Category Archives: occupational therapy

General Tips for Selecting Developmental Toys for Children

By: Laura Van Zandt, MS, OTR/L and Sarah Peabody, Physical Therapist

It’s the most wonderful time of the year! Time to decorate your home with seasonal decorations, listen to cheerful holiday music, start baking lots of yummy goodies, spend time with friends and family, and shop for the perfect holiday gifts. This time of year can bring merriment and stress! Especially when considering gift ideas for children.

If you are buying a toy for a child, it’s important to select something that is based on his/her individual need. Every child is unique. Purchasing a toy for a child with special needs involves taking into consideration the child’s unique developmental profile.

IMG_2343Children who lack fine motor skills often have trouble doing things with their hands, like holding a crayon, so they might enjoy toys with large knobs or big levers that will enable them to grasp them more easily. Children with social learning difficulties or sensory processing difficulties might prefer toys that offer movement or heavy work.

Children with physical disabilities might enjoy toys that have buttons and don’t require a lot of fine motor manipulation. They might also enjoy more arts and crafts that allow them to just move their arms without having to worry about holding onto something.

Choosing a toy that is age-appropriate, promotes healthy development, and encourages positive behavior works best. Use these tips below to help guide you for buying gifts for your child, a niece or nephew or other child:

General Tips for Selecting Developmental Toys for Children:

  1. Spanning multiple age ranges

Finding a multipurpose toy that spans multiple age ranges is a great investment. Toys that are meant for several ages and stages of childhood will be kept around and cherished for a long time.  For example, this Shape Sorter, can be used in late infancy as you place the shapes in and out of the box with the lid open. As your child grows into the toddler stage and enhances their fine motor skills, he or she will learn how to manipulate the shapes and place them in the appropriate spot. You can then incorporate colors, shapes, etc. all into one piece as they advance even more. Another example is magnetic letters. A child can use these at a young age to learn letters and sounds and as they grow into elementary years use them together to make words.

2. Be cautious of age recommendations

Many toys have a suggested age range based on the safety and developmental appropriateness for a child. These recommendations are based on the developmental abilities of an average child and may serve as a starting point for you when selecting a toy for your child. A toy should be challenging, but not frustrating. Likewise, if a toy is too simplistic and beyond your child’s abilities, he or she will quickly lose interest. Children learn and grow at various paces, and what might be an appropriate toy for one two-year-old child may not be for the next.

3. Promoting Exploration and Imagination

17_LilyPennyMaddy2.jpgResearch has found that toys that do “too much” don’t encourage children to use their imaginations. Stuffed animals that talk and sing only prompt the child to press a specific button which takes charge of the play scheme. Instead, look for a toy like blocks. Blocks can be stacked up to build a tower, knocked down by a dragon, lined up to make a city, the list goes on and on. The more your child has to problem solve and use his or her imagination, the more your child will learn through play.

4. Think, Move, and Interact

This generation loves to be entertained with screens. Instead of getting that Ipad or other video console, look for toys that provide opportunities for cooperative play that encourage the development of social skills and positive behaviors like taking turns. Board games are a great example!

5. Sensory Considerations

Toys that are tactile or visual can often help improve how a child processes the information. Music, varying textures, flashing lights, and colors can all improve the sensory appeal to your child. It is important to know the needs of your child because what is appealing for one child may be overstimulating for the next.

6. Promoting Inclusion

Toys that promote groupwork and peer interaction with other children are great to promote social skills and improve self-esteem and overall quality of life.

7. Think outside the box.

Toys don’t always have to be used in the conventional manner. For example, that food puzzle might be a little hard for your child to sit still and focus to complete, however, maybe your child would be motivated to find the pieces hidden in a tactile bin or exploring the house on a gross motor adventure to find the food. For children with physical disabilities, many battery operated toys can be adapted for switches. Check out this blog for directions and this link for purchasing battery interrupters.

If you child is younger, can you use that ring stacker to look through the circles together at each other. Or maybe the rings fit on different body parts. If your child is older, think about using the toys within movement activities.

8. Will the child make memories with it?

Giving experiences is becoming a new, more popular trend (for multiple reasons!). Taking time to explore local attractions can create long lasting memories and even new post-holiday traditions. Most businesses and even public libraries offer gift certificates to local attractions. This is a great way to really personalize a gift for your child.

9. Fun!

Last but not least, make sure the toys are engaging and fun. Do not force a toy upon a child. If they appear not interested in a certain toy, leave it for a few days and re-introduce it at another time. Keeping the toys fun will ultimately make the learning fun for your child.

Visit this blog next week, for more of our specific toy recommendations! You can also search our previous blogs for each year’s toy recommendations like here and here. Happy Holidays! For more information on Easterseals DuPage & Fox Valley visit eastersealsdfvr.org.

 

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Preparing for Halloween

By: Laura Van Zandt, MS, OTR/L

Halloween is right around the corner! Most kids can’t wait to put on their costumes and make their way through the neighborhood. No child wants to be left out of the fun of trick or treating or holiday parties. Unfortunately for some children this often happen.s However, with some planning and preparation, children with sensory issues or other special needs, don’t have to be left out and can enjoy this exciting time of year.

article-calendarGeneral Tips

  • Create a schedule for special activities. Tailor the schedule to your child’s needs. Whether it’s a picture schedule or written schedule, using a schedule will help your child be able to anticipate what is coming up and feel calmer. Discuss the schedule regularly and provide information for each transition. Sometimes just knowing what’s next can help children with extra needs feel less anxiety.
  • Try using a social story that includes a pictures for your children to help visualize the day and better predict what will happen. You can click here for some sample stories.
  • Try having a code word your child can use if he or she feels overwhelmed and needs a break. When your child uses the code word, help them leave the situation for a few moments and discuss coping skills. Again, giving children some control during activities that may be overstimulating will reduce anxiety and enhance the fun.

Decorations

Decorations like fake cobwebs, scary jack-o-lanterns, hanging ghosts, and mist from fog machines can bother kids with special needs.

  • Consider taking your child to explore the Halloween section of a local big-box store. You can help your child get used to the various sounds and sights by pressing the different buttons on the various machines. You can also help them get used to the different sensations by touching the variety of decorations. This can be helpful to figure out which ones to avoid during the festivities.
  • If your child doesn’t like the smell or slimy texture of pumpkin insides, there are a ton of different ways to decorate pumpkins. You can use paint or permanent markers and stickers to decorate your pumpkins. Pinterest has a ton of ideas like using playdough, coloring with crayons, or using decorations.

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Costume Tips

Costumes can be really tricky for our kids. Remember, costumes don’t have to be expensive to be fun and enjoyable for the holiday. When trying to decide on the just right costume, it is important to think not only about the theme but also about how it will feel, fit, and even smell.

  • When you find the just right costume, some kids will benefit from washing it a few times to soften the fabric before wearing it the first time.
  • Some children might benefit from practicing wearing their costume before the big deal. This will allow your child to problem solve anything that doesn’t feel comfortable. You should practice walking and sitting while wearing the costume.
  • It might be helpful to wear comfortable clothes or pajamas under the costume.
  • Don’t overlook simple costume ideas. With pinterest now there are a ton of creative ideas that don’t have to involve store bought costumes. You can involve the whole family with themed costumes (this year my family is doing Rock, Paper, Scissors with our regular clothes and few adaptations).
  • For trick-or-treaters who use a wheelchair or need help walking long distances, you can get creative and decorate their equipment or wagon.
  • For parents who want help in designing or making costumes, there are several resources in bookstores and on the web. Some sites, such as Family Education, provide costume making instructions. Also, organizations, such as the Muscular Dystrophy Association (MDA) and The Bridge School, offer tips and examples of costume ideas. Charities, like Costumes for Kids, collects used costumes and offers them to physically disabled kids too.

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Trick or Treating Tips

Trick-or-treating can also be hard. Noisy crowds of kids and flashing decorations. Walking around the neighborhood. Walking at doors. Talking to unfamiliar people. Food sensitivities. Food allergies.

  • Do you know about the teal pumpkin? The Teal Pumpkin Project encourages people to raise awareness of food allergies and promotes inclusion of all children by offering an alternative treat for whom candy is not an option.
  • Go out at dusk or before the streets get very dark and crowded.
  • Only treat or trick at houses you know.
  • Map out and practice the route with your child ahead of time so it feels familiar.
  • Pull your child in a wagon or let your older child ride a bike to avoid having other kids crowd/bump into him or her.
  • Program a special Halloween message into a communication device for kids who need help with language.
  • Have some favorite calm down activities or toys ready in case it gets too much for your child.

Please comment below with any suggestions or strategies that have worked well for you. For more information on Occupational Therapy at Easterseals DuPage & Fox Valley and helping children with sensory needs visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

 

How Speech-Language and Occupational Therapies Work Together

By: Danielle Maglinte, MAT, MS, CCC-SLP

Ryan - webYoung children go through many developmental stages before they begin talking. One of the first stages of development is shared attention. In a baby, shared attention looks like the baby turning her head toward mom when she hears mom’s voice or a baby looking into dad’s eyes when dad talks to the baby. As children get a little older, shared attention looks like mom holding up a toy, the child looking at the toy, then looking back at mom and smiling. The next step in developing shared attention is dad looking at or pointing to a toy, the child looks where dad looks or points, then he looks back to dad. These steps towards developing shared attention typically happen within the first 12 months of a child’s life.

When a young child reaches a stage of shared attention where they can follow a caregiver’s point and they can shift their gaze between the caregiver and the object, they start to develop back-and-forth communication. At first, this looks like a child reaching for an object to tell the caregiver “I want that.”

As back-and-forth communication with gestures continues to develop, the child starts to vocalize. In the beginning, these vocalizations are mostly babbling. As parents talk back when the child babbles, these vocalizations turn into jargon where a child sounds like they are speaking in sentences but not actually saying words. Some parents comment that it sounds like the child is speaking in another language. Over time, the child’s vocalizations are shaped into short, simple words, such as mama, dada, and baba for bottle. Children with speech delays often demonstrate limited shared attention. Working to develop strong shared attention will help a child learning to communicate.

One challenge for some children with speech delays is that they need to maintain a calm, regulated state so that they are available for interactions and can share attention with another person. Read more about self-regulation from OT Maureen here.

15_JJAzariahIf a child is focused on seeking sensory input, they may not have the ability to focus on social interactions, developing shared attention and speech with caregivers. Occupational therapy can help figure out activities and ways we can include these activities in everyday life so that a child can remain in a calm, regulated state so that she is available for social interactions. This may look like a child with limited eye contact running away and looking back to see if you are chasing him or a child who is quiet asking for “more” when you stop pushing the swing.

When a child stays regulated for longer periods of time, she will be available for interactions so that she can continue to develop strong shared attention, and move on to using gestures and speech to communicate. By working together, speech-language therapists and occupational therapists can help a family find activities, such as climbing, playing chase, swinging, and swimming  or others that help a child with speech delays stay regulated and available to develop shared attention and communication skills.

To learn more about speech-language and multi-discipline therapy at Easterseals DuPage & Fox Valley visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/speech-language-therapy.html. 

Back to School Organization

By: Laura Van Zandt, MS, OTR/L

With many of our children returning back to school, I thought this would be a good time to review some strategies to help with school organization. Kids need organization skills in order to function during their school day as well as to get their homework done efficiently at home. If your child struggles with a messy desk, overstuffed backpack, keeping homework and classroom assignments organized, or lost and missing parent/teacher communication slips then hopefully you can find some tips and tricks in this blog. Remember every child is different and what works well for you or another child may not necessarily work well for your own child.backpack

  • Most importantly develop routines and stick to them as closely as possible. Some children might benefit from additional support to help learn the routine such as checklists, picture schedules, and/or social stories. Younger children might also benefit from turning the routine into a fun song.
  • Create backpack organization systems. Look for backpacks that offer multiple compartments to denote separate spaces. A backpack with at least two compartments is highly recommended. Use a zippered pouch (clear is the best) for pencils, erasers, calculators, etc. in the backpack.
    1. Please check out my previous post on backpack safety.
  • Place a laminated checklist clipped to your child’s backpack zipper that lists what needs to be brought home each day. This one from Understood.org is great. 
  • Go through the backpack on a regular basis with your child until he/she gets the hang of keeping it organized. Gradually give your child more responsibility and continue to check in even when you have turned in all the responsibility to your child.
  • Create a simple schoolwork folder system. A simple 2 pocket folder often works best. Use a bright sticker to place on one side for “KEEP AT HOME” and another bright sticker for the opposite pocket for “BRING BACK”. If your children are older, you can create a color coded system that corresponds to each class. Books and notebooks can use prefabricated book covers or you can use colored paper to create book covers in a variety of colors.
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Picture from caffeinatedconclusions.blogspot
  • Depending on the age of your child you might start to create a really good binder system. The best ones have a locking rig. Some binders have a clear plastic cover which can be used to create large labels on the outside for different subjects (if you are using a different binder for each subject) or you can use it to hold assignment sheets.
    1. If you are going to start a binder system, then you should invest in a few more organization assistants. Things like subject dividers, a zippered pencil pouch, sheet protectors, two pocket three-hold punched folders, and a portable three-hold punch are really helpful. You can organize each subject section the same. Label each subject divider tab and then include an empty sheet protector immediately behind for important handouts. Behind the sheet protector you can include a folder which follows the same simple schoolwork folder system idea above.
    2. A different option could also be to continue to use the subject divers, zippered pencil pouch, sheet protectors, two pocket three-hold punched folders, and a portable three-hold punch; however, instead of using the simple schoolwork folder system idea above with the two pocket folders, you can create one global folder that is in front of the binder where your child put homework for each class in front. At the end of the day, when at home, you can then sit with your child and help organize their homework when completed back into each individual subject folder.

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  • Some children might do also better with an accordion file based system. One suggestion for organized would be using the front section to keep your child’s homework planner or global two-pocket folder homework folder. Each additional pocket would be labelled with the different subjects and might include a separate pad of paper for that subject. I like to avoid loose sheets of paper as much as possible with an accordion system as I find they tend to slide down.
  • Create an organization system for lockers. Some children like to create a container system where they use separate containers for different belongings which are labeled with pictures on the outside to know what goes inside each bin. You can also add a picture to the locker for a visual cue for where each item belongs which the locker to further help keep things organized. Shelves are also helpful to better divide the space.
    1. lockerTo help you and your child determine the most logical and efficient way to organize the locker and backpack, here are some helpful questions (source: The Organized Student)
    2. What is your child’s schedule like? If the schedule is consistent, you can probably just separate the locker into two sections, morning and afternoon. If it changes every day, you might want to organize differently
    3. What extracurricular activities does your child participate in and what supplies/equipment is needed?
    4. Does your child keep supplies and equipment in a locker at school or do they travel back/forth between school and home on a regular basis?
    5. How many books is your child required to keep track of throughout the day
    6. Does your child’s school offer a second set of textbooks on loan?
    7. What type of storage and accessories does the locker already contain?
    8. Does your child have time to go back to his/her locker between classes?

 

  • Create a homework station at home. Include all necessary school supplies such as pencils, pens, crayons, markers, glue, scissors, paper, etc. You can use everyday items (mason jars, muffin tin) to help organize items. Containers available at any office/home good are great ways to help organize. You can attach labels made from a label marker or also just use post-its and adhere using clear tape. Every item has its own place and it is easy to spot. Ask your child’s school if it is possible to get a second set of textbooks to eliminate the need to bring books back and forth between school and home. Mark off spaces for items like books and pencil box using painter’s tape. If your child is older, you might think about creating a “desktop file box” which is described in a lot more detailed in The Organized Student book.

 

  • Help your child learn to breakdown assignments into manageable chunks. One example includes folding worksheets into sections that can be completed before moving onto the next section.
  • Invest in some telling time systems. It is often helpful to breakdown into the concept of telling time, daily time, weekly time, and monthly time. I prefer to use analog’s watches or timers for this as you can see the passage of time which is missing from digital systems. When first learning to tell time and gauge time, create from fun activities to experiment with by guessing how long it will take and then compare guess to actual. It might be useful to have several timers. One for the global amount of time your child/you think he/she needs to complete the assignments and an individual one to break down individual assignments into manageable chunks and to add a spot for a quick break. If you can find an analog clock that also allows for a quick glance to see the time digitally, that might also help.clock
  • Finally, if you have read any of our previous posts on executive functions or attended our executive function client group, then you might be familiar with the group Cognitive Connections. They developed an app that allows users to create a time marker to get ready for work, a timer marker to check in during work, and a marker when the work is planned to end. There are tones activities when the time reaches each marker. This could also be a good choice for some children.
  • The key to any organization system is be flexible to your child’s unique organizational style and needs as well as be consistent and offer check-ins until your child has mastered the system. Even when your child has mastered the system, continue to offer periodic support.References and Helpful Resources:

From one mom to another: Early Intervention tips

By: Laura Van Zandt, MS, OTR/L

Having a newborn baby can be just as equally thrilling as it can be equally exhausting. Adjusting back to home life can be overwhelming at times as you are healing and beginning to learn all about your new bundle of joy. Understanding that all newborn babies are very different from each other, here are five tips that I found helpful as both a new mom and pediatric occupational therapist:

  1. First and foremost remember to breathe and smile. This time of your life is both wonderful and stressful. Deep breathing has been proven to be very beneficial. The many benefits include a reduction in stress and blood pressure. Deep breathing releases natural “free-good” hormones in our body. Learning a few techniques and tuning into your body for just a few moments can help. If you can force a smile on your face. A smile can be enough sometimes to turn any situation into something to find humor within.

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    Try calming breaths while giving your infant a massage.
  2. Use your tribe and forget as much as possible about modesty. Your tribe, or your support team, doesn’t care what you look like or that you haven’t showered in several days. They love you for who you are and not anything else. Those first weeks can be challenging, especially if you have a children with medical needs. Let them help so you can a little rest to keep yourself going strong.
  3. Talk to yourself. It might feel funny at first but it can help. It doesn’t matter what you say. I often find myself talking about anything and everything- the plan for the day, what is happening right now, about my son’s family, etc. The added benefit of talking to yourself is your child also gets to hear your voice.
  4. Try to develop routines early. It’s really hard the first weeks adjusting and even thinking about routines. I’m not even sure most newborns have routines aside from eat, sleep, and diaper changes; however, if you can try to establish some routines it will help your sanity and also help your newborn develop. For my little one, we try to follow a little routine of eat, quiet alert/play if he stays awake, and sleep. I try to use similar songs and even sing the same song over and over when he is trying to sleep. You can even plan to take a stroller walk around the block the same time every day. Having routines help signal to our bodies a sense of calmness and can provide a little bit of organization when things are crazy.
  5. baby sleeping on white cotton
    Photo by Pixabay on Pexels.com

    Sensory strategies can be your best friend. Some ideas include the use of auditory input such as white noise, talking softly, or singing, movement and swings, and deep pressure or swaddling. It was crazy what a little bit of white noise did for my son. It was enough to calm and quiet him. Now I use it at bedtime to help him get back into a deeper sleep. I use one with a timer so it doesn’t run continuously. I also talk a lot to my son. It was amazing how fast he learned to recognize my voice and respond to a calm voice, if he wasn’t too upset. I was never someone who spoke aloud but now I found myself telling him all kinds of things. I think the soft melody of my voice must have some calming property for him. Also deep pressure and movement can help a newborn in those early months. When a newborn enters this world they are in a position called physiological flexion which they slowly work out of over the next month or two. Swaddling provides physical boundaries much like the womb which allows your child to feel secure. When they wiggle within the swaddle believe it or not they are learning very early about where their body is in relation to this great big world they entered. Along with swaddling you can also try massage. Infant massage has shown to be a wonderful bonding time for newborns are their parents. Movement is the next sensory strategy. I was very lucky my son loved his swing from the very beginning. I don’t know if this had anything to do with how much I moved around on my job, but back and forth movement is one of the best ways to help calm a child. Rocking chairs and swings can be your best friend.

If you find this newborn phase to be very difficult or think you child may not be reaching his/her milestones, talk with your pediatrician and schedule an evaluation. Many parents find physical, speech, occupational or nutritional therapy for short or long periods provide much needed support and growth for their infants. Learn more at eastersealsdfvr.org. 

 

 

Improve Children’s Handwriting

By: Laura Van Zandt, MS, OTR/L

There are many reasons children are referred to occupational therapy, but one of the most common, especially for school-age children, is because of difficulties with handwriting. Expectations for handwriting increase quickly between grades.

In most preschools, handwriting is done through more hands-on activities (think playing with play dough or using a paint brush). Then in kindergarten, children are expected to be able to write. By first and second grade, they are expected to write for longer periods of time with accuracy.

Many of the children we see as Occupational Therapists are able to write, but might have concerns with proximal stability (think core and shoulder strength), endurance, or have an inefficient grip on their writing instruments that may lead to messy handwriting. Other reasons might also be related to vision or sensory processing.

NicholasBelow are a few tools for children to help their hands for strength, endurance, and grasp.

Some things to keep in mind when picking out writing tools for children:

  • The smaller the writing instrument is, the more likely it is to encourage a tripod-like grasp (you may need to build up the handle to encourage)
  • For kids with decreased grasp strength, drawing and coloring with markers or gel crayons may be easier and decrease frustration when presented with more challenging activities
  • Work on a vertical surface whenever possible. It’s not only great for working on increasing upper extremity and core strength, it encourages wrist extension which is important for proper grasp on writing instruments

Squiggle pen

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Who doesn’t remember this pen from their childhood!? The Squiggle Wiggle Writer is a vibrating pen that produces squiggly lines. It comes with 3 interchangeable pens which slide in and out of the tip of the pen (which is great for working on bilateral coordination). The vibration is great for providing children with sensory input while drawing or writing which helps with focus and attention.

Mechanical pencils

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Picture by: www.raymondgeddes.com

I am a huge fan of using mechanical pencils with children because it helps them work on grading the pressure they use when writing. If you press too hard, the tip will break which gets frustrating after a few tries.

 

Twist and Write Pencil

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This pencil was designed for a child’s hand. The Y design not only encourages a child to utilize a tripod grasp, but it also forces them to use less pressure allowing them to write for longer periods of time without tiring.

 

Small Pencils, Broken Crayons

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I always have a collection of 1/2 pencils to use with the kids. The shorter a pencil, the more likely they are to use a proper grasp.

 

Beginning Writers

palm eggs

Crayola has launched a handful of new products meant just for little hands. These egg-shaped crayons are the perfect size and shape for your little artist. There are many benefits of children drawing at an early age including developing fine motor and grasping skills, encourages creativity and imagination, improves hand-eye coordination and bilateral coordination.

If you have an easel, I highly recommend having even the youngest of artists to use that because working on a vertical surface is great for kids of all ages. Working on a vertical surface helps increase core and upper extremity strength while encouraging proper wrist position, head and neck position, promotes bilateral coordination, and crossing midline skills.

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Stylus

 

pexels-photo-416396.jpegFor a variety of reasons, kids spend more time on tablets these days. As with all things, as long as you don’t overdo it, working on the iPad can provide a lot of benefits. One of the things I recommend to all parents is that if they are going to let their kids use an iPad or other kind of tablet, be sure to have them use a stylus as much as possible to help develop fine motor and grasping skills. I think this is especially important if your child is doing any kind of handwriting or drawing apps. There are a lot of different stylus’ to choose.

 

Sidewalk Chalk or Small Chalk Pieces

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One of my favorite outdoor activity is drawing with chalk.

 

Learning Without Tears Flip Crayons

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Photo by: therapro.com

This is one great product. The crayons are already nice and small to encourage a tripod grasp and having a different color on each end encourages in-hand manipulation skills.

 

Triangle Shapes

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Triangle shapes are perfect to encourage the use of just your first three fingers.

Forbidden Tools

window crayons  bathtub crayons

Who doesn’t like the power of doing something forbidden like writing on windows or in the bathtub! These special items from crayola are designed to encourage writing and creativity is a fun way but also keep mom and dad’s sanity with easier clean up!

For more information on occupational therapy services at Easterseals DuPage & Fox Valley, visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

Techniques of Occupational Therapy: Integrated Manual Therapy

Editor’s Note: Janet Mroz serves on the Occupational Therapy team at Easterseals DuPage & Fox Valley. She has been an occupational therapist for over 30 years and below are excerpts from a couple interviews about her work.

Janet Mroz.jpgWithin the field of Occupational Therapy there are a variety of techniques offered. The sciences are constantly evolving, which makes the profession fascinating and fun, especially for those who enjoy learning about one of the most complicated objects, the brain.

Circumstances in a person’s life can lead them to different areas of the journey. Janet was introduced to alternative medicine because of a significant car accident she faced.  Due to the injuries sustained and because traditional medicine did not resolve her medical issues, she was lead down the path of alternative medicine. At the Upledger Institute she learned about Cranial Sacral Therapy (CST) and studied the program for multiple years.

Upledger Institute says “CST is a gentle, hands-on method of evaluating and enhancing the functioning of a physiological body system called the craniosacral system – comprised of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord.

Using a soft touch generally no greater than 5 grams, or about the weight of a nickel, practitioners release restrictions in the craniosacral system to improve the functioning of the central nervous system.

By complementing the body’s natural healing processes, CST is increasingly used as a preventive health measure for its ability to bolster resistance to disease, and is effective for a wide range of medical problems associated with pain and dysfunction, some of which include:

  • Migraine Headaches
  • Chronic Neck and Back Pain
  • Motor-Coordination Impairments
  • Colic
  • Autism
  • Central Nervous System Disorders
  • Infantile Disorders
  • Learning Disabilities

Janet also learned about Integrated Manual Therapy techniques that impact not only the cs craniosacral system but also impact the fascial system, organs, lymph system, and nervous system. She enjoys learning this field and continues to work with a mentor to continually improve her abilities. In addition, working with various colleagues that are trained in IMT has introduced her to additional alternative approaches which makes it very rewarding for her.

Janet’s Integrated Manual Therapy (IMT) program is based from this study and incorporated into a traditional occupational therapy approach (and sometimes aquatic therapy settings). The therapy helps a body achieve balance to help a body work as optimally as possible. A person’s anatomical, physiological and emotional systems can all take a toll on a body’s balance. Through this very light pressure at specific points of the body she investigates and eases the primary cause of the current pain or dysfunction. Her work may help a person have improved mobility and movement, circulation, sensory function and immune responsiveness.

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This treatment is very individualized and Janet feels that many people can benefit from the treatment, even those without a disability. Janet will often get “tune ups” so that her body is able to work with less compensations and work as optimally as possible with less effort. The treatments may benefit many people to live with less pain, greater mobility, greater energy and better sleep.

For more information about Occupational Therapy services such as IMT at Easterseals DuPage & Fox Valley, visit our website.

What are Fine Motor Skills?

By: Kelly Nesbitt, Occupational Therapist

If you’re a parent, you know how busy your child’s hands are 24/7. Kids are constantly using their hands to pinch, squish, pull, draw, and manipulate toys and objects in their environment; all thanks to fine motor skills that they have developed over months of play and exploration. But what are fine motor skills exactly, and why do they matter?

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Fine motor skills typically refer to the ability of the hands (through development of the small muscles of the hand and experiential learning) to manipulate objects in order to accomplish specific tasks. Without fine motor skills, your child would have trouble zipping up their coat, buttoning their jeans, tying their shoes, pinching finger foods during dinner, writing with a pencil, scribbling with crayons, opening containers to get a snack, pushing LEGO® together, or turning pages in their favorite bedtime story.

How do fine motor skills typically develop? While every child develops fine motor skills at different rates, children typically develop fine motor skills in this general developmental sequence:

Babies: Learning to reach, grab, and pinch!

  • 1-2 months old:
    • Bat arms inaccurately toward a toy placed by them and will occasionally struggle to grasp onto toys in an intentional manner.
    • Babies at this stage (from birth to approximately 4-6 months old) have a reflexive grasp, meaning that if an object is placed in their palm, they will automatically grasp around the object.
  • 3-4 months:
    • Grasp onto objects in the palm of their hands without their thumb helping them hold onto the object.
  • 5 months:
    • Reach and grasp onto objects placed by them with greater accuracy.
    • Begin to use the thumb more in grasping with their palm of their hand around 4-5 months. This is called a “palmar grasp
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    Photo by Lauren Vitiello

    6-8 months:

    • Reach accurately to items they want.
    • Start using their first 3 fingers (thumb, index, and middle fingers) to hold items in the palm of their hands. OT’s refer to this type of grasp as a “radial palmar grasp
  • 9 months:
    • Start to primarily use their fingers to hold onto objects. For example, they may hold a block between their thumb, index and middle fingers around their knuckles and not with the very tips of their fingers. OT’s refer to this kind of grasp as a “radial digital grasp
  • 10-11 months:
    • Develop an “inferior pincer grasp” in which they can use the pads of their thumb and index fingers to “pinch” onto objects
    • Become interested in dropping objects into containers for play
    • Starts scribbling on paper while coloring

Toddlers: Learning to manipulate, grasp, and cut with scissors

  • 12 months:
    • Develop a “superior” or “fine pincer grasp” in which they can use the very tips of their thumb and index finger to pinch onto smaller objects. Think about how you would pick up a tiny bead with your thumb and index finger; that’s the superior pincer grasp!
    • Move small items in one hand from their fingertips to the palms of their hand. This is referred to as “finger-to-palm translation.” A good example of finger to palm translation is the action of picking up multiple coins, one-at-a-time, with the fingers and moving them into the palm of your hands.
    • Color using their whole hand to grip onto markers and crayons with their palms facing up, known as a “palmar-supinate grasp.
  • 15-18 months:
    • Kids are able to stack 2 cubes on top of each other
    • Kids are able to put large puzzle pieces into a puzzle
  • 2 years:
    • Develop the ability to move small objects from their palm to their fingers, also known as “palm-to-finger translation.”
    • Start motion of twisting caps on bottles with their fingers tips, called “simple rotation.”
    • When drawing, copies an adult in making horizontal, vertical, and circular marks
    • Unbutton buttons
  • 2-3 years
    • Color using a “digital-pronate grasp” where the palm faces down and whole fist is wrapped around the marker or crayon, with one or two fingers “pointing” on the utensil.
    • Start to use scissors to make small little cuts into paper.
  • Marita Blanken_3_MG_9081A3-4 years
    • At 3, kids can copy a pre-drawn vertical and horizontal line and circle
    • Thread medium sized beads onto string
    • Color/write using a “static tripod grasp”, which means that kids use their thumb, index, and middle finger to hold onto a pencil with the tips of their fingers and use their wrist to move the utensil.
    • Uses scissors to cut straight lines and simple shapes like squares and triangles. At this point, cutting out circles is pretty tricky.
    • Around 4 ½ years, kids may begin using a “dynamic tripod grasp” which involves the thumb, index, and middle finger to hold a utensil with the tips of their fingers and use the motion of their fingers to draw
    • Around 4-5 years old, a child is able to write some letters and numbers and may be able to write their own name
    • Can copy a cross when drawing

Kindergarten

  • 5-6 years
    • Further development of the dynamic tripod grasp occurs from 4 ½ -6 years old
    • Cuts out complex shapes with scissors and is able to more neatly cut out circles
    • Able to copy a triangle
    • Copy most uppercase and lower case letters
    • Print their name
    • Tie shoes

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Of course, this is not an exhaustive list of the fine motor skills that kids display at different ages. But, this list will definitely give you an idea of what skills you should see in your little one in time.

 

If you have any questions about your child’s fine motor development or any concerns get connected with an occupational therapist. The Occupational Therapy team at Easter Seals DuPage & Fox Valley offer a depth of knowledge and range of certifications to assist children with autism or physical challenges at any level of involvement. Because each child’s needs are different, we create an individualized treatment plan based on parent concerns and the most current treatment approaches. Click here to learn more. 

References

[1] Case-Smith and O’Brien (2015). Occupational Therapy for Children and Adolescents (7th ed.). Saint Louis, MO: Elsevier

[2] Rita P. Fleming-Castaldy (2014). National Occupational Therapy Certification Exam Review & Study Guide. Scranton, PA: TherapyEd.

[3] Lurie Children’s Hospital (2018) Fine Motor Development Milestones. Retrieved from: https://www.luriechildrens.org/en-us/care-services/specialties-services/occupational-therapy/developmental-milestones/Pages/fine-motor-skills.aspx

 

 

 

 

[1] Case-Smith and O’Brien (2015). Occupational Therapy for Children and Adolescents (7th ed.). Saint Louis, MO: Elsevier

2 Rita P. Fleming-Castaldy (2014). National Occupational Therapy Certification Exam Review & Study Guide. Scranton, PA: TherapyEd.

3 Lurie Children’s Hospital (2018) Fine Motor Development Milestones. Retrieved from: https://www.luriechildrens.org/en-us/care-services/specialties-services/occupational-therapy/developmental-milestones/Pages/fine-motor-skills.aspx

 

 

 

 

Sleep Tips for All Ages

By: Laura Van Zandt, OTR/L

As a soon to be new mom, sleep is something that is very important to me and something I will soon be getting very little of in my life! I often get questions by parents about sleep and how to better help their little ones develop good sleep habits and routines. There are many great sleep books available  to read and review for sleep suggestions. Many are targeted towards babies; however, they still contain useful information about typical sleep patterns as well as some guidelines for establishing sleep routines and how to sleep coach. In order to better prepare myself and my husband, I’ve been reviewing some of my handouts on sleep and wanted to share what I found useful.

My first step with families is to help them understand that sleep is a learned behavior. There are many reasons children have difficulties with sleeping. A child may have difficulty sleeping because:

  •  She hasn’t yet learned to put herself down to sleep
  • He might have difficulty self-calming and quieting his body and mind for sleep.
  • She might have separation anxiety
  • He is testing limits
  • She might have an overactive imagination
  • He wants to play longer and will resist going to bed
  • She is sensitive to noise, textures, or odors which makes it difficult to relax to sleep.

04_Bodhi2.jpgOlder children have increasing demands on their time from school, sports, extracurricular activities, and other social activities which can impact sleep.  A child might also snore or have noisy breathing during sleep which should be evaluated by their pediatrician with possibly a referral to an ENT to rule out sleep apnea or enlarged adenoids.

Going to sleep and getting enough sleep are skills we need to teach our children. Optimal sleep helps to ensure children are able to play and ready to participate in daily activities. It also promotes brain development and growth.

How many hours does a child need to sleep?

Newborns sleep about 8 to 9 hours in the daytime and about 8 hours at night. Most babies do not begin sleeping through the night (6 to 8 hours) without waking until at least 3 months of age; however, this varies considerably and some babies do not sleep through the night until closer to 1 year.

Infants typically sleep 9-12 hours during the night and take half hour to two hour naps, one to four times a day, fewer as they reach age one. Research shows that when infants are put to bed drowsy but not asleep, they are more likely to become self-soothers which allows them to fall asleep independently and put themselves back to sleep when they wake up. Babies need our help to establish their own sleeping and waking patterns. You can help your baby sleep by recognizing signs of sleep readiness, teaching him/her to fall asleep on their own, and providing the right environment for comfortable and safe sleep. Your baby may show signs of being ready for sleep by rubbing their eyes, yawning, becoming fussier, or looking away.

Toddlers need about 12-14 hours of sleep in a 24 hour period. When they reach about 18 months of age their nap times will typically decrease to one a day lasting one to three hours. Caregivers should try to avoid naps occurring too close to bedtime as this could delay sleep at night.

Preschoolers typically sleep 11-13 hours each night and most do not nap after 5 years of age. It is not uncommon for preschoolers to experience nighttime fears and nightmares in addition to sleepwalking and sleep terrors.

Children ages 5-12 years need 10-11 hours of sleep. Older children may show signs of insufficient sleep by falling sleeping when it is not nap time, frequently waking-up tired and crabbing, seeming irritable or difficulty to please, appearing clingy, or may have a short attention span.

Here are some general tips for all ages.

19_JOERGENRUDAbel.jpgRoutines and consistency is a critical. Parents and caregivers can significantly influence a child’s sleep through scheduling and routines. Some kids do well taking a bath and reading books/telling a story while lying in bed and preparing to sleep. Reading together can be a great way to spend some quality time together and allow the body to relax. Some kids might also need some calming heavy work input prior to bath time or getting into bed for stories. One of the first things new parents learn at the hospital is how to swaddle their newborn because snugly wrapping your baby in a blanket provides calming deep pressure tactile and proprioceptive sensory input allowing the newborn to feel secure and safe. Rocking chairs and baby swings are also some of the most valued and used pieces of baby equipment because of the repetitive movement qualities that provides calming vestibular sensory input.

Some examples of calming heavy work input and movement that might help your child include massage, yoga, pillow squishes, gentle, rhythmical, and linear swinging for at least 15 minutes before bedtime. I would recommend trying simple games that don’t have a competitive nature to them since they are more likely to increase arousal level. We want our children to learn to calm down and be quiet before bedtime.

Darkness is key. Make sure that the bedroom where your child sleeps is as dark as possible and pay special attention to blocking out the early morning sun. Sunlight is a natural wake-up signal; using room-darkening shades and curtains to block out light will help your child sleep. If you are going to use a night light in your child’s room, try to make a compromise and place one right outside your child’s bedroom or opt to turn off the night light after an hour. You can also try a touch operated, battery powered night light with a timer that goes off if your child wakes up in the middle of the night and needs to use the bathroom or hears a noise and needs to be reassured briefly.

Provide some white noise. Parents and caregivers of babies can often be heard making the familiar “shushing” noise or quietly humming to quiet and calm their little ones. These repetitive, quiet sounds mimic the calming, reassuring noises the baby heard when he was in the womb. A sound machine or small fan in your baby’s room will provide a soothing hum of background noise. This has the added benefit of drowning out other noise that might otherwise wake your child

Adjust pajamas. Don’t let your child go to sleep in daytime clothes. Observe your child’s sensory preference for touch. Typically speaking, soft textures are not just comforting but it is also a tactile sign for your body to be calm and quiet down. If you are the parent of a baby, you might want to consider swaddling or using a sleep sack as they grow. Swaddling providers a snug comfort via deep pressure and tactile input that is similar to the womb space.

Look at different blankets and mattresses. Some children, especially children who might have difficulties with sensory processing, are sensitive to the feel of different textures. Blankets of different weights and materials might also be preferred at different times of the year. Weighted blankets or lycra sheets over the mattress may also be helpful options as the provide gentle but sustained deep pressure input which can be calming to the body. Some children like to create a cocoon of several blankets, prefer a sleeping bag, or some have favorite blankets that they use. I was surprised to find many different mattress textures. Try as many mattresses as possible in the store to see which is more comfortable.

plush.pngTry for natural warmth: Try tossing a blanket in the dryer or cuddling up to a warm scented stuffed animal. Warmth typically sends calming signals to the body to help quiet the mind.

Look at scents: Certain scents can have a calming effect on the nervous system and help to encourage sleep. There are a variety of different scents that can be calming.

Look at nutrition: Proper nutrition throughout the day can also significantly impact the ability to sleep at night. This can be difficult with our picky eaters but being more aware and trying to find a balance can be helpful. The biggest factors to keep in mind include:

  1. Plenty of protein
  2. Limiting carbohydrates and sugars
  3. Limiting preservatives, additives, and dyes,
  4. Having plenty of fruits and vegetables.

Incorporate heavy work during the day: Exercise helps tire our bodies out and make us ready for night. Provide plenty of opportunities throughout the day to engage in heavy work activities (i.e. push, pull, climb, squeeze, gentle rough housing). These activities can include pushing/pulling a laundry basket to the bathroom to complete nighttime routines. Inside the laundry basket include several heavy items as well as pajamas, toothbrush, toothpaste, favorite books to read, etc. The activities can also include wall push-ups to be completed by standing 2-3 ft. from a wall, placing hands on the wall, and slowly lowering body to wall. There are a ton of ideas for heavy work input. Heavy work input involves any type of activity where the person is actively moving their body against resistance.

Limit screen time: No screen time at least one hour prior to bedtime. It has been suggested that longer screen times may be affecting sleep by reducing the time spent doing other activities – such as exercise – that may be beneficial for sleep and sleep regulation. The content on the iPad can also impact sleep. For example, exciting video games, dramatic or scary television shows, or even stimulating phone conversations can engage the brain and lead to the release of hormones such as adrenaline. This can in turn make it more difficult to fall asleep or maintain sleep. Less obvious is the impact that light has on sleep and on our sleep-wake patterns in general.

Try an earlier bedtime: Contrary to popular belief, kids tend to sleep more and longer with an earlier bedtime. Ever heard of the “witching hour”? This is typically when kids are overtired and doing everything in their power to fight off sleep. If a child gets to the point of exhaustion or over tired, it can backfire on the nervous system. Just think of the nights when you pushed past your feeling of exhaustion because you just had to get that one last thing down. How did you feel later that night when trying to fall asleep? It was probably more difficult for you.

This is because when you work past your point of exhaustion it is usually because you are stressed. Stress releases the hormones adrenaline and cortisol. Cortisol normally rises and falls throughout the day and it typically highest at around 8AM and lowest between midnight and 4AM. Stress normally causes a surge in adrenal hormones like adrenaline and cortisol that increases alertness making it more difficult to relax into sound sleep. Frequent stress can chronically elevate these hormone levels, resulting in a hyper-vigilant state impacting continually restful sleep.

We ALL need sleep, and when there are concerns, it becomes even more important. When we are not getting enough sleep it impacts our mood, behavior, and overall self-regulation.

Visit eastersealsdfvr.org for more information about our occupational therapy services.

Additional Resources:

  • Stanford Children’s Health
  • St. Luke’s Hospital Sleep Medicine and Research Center
  • American Occupational Therapy Association
  • GetYourBabytoSleep.com

What is a “Sensory Diet”?

By: Laura Van Zandt, OTR/L

A “sensory diet” is a treatment strategy occupational therapists use to help children learn to process and understand sensory information from their environment and their own body to more effectively interact within the environment and with others. The term sensory diet was first coined and originated by occupational therapist, Patricia Wilbarger. A sensory diet is meant to be individualized to the child so that the activities provided are a ‘just-right’ challenge for the child. The “just right” challenge is defined as “a challenge that is on the edge of competency and engages the drive for mastery.”

A sensory diet is not too hard, yet not too easy. An effective sensory diet should include a wide variety of activities within the child’s day that provide a variety of sensory input for play and learning. An effective sensory diet should also be a collaboration with the client, family, and caretakers.

Occupational therapists often use the analogy of comparing a sensory diet to a balanced food diet to help parents and caretakers understand we need a variety of activities that feed all our sensory systems to allow them to work well together. Just like a well-balanced diet is often tailored to our individual bodies for different nutritional needs at different points in our lives, a sensory diet is an ongoing list of activities that is established over time and modified as needed to help address the imbalance in the child’s sensory processing abilities or as the environment changes and the demands shift.

A sensory diet is designed to help keep the child calm and organized via activities that based on a child’s preferences which then helps them to be able to learn, attend, and fulfill social expectations. As a child learns to remain calm and organized, they learn to better self-regulate and hopefully move from depending more on others to being more independent in managing their sensory needs. The goal of any sensory diet is to help overtime retrain your child’s brain to process sensory information in a more typical way so that can perform at their own unique best.

Each child has a unique set of sensory needs. Generally, if a child is more sensory seeking, they may benefit from adding more movement and stimulation that includes heavy work as well as other sensory stimulation (e.g. tastes, colors, smells) to help achieve a calm, organized more focused state so they are not constantly on the go looking for input. If a child is more sensory avoiding, they may also benefit from heavy work but may need it more graded and introduced slowly over time. The child may benefit more from activities that focus on reducing sensory input and breaking tools that allow them to limit information from their environment. One of the trickiest aspects of developing and implementing any sensory diet, is beginning to recognize your child’s signs and signals as well as starting to recognize when your child is over-reacting, shutting down, or under-reacting and adjusting the sensory input so your child remains just right and able to function.

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When occupational therapists provide ideas for a sensory diet, they keep in mind several different guiding principles:

  • Frequency of input: The frequency of need varies for each child and should be guided by observations of the child before and after each activity.
  • Intensity and duration of input: How much time you spend on each activity and how much sensory input (e.g. how much weight to use to push/carry/drag/lift, how loud to play the music, what type of tactile media to present, how much tactile media to present, etc.) is directly related to the child and how the child is doing not only on a specific day but also at a specific moment in time.
  • Timing of activities: Sensory diet activities are meant to be proactive and are best used before as well as during activities that are known to be tricky to the child.

    For example, if you know sitting for a mealtime is difficult for your child, you might want to help prep your child’s body and sensory system prior to sitting down. These activities should be tailored to your child; however, heavy work activities that actively require the child to use their muscles to push, pull, carry, drag, climb, bury, dig, suck, etc. are usually beneficial to many children. Sitting for a mealtime is a very complex sensory activity that involves all your sensory systems working together. You can try prepping your child’s sensory system prior to sitting down by re-arranging the chairs around the table and cleaning the table with spray bottles and towels to dry. You can try exploring different options for their chair- maybe your child might do well with a move-n-sit cushion or having a band around the legs of their chair to kick against. Your child might be bothered by the sounds of other people chewing their food and might benefit from noise cancellation headphones. Your child might be bothered by the sights of all the different foods or by all the foods touching each other. There are many different ideas and strategies to help both of those difficulties.

Your occupational therapist may ask you to become the detective and create a daily log of behavioral changes. You are your child’s best advocate and are the best expert in your child’s abilities and areas of growth. By creating a log of activities and your child’s responses to activities over the course of different days and different times, you can help better curtail some of the trial and error process that is inherent within any sensory diet due to our own individuality.

The sensory diet activity that might have worked well for another child with a similar difficulty, may not necessarily work for your child. The various times of the day and different environments may be work better for certain activities. Not all strategies work all the time. It is important to keep track of all the different activities your child responds positively to, so that you can create variety and have more than one strategy to help your child.

With help from an occupational therapist, your child can develop the ability to process sensory information in an adaptive manner and learn strategies to help him or her cope with everyday experiences. Learn more about our program. 

Resources:

  • Shiela Frick and Julia Wilbarger – “Creating Effective Performance, Precision, and Power in Treatment and Sensory Diets”
  • The Out of Sync ChildThe Out of Sync Child Has Fun, Growing an In-Sync Child by Carol Stock Kranowitz
  • childdevelopment.com