Wellness project for Little People

Jason, Ashlee, Virginia and I did this hypothetical project for our management class…just copy/pasting the entire document!

     Occupational therapy can be used with diverse populations of all age groups, to help improve occupational functioning. We would like to develop programming for “Little People”, which is a population that has not typically utilized occupational therapy. We plan to use the Person-Environment Occupation (PEO) model of practice to help us determine program development.  

     The PEO model explains how the person, environment and occupations relate to each other as a system.  The person is defined as a unique being who assumes various roles simultaneously.  The environment is defined as the context in which behavior takes place.  The environment provides cues to the person about how to behave.  Occupation is a group of self-directed, functional tasks and activities a person engages in over the lifespan.  And occupational performance, the fourth element of the model, is defined as the outcome of a dynamic and transactional relationship between the other three elements.  The PEO model is a conceptual model that can be used in all settings and with all types of populations.  It also facilitates communication with those outside of occupational therapy by interfacing with other theories and perspectives.

Assumptions made by the PEO model

·         The person is a dynamic, motivated, and ever-developing being, who is always interacting with the environment.  

·         The environment can enable or constrain occupational performance.

·         The environment is often easier to change than the person.

·         Occupations are necessary for quality of life and well-being.

·         The relationship between person, environment and occupation is interwoven and difficult to separate.  Their congruency is constantly changing.  The closer the fit, the greater the occupational performance.

The role of the occupational therapist is to identify and evaluate barriers to performance and the resources available.  The therapist, family, and client develop strategies to eliminate these barriers and provide supports to improve the quality of the PEO fit.  This leads to better occupational performance in the area of concern or deficit. 

Doing a literature review of little people helped our team identify several themes that are common issues among little people. The majority of resources were based on medical or health related topics. These issues included common characteristics, orthopedic issues, nutrition, pediatrics, and stages of development. This reveals the little people’s strong desire for answers about their physical disabilities. The second theme was based on psychosocial issues. This included topics about raising children with dwarfism, legislation, and advocacy. These issues were brought up because of the difficult life little people lead in the midst of a world designed for the average height. The final theme identified was quality of life issues. These topics included different perspectives of little people, occupational functioning and qualitative research on quality of life. Quality of life and occupational performance for a little person is diminished due to the lack of person and environment fit.

Our research led to the identification of three major gaps in little people literature. First, research was difficult because of the extremely limited amount of sources available. Second, the articles we found were often out-of-date by ten or more years. Thus, we were able to access only the abstracts from those articles. When we were able to locate an article, access to them was restricted for cost reasons. The final gap was the lack of information regarding adaptations in home, school and work environments. A limited amount of information was available concerning the variety of adaptations and modifications needed to make these environments functional on a day-to-day basis.  We then used the PEO model to outline the findings of our literature review, to help us determine program content for little people.

Population challenges


·         Physiological

o   Short stature, limbs and fingers

o   Curvature of the spine

o   Trouble with joint flexibility and early arthritis

o   Lower back pain or leg numbness

o   Breathing problems caused by small chest cavity

·         Psychological

o   Self worth

o   Stress of day to day requirements

o   Social isolation

o   Psychosocial problems related to body-image

o   Depression

o   Support systems needed


·         Adaptations

o   Adapted tools needed for ADL’s

o   Tool requirements such as requiring large hands for gripping

o   Unreachable height of environmental controls


·         All Normal Occupational Roles Affected

o   Parent, Student, athlete, employee

o   ADL’s

§  Personal hygiene such as being able to see into a mirror for grooming, functional mobility and showering.

o   IADLs’

§  Community mobility such as difficulty driving, and raising children, meal preparation, shopping.


Program objectives:

·         Create new “Wellness” niche in occupational therapy, for the little people population.

o   Create advertising campaign to use in newspapers, e-mail, websites, listservs, and fliers, promoting occupational therapy wellness program for LP.

o   Examine LP listservs, LP websites, and LP focus groups, to collect data about daily issues the LP population can face, including psychosocial issues.

o   Show LP that OT understands the unique characteristics of LP and that their dignity is respected and valued.

Physical disabilities:

·         Determine medical issues that are common to LP (such as arthritis) and provide education on how LP can be aware of/handle these issues.

·         Compile educational resources for LPs such as websites and listservs.

Psychosocial issues:

·         Start psychosocial support groups for LPs, on a local scale as well as an online national scale.

Quality of life:

·         Determine basic home modification techniques that will be helpful for LP, such as adjustable counters and reachers.

·         Determine basic car and environmental modification techniques that will be helpful for LP, such as custom foam car seats and advice on handling check-out lines. 

·         Determine cheap and easy ways for LPs to make basic adjustments to daily life in order to improve quality of life while not compromising LP identity



The most effective medium for implementing the planned programming is the internet.  We plan to create a website that little people will be able to use as a source of information for improving their performance.  This website will explain how occupational therapists can work with people in the community on ways to decrease environmental barriers and to help individuals on a personal level.  We could be
gin by advertising the soon to be created site at the major conference.  Attendees would take this information with them and distribute it at local levels which would decrease the costs and effort of traveling around trying to create interest.  Finding an endorser to promote the website may improve our credibility within the community. 

The goal is to create a website called littlepeopleonline.com that acts as a centralized hub for information and communication about issues affecting little people.  Chat rooms and message boards could be hosted on this site to promote communication and community among its members.  Online support groups could be conducted since many individuals may be unable to find a local group.  For those in more heavily populated areas, contact information for local support groups could be posted on the site as well as information on how to start a support group.  Regional meetings could be organized through the website to bring those in the community together in fellowship.  Web video content could be uploaded to the site.  Videos posted on the site could be instructional, provide information, or be humorous in nature.    An online gift shop that sells t-shirts that promote the site, LPO, could be used to help fund it. 

This website, LPO, is directly based on the PEO model. Little people constantly find that there is a poor fit between person and environment, due to their small stature. It is obvious that a little person cannot change their height; therefore the environment must change in order to enable better occupational performance. One item to use in education and promotion would be universal design. The website could include a form letter to be sent to congressmen regarding the importance of universal design, how it is all-inclusive, and how it actually saves money long-term. It could also include a generic organizational letter for little people to send to local areas. Universal design is heavily promoted in the PEO model since it focuses on the fit between person and environment. Improving physical access to indoor and outdoor environments will allow a little person to more fully participate in age-appropriate activities with others of more typical size.  

The website could also have a section on common adaptations and modifications. For example, many little people have difficulty driving comfortably or safely, due to the height of the seat. There are ways to make a portable custom-foam seat that can transfer to different cars, and allow the person to be more comfortable and safe. Directions on how to make this could be posted. Other modifications or adaptations that could be discussed included lever door handles, the use of assistive devices such as reachers, using easy to manipulate rolling-open drawers, informing them of smaller keyboards for easier use, using non-skid liner to help keep things steady, reorganizing their kitchen so the most commonly used items are down low, installing adjustable counters, putting another lock on doors lower down, and more. The possibilities are numerous.

     Finally, the website could focus on sharing resources and promoting support systems. Little people often feel isolated. They are unaware of support systems or resources that can help make their life easier. There are many active listservs online specifically for issues that little people, and there is a Little People Association (LPA). OTs can be on these listservs to monitor issues within the OT scope of practice.  Also, both online and local support groups could be encouraged. Currently there are almost no online resources related to little people and occupational therapy. By providing a website that provides many helpful tips, a little person will have new ways to make a better person-environment fit, thereby enhancing occupational performance.

     Little People Online (LPO) is dedicated to improving the quality of life for people with dwarfism by providing education and resources on ways to adapt their environment so they can be successful and productive members of society.  These adaptations will increase their function, mobility, and independence. LPO strives to bring people together to share their stories. These support groups will increase self-confidence and community outreach. We hope to expand this program in the future to an organization that will be able to provide more resources and support to all the little people in America.


Adelson, B. (2005). Person’s with dwarfism: A changing perspective. The Genetic Family History in Practice, 4, 1-8.

Bailey, J. (1970). Orthopaedic Aspects of Achondroplasia. Journal of Bone and Joint Surgery, 52, 1285-1301.

Campbell, J., Dorren, N. (2006). A Guide for raising a child with dwarfism. Little People of America, 1-33.

Hall, J., Flora, C., Scott, C., Pauli, R. & Tanaka, K. (2004). Majewski Osteodyplastic  primordial dwarfism type II (MOPD II): Natural history and clinical findings. American Journal of Medical Genetics, 130A, 55-72.

Stewart, D., Letts, L., Law, M., Cooper, B., Strong, S., &Rigby, P.  (2003).  The person-environment-occupation model.  In E. Crepeau, E. Cohn, & B.Boyt Schell (Eds.), Willard & Spackman’s Occupational Therapy (10th ed.).  Philadelphia:  Lippincott, Williams & Wilkins.

Strong, S., Rigby, P., Stewart, D., Law, M., Letts, L., Cooper, B.  (1999).  Application of the person-environment-occupation model: A practical tool.  Canadian Journal of Occupational Therapy, 66 (3), 122-133.

Trotter, T., Hall, J. (2005). Health Supervision for Children with Achondroplasia. Pediatrics Journal, 116, 771-783.

Mar 20, 2008 | Category: Occupational Therapy | Comments: 1