Wearing Sensory Strategies

retrieved from amazon.com

Receiving proprioceptive input throughout the day is important for children who seek sensory input.  Sensory breaks are an important part of their day to assist with regulation so they can function in whatever situation they may be a part of.  That being said, it may not always be possible to get in the needed sensory break.  Here are some different options that may help them meet their sensory needs throughout the day:

Hats: Tighter caps or hats can provide input to a child’s head throughout the day. This is especially beneficial for prepping those kids that have difficulties tolerating hair cuts.

Tighter clothing: Tighter shirts, such as Under Armor can provide some input and comfort throughout the day. These can be worn under clothing if needed as well.

Wrist Fidgets: A variety of bracelets can be bought or made to be used as fidgets in order to help maintain attention. Rubber bands, thera tube, thera bands, Velcro, beads, hair elastics, etc. could all be used.

Chewy necklaces: Great for those kids that come home with drenched shirts from chewing on them all day.

Sunglasses: For those visually sensitive kids with sunlight and lighting in rooms.

Puff paint pick: Some kids have the urge to pick at things throughout the day, whether it be themselves or items. Buying some cheap t-shirts and decorating them with puff paint can be a great alternative strategy. This way they’re picking at their shirt all day instead, as long as you don’t mind finding trails of puff paint.

Self Regulation Reminders: Some kids need reminders of when their regulation levels start raising in certain situation or going the other way and getting extremely low. Verbal cues don’t always work, especially in busier areas where there may be a lot of stimulus to become overwhelmed by. Visual reminders can help with this. Make a key chain out of tiny laminated visuals to attach to your child’s belt loop, bracelet or backpack. This way it’s with them and easy to refer to when they need a regulatory strategy and it can be their choice.

 

OT Month Handouts

In honor of OT month we decided to create a few handouts for the school districts we work with.  I made them into photo format so that I could share them here but please let me know if you would like the PDF format and I will send them to you.  Happy OT Month!

 

 

Development of Writing Utensil Grip

Another article by one of our OT’s.

As children are getting back to school, we often hear questions about children’s writing utensil grasps. Teachers may point out the way a child holds a crayon or pencil, or parents may take notice when one child doesn’t follow the same pattern as older siblings. But why is pencil grasp so important? The quick answer is: the way a child grasps a writing utensil affects his or her efficiency and accuracy. It follows then, that if the child perceives handwriting as a particularly difficult, tedious, or even painful task, they are more likely to have decreased confidence in their performance and this might affect willingness to engage in writing necessary for school or other everyday tasks.

But how do you know whether your child’s grasp is appropriate? The first thing to recognize is that children’s development of writing utensil grasp tends to follow a particular progression. Toddlers first grasp a crayon or marker by wrapping their whole fist around it, and scribbling with the pinky side of their hand toward the paper. This is called a palmar supinate, fisted, barrel, or cylindrical grasp, and it tends to begin around 12-16 months and is illustrated below.

Next, as children experiment with grasp and develop more dexterity in their forearm, wrist, and hand, they learn that they get more precision by turning the palm downward, with the pointer finger toward the pencil tip and the paper. This is called a digital pronate grasp and can be expected to emerge between the ages of 2 and 3.

Later, as the many small muscles of the hand develop increased strength and coordination, the child develops what is known as the static tripod or quadrupod grasp, in which the thumb is opposed to the next 2 or 3 fingers, with the pinky side of the hand toward the paper and the top of the pencil extending up from the space between the thumb and index finger. This grasp generally emerges somewhere between 3-4 years. Finally, as the child develops even more dexterity, the grasp becomes a dynamic tripod or quadrupod, in which the pencil is held in the same general orientation as the previous grasp, but the wrist and fingers are now able to create small, refined movements rather than depending on using the arm as a whole. This grasp tends to develop between 4 and 6 years of age.

 

When to consider OT

Just because your child’s grasp doesn’t follow the developmental pattern above does not necessarily mean they will have problems requiring intervention. There are other grasps that may also be considered functional, and there are children with appropriate grasps that still develop problems due to other factors. Your OT can help determine the best way to help your child develop a functional grasp, including working on other factors that may help, such as posture, adaptive aids, or strengthening activities. Here are some other things to look for that might signal a problem worth looking into:

-       Child frequently putting utensils down to wiggle or shake out fingers

-       Writing that is too light or too heavy (i.e. too light to read, or heavy enough to break the pencil/crayon)

-       Writing with arm not resting on the table

-       Using the whole arm to write rather than wrist and hand movements

-       Poor posture

Please don’t hesitate to ask your therapist if you are concerned about your child’s writing utensil grasp- we’re here to help!

The Eight Key Components to Good Handwriting

This article was written for our newsletter and discusses the key components to successful handwriting and what to do if you suspect difficulties related to these components.  Many handwriting problems can be avoided or solved by teaching good strategies.  Also, consider consulting with an occupational therapist or other professional trained in handwriting assessment and remediation.

Memory refers the process of remembering and producing quick and automatic recall for letters and numbers.  Poor memory often affects production, speed and accuracy.  If you suspect problems with memory, play visual memory games with letters using flashcards or other hands-on materials to encourage letter and number discrimination.

Orientation refers to ensuring that all letters and numbers are facing the correct direction.  Errors in orientation can be distracting and often result in children frequently stopping to think about which way a letter faces.  Difficulty with letter orientation is linked to spelling errors and poor legibility.  If you suspect problems with orientation, teach your child that English is a top to bottom, left to right language.  Teach orientation for “B D E F P R N” by having your child write the big line on left edge of paper, encouraging them to start at the top.  The next component of each of the aforementioned letters will be on the right side.

Placement refers to placing letters and numbers on the baseline.  It helps with legibility.  If you suspect problems with placement, model how letters sit on lines.

Size refers to how big or how small a child writes.  Children learn to control movements in their wrist and fingers to ensure that the size of their writing is appropriate given their grade level.   If you suspect problems with size, make sure the child is using age-appropriate paper.  Provide paper that guides the size of letters until children naturally develop a sense of size.

Start refers to where each letter or number begins.  Good habits ensure that children learn to form letters in a top to bottom and left to right format.  Speed, size and spacing are often compromised with incorrect starting habits.  If you suspect problems with start, demonstrate the correct starting position and correct all bottom-up writing.

Sequence refers to the order and stroke direction of the letter and number components.  The ability to form the components of various letters and numbers is acquired through direct teaching and consistent practice.  Speed and neatness are often compromised if incorrect teaching methods are adapted.  If you suspect problems with sequence, demonstrate letter formation.  Teach letters that use a similar formation pattern in groups.  For example, letters o a d g q all begin with a c stroke then change into another letter.

Control refers to neatness and proportion of letters and numbers.  Problems with control do not always require direct remediation; rather they are almost always caused by the adaptation of poor habits and in turn will improve once better habits have been adopted.  One of the most common poor habits is an awkward and immature pencil grip.  Teach children how to hold their pencil correctly.

Spacing refers to the amount of space between letters in words, and between words in sentences.  Spacing is important to the legibility and uniformity of writing.  Avoid using poorly designed worksheets that do not give enough room, as this may lead to problems with spacing.  If you suspect problems with spacing, create and use worksheets that model good spacing.

Questions about Oral Motor Input and their Answers

Here is an article written by one of our OT’s that I thought would be great to share!

Why is my child always putting things in his or her mouth?

When a child puts something in his mouth, he or she may be seeking oral motor input, which basically includes anything that gives the child sensory input to the mouth and may result in a motor behavior such as sucking or chewing. In short, oral motor input is organizing, meaning that it provides us with sensory input that elicits motor behaviors that help us calm down and focus. This is true not only for infants and children, but across the lifespan. In fact, before babies are born, they develop a sucking reflex that will allow them to feed and get nourishment. Thus, from the early stages of life, we learn that getting input through our mouths is a way to satisfy our more basic needs (i.e. nourishment) so that we can focus on more complex needs (e.g. learning from our environment, engaging in social interaction). Even older kids and grown-ups sometimes continue to seek oral motor input- think about chewing gum, biting nails, snacking “just because” or chewing on a straw or pen.

What’s the big deal?

Seeking oral motor input can become problematic once children move beyond the toddler stage, as it becomes socially inappropriate and of course potentially unsafe for them to be indiscriminately putting things in their mouths. Children may develop maladaptive patterns such as overeating, biting other children, or mouthing objects that are potential choking hazards.

What can I do about it?

We can use behavioral strategies to “teach” older children not to put toys or other inedible things in their mouths; however this may not change their basic need or craving for it. This is why we shouldn’t just ignore it- it certainly won’t do kids any good in the long run, particularly in the social arena, to allow them to mouth toys that are shared by other kids in the classroom, chew on their sleeves, bite their siblings during horseplay, or chew the ends of their pencils to bits. What we can do in these cases is provide alternatives or preparatory strategies to meet the child’s oral motor needs (see list below). This means either anticipating the need and providing oral motor options ahead of time, or having alternatives on hand to replace the inappropriate object/behavior.

What are safe/appropriate ways to provide my child with oral motor input?

• Use an electronic/vibrating toothbrush in the morning before school
• Chew foods that are crunchy like carrots or pretzels, chewy like taffy or peanut butter, sour like citrus fruits, or icy cold like a popsicle
• Drink something sour like water flavored with lemon juice (for more input, use a narrower straw)
• Use a thick straw to eat yogurt, pudding, or jello
• Play with whistles, harmonicas, blow bubbles, or blow up balloons
• Use a “chewy” or a vibrating teether

Remember, children should be supervised during oral motor activities to make sure they are using these tools safely!

Using the Penguin Shuffle to Teach Turn Taking

So, Penguin Shuffle is a board game by Milton Bradley from 1995 that is no longer in production.  Our therapist loved it so much she bought it off of ebay and wants to start a campaign to get Milton Bradley to begin making it again (feel free to let us know if you want to join her campaign).  What she loves about it is that it is set up for practicing taking turns.  First one person tries to get their penguin down the shoot onto the carousel and then the other takes their turn.  Depending on the child you may need to provide cues such as verbally saying whose turn it is, or pointing, or shaking the penguin slightly as a reminder that its not the child’s turn.  Ideally you start to wean down off of the cues until they recognize when it is their turn.  Usually you will see two things happen, a child will try to keep going, without waiting for the other person to have a turn, or they will sit there and not realize its their turn.  Its especially hard for the child to wait with this game if their penguin doesn’t make it in the slot and slides off the iceberg because their tendency is to want to try again immediately.  You can even keep track of how many times you need to cue the child during the course of a game and see if it decreases or they types of cues decrease as they get more practice with it.  Of course you then want to see if you can generalize it out to other activities but this is a great game for setting the building blocks of taking turns.

In addition to taking turns, it also can help a child to work on object manipulation to get the penguin standing on his feet in the chute and it can work on visual motor for timing the best time to let your penguin begin his shuffle down the shoot in the hopes of landing on the iceberg carousel.

I know I said this game isn’t available by the manufacturer any longer but has anyone used this game, or a game similar to it that you can also inherently work on taking turns?

Organizing Crafts for Use in OT

      

So I just wanted to take a moment to brag and show off the project our most recent OT student did.  She created a binder of crafts that can be used in OT sessions with instructions and a sample of each craft.  She also labeled each one for what skills the craft can address depending on how you focus it.  Depending on the child’s age and what you are working on specifically you may want to do it over several sessions or to have part of the craft finished ahead of time so that the child can focus on just one aspect such as cutting, coloring, pincer grasp, threading, visual scanning, etc.

I will try to post about some of the crafts in upcoming blogs.

What other great organization strategies do you use?

Red Rover the Toy!

  

One of our therapists has this toy which is great.  I had never seen it before but its a Red Rover Game.  He comes with a back pack full of plastic bones that are decorated with a number, color, letter and/or shape.  It talks to you with its pre-programmed game which is on the loud side (just as a warning) and the child can ‘feed’ the bone to the dog.  You can play the pre-programmed games which can work on following directions and listening for instructions or you can make up your own games.

What’s great about this is that just like my ‘old’ favorite toy, the Parents brand shape sorter, you can work on so many skills at once.

Gross Motor:

• Squatting to pick up the bone
• Standing on tip toes to pick up the bone
• Jumping up to reach for the bone
• Traversing across the room to get the bone by crawling, animal walking, jumping, walking, running, hopping, skipping, knee walking, rolling, tip toe walking, heel walking
• You can also use the bones to encourage repetitions of activities such as walking across a balance beam to get a bone and then walking back to feed the dog, or going up and down stairs or transitioning from the floor to standing
• You can use a chart to make the symbols on the bones mean something and have them face down so when they pick up a bone they have to do the activity that corresponds to the letter, number, color and/or shape.  By having the kiddo help come up with the list of activities you get them actively involved and you’d be surprised at how they pick the activities you are actually working on.

Fine Motor:

• Kids can work on grasping to pick the bone up off of different surfaces
• Bilateral coordination to stabilize the dog while trying to feed it.  If they don’t stabilize the dog could fall over!!
• Hand strength to get the bone into the mouth.  For kids that are a little weaker you could provide some hand over hand to assist.
• Accuracy in getting the bone lined up and into the slot.  The kiddo will have to work on manipulating the object so that it is lined up correctly (similar to a shape sorter)
• Just as in the gross motor section you can use it for repetitions of tasks
• You can use it for ‘reward’ or breaks in your sessions.  For example, if a child finishes an activity they can feed the dog a bone!

Visual:

• Letter, number, color and/or shape recognition

Has anyone else ever used this game?  What variations did you use?

 

Taking the visual out of handwriting practice

I love having students in our practice.  Not only do they challenge us as therapists to be deliberate and think about why we do what we do, but they also bring an influx of ideas in and add to our overall toolbox.  Our most recent OT student shared this idea with us that she did a paper on in grad school.

Her paper focused on a child with Developmental Coordination Disorder (DCD) and handwriting. The resources (Benbow, 2006; Ziviani & Wallenberg, 2006) suggest that a child’s slow performance in writing is a result of compensation strategies of decreased visual motor control with greater reliance on visual monitoring.  Some of the sources suggest that helping a child to develop kinesthetic memory and kinesthetic feedback can be beneficial. Activities that develop kinesthetic memory will increase internal sensitivity to when a letter movement is correct. Kinesthetic feedback can be developed while minimizing visual motor control (i.e. taking vision out of the equation).

An example of an activity includes having the child place an object on the desk surface within their reach. Then have the child place their hands on their lap and reach for the object with their eyes shut.  They tried this strategy with one of their kiddos who was able to reach for the object, but miscalculated and placed their hand directly to the side of the object on the first try.

The resources suggest this can be applied to handwriting by blindfolding the child while they write a couple of letters of the alphabet. Or, for those kiddos that would not do well with blindfolding, stick a pen through a paper plate and have them write a  few letters. If this is continuously practiced, the movement patterns will be part of the child’s kinesthetic memory. Eventually, handwriting will progress in speed and ease with less visual monitoring.

References:

Benbow, M. (2006). Principles and practices of teaching handwriting. In A. Henderson & C. Pehoski (Eds.) Hand function in the child: Foundations for remediation (pp. 319-342). St. Louis, MO: Mosby Elsevier.

Ziviani, J. & Wallenberg, M. (2006). The development of graphomotor skills. In A. Henderson & C. Pehoski (Eds.) Hand function in the child: Foundations for remediation (pp. 217-236). St. Louis, MO: Mosby Elsevier.

Make your own Magic Wand

Ok, we are big fans of Harry Potter so when I saw this post on how to make your own wand, I had to pass it along to our OT’s because I thought not only could it be ‘therapeutic’ in that kids could work on skills, but it would also be motivating.  This wand was made over several weeks and our OT and her kiddo would do a little bit each session.  It let the kiddo think about how they wanted the wand to develop and take the time to put the colors and designs in that she wanted.  This kiddo has a left hemiplegia so it really allowed her to work on using both hands to create the project.  She had to use her stabilizing hand to hold the stick while wrapping the string, also both hands need to be used for threading and tying knots to name a few.  I think the best thing it works on is encouraging a child to express their creativity and individuality in a way that can evolve with the project.