The main aim of an occupational therapist is toimprove the performance of a child with DYS disorders (dyslexia, dyspraxia, dysorthographia, dyscalculia…), to teach them how to work around and compensate for their day-to-day difficulties. To achieve these aims, he may need to use conceptual models, such as the “Bottom up” approach, the “Top down” approach, or both. Presentation.
The “bottom-up” approach, focusing on the deficit
In the “bottom-up” approach, the occupational therapist considers the child’s abilities and skills, and focuses his or her intervention on deficits, to improve performance. This analytical approach seeks to improve performance indirectly.
Therapies based on this bottom-up approach include sensory integration, which is based on the assumption that there is a correlation between sensory deficits and the child’s praxis difficulties. There are also sensory-motor therapies based on the premise that the coordination of sensory and motor information is necessary for motor execution. The Bottom up approach is also illustrated in process-oriented therapy, which aims to increase motor skills by improving kinaesthetic awareness.
Top-down approach
The more recent “Top Down” approach is more direct: it aims to improve performance directly, by focusing the occupational therapist’s intervention on the problem occupation, rather than on the abilities that could impact it.
Therapies based on this top-down approach include Neuromotor Task Training (NTT), which revolves around demonstration, verbal instruction and final acquisition. There’s also the CO-OP (Cognitive Orientation of Daily Occupational Performance) approach, which focuses on the individual, activity and participation.
Are these approaches opposed or complementary?
According to ANFE (Association Nationale Française des Ergothérapeutes), occupational therapy aims to “To maintain, restore and enable human activities in a safe, autonomous and efficient manner. It prevents or eliminates situations of disability, taking into account people’s lifestyles and their environment.
With this goal in mind, the professional is free to choose the approach that seems best suited to his or her patient. Bottom-up and top-down are certainly opposing approaches, but they can be complementary and compatible, to achieve the same goal or several goals…
The choice of one approach over another depends essentially on the patient’s profile (for example, Top Down for a dyspraxic child), age (younger children respond better to Bottom Up approaches), and strengths and weaknesses. Finally, the occupational therapist’s sensitivity and experience naturally lead him to the most suitable path…
Don’t hesitate to contact a professional on the Ora-Visio platform, to find out how an occupational therapist can help your child with DYS disorders!
