Starfish Therapies

February 4, 2016

Childhood Occupations

Filed under: Developmental Milestones — Starfish Therapies @ 12:50 pm
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Childhood Occupations

We often get asked ‘What is Occupational Therapy,’ especially when we are talking about it in reference to a child.  As a result we thought we would publish a breakdown based on the Occupational Therapy Practice Framework to help give people a better understanding.

As Occupational Therapy refers to how one occupies their time, it is a profession that believes in daily participation in occupational routines. As defined by the Occupational Therapy Practice Framework, a child participates in the following occupations including: Activities of Daily Living, Rest and Sleep, Education, Play and Social Participation. Each occupation is taken into consideration during your child’s treatment and as such obtaining an understanding of these areas will contribute to the families ability to work in collaboration with the OT and develop the ability to transfer skills into the child’s daily routine to foster independence. The following descriptions are taken from the Occupational Therapy Practice Framework.

Activities of Daily Living: Activities that are oriented toward taking care of one’s own body. These activities are, “fundamental to living in a social world; they enable basic survival and well being.” They include:

  • Bathing/Showering: obtaining/using supplies, maintaining positioning, transferring to and from bathing position
  • Bowel/Bladder Management & Toilet Hygiene: intentional control, obtaining/using supplies, clothing management, transferring on/off the toilet
  • Dressing: selecting appropriate clothing, obtaining clothing from a storage area, dressing/undressing in a sequential pattern
  • Eating: the ability to keep and manipulate food or fluid in the mouth/swallow
  • Feeding: the process of setting up, arranging and bringing food/fluid to the mouth
  • Functional Mobility: moving from one position in space to another during performance of everyday activities such as those listed in this post
  • Personal Hygiene/Grooming: obtaining and using supplies to brush hair, groom nails, wash hands, clean mouth etc

Rest and Sleep: Including activities related to obtaining restorative rest and sleep that supports healthy active engagement in other areas of occupation.

  • Rest: quiet and effortless actions that interrupt physical and mental activity including identifying need to relax to restore energy, calm and renew interest in engagement
  • Sleep: a series of activities resulting in going to sleep, staying asleep
  • Sleep preparation: engaging in routines that prepare the self for comfortable rest including grooming, reading, setting an alarm etc.

 Education: Includes activities needed for learning and participating in the environment.

  • Formal educational participation: including categories of academic classes, nonacademic (e.g. recess), extracurricular (e.g. sports)
  • Informal personal education participation: participating in classes, programs, and activities that provide instruction/training in identified areas of interest

Play: A spontaneous or organized activity that provides enjoyment, entertainment, amusement or diversion.

  • Play Exploration: identifying appropriate play activities, which can include exploration play, practice play, pretend play, games with rules, constructive play and symbolic play
  • Play Participation: participating in play maintaining a balance of play with other areas of occupation; and obtaining using and maintaining toys, equipment, and supplies appropriately

Social Participation: Organized patterns of behavior that are characteristic and expected of an individual or given position within a social system.

  • Community: engaging in activities that result in successful interaction at the community level (i.e. neighborhood, organization, work, school)
  • Family: engaging in successful interactions in specific required and/or desired family roles
  • Peer, Friend: engaging at different levels of intimacy


Reference: Occupational Therapy Practice Framework: Domain & Process 2nd Edition. The American Journal of Occupational Therapy. Novemeber/December 2008, 62:6, pg. 631-633.

August 14, 2015


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The Merriam Webster Dictionary defines participation (in relationship to kids) as ‘the act of joining with others in doing something’. At one point or another during childhood, most kids may struggle to participate in an activity that they are interested in whether because of timing, funding, level of challenge, etc. For kids that have difficulty achieving their milestones or who are delayed in various areas of development, participation in day to day activities or recreational activities may feel like an insurmountable mountain to the child and/or the family. These limitations of participation can often leave them feeling different or left out.

While it’s important to aid a child in achieving milestones in development of individual skills, it is also important to look at how we can impact their participation. For example, if a child is still learning how to walk, but all their friends take dance class and that is something they really want to do, we may look at finding dance classes that allow alternative mobility, or work with the dance class that their friends are in to find ways to include the child. By looking at the big picture of how a child’s limitations are affecting their ability to participate in tasks and activities that are important to them we can make a meaningful impact on the child’s life, while continuing to work on individual skills.

This allows the child to: develop friendships with peers from a young age, interact within their family unit, continue to develop skills while seeing success in an areas of importance, and teaches them that, while they may do something different, they can do it. This also helps a child develop a set of interests and desires that can fuel their internal drive to want to learn ‘that’ skill for themselves which as pediatric therapists, we find to be one of the largest indicators of a child’s potential.

As a result, we find, in order to best serve the children and families we work with, that maintaining the focus of goals and interventions on the big picture things a child and their family want to participate in results in the most meaningful, motivating, and individualized intervention, and is the key to our success as therapists.

February 11, 2015

Valentine’s Day Games and Ideas


With Valentine’s Day coming up, you can make this day special for your kids as well. Here are some fun ideas that you and your kids can participate in together, while learning, and working on some gross and fine motor skills. Have fun!

1)   Scavenger Hunt: Hide a bunch of hearts or valentines all over the house or room. Place these items in hard to reach spots so your kids will have to get on their hands and knees (quadruped position), tip toes, or run to find them. Quadruped position will help build shoulder, core and leg strength; while tip toes works on calf strength, which will allow for more power with jumping, skipping, and running!

2)   Heart Hop: Cut out large construction paper hearts and tape to them to the floor. Have your kids help so they can work on their cutting and fine motor skills. Put on some music and have them hop on to each heart. You can either have them hop with two feet or one foot. If you want to work on hop scotch, place the hearts into a hopscotch line up and hop away!

3)   Make a heart with your feet: Get some paint and use your feet to create a heart on large construction paper. This will allow your kids to work on balance with their feet close together, which makes things more difficult. To keep them in this position, add a ball and play toss, to challenge their balance to keep their feet on the floor to make a heart.

4)   Musical Hearts: This is similar to musical chairs except instead of sitting, kids will work on gross motor activities. What you will need is construction paper, scissors, and a marker. Cut out large hearts that you can place on the floor for kids to step on. Write whatever activities you would want on the hearts (5 jumping jacks, standing on one leg for 10 seconds, hop 5 times, crab walk, etc.) All these activities work on strength, coordination, and motor planning. Once you have all your hearts, place them on the floor and start some music, have your child and friends or family walk around the hearts until the music stops. Once the music stops, find a heart and perform the activity. Find the link here.

5)   Valentine’s Day glitter and sensory board: For only two dollars, Target has some great valentine’s day themed vinyl placemats that would be a great way to make a sensory board. Then, all you need is some shaving cream (unscented to avoid any allergies), glitter, and sparkles. Spray the shaving cream on the board and let your child feel the texture of the cream. Once they are comfortable with the cream, feel free to add some sparkles and glitter to make it more colorful and texture oriented. They can make different shapes, like hearts, and X’s and O’s. Find the link here.

6)   Heart straws: This activity is meant to help your child with their fine motor skills. All you need are some straws, play dough, and heart shaped pastas. Find a hard surface, like a cutting board and use play dough to make a base for your stand. Place a clump of play dough on the table or board and stick a fun colorful straw as a pole. Then have your child grab the heart shape pastas and start stacking and unstacking. This will work on your child’s finger pinching grip and hand, eye coordination.

7)   Heart themed sensory box: This is a great activity to help promote learning through sensory input. You will need, a plastic bin, rice, shredded red paper, and Valentine’s Day items. Some Valentine’s day items you could use include hearts cut out with different textures (felt, paper, glittered ), heart bracelets, balloons, and whatever else you may want. You can promote learning by having your child put in only the felt hearts, and then only the glittered, promoting categorizing. Then you can have them count how many bracelets you may have as they put them into the bin. If you have different color hearts, have them choose the pink ones, red ones, or white ones, in order to learn the colors. Find the link here.

January 5, 2015

Five Ways to Use Drinking Straws


Straws are a fun and affordable way to develop fine motor skills such as cutting and stringing. Straws also can be used for fun tabletop games or for arts and crafts.

1.  Blowing bubbles: Who remembers blowing bubbles in a glass of milk as a child? Blowing bubbles are a great way for improving oral motor skills as well as improving muscle tone in cheeks and lips. An easy fun activity is adding a couple drops of dish soap with some water into a large bowl. To make it extra exciting, food coloring can be added. Have your child blow as many bubbles as possible by exhaling through the straw. A trick to make sure your child does not inhale any soapy water, is to cut a small hole near the top of the straw so the child is able to exhale but not inhale water!
2.  Cutting: Cutting different sized straws is a great way to develop scissor skills. Cutting straws helps to develop ability to snip and open/close scissors because straws are easy to hold and align. Plus there is the added fun factor that the pieces fly when cut!
3.  Stringing: Using cut up straws to string onto pipe cleaner or yarn is a great fine motor activity to increase pincer grasp skills, and bilateral hand use. Different beads can be added for color and they can make great bracelets or key chains.
4.  Painting: Place different colored washable paint dollops on a large sheet of paper and have your child blow air through a straw to create a masterpiece! The same technique can be used for blowing bubbles, cut a small hole near the top of straw to prevent ingestion of paint.
5.  Maze: Glue straws to the top of a cardboard box lid to create a maze. You can use shoe box lids, or old soda cartons. Feel free to get creative and it can be simple or complex. Place a marble in the maze and have your child hold the lid using both hands to move box in order to have the marble travel through the maze. This is a wonderful activity that addresses bilateral hand skills, motor planning, and force modulation.

April 9, 2014

Making Use of the Junk Drawer

Filed under: Developmental Milestones — Starfish Therapies @ 9:00 am
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Wait don’t throw that away! Our junk drawers can hold some quick and easy fine motor and visual activities for our kids. Let’s get creative with what we unknowingly have in our possession already. Here are some great ideas and activities to do with 3 things that may be in a junk drawer:

Rubber band:

  • Place the rubber band on the index finger and thumb and have them open their fingers against the resistance of the rubber band. They can also put the band on their thumb, index and middle finger to work on strengthening the tripod grasp as well.
  • Stretch the rubber bands over blocks and paint the bands for a fun stamp.
  • Stretch the rubber bands around a small white board and hang the board up or leave flat on the table in front of child. They can place anything under the bands to make their own picture. Animals, crayons, or any small item that’s available. Picking up the bands works on pincer grasp and they have to use two hands to both hold the band and place the item under. Hanging the board up would also work on reaching with bilateral hand use.


  • Make a chain of paperclips or undo a chain of clips. This works on motor planning, bilateral hand use and finger dexterity skills. You can pretend its fun jewelry after putting it together as well.
  • Hang a paperclip from a string and add a balloon to the paperclip. You can adjust the height to play different visual and gross motor games with this. Up high you can try hitting the balloon with your hand. Or use a bat or stick to make it trickier for those that have more visual difficulties. You can also have the kids jump and try and hit the bottom of the balloon with their heads. Bringing the balloon low they can work on kicking. They also can lay on their stomachs or backs and try and hit the balloon with their hands or feet together to work on flexion and extension strengthening.


  • Sorting games: you can sort the different kinds (rubber, metal), as well as the different sizes. Painting them different colors, can give them another way to sort them as well.
  • Place the washers in different spots and make a game out of collecting the washers. Give them an unsharpened pencil to walk with in one hand and they have to go around and collect the washers to place on the pencil. Increase the difficulty by having them collect in a certain pattern. This is great for eye-hand coordination, bilateral hand use and visual tracking skills.
  • Play a toss game. Taking a paper cup and placing it a small distance from your child you can play a tossing game in standing, sitting, on their belly, etc.

Next time you empty out that junk drawer, get creative and explore the different uses of everyday items that are found in your home. Your kids will love it!


April 3, 2014

The Ins and Outs of Pencil Grips

child at desk

A pencil grip can be a quick and easy fix for an awkward grasp. There is such a huge variety of them out there, but how do you know what ones to choose. Here’s some quick tips on how to choose a pencil grasp for your child.

The Simpler the Better: If your child needs a pencil grip, they are most likely having difficulty planning how to hold the pencil in the first place. Keep it simple so the grip doesn’t become as frustrating as the pencil initially was to hold. It will also make it easier to transfer from pencil to pencil if needed and recall how to hold it correctly each time.

Look at the concerns: The type of pencil grasp that your child will use is going to depend on what the areas of concern are when they are holding the pencil. Here are some common concerns, along with which direction to possibly take:

  • Low tone (fine motor weakness): This can be observed one of 2 different ways. One such way is when your child is holding the pencil too loosely and often resorts to an awkward grasp to compensate. The other way is they will look like they are actually applying too much force when writing and are using it as an over-compensation for the weakness. Thicker or jumbo grips are usually easier for these kiddos to hold onto and can cut back on some of the force when writing concerns. Weighted pencils or grips can also help in some cases, so the child doesn’t feel the need to push down the pencil so hard when writing.
  • Motor Planning: This is when your child just can’t seem to get the motor patterns correct for holding the pencil. These are the kids that the more simple the grip the better. Single grips or crossover grips would be most beneficial for these kids.
  • Kinesthetic feedback: These kids usually grip the pencil with a tight fisted grasp or barrel grasp. They’re looking for input when writing in order to fill a sensory need, as well as give them some proprioceptive feedback to assist with guiding the pencil. Wider or jumbo pencil grips or textured ones may be most beneficial for these kids.

Make it Fun: There’s different colors, shapes and even grips with glitter. You want to get the right type of grip, but you want your child to be excited about using it as well. Let them choose colors or other features of the pencil grip as long as it doesn’t impede overall function of what you wanted it to do originally.

It’s not forever: Pencil grips are just to encourage the use of an appropriate grasp for the time being and not to use as a permanent fix. It should assist your child in making the grasp more of a habit and you should be able to eventually end up with no use of no grasp at all. Just another helpful trick along the way.

March 31, 2014

Fun With Finger Play

Filed under: Developmental Milestones — Starfish Therapies @ 1:48 pm
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finger play
Our hands perform intricate movements that allow us to manipulate various objects around us. Our hands provide us with opportunities to interact with and learn from the environment. Hand function is dependent on several different factors. The large upper body muscles in the trunk, shoulder, and forearms provide strength and stability to push, pull, lift and hold. It is also important to develop strength in the small muscles of the hand in order to position our hands in precise and delicate ways.  Finger plays are a great way to promote improved hand skills. Some of the benefits of Finger plays include:
  1. Develop arches of the hand. The arches give the hand a rounded shape and help to position the fingers for accurate use.
  2. Develop finger isolation skills. The thumb, index and middle finger need to be able to be able to perform small accurate movements while the ring and small finger are tucked toward the palm. It is important to be able to move each finger individually in order to complete mature grasp patterns.
  3. Develop the web space. The web space is the space between the thumb and index finger. The web space is important because you have to keep it open and rounded (like an “ok” sign) to perform precise movements such as picking up small objects from the table.

 In addition to hand improved hand skills, finger skills facilitate improved ability to follow directions and improved imitation skills. Finger plays are a fun and exciting way to interact with your child while at the same time encouraging skill development.

Funny Bunny:

(Author unknown)

Here is a bunny (Raise two fingers.)
With ears so funny (wiggle raised fingers)
And here is a hole in the ground. (Make hole with fingers of other hand.)
At the first sound she hears,
She pricks up her ears (Straighten fingers.)
And pops right into the ground. (Put fingers in hole.)

Ten Fingers:  I have ten fingers    (hold up both hands, fingers spread)

And they all belong to me,  (point to self)
I can make them do things-
Would you like to see?

I can shut them up tight   (make fists)
I can open them wide    (open hands)
I can put them together   (place palms together)
I can make them all hide  ( put hands behind back)

I can make them jump high   (hands over head)
I can make them jump low  ( touch floor)
I can fold them up quietly   (fold hands in lap)
And hold them just so.

Three Balls:

Here’s a ball     (make ball with thumb and index finger )

And here’s a ball   (make ball with other thumb and index)
A great big ball, I see   (put arms up and touch fingers over head)

Shall we count them?
Are you ready?
One, Two, Three    (make all three balls in succession)

Open/Shut Them:

Open, shut them, (open and shut fists)
Open, shut them,
Give a little clap. (clap)

Open, shut them, (open and shut fists)
Open, shut them,
Put them in your lap. (place hands in lap)

Creep them, creep them (walk hands up body to chin)
To your chin.
Open your mouth,
But do not put them in.

Roll them, roll them, (make rolling motion with hands)
Roll them, roll them,
Roll them just like this.

Wave them, wave them, (wave)
Wave them, wave them,
Blow a little kiss! (blow a kiss)

Where is Thumbkin?:

Where is Thumbkin? (put both hands behind back)
Where is Thumbkin?
Here I am. (bring one thumb out front)
Here I am. (bring other thumb out front)

How are you today sir? (bend one thumb as if talking to the other)
Very well I thank you. (bend other thumb as if talking back)
Run away. (put first thumb behind back)
Run away. (Put other thumb behind back)

Repeat with: Pointer, Tall Man, Ring Man, Small Man.

January 22, 2014

Fine Motor Group Ideas

IMG_2871 IMG_2870

This past summer we did a fine motor group and each of the participants left with a basket of goodies for things they could work on after the group ended.  Here is what was included on the worksheet that went with it:

What Your Fine Motor Baskets Contain



The benefits – Encourages a tripod grasp, builds up hand endurance, allows children to work on increasing and decreasing the amount of force used, encourages isolation of wrist and fingers.

Recommendations – Have your kids break the crayons to encourage a tripod grasp. Vary the sizes and textures that they are coloring on. Encourage coloring on slanted surfaces or standing at an easel to build on endurance and strength of wrist extensors.



The benefits – Texture tolerance if your kids have tactile concerns. Visual motor and pincer grasp encouragement, proprioceptive input to hands for those sensory seekers.

Recommendations – Hide beads or small items in the floam to encourage more manipulation of it. Have them squeeze it with their whole hand or pick up the small individual beads to encourage use of a pincer grasp.



The benefits – Eye-hand coordination, pincer grasp, body spatial awareness, midline crossing.

Recommendations – Stick the stickers on the back of their hands to encourage them to cross midline to get the sticker off with their other hand. Peeling the stickers off also encourages use of a pincer grasp to complete this. Sticking the stickers on different parts of their body can help their overall body awareness as they are looking for the stickers.



The Benefits: Increases grasping strength, eye-hand coordination and bilateral hand use.

Recommendations: Play some silly games to get the interest going with clothespins. Have them pin them onto your clothes so they get to make you look silly or make hair for their baskets. If they are not ready to pinch them on, you can create a game where they have to pull them off of themselves, you or another surface to work on more whole hand grasping.


Balloon Fidget:

The Benefits – Overall hand strength, regulation, sensory input.

Recommendations – Demonstrate different ways that you can utilize the fidget (pull, twist, squeeze). Use it as a regulatory tool when children are dis-regulated or over-stimulated.



The Benefits: Eye-hand coordination, bilateral hand use, pincer grasp, motor planning.

Recommendations: There are both pipe cleaners and string in the basket to match the level at which your child may be at for beading. Starting with the pipe cleaner is easier and allows them a stiffer material to work with. When ready they can progress to the string. There are large beads included but smaller ones can be threaded on as well to increase to another level of difficulty.


Finger crayon:

The Benefits – Finger isolation, quadrapod grasp.

Recommendations – Allows more stabilization when coloring for some children and gives them more control when coloring. It may not work well for some kids, but allow them to explore.

January 15, 2014

Letter Sorting Activity – Small/Tall/Fall

small tall fall

This great activity came from one of our OT’s!

This activity involves sorting letters into 3 categories:  Small, Tall and Fall.

It can help kids not only work on specific letter recognition but also:

  • visual discrimination between different kinds of letters which can help to improve their handwriting legibility
  • spatial awareness as they learn and recognize how to place letters accurately on the line (i.e under the dotted line, within the lines, going below the line)
  • fine motor because the laminated letters are small so they get to work on pincer grasp and manipulating small pieces with their hands

For kids that have challenges with working with small pieces you can enlarge everything or use letters made from different materials such as the foam sticky letters so that kids can still work on the activity but its graded for their abilities with fine motor.

Overall this task provides another option for working on letter recognition and allows a hands on approach to teaching letter placement to improve handwriting legibility.  It will also eliminate some of the motor component (actually writing the letters) than can cause some kids frustration while they are learning so that they can focus on letter placement and sorting letters.

What other ways do you use to work on letter recognition, sorting and placement?

January 8, 2014

Eye See: Visual Perceptual vs Eyesight

Filed under: Developmental Milestones — Starfish Therapies @ 7:00 am
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Occupational therapists are frequently asked what the difference between visual perception and eyesight is. Vision plays a significant role in the way we interact with our environment and how we learn.

Visual acuity refers to how clearly a person sees. Vision is more than just eye sight and how clearly we see. A person can have “20/20” vision but also have difficulty with visual perceptual skills.

Visual perception refers to the brains ability to make sense of what the eyes see. All of the body’s sensory experiences contribute to visual perception including sight, sound, touch, smell, balance, movement and muscle control contribute to visual perception. Visual perception is important for many different school tasks including reading, writing, cutting, copying from the board, visualizing past experiences, giving/getting directions, navigating the playground, and eye-hand coordination. The sub-areas of visual perception include the following:


Visual discrimination: The ability to see differences and similarities in shapes, patterns and objects.

Form Constancy Perception: The ability to identify, sort and name the same objects, shapes and symbols despite differences in their size, shading, texture and/or position.

Figure Ground Perception: The ability to distinguish an object/word/letter/number from a busy background. It requires the eyes to focus on and identify specific objects/words/letters/numbers between others.

Position in Space Perception: The ability to understand and perceive the position of an object in relation to one’s own body.

Spatial Relationships Perception: The ability to perceive the position of two or more objects in relation to oneself and to each other. It includes the ability to identify left and right on one’s own body and apply it to objects.

Visual Closure Perception: The ability to identify an object, shape or symbol from an incomplete presentation.

Visual Memory: The ability to recall or reproduce a number/letter/object/figure that has previously been seen for a short period of time i.e. to remember what has been seen.

Occupational Therapists frequently work on visual perceptual skills to facilitate improved visual motor and fine motor skills. Activities to promote improved visual perceptual skills include puzzles, finding hidden pictures, Where’s Waldo, “I SPY” (figure ground), bingo (visual scanning), memory card game ( visual memory and matching), and block design duplication (visual-spatial relations).  Visual perception plays an important role in how a child learns and interprets his or her environment.

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