We know that motor planning, spatial perception, sensory modulation, figure-ground perception and bilateral integration, amongst many other modalities, underpin the learning process in the classroom. But how do all these modalities fit together if at all? Are they just a random collection of foundations, or do they actually fit together in some kind of meaningful way? The Wall Model is a framework for occupational therapists. It places all of the underlying sensory-motor and visual-perceptual modalities in context to enable occupational therapists (OTs) to plan and direct effective treatment. Although not my name for it, The Wall has also been called The Wall Model of Occupational Performance by some therapists. Over the years, it has also become known by students and therapists in South Africa as Bunty’s Wall. The Wall Model is the tool you have been looking for to understand how all these building blocks fit together in a logical sequence.
I have always found it easier to see things in diagrammatic representations. Trailing through long paragraphs is exhausting and I need to jot down the important points I need for later. I like to place them in a logical order and sequence. So, when presenting the scope of occupational therapy in children with classroom related difficulties, I found a way to place the different aspects in sequence, showing how the pieces of this complicated puzzle fits together.
If you look at The Wall Model on its own with all its interconnections, it can be bewildering. But its power comes from watching how it is built brick by brick, along with it the inter-relationships and connections between the foundations and each of those bricks. And then finally, how weaknesses in any one of the foundations or bricks can flow through to affect a child’s functioning. And then it all makes sense! And you can use it to help it make sense to others.
The Wall has so many applications. It can be used for teaching, for clinical reasoning, and to explain what we are up to parents. And then, it can be used for goal setting and treatment planning.
Bunty’s Wall is a tool for occupational therapy students.
Occupational therapy students have a lot on their plates! OT, because it is linked to human occupation, is such a diverse field. There is so much for students to focus on and assimilate that they can be left somewhat bewildered and confused by the field of child development as it relates to school and academic learning. The different aspects pertaining to child development are traditionally taught in sections. And while the student may master each of these sections, it can be a confusing puzzle to put together. Because teaching takes place in isolated sections, it can be very difficult for the student to view the wholistic picture of the child’s development and how it impacts on the functional challenges they are experiencing. But The Wall Model of occupational performance can make this simple and reachable in a couple of hours and who wouldn’t want that?! If you follow in The Wall – Part 1, you will be able to follow along as The Wall Model of occupational performance is built brick by brick.
I have also had some fun with some “mini Walls” which are extracts and expansions of the original Wall. While you can, and you must, customise your Wall for each of your children, due to copyright conditions, I am the only one who can make adaptations to The Wall Model of occupational performance.
The Wall Model of occupational performance. A tool for clinical reasoning
Our skills as occupational therapists are much like those of a detective. We call those detective skills clinical reasoning. We need to work out why the child is struggling with a certain aspect so we can direct our treatment. It is of little use if we spend weeks directing intervention towards the wrong aspect. The Wall helps us to be the best detectives we can be. We are able to look at all the information from our assessments and group our findings to enable us to identify the bricks on the wall which are shaky. Once we have all that information, we can figure out how it fits together and how it is impacting on a child’s ability to accomplish their daily tasks – the things they have to do and the things they want to do in school and the classroom.
Suddenly all the confusing aspects come together in a way that makes sense. The Wall – Part 2 will go on to provide the basic treatment principles for each of the blocks in The Wall. And yes, it is coming soon! It is not a comprehensive work on each of the aspects. It is a starting point of solid principles and strategies you can apply knowing that you are targeting the correct aspects. As your skills as a therapist grow, you can delve into each of the bricks in greater depth. There are whole courses on the individual bricks! But as students, your job is to get a solid foundation, and this is what the Wall – Part 2 offers.
You will expand on each of those bricks for the rest of your working life. You will add bricks. You will move things around. But you have the solid framework for now. And you will, and must, add to that as you go. The Wall Model of Occupational Performance will give you the foundation you need for the rest of your journey as a paediatric occupational therapist.
A tool for engaging parents
I have children. And they have passed through the schooling system and all that goes with it. I always wanted to understand any challenges my children were experiencing. Once I understood, it gave me confidence in whomever was working with my child. I was then happy to back off and let them do what they needed to, and to step in and offer back up support when requested and required.
Because, as occupational therapists, we work with these things every day, the complexities of sensory, motor, and perceptual functioning are second nature. But for parents it is simply baffling. They are bewildered, for example, as to why we are working on midline crossing when their child presented with letter reversals. Surely, we should be practicing writing letters? And yes, they do need help with that. But they also need help with the shaky foundation that caused the problem in the first place. And this is why I used The Wall in every parent feedback I did. To be able to show which areas were shaky and how they linked to the presenting problem, was the key to engaging parents in the process.
The Wall Model as a framework work for teaching
And what about teaching? This is the place where it all started with The Wall. It is part of our jobs as occupational therapists to empower those around us to understand our scope of practice. Being able to present this in reachable format to teachers, parents and therapists enables us to present what we do with clarity.
Cindy from Your Kids OT explores the Pyramid of Learning which explores how the sensory systems underpin sensory-motor and visual-perceptual development and their impact on academic learning.
In closing about The Wall Model of Occupational Performance
Once you have seen The Wall built brick by brick it just makes sense. And once you have seen it, it seems so logical. This graphic representation of the areas that we as occupational therapists address is a must for every student and occupational therapy practice where engaging parents and empowering them to understand the nature of their children’s challenges is as important as the therapy itself.