Category Archives: occupational therapy

Executive Functioning Skills: CO-OP Model Part 3: Time Robbers

By: Laura Van Zandt, OTR/L

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I was recently asked by a parent to elaborate more on a concept I integrate within GoalPlanDoCheck called “time robbers”.  The concept of “time robbers” was first introduced to me at a continuing education class taught by speech therapist Sarah Ward. A “time robber” is something which keeps us from doing other things which have more value or importance to us.

The concept of “time robbers” can be a fun way to call to attention all the little (or maybeclock not so little) things we do that take away from our goal. Time robbers can occur to everyone. They can occur anywhere. They can also be anything. Time robbers can be things we do as well as things other people do. Sometimes time robbers are imposed upon us by others or circumstances and are less in our control. Other time robbers are self-inflicted. Some examples of time robbers are being hungry, tired, or worried. They can also be sounds in our environment, noises/shows on the television, or games on the iPad.

The following is a handout I developed to help introduce the concept to children.

What? Time robbers are a little like impulses. Impulses are the feelings we have to do or say something…sometimes without even realizing! Time robbers are just like impulses. They are the things that we do that take away time from our overall goal and plan.
When? Time robbers can happen all the time. They don’t have to be limited to just school or home.
Examples? Time robbers can come in all forms. They might as easy as a thought that should remain in my thought bubble or as complicated as getting your bike out, riding to the store, buying a snack, and returning home to finish your homework. Other examples can be having the television on when doing homework, wanting to play longer with a favorite toy, arguing, changing ideas, etc.
Consequences? Time robbers are not our friends. They take away time from us getting things done. If they take away from one thing it means there is less time to do something that might be more preferred or fun.
How to fix? Practice your thought bubbles and keeping any time robbers hidden away inside our brains until we are finished with our goal and initial plan. STOP and Think – monitor your space, time, objects, and people. Think if this is an expected time to bring up your time robber.

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When beginning any new strategy or tool with your child, I often find it helpful to first identify in yourself examples and then start calling attention to different tools you use to help defeat the different time robbers. When your child is starting to recognize time robbers, then it is a good time to introduce the concept to your child to help identify and address them.

To learn more about Easter Seals DuPage & Fox Valley’s occupational therapy services visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

 

The Interactive Metronome

By: Kara Lyons, OT

blog12TIMING IS EVERYTHING
Did you know that precise timing is responsible for the synchronous interaction within our brain that connects physical movement and cognitive processes?

Why is timing important? To name a few, timing is responsible for a person’s ability to walk without falling, catch or throw a ball, jump, climb a ladder, play music, and speak without stuttering.

Research suggests that training with the Interactive Metronome, or IM, supports the interaction between critical brain networks, specifically the parietal-frontal lobes, which are often associated with general intellectual functioning, working memory, controlled attention, and executive functions (McGrew, 2002).

What is the Interactive Metronome (IM)?

The IM is a computer based interactive program that provides a timed rhythmical beat, or metronome, which works to pace an individual’s movements.

In this program, an individual synchronizes a variety of upper and lower extremity exercises to a precise computer-generated tone heard through headphones.

The IM responds to a client’s physical movement by providing real-time auditory and visual feedback in milliseconds, indicating whether they are in sync with the beat, or they are too early or late.

blogggg1What skills does the IM target?

• Improved timing, rhythm, and synchronization in the brain
• Motor planning, motor control, and bilateral coordination
• Attention, working memory, and processing speed
• Speech/language and social skills

Who could benefit from the IM?28321120_Unknown (1)

Pediatric population
Individuals with ADHD, Autism Spectrum Disorder, Sensory Processing Disorder, children with developmental delays or learning disabilities, cerebral palsy, auditory processing disorder, and dyslexia.
Adult population
Post brain injury, stroke, or concussions, adults with ADHD, Parkinson’s Disease, Alzheimer’s/Dementia, and amputees

How do you get started with this program?

• The first step is to be evaluated by an occupational, speech, or physical therapist that is also trained and certified as an Interactive Metronome Provider. You may find a provider in your area through the Interactive Metronome’s locator index.

• The assessment will consist of a comprehensive speech, occupational, or physical therapy evaluation, including an IM assessment, information sharing with the family and evaluating therapist, clinical observations, and other objective measures or evaluation tools (which may provide additional information regarding strength, coordination, fine and visual motor control, and/or speech and language abilities). At that time, the evaluating therapist will identify concerns expressed by the family and work to establish functional goals for the child.
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• The IM assessment provides data on the child’s current level of functioning, including their timing tendencies, attention to task, their ability to motor plan, sequence, or coordinate the movement patterns.
• The evaluating or treating therapist will determine if the client is appropriate for the program before customizing a treatment plan and program.

• REPETITION and FREQUENCY are critical for making lasting, functional changes in the brain.

• It is recommended that a client participate in the program at least 3 times per week for a minimum of 30 minutes of training per session.

THE IM HOME UNIT

blog123The IM home training unit is an option for families to meet the minimum recommended frequency or if the client is unable to attend therapy in the clinic setting.

To purchase and utilize the IM home program, a client must establish a relationship with an IM home certified therapist (also available through the IM Locator Index). The treating therapist will customize the child’s treatment plan, provide ongoing feedback, and adjust the plan as needed.

Overall, the IM is an excellent adjunct to traditional therapy services as it provides objective data (the child’s performance over time, measured in milliseconds) to support functional outcomes. If you are interested in the Interactive Metronome or feel it may be appropriate for your child, speak with your treating therapist.

For more information on the Interactive Metronome, including evidence to support the program, please visit https://www.interactivemetronome.com

To learn more about Interactive Metronome services at Easter Seals DuPage & Fox Valley and set up an evaluation contact us.

 

 

References:
McGrew, Kevin (2002). The Science behind the Interactive Metronome: An Integration of Brain Clock, Temporal Processing, Brain Network, and Neurocognitive Research and Theory. MindHub Pub, 2.

Executive Functioning Skills: CO-OP Model Expanded

By: Laura Van Zandt, OTR/L

Recently I wrote a blog on how to develop and strengthen executive function skills using the CO-OP (GoalPlanDoCheck) model. I thought I’d take a moment and expand on a very important foundational skill.

“Do with me and not for me”

So often we have great intentions and we do for our children. This isn’t a bad thing; we want our children to succeed. It’s hard to see them struggling. When we do for our children we neglect one very important step in developing their executive function skills. We accidentally take away their ability to plan, prioritize, problem solve, manage their space/time/materials, and reflect.

If we do not expect our children to be an “active participant” in his or her life, then we take away the many opportunities to learn the daily life skills needed for adulthood and the ability for learning how to tackle and master challenges. Involving your child in daily activities and encouraging them to be an active participant builds a strong sense of competency and positive self-esteem. It helps provide the confidence that your child can do many things and learn to ask for assistance when things go wrong.

Getting your child involved doesn’t have to be an elaborate process. Take whatever you are currently doing for your child and give him/her a simple job with the task. If the child is used to doing “nothing” start very small. Any job, regardless of how small (e.g. hold the pillow and place it on the bed while you make the bed, put one or two dishes into the dishwasher, drop a few articles of clothes in the washer, raise his arms to put his shirt on, etc.) is a start.

The best therapeutic opportunities are often right in front of you. There are endless activities (e.g. cooking, laundry, shopping, bathing, etc.) that make up your day.  You can use all your little interactions for many opportunities to develop executive function skills. By taking a little more time, you can  get your child involved around the house. Instead of just doing, slow down and ask for help. You might find your child enjoys helping and you may even start making some new memories together!

Basi Family

By doing with your child, you have the opportunity to break down the task so your child can be successful. In the process your child then starts to learn that a goal (e.g. making a bed) has many steps to the plan (e.g. put on the fitted sheet, do opposite corners, put on the sheet, put on the duvet/comforter, hold open the pillow case and put in the pillow, place the pillows on the bed). When we do the goal sometimes we work with a team (e.g. you and your child) and sometimes we need to adjust our plan (e.g. having them help this time) and sometimes we check throughout the process (e.g. did we get all the pillows?). You should celebrate with your child by “doing it together” with praise, giving high fives, and other gestures of companionship that you and your child share together. In turn, your child feels productive and competent; driving a desire to learn more. Over time your child learns to feel “good” about doing, and the typical daily challenges that are now a major struggle start to melt away. The child becomes more eager to learn, rather than driven to avoid.

I briefly used GoalPlanDoCheck but let’s use the concept in two better examples. Let’s use the first example for getting your children ready for school and let’s use the second example to model tools you use to help yourself get ready. Both ways involve your children.

1) Helping Your Child Get Ready in the Morning

Goal– While first getting your child up in the morning, tell them “It’s time to get ready so our goal is for you to be at school on time.” Use the word goal so your child knows that is GettingReadyforSchoolyour expectation.

Plan– Talk to your child about the steps. “First we need to go the bathroom so we can wash your face and brush your teeth. This usually helps wake you up so you can focus on getting dressed all by yourself. When you are getting dressed all by yourself, mom and dad will be downstairs making your breakfast. You need to eat your breakfast and then grab your lunch so we can get you to school. Don’t forget to double check your backpack and make sure you have everything you need for school or any after school activities.”

Depending on your child and the age of your child, you might simplify the plan. You might use visuals to help your child remember the plan. There are tons of different strategies that can worked within each child’s individual plan that are tailored to his or her specific needs and specific interests to ensure motivation. Depending on your child you might also need to use incentives to help with motivation and time management.

Do– Divide and conquer. Depending on your child’s age, he or she would not be expected to do all the pieces of the plan.

Check– Keep talking to your child. “Did we get everything? Are we on time? What helped us stay on time? What were time robbers?”

2) Modeling Tools You Use to Get Ready in the Morning

Children learn through modeling. This is a great way to begin introducing your child to this concept as well as teach through modeling different strategies.

Goal– While first getting up in the morning and working with your child, talk aloud to them. Talking aloud is not something that comes naturally and must be practiced; however, talking aloud is a great strategy for modeling the development of executive function skills. Tell them “It’s time to get ready so our goal is for you to be at school on time.” Use the word goal so your child knows that is your expectation.

Plan– Talk to your child about the steps; however, instead of listing the steps like we did in the first example, we are going to focus on you and tools that you use. This is important for kids who just seem disorganized, can’t get their arousal level just right, and just need help. Modeling is great to let them know we all use a variety of tools and that tools can be helpful. Here is an example of a conversation you might have while getting ready with your child:

“It’s time to get ready so our goal is for you to be at school on time. I don’t know about you, but mom is feeling really tired today. I have to get up earlier than you so that I can help you get ready. Do you know what helps me wake up so I can focus on getting ready? I start my morning with a shower. Sometimes the feel of the water on my skin wakes me up. Let’s try washing your face since we don’t have time for a shower.”

Notice how in this example, you discussed with your child a tool you use (shower) and provided them with an option to try. This is a great way to model. There are lots of other dialogues you can have with your child to model tools. This was just one example.

Do– Looks the same as in the first example; however, depending on the tool you may or may not be modeling. Do in the example above was telling your child and then providing your child with an example to do together.

Check– Remains the same. In this stage, we are actively involving our child to think and problem solve.

Have fun with it and know that you are working on developing and strengthening your child’s executive function skills. Executive function skills are developmental and must be taught. When working with your child, you are setting a path toward greater independence. Start simple and build gradually.

If your child is not used to doing much, start with a couple of activities a day. Pick a time of the day when you are not feeling rushed and your child is not feeling stressed. This will give you practice in how to guide, assist, and engage your child. Once it starts to feel natural, expand the “we-dos” into many daily activities. Do them together, giving him/her a little part to play, and gradually expanding his/her role to build more competence.

You are an important part in the development of your child. The more you can help your child think about what they do and why, the more they will be able to use that thinking in any problem solving situation. As my other blog concluded, the overall goal is to teach your child how to work through a problem using a planned approach instead of acting impulsively.

To learn more about Easter Seals DuPage & Fox Valley’s occupational therapy services visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

Climbing and Bouldering Therapy: The Benefits to Rock Climbing

By: Laura Van Zandt, OTR/L

This summer, physical and occupational therapists are excited to provide therapy on the walls as part of our summer outreach program “Climbing and Bouldering.” The varied terrain offers countless opportunities for physical and sensory challenges.

Rock climbing has so many benefits for kids of all ages and abilities.15_Patrick_Krueger

  • Strengthening and endurance: Climbing walls require strength and flexibility to
    successfully maneuver. Kids develop hand and finger strength as they grasp and hang onto holds of all different shapes and sizes. Some of the holds are tiny and don’t have much to grasp. Making your way up a climbing wall also requires a great deal of core strength and leg strength as your hold yourself in space. All that movement and use of your arms, legs, and core will help develop endurance for other gross motor activities.
  • Sensory processing: Kids get great proprioceptive input (sensory input to the muscles and joints) and vestibular (movement-based) experiences as they power themselves up and over while using the different holds as well as glide back down to the floor from the top of the wall! For kids who experience gravitational insecurity, rock climbing can be an extreme challenge but can be graded to meet their needs. For example, kids who are reluctant to climb high up on the wall can work on moving from side to side first. Children who also experience tactile sensitivities could also be help by all the proprioceptive input into their hands to help desensitize prior to working with different textures.
  • Motor planning and visual spatial/perceptual skills: Climbing is an awesome way to help kids develop motor planning skills. Indoor rock climbing is a great puzzle just waiting for your child to solve! The holds are all different shapes and colors. Most climbing walls also have colored tape markings that show climbers different paths they can take up the wall. This makes it easy to give a child instructions (e.g. “step your right foot on the blue hold” or “find the next hold with green tape next to it”) to challenge their abilities. Also, climbing walls usually have “routes” with
    a variety of difficulty levels, making it easy to adjust the activity depending on the skill level of the child.

    15_Brady Pembroke

  • Bilateral coordination: When kids are rock climbing, they must use both sides of their body together, usually in an alternating pattern — right hand and right foot move up to the next level, followed by the left hand and left foot. Also, kids have to learn how to differentiate between the movements on either side of their bodies. They stabilize themselves with one foot/hand while motor planning how to grasp onto and step on the next holds with their other foot and hand.
  • Confidence: Allowing kids to move outside of their comfort zone in a safe and controlled environment will undoubtedly help to build their confidence and promote development of positive self-esteem.

If you think your child might benefit from this outreach group, please visit our website for more information on Climbing and Bouldering Therapy and check out other Community Based Therapy Programs for Summer 2017!

Executive Function Skills: CO-OP Model

By: Laura Van Zandt, OTR/L

GOALPLANDOCHECK.

Executive functioning skills seems like the new ‘buzz’ word for therapists and parents working with children of all ages. Executive functioning skills include the ability to pay attention, recall a series of information, manage your time, be flexible, self-monitor for your emotions and impulses, initiate tasks, problem solve, persist as well as plan, organize, and sequence. One of our former speech therapists, Jennifer Tripoli, wrote a nice blog in August 2014 which you can refer to for more information regarding the definition of executive function skills.

One strategy that I like to teach children is a concept from the Cognitive Orientation to Occupational Performance or CO-OP model by Helene Polatajko and Angela Mandich called GOALPLANDOCHECK.

The CO-OP model is a “client-centered, performance based, problem solving approach that enables skill acquisition through a process of strategy use and guided discovery.” Occupational performance is what we do and how we do things throughout our day. Cognitive orientation implies that what we do and how we do things involve a cognitive process. The approach is designed to guide individuals to independently discover and develop cognitive strategies to meet their goals. That sounds like a lot of executive functioning skill development to me!

The use of self-talk is key with GOALPLANDOCHECK. When we require children to walk us through their plan and teach us their steps by talking aloud, they engablogge in more effective approaches to learning.

When teaching children, we start with the GOAL. We teach the child to understand the word GOAL as being something we are working towards completing. One strategy that has been helpful for visualizing the end GOAL is the concept of “future glasses.” Have the child wear funny glasses or simply make your hands in the shape of glasses. Then close your eyes and visualize the completed GOAL and what it might look like when completed.

The word PLAN implies there are a series of steps we need to do in order to meet our GOAL. To me the PLAN is critical for developing our problem solving skills.

Next we DO our goal.

Finally, we CHECK. The CHECK is really important for developing and strengthening our meta-cognitive skills. It is very important to understand how we can do better next time based on what we did today. CHECK gives the opportunity for feedback control by finding and correcting a mistake before the plan is final. It allows for incorporating flexibility and the ability to shift strategies when the current plan is not working.

KevinThis process helps children strengthen their executive function skills in the areas of working memory to pull from previous experiences, planning and prioritizing steps involved, persisting to achieve goals, and reflecting back by checking in with the plan to see if it was successful. If not, make alterations in order to be successful, eliminate time robbers to help with impulse control, and manage their time. Remember, initially it is about the practice and not the end result. It is okay to make mistakes. We all learn from mistakes.

Parents and family are an important part of the CO-OP approach. The effectiveness of the intervention is greatly increased when everyone is involved. Parents and family help the
individual child to acquire and practice these skills. It also helps them to transfer and generalize the learned strategies into everyday life. By providing explanations as well as guidance and asking questions at an appropriate developmental level, we provide just enough support necessary for the child to be successful. The more you can help children think about what they do and why, the more they will be able to use that thinking in any problem solving situation. The overall goal is to teach a child how to work through a problem using a planned approach instead of acting impulsively.

To learn more about Easter Seals DuPage & Fox Valley’s occupational therapy services visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

Helping Children Understand and Process Emotions

By: Laura Van Zandt, OTR/L

One of my favorite resources as a pediatric occupational therapist to help kids begin to understand and process emotions as well as come up with strategies for self-regulation is the Zones of Regulation curriculum developed by Leah Kuypers. The Zones of Regulation helps teach kids how to self-regulate and deal with everyday strong emotions or unexpected emotions for different social environments.

zones-of-regulation

The zones can be compared to traffic signs. When we see a green light, one is ‘good to go’ and can keep proceeding forward without making any changes. A yellow light, on the other hand, means to be aware or take caution. Sometimes we can keep going and other times we need to make a change. A red light (or stop sign) means stop. Often the behavior we are demonstrating is unexpected. The blue zone is most often compared to the rest area sign where you go to rest or re-energize.

 

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Photo by Christine Carroll

When teaching children to begin using the Zones of Regulation, I tend to follow three stages of learning.

  • In stage one, the child learns how to identify the terminology and sort emotions according to the physiological features of each specific zones
    • Examples:
    • Frowning, yawning, crying = blue;
    • Happy, calm, focused= green
    • Upset, butterflies in stomach, Heart beating fast = yellow;
    • Yelling, body feels tenses = red).
    • In this stage, there is a lot of detective work and identifying features of body language. I like to use a variety of pictures, books, and movie clips when possible to help during stage one.
  • In stage two, children start to learn strategies to adjust their zone and help them manage their internal emotional feelings. Children learn a variety of sensory motor strategies (e.g. swinging, taking deep breaths, walking, squeezing something) as well as cognitive behavioral strategies (e.g. expected versus unexpected, size of the problem, inner critic versus inner coach, stop/opt/go).
  • In stage three, children are more independent and are beginning to select appropriate tools to help with self-regulation. Depending on the child’s age, supports might still be in place such as visuals for choosing appropriate tools.

It is important to remember that ALL of the zones are expected to occur at one time or another. At some point we may feel tired in the Blue Zone, calm in the Green Zone, worried in the Yellow Zone, and possibly furious or elated in the Red Zone.

The Zones of Regulation focuses on teaching children how to manage their zone based on the environment and the people around them. The Zones of Regulation was designed to support people in managing all the feelings they experience, without passing judgment on what people are feeling or how they are behaving.

Leah suggests four main points to keep in mind with beginning to use the Zones of Regulation with any child:

  1. It is natural to experience all of the Zones; there is no bad zone.
  2. Our Zone is defined by the feelings and internal states we experience on the inside.
  3. Our behavior is a byproduct of how we manage our Zone; therefore, consequences should not be tied to a Zone.
  4. The context we are in helps us figure out how to manage our Zone so our behavior meets the demands of the social environment, and in doing so we are able to achieve the tasks we are trying to accomplish and/or the social goals we’ve set for ourselves in that situation.

Here are some additional tips to help kids develop their emotional intelligence and emotional self-regulation:

  1. Provide as much stability and consistency as possible. Consistent limit-setting, clear household rules, and predictable routines help children know what to expect. This is turns help them feel calmer and more secure.
  2. Model, model, model. We cannot do this enough. How we react and deal with emotions will establish the foundation for how those around us will also respond. We usually don’t have a choice in what we feel, but we always have a choice about how we choose to act regarding our feelings. Children learn from us. When we yell, they learn to yell. If we remain calm and speak respectfully, they learn to do the same. Every time you model in front of your child how to respond to an emotion, your child is learning.
  3. Connect. Spend time everyday unplugging and connecting with your child. Young children first learn how to regulate by being soothed by their parents. When you notice your child getting dysregulated, the most important thing you can do is try to reconnect.
  4. Name it and Accept It. Calling attention to your child’s feelings helps them understand what is going on inside them and learn that it isn’t okay to feel different emotions. Your child will know that someone understands, which might make him or her feel a little better.

The Zones of Regulation was designed to be used with students in early elementary through adulthood. Where relevant, the curriculum offers activities within the lesson plans for younger students. The Zones of Regulation was turned into a curriculum and published by Social Thinking in 2011, titled The Zones of Regulation: A Curriculum Designed to Foster Self-Regulation and Emotional Control. Since that time Leah Kuypers has expanded it into two apps, The Zones of Regulation and The Zones of Regulation: Exploring Emotions.

To learn more about Easter Seals DuPage & Fox Valley’s occupational therapy services visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

What is Occupational Therapy?

By: Laura Van Zandt, OTR/L

I’ve been an occupational therapist for seven years and it’s taken a long time to perfect the answer to the question “What is OT?” from people I just met. Today, I think I finally have a good answer.

To begin, occupational therapists see individuals across their lifespan and in a variety of different settings. We work closely with medical staff, parents, and educators. Typically there is some underlying problem that has initiated a meeting with an occupational therapist.

Depending on their training, there are a number of different approaches an OT may take to solve the problem.  One approach is the “Person, Environment, Occupation” (PEO) model. The PEO model (Law et al., 1996) is a well-known and established conceptual model of practice within occupational therapy. It offers a foundation for guiding assessment and intervention across all practice settings and client populations.
peos
This model of practice helps an OT consider the whole child…their roles, activities, where their performance may need help, areas of strength, and more. Since I work with children, I am going to define the person as a child. The environments are the places a child interacts (e.g. home, school, community) and the occupations are the things he/she does in those places (e.g. get dressed, feed themselves, learn to write/color/draw, play). It is an occupational therapist’s job to evaluate a child and determine what makes it hard for those occupations in all his/her environments. It could be strength, sensory, visual, etc. or a combination of all those areas. It could also require a team approach, short term services, or long term services.

Let’s look at an overview of the assessment process with a simple case study to make it easier to understand:

ASSESSMENT PROCESS (Person, Environment, Occupation)

Referral: A 7-year-old is referred by a doctor for occupational therapy services based on her parents’ concerns with difficulty sitting still at home and completing homework tasks. She also has difficulty focusing and getting ready for the morning.

Occupational Roles:
An OT would consider the child’s role as both a developing child, sibling, daughter, student, and friend. What is preventing her from participating fully in those roles? We would also consider the family’s values, interests and daily roles. We try to look at the client’s pattern of engagement in occupations (i.e. getting ready) and how they changed over time.

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Photo by Marita Blanken

In the example above, we would consider the entire family. This child has many roles. She is not only a child of a two parent working family, but she is also a sibling with a younger brother. She is also a first-grade student. In further conversations, we discover she also participates in gymnastics after school. In order to best support this child and her family, we would need to consider each of those roles and how they contribute to the overall profile of this child.

Occupational Performance Areas:
Then we consider the areas of occupational performance (e.g. activities of daily living, instrumental activities of daily living, rest and sleep, education, play and leisure, and social participation).

In the example above, this child is possibly presenting concerns with activities of daily living. Specifically, we might look at her ability to dress herself and completing grooming/hygiene tasks. Her mother, also mentions the child is having difficulties with staying focused and managing her assignments in school. Is this also impacting her social participation both at home, school and community where she does gymnastics?

Occupational Performance Components:
What components need to be addressed that may explain underlying difficulties?

Body Structure and Function – This may include muscle tone, range of motion, posture and alignment, postural control, strength, joint stability, endurance, fine motor skills, manipulation and dexterity, gross motor skills, coordination, bilateral coordination, etc. We may also evaluate her nutrition, respiration and gastrointestinal background to make referrals.

Sensory motor – This may include a child’s under or over responsiveness to touch, movement, sight, sound, taste and smell as well as their visual perceptual skills and body awareness. This may also include a child’s behavioral responses to activities.

Cognitive – This may include perceiving, understanding concepts, learning, and executive function skills (initiating, planning, organizing, sustaining, sequencing, flexibility, problem solving, managing emotions, etc.). We may make referrals to further understand the role cognition plays in your child’s abilities.

Social-Emotional – This may include self-regulation, self-esteem, as well as inner drive and motivation to participate in activities. It could also include the ability to relate to other children and adults.

TakeThreePhotography_05202010-102In the example referral above, we would need to determine what areas of occupational performance are making it difficult for her to participate to the best of her abilities. We could evaluate her strength by having her climb to see how she manages her body in space and uses her arms to support her body weight. We might also look at her core strength to see if she is weak and if that is causing her to feel unstable while sitting which impacts focus (e.g. if she is having to concentrate hard on keeping her body upright to be able to use her eyes and hands, then it will be hard for her to also concentrate on math facts).

We will also look at her hand skills. There might be concerns with weakness, grasp, manipulation, etc. that make it hard for her to use writing tools to complete tasks.

We can create a sensory profile, by asking questions, having a parent fill out questionnaires, and observing a child during activities. We would use our background in sensory integration too during our observations. For example, perhaps the feeling of clothing is too irritable to this child and she is having trouble focusing because she is needs to move to readjust how her clothing feels on her skin. We can evaluate vision to determine if we need to make a referral to another doctor. By planning some activities to do together, we can look at how her sequencing and planning behavior.

Finally, occupational therapists are mindful of the social-emotional development of children and how difficult things impact his/her daily function. We might ask the parent further questions if we notice that she is getting frustrated easily during a task and has trouble managing her frustration.

There are many hats that an OT wears in this therapeutic relationship….another adult, parent, teacher, friend, etc. When we begin, we often know very little about each other. However, we work together and figure out plans that best help a family address their wants for their child. In the process, we may not know all the answers yet and it may take time to figure them out. That is one of the hard parts of an OT’s job but also a fun aspect too. Wearing these different hats while at the core serving as an occupational therapist, is what I love about my job. To learn more about Easter Seals DuPage & Fox Valley’s occupational therapy services visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

Visual Supports

By: Laura Bueche, MOT/OTR

Visual supports are concrete cues that provide your child with information about a routine, activity, behavioral expectation, or how to learn the component of a new skill. They may include pictures, symbols, written words, objects, visual boundaries and schedules.

Goals that can be addressed by using visual supports include:

  • Increase frequency of smooth transitions.
  • Decrease amount of time to transition.
  • Increase predictability.
  • Reduce inappropriate behaviors associated with a task or transition.
  • Increase independence.
  • Minimize teacher and adult support (e.g. prompts and reinforcement).
  • Increase understanding of expected task or activity to complete.
  • Maximize understanding of environment.
  • Decrease distractions.
  • Reduce self-injurious behaviors.
  • Increase social interaction skills.
  • Increase demonstration of play skills.
  • Increase understanding of behavior expectations.

There are three types of visual support: visual boundaries, visual cues, and visual schedules.

Visual boundaries are a helpful way to help your child make sense of the world around them. It will help your child to stay on task, understand personal space, and stay organized. Visual boundaries can include:

Floor tape

floor-tape

Spot markers

spot-markers

Visual Cues are helpful for a variety of different applications. For example they can help with:

Breaking down the steps of a task.

breaking-down-steps-fo-a-task

Organizing concepts and ideas.

organizing-concepts-and-ideas

Assisting with communication.

assist-with-communication

Organizing materials.

organizing-materials

Time Management.

time-management

Visual Schedules – Visual schedules can increase your child’s understanding of expectations and provide support for transitions in between activities.

When developing a visual schedule, there are a lot of components to consider:

  • schedules-jpgForm of the visual (picture, photos, words, phrases).
  • Length of the sequence (one item, two items, half day, full day).
  • Presentation (left to right, top to bottom, technology based).
  • Manipulation of the visual (child carries object to next activity, “all done” pocket, marks).
  • Location of the schedule (on a wall, desk, notebook).

Be sure to work with your child’s speech and language pathologist, occupational therapist, or special education teacher to determine what the most appropriate type of visual schedule is for your child.

For more information on occupational therapy services including helping children and adults with sensory-processing abilities, coordination, peer interaction, play and self-care skills to participate in daily life activities, visit eastersealsdfvr.org.

 

Getting Ready For Fall by Teaching Your Child to Dress a Coat

By: Maureen Karwowski, OT

As the leaves begin to turn, it will soon be time to break out those sweaters and coats. This is a great time for your child to practice dressing their coat independently.

As an occupational therapist, I am always looking for ways to help my clients reach their maximum independence. As children become more independent, they develop more confidence and are more likely to try other challenges as well. For my clients that have fine motor difficulties, practicing dressing skills is a natural and routine way to help them develop their fine motor abilities.  Independence with dressing occurs one step at a time, so we can start with dressing a coat as the first step.

Once a child is able to stand securely, or sit securely if they have postural difficulties, it is a good time to start. Here is the “over the head” method that I would start with:

  1. Place the coat on the floor or a low table
  2. Lay the coat flat with the inside facing up
  3. Stand facing the top or collar of the coat
  4. Bend over and place the arms in the sleeves
  5. Lift the entire coat up and overhead
  6. When the arms come down you are all set!

Zipping up a coat requires more precise fine motor skills and strength. I would start by having the child zip up the coat once you have engaged the zipper. When assisting your child with any fasteners, always stand behind them to give them perspective on how their hands should work. You can use a zipper pull to make it easier for your child to grasp the zipper. A quick online search yields many cute options, but you can also use a key ring that you have at home. A magnetic zipper is also a nice alternative while your child is working on manipulating a zipper. Several clothing companies offer this.

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It is important to assist your child, while not jumping in too soon. Be sure to leave extra time, and focus on one step at a time. Once they are independent with this, then you can focus on promoting another dressing task. Good luck and stay warm!

To learn more about Easter Seals DuPage & Fox Valley occupational therapy services, visit eastersealsdfvr.org.

Occupational Therapist Recommended iPad Apps

By: Laura Bueche, MOT OTR/L

No one can deny the powers of the iPad. The back lit animations, sound effects and interactive games make apps a great tool for kids to learn. Kids and adults are drawn to the technology?

The American Academy of Pediatrics (AAP) recommends limiting the amount of screen time a child has to “high-quality content.” They recommend children and teens should engage with entertainment media for no more than one or two hours per day and that television and other entertainment media should be avoided for infants and children under age 2.

But what games or content are high-quality? As a pediatric occupational therapist, I use iPad apps during therapy as a therapeutic tool to help kid’s develop skills.  Below are my favorite quality iPad apps.

Fine Motor Skills

Dexteria

 

Dexteria By: Binary Labs, Inc.
Price: $3.99

Dexteria turns your iOS device into a therapeutic tool that improves fine motor skills and handwriting readiness in children and adults.

dexteria jr

Dexteria Jr. By: BinaryLabs, Inc.
Price: $2.99

Set of hand and finger exercises to develop fine motor skills and handwriting readiness. The activities are specially designed for kids age 2-6.

dottodot

Dot to Dot Numbers and Letters Lite By: Apps in My Pocket Ltd By Apps in My Pocket Ltd
Price: Free

Trace through dot-to-dot puzzles for visual motor skills and visual tracking.

bugsandbuttons

Bugs and Buttons By: Little Bit Studio, LLC.
Price: $2.99

18 mini-games and activities that make learning fun. Count colorful buttons, recycle with marching ants or dainty ladybugs, recognize letters, solve bug mazes, and more!

 

Letter and Number Formation

letter&number2 letter&number

Letter School By: Letterschool Enabling Learning B.V.
Price: $4.99

Play to learn how to write all letters of the alphabet: abc – xyz and the numbers 1-10 with LetterSchool.

letterworkbook

Letter Workbook Home Edition By: BigCleaverLearning
Price: Free

Letter Workbook is an interactive educational app which teaches toddlers and children how to form and write letters. Through the simple, interactive guide children will learn how to write their ABC, improve vocabulary and have fun along the way!

myfirst number trace

My First Number Trace By: Neutre
Price: $1.99

Easy tracing for little fingers. Trace letters 1-10.

iwritewords

iWriteWords By: gdiplus
Price: $2.99

iWriteWords teaches your child handwriting while playing a fun and entertaining game.

 

Visual Perception

littlethings

Little Things By: KLICKTOCK
Price: $2.99

An innovative seek and find game. Search colorful collages built from thousands of little things. Randomized searches ensure a different game each time you play.

rushhour

Rush Hour Free By: Thinkfun Inc.
Price: Free

The original sliding block Traffic Jam puzzle, works on visual perception, problem solving, and attention.

 

visual attention
Visual Attention Therapy By: Tactus Therapy Solutions Ltd. Price: $9.99

Visual Attention Therapy helps brain injury and stroke survivors, as well as struggling students, to improve scanning abilities. It also helps rehab professionals to assess for neglect and provide more efficient and effective therapy for attention deficits.


Cause and Effect Apps

peekaboo

Peekaboo Forrest, Barn, or Fridge By: Night & Day Studios, Inc.
Price: $1.99

If you see something moving, tap on it to find out who it is!

ilovefireworks

Ilovefireworks lite By: Fireworks Games

Price: Free

Create beautiful fireworks display by easy tap operation! Touch on the screen, you immediately see breath taking fireworks in 3D graphics and real sounds.

touchofmusic

Touch of Music By: gamegou

Price: Free

Enjoy the freedom to play songs at your own beat while never missing a note.

 

Self Care Skills 

idohygiene

IdoHygiene By: C.E.T – THE CENTER FOR EDUCATIONAL TECHNOLOGY
Price: Free

Learn the most common personal hygiene daily activities (teeth brushing, shampooing , hand washing, toilet training, taking a shower , public bathroom, etc.)

t-rex

T-Rex Toothbrush Timer By: PCAppDev Limited
Price: $0.99

Encourage your kids to brush their own teeth properly by following Dino brush his teeth!!

To learn more about Occupational Therapy at Easter Seals DuPage & Fox Valley visit eastersealsdfvr.org.