Starfish Therapies

October 31, 2012

Some Thoughts on Perplexus

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 pm
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We have a few of the Perplexus models here because I think they are really cool. For those of you who have never seen them they are a clear globe with a complex track inside that is broken up by colors and you need to keep a small ball on the track from the start to the end.  It is a great way to work on motor planning, visual motor skills, and bilateral coordination.

I recently decided to try the ‘rookie’ with my kiddo who has spastic quadriplegia CP.  I wasn’t sure how it would go based on his physical challenges but I knew intellectually he was bright enough to know what to do.  It was really interesting to watch him try to work it out.  First I demonstrated it to him and he talked me through which way to turn the globe so that the ball stays on the track.  He was able to verbally instruct me as well as point to the direction of movement that I needed to move the globe.  Clearly he understood the concept of it.

Next I gave it to him.  He concentrated so hard on it but had a really hard time moving the globe within his hands.  It was easier for him to keep his hands stable on the globe and try to twist it.  When he did this the ball frequently fell off the track.  I began working with him on how to turn the globe within his hands.  I used some hand over hand and step by step verbal cues and he began to get the hang of it.  He needed to use a lot of extra stabilization such as with his chest and his chin while he attempted to move his hands without the globe moving with them.  He also did a great job of maintaining an upright posture while doing this activity.  He has a tendency to slouch when sitting in a chair and performing activities with his hands so it was great to see that this game allowed him to maintain his postural stability much better than normal.

I would say with a kiddo like this the motor planning required for the bilateral coordination of his hands and then integrating the visual is what it really works on.  Whats great is that because it is broken up by color you can create goals such as get to the red track and then get to the purple track, so that they don’t get frustrated when the ball falls off the track.  When I did step in and help a bit I had him continue to direct how we should turn it so that he was able to continue his intellectual and visual problem solving.

How have you used the Perplexus?

October 23, 2012

A Multi-Tasking Activity

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 pm
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One of our OT’s was so excited last week to show us the new activity she was doing with a few of her kiddos.  She had just started it so she hasn’t had time to embellish it for pictures and make it look pretty!  Also, we had to wrangle one of our other OT’s in for the picture because no kiddos with photo rights were available at that time.

Basically she has a few kiddos who are working on balance, visual motor control and letter recognition.  So, in order to combine all three she has them standing on a spot (their feet aren’t allowed to leave the spot) and throwing the ball at whatever letter she calls out.  She currently has capitol and lower case letters because the kiddo this set up was for is working on being able to tell the difference.

When she showed me, I immediately loved the idea and came up with all different variations.  As the kiddos’ balance improves you can have them stand on one foot, or on a balance board or a balance disc.  You can have them work on maintaining stability in other postures such as high kneeling (like pictured) or half kneeling or staggered stance.  I also thought it could be used for numbers or colors as well and the ‘pictures’ on the wall could be adjusted depending on the child’s visual needs.  For instance, the white on white may be too challenging for some kids.

In addition to the learning and balance, it also helps kids with throwing and eye-hand coordination.  They have to be able to throw the ball (you can have them do overhand, underhand, two handed overhead, chest pass) and they have to be accurate with their throws.  It also assists with auditory processing because as the therapist calls out the target they have to figure out what they are hearing and then translate it to what is in front of them.

Another variation of this could be letter bowling.  You could have bowling pins with letters/numbers/colors on them and the child would have to work on rolling (which can be a hard skill to learn) the ball to knock over the correct pin or hit the correct target taped low to the ground.

How else have you used this idea and what skills have you worked on?

September 26, 2012

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.


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.

July 18, 2012

Stacking Cups

Stacking cups can be a great activity for many skills including motivation for gross motor skills!

  • Visual motor skills – you can vary the size of the cups, the color of the cups or even the weight of the cups to provide different input and make it easier or more challenging
  • grading of movements – if the child puts the cup down too hard the whole tower may fall over so they get to practice regulating their force
  • accuracy of movement and body awareness – when reaching to place the cup the child can work on accuracy.  They get immediate feedback if they aren’t accurate because they can knock the whole tower down or the single cup they are placing could fall off!  In addition, if they walk right into the tower they will receive immediate feedback as well.
  • squatting – you can have the cups on the floor so the child has to squat down to pick up the next one and then stand to place it on the tower.

Once the tower is built you can practice rolling balls, throwing balls, riding on a scooter to crash into the tower and then start all over again!

Crashing can be used as an activity to increase arousal or to work on self regulation.
What other ideas do you have?

May 15, 2012

Stickers – So Simple, Yet So Effective

When working with kids motivation is the key.  Depending on the day, the hour or the child that motivation could look different.  One of the simplest yet so effective methods of motivation are stickers.  Kids love them!  Not only are they great motivation but they actually work on skills and the child doesn’t even realize it (that’s my favorite kind of motivation)!

I’ve talked about using sticker charts before and we make use of them in many ways.  We have some kids who have ongoing ones that will result in something once it is all filled up.  One of these uses is where they have to earn a sticker each day for behavior/participation/etc.  Others have an ongoing one with tasks they are working on and each session they do the skill/task they earn a sticker until the whole chart is full.  Others have sticker charts for each session where they write down their tasks or they have a goal for a certain number of stickers and they get to put one on every time they accomplish what they were supposed to.  We also just hand out stickers at the end of the session sometimes and they love to wear it proudly on their hand or shirt or forehead occasionally!

Other than motivation you may be wondering what else the kiddo is working on.  Well here are a few things:

  • Bilateral Coordination – If they are peeling the sticker off they need to stabilize the paper with one hand while manipulating the sticker with the other hand.  Also for precision of placing the sticker they need to use a stabilizing helper hand as well.
  • Mature Grasp Patterns -In order to effectively peel off the sticker it works best with a pincer grasp.  They may evolve to this and you may need to help them by starting with larger stickers first and then working your way down to smaller stickers.  Also, in the beginning the more you start the peel for them the easier it will be for them to get it but eventually you want them to be able to manipulate the sticker off the paper by themselves.
  • Fine Motor Control – This goes along with both of the above points but it also takes control to put the sticker on the surface that they want, especially if they want it in a certain location.
  • Visual Motor -If you have a square on a chart or they are making a picture with stickers they get to work on visual motor skills and precision by placing the sticker in the correct spot.  To encourage success, start with larger areas and work your way down to smaller areas for them to place the sticker in.
  • Body Awareness -You can have the kiddo place the sticker on a specific body part for increased body awareness.  Its always interesting to see where the stickers end up when you say something like ‘place the sticker on your forehead’!
  • Counting/Reading – For the kids who are working on charts they always want to know how many they have or how many more they need so its a great opportunity to work on counting and one to one association because they will have to point to the sticker or empty space while they count.  Also if you have specific tasks/skills written down they can work on locating the word(s) for where to put the sticker.
  • Choices/Decision Making – We will also use letting the kiddo pick out their own sticker as another whole type of motivation.  Sometimes we pick it out for them but on some ‘special’ occasions we let them pick it out.  The thought process that goes into what sticker is pretty amazing and you can see them weighing the pros and cons of their sticker choice as they go through the sheets of stickers and decide yes/no/maybe for that sheet to narrow it down and then making the final decision.  Sometimes its based on what they like and sometimes its based on what is already on their chart and wanting just the right mix of stickers.

How do you use stickers?

April 23, 2012

Bubble Fun


Bubbles are a ton of fun and can be very beneficial for development.  Some of the ways that playing with bubbles can be beneficial are:

  • Hand-Eye Coordination: When a kiddo tries to pop a bubble they need to coordinate where they are reaching so that they can get to the bubble efficiently.  Its a great way to get feedback because kids love to watch the bubble pop.  To make it easier for them to have success, you can leave the bubble on the wand so they have an easier time getting it.  As they get better at finding the bubbles you can blow them into the air and let them see how many they can pop!
  • Visual Motor:  Kiddos get to work on eye tracking as well as convergence and divergence by following the bubbles and visually tracking them to be able to pop them.
  • Breath Control:  Practicing blowing bubbles through the wand not only works on breath control (you need to be able to blow for a longer period of time) it also works on oral motor control by having the kiddos have to purse their lips.
  • Fine Motor Control: Usually kiddos want to try to do it themselves so when they hold the wand they are working on grip, and then precision when they try to dip it into the bubble juice.  They also have to work on steadiness with their hand so that they can blow through the wand to create the bubble.
  • Finger Isolation:  When kiddos go to pop the bubbles they work on isolating one finger to be precise with pointing and improved ability to pop the bubbles!
  • Gross Motor Play:  If you are outside and blowing bubbles the kids can run around to try to pop them.  You can also have them try to stomp on the bubbles to pop them which will help with single leg stance and foot/eye coordination.
  • Bilateral Coordination:  If the kiddo is holding the bottle of bubble juice while trying to dip the wand in, they are working on bilateral coordination and hand use.

And just for some fun here is a link to some bubble recipes for you and your kids to enjoy!


February 8, 2012

Making a Torn Paper Owl – ‘Whooo’ Can Benefit

The newest pinterest project used in OT around here was making an owl out of torn paper.  It was posted from this blog that has a ton of crafts on it.  After completing the project, the feedback our OT gave on its benefits is below:

  • the cutting provides scissor skills practice as well as practice with visual motor skills and bilateral hand use (to hold the paper while cutting)
  • tracing the shapes works on pencil skills as well as grasp and more visual motor
  • having the kiddos put the eyes and beak on can work on body awareness and eye-hand coordination
  • tearing paper works on bilateral coordination of hands, motor planning and mature grasp

With the paper tearing what she really noticed is that some kids can have a really challenging time doing opposing motions with their hands.  Some of the kids just tried to pull their hands straight away from each other and had a hard time figuring out how to move one hand forward and the other hand backwards to create a tear.  Also by pulling their hands straight apart they were using an immature grasp whereas the opposing hand motions encourages a more mature pincer grasp.  Think of the fun your kids can have tearing paper!

January 25, 2012

Marble Painting – More Than Just a Cool Piece of Art

Ever since I discovered Pinterest I have been bombarding my OT’s at work with ideas that look really fun and purposeful.  The idea I was the most excited about was the marble painting from Play Based Learning, so when one of the OT’s decided to try out this activity for a kiddo to encourage bilateral hand use because he doesn’t like to use 2 hands I was so excited to hear about it and see the final result!  Luckily it was a success as you can see from his finished art work.  And, even better the OT was able to realize other great skills this activity provided the opportunity to practice.  I thought I would share them:

  • It worked on visual motor because he was tracking the marble as he moved it about the paper
  • It worked on his ability to use a utensil because he was so excited to spoon the marble out of the paint onto the paper that he was actually willing to use a spoon – something that was not the norm
  • It worked on grading movement because if he moved the bin to fast or made too large a movement the marble came flying out
  • It also worked on variable movement because the tendency was for the child to want to move the box back and forth in one directional plane but then all he would get is a line on his paper.  This activity allowed them to work on diagonal and horizontal and vertical and circular motions to name a few.

Overall though, the best part was that the kiddo loved doing the activity and couldn’t wait to show his parents and didn’t want to let go of the project once it was complete!

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