Occupational Performance Intervention Protocol
Classroom Movement Breaks for Visual Attention
Dosed, teacher-run movement used as a performance sustainer for visual attention across the instructional block.
1 — Introduction
What this protocol is for
This protocol is not about a student who cannot attend. It is about a student whose visual attention is available at the start of a task and gone by the middle of it — the child who is accurate for the first five problems and drifting by the fifteenth.
Movement breaks are treated here as dosage, not as reward or as a behavior strategy. The clinical claim is narrow and defensible: brief, structured movement re-establishes postural readiness and gaze stability, and the near task that follows is the thing we actually measure.
The protocol is written so a teacher can run it without the OT present. The OT's job is selecting the break, setting the dose, and reading the tally sheet — not delivering every repetition.
2 — Clinical reasoning
Why this sequence, for this student
Visual attention to near work is not absent but unsustainable: accuracy, place-keeping, and output decline within a single instructional block.
Likely limiting factors
Level 5: Functional Integration
The pattern is duration and context dependent — capacity across the day, not skill at a point in time.
Level 2: Visual Efficiency
Sustained near demand without recovery drives the fatigue that looks like inattention.
Level 3: Visual Processing
Cluttered visual fields and figure-ground demand raise the cost of every look back at the page.
Before you start
- The near task itself is at an appropriate instructional level — a task that is too hard is not an attention problem.
- Visual access is addressed: seating, lighting, glare, and print size have been checked first.
- The teacher has agreed on a dose and a signal; an unscheduled break is a behavior response, not a protocol.
Stop, grade down, or refer
- Do not use movement as a consequence, earned or removed — that converts dosage into behavior management and invalidates the data.
- Screen for medical movement restrictions before any vestibular or rapid-position-change break.
- If attention is deteriorating across weeks rather than within tasks, stop and refer for medical and educational evaluation.
3 — Recommended intervention sequence
Preparation → Occupational Performance Activity → Interactive → Printable → Carryover. The order is the reasoning: stabilize, load in movement, control the variables, transfer to the occupation, distribute the dose.
Preparation
Set once, review monthlyReduce the visual cost of the environment before adding anything. If the room is doing the damage, breaks will not offset it.
Watch for
- Glare on the work surface and on the board.
- Visual clutter in the primary field of regard.
- Seating that leaves feet unsupported — an unsupported base fatigues the whole system.
Use from the library
Nothing tagged for this stage yet.
Occupational Performance Activity
2–3 min per breakThe break itself: dual-task and scanning movement that re-engages postural control and eye–head coordination without over-arousing the class.
Watch for
- Return-to-seat latency — a break that takes four minutes to recover from is the wrong break.
- Whether the student can talk or count while moving; dual-task tolerance is the readiness marker.
- Over-arousal: louder, faster, less organized after the break means grade down.
Use from the library
Nothing tagged for this stage yet.
Interactive
3–5 min, 1–2× weeklyOptional pull-out or center use: a controlled scanning and attention task that gives the OT objective numbers the classroom cannot produce.
Watch for
- Accuracy at minute one versus minute four — the within-task decline curve is the point.
Use from the library
Nothing tagged for this stage yet.
Printable
5–10 min after the breakThe near task that follows the break is the measure. Use a consistent paper task so performance after a break is comparable week to week.
Watch for
- Items completed and accuracy in the five minutes immediately after a break versus a no-break block.
Use from the library
Nothing tagged for this stage yet.
Carryover
OngoingHand the protocol to the adults who are there all day. Teacher owns the break menu and the tally; family mirrors the pattern for homework.
Watch for
- Whether breaks are still happening in week three — fidelity fades before effect does.
- Whether the teacher can name which break helps this student most.
Use from the library
Nothing tagged for this stage yet.
4 — Grading
Progressions and regressions
Break frequency
Progress
- Every 10 minutes → every 15 → every 20 → student-requested with a signal card.
- Fade frequency only after two consecutive weeks of stable post-break accuracy.
Regress
- Return to a shorter interval before making the break longer or more intense.
Break intensity
Progress
- Seated in-place movement → standing at the desk → moving within the room → whole-class movement.
Regress
- Drop back to seated proprioceptive input if return-to-seat latency exceeds one minute or arousal rises.
Independence
Progress
- Adult-cued break → visual schedule cue → student self-monitors and requests using a card.
Regress
- Return to a scheduled adult cue; self-monitoring is the last thing to add, not the first.
Near-task demand
Progress
- Short task after each break → longer task → same task with reduced break support.
Regress
- Shorten the post-break task rather than adding more breaks.
FITT-P dosage
- Frequency: one break per 10–20 minutes of sustained near work, scheduled rather than reactive.
- Intensity: enough to change position and load the postural system; not enough to raise arousal for the class.
- Time: 2–3 minutes per break, with a target return-to-seat latency under 60 seconds.
- Type: dual-task and scanning movement, graded from seated to whole-body.
- Progression: fade frequency first, then adult cueing. Hold the environmental changes permanently.
5 — Documentation
Session record and progress measures
Two pieces make this run without the OT in the room: a short teacher-facing break menu posted at the desk, and a two-week tally sheet. The tally is what tells you whether the dose is working, and it is the only data the teacher is asked to keep.
Classroom Movement Breaks for Visual Attention — session record
Break menu — 4 options
Name each break in teacher language, one line each, posted at the desk.
Scheduled interval
Every 10 / 15 / 20 minutes. Circle one and keep it stable for two weeks.
Break signal
How the break is cued: timer, visual schedule, or student card.
Daily tally — breaks delivered
Tick per break. Fidelity is the first thing to check when results are flat.
Return-to-seat latency
Under 1 min / 1–2 min / over 2 min. Over 2 minutes means grade the break down.
Post-break near task
Items completed and accuracy in the 5 minutes after the break.
Teacher note
One line: what the student looked like before and after.
Week 2 comparison
Compare week 1 and week 2 post-break accuracy before changing anything.
Progress measures
- Minutes of sustained near work before observable drift (primary occupational measure).
- Items completed and accuracy in the 5 minutes following a break versus a matched no-break block.
- Return-to-seat latency in seconds.
- Teacher rating of independent work participation across the block.
Reassessment
Re-screen the limiting level after 6–8 weeks of consistent dosage. If the occupational measure has improved, fade the protocol and hold the carryover pieces. If the contributing level improved but the occupation did not, the limiting factor was elsewhere — return to the pathway and re-reason. If neither moved, or symptoms are new or worsening, refer rather than continue.