence and progress from their loved one.

This is where scaffolding techniques really shine. Because of the simple nature and illustrative title, most people are able to understand the concept of scaffolding in terms of rehabilitation, fairly easily. By providing this education to parents, caregivers, loved ones, and even staff, we are able to facilitate greater carryover of the therapeutic techniques that we provide to our patients.

When providing scaffolding techniques to others, it is generally best to give specific, individualized recommendations. Instead of simply saying “let Bob dress himself as much as he can” or “Let Susie ease her way into the classroom,” we can specifically encourage them to implement the same therapeutic techniques that we are using in our treatment.

Not only will this make it easier for the caregivers assisting our patients, but it will make for better therapeutic outcomes and greater carry-over of skill between sessions.

As therapists, we are expertly trained in adjusting our treatment plans and accommodating the changing needs of our patients. By helping others use scaffolding techniques with our patients, we can help them see the best way that will help to give them the greatest amount of independence possible.

How have you used scaffolding as an OT practitioner? Share your experiences and any tips in the comments below!

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