Category Archives: occupational therapy

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
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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.

Ada
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

What is Sensory Processing Disorder?

By: Laura Van Zandt, OTR/L

As an occupational therapist, I have heard sensory referred to as many different things. Just a few examples include “sensory integration, sensory processing, sensory disorder, sensory dysfunction”. Not only is this confusing as an occupational therapist, but it has to be extremely confusing to parents too.

Sensory processing is a broad term that is used to refer to the way sensations are received and organized by the brain and how our bodies respond to this sensation and appropriately use it to interact within our environment. Our brains not only process information through the senses of touch, taste, smell, sight and sound but our brains also process information from our inner ear, muscles, joints, and ligaments to help us with movement and body position. All the sensory systems need to work together for effective sensory processing.

Overview of these sensory systems

  • Visual sense: is the ability to interpret what is seen regarding contrasts of light and dark, color, and movement.
  • Olfactory sense: is the ability to interpret smells
  • Auditory sense: is the ability to interpret what is heard regarding volume, pitch, and rhythm.
  • Gustatory sense: is the ability to interpret to receive taste sensations
  • Tactile sense: is the ability to interpret touch sensations like pressure, vibration, movement, temperature and pain.
  • Proprioceptive Sense: is the ability to interpret where your body parts are in relation to each other.
  • Vestibular sense: is the ability to interpret information relating to movement and balance related

If there is inefficiency in processing sensory information, a child’s ability to function is compromised and there be difficulties in the child’s arousal, alertness, attention as well as play, self-care, fine motor and gross motor skills. This difficulty has increasingly become known as sensory processing disorder and was first recognized by Dr. A. Jean Ayres, occupational therapist, educational psychologist, and neuroscientists.

Sensory processing disorder can be a confusing term. No two children are alike. Symptoms of sensory processing disorder, like most disorders, occur within a broad spectrum of abilities. While most of us have occasional difficulties processing sensory information, for individuals with sensory processing disorder, these difficulties are persistent and can significantly disrupt everyday life.

22_Everett_MazzieSome children may experience difficulties processing sensory information in all or only a few areas of sensory processing. Likewise, it is also common for some children to not experience difficulties in any one sensory system but have difficulties combining the sensory systems to develop a meaningful response. A child’s response to a certain type of sensory input or activity may vary from one instance to the next and is impacted by the events preceding the activity, how the child feels (tired, fidgety, ill, healthy), and the context in which the activity occurs (quiet, noisy, busy, structured). When describing a child’s sensory processing, it is important to remember that anyone’s sensory processing patterns are merely a reflection of that person’s ways of responding to sensory experiences in the course of everyday life (at home and school). Knowing a person’s patterns creates a tool for gaining insights about what settings and activities are likely to be easier or more challenging and reveals possibilities for navigating successfully in everyday life.

Sensory processing disorders can be divided into three main areas: sensory modulation, sensory-based motor, and sensory discrimination.

Sensory modulation disorder refers to the ability to filter sensations and to attend to those that are relevant in a graded and adaptive manner whereas sensory discrimination disorder refers to difficulty interpreting subtle qualities of objects, places, people or other environments.

Sensory modulation disorder can further be broken down into children who are over-responsive, under-responsive, or sensory cravers/seekers. Children who are sensory over-responsive are often predisposed to respond too much, too soon, or for too long to sensory stimuli most people find quite tolerable. These children are often in ‘fight or flight’ to common daily sensations and may try to avoid or minimize sensations or act out to counterbalance feeling constantly bombarded.

20150320_ES-LegoRoom-19.jpgFor example, a child who is over-responsive to touch sensation may find physical contact, clothing, and other touch sensory input difficult. Children who are sensory under-responsive are often unaware of sensory stimuli, have a delay before responding, or responses are muted/less intense as compared to the average person. They may appear withdrawn, difficult to engage, or self-absorbed because they do not detect the sensory input to the environment. For example, a child who is under-responsive to touch sensation may not be aware of clothing twisted on their body or messes on their face. The child who is sensory craving is driven to obtain sensory stimulation but getting the stimulation results in disorganization. They tend to be constantly moving, crashing, bumping, and/or jumping. They may “need” to touch everything and not understand what is their space versus other space. Sensory cravers can be difficult to decipher between children with ADHD.

In children whose sensory processing of messages from their muscles and joints is impaired, posture and motor skills can be affected. Children with a sensory postural disorder may have a poor perception of position of body, poorly developed movement patterns that depend on core stability, and appear weak with poor endurance. When posture is impaired these children might seek additional support by leaning on walls or resting their head on their hands when working at the table. When motor skills are involved these children often have difficulty with the ability to make a plan to execute an action as well as execute the necessary actions supporting the performance.

Click here to link to our sensory processing intake form to see if your child might benefit from an occupational therapy evaluation to determine if there is a sensory basis for your child’s difficulties.

With effective treatment provided by 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. Our occupational therapists are trained to use a variety of different standardized tests and clinical observations as well as caregiver input to help put all the pieces together of the puzzle and make appropriate referrals. Then our therapists expertly look at the match between the child, the activities and expectations, and the context to determine when there is a mismatch that needs intervention attention.

For more information visit our sensory processing webpage and visit the links below.

 

My Kid is a Picky Eater and I Need Help!

By: Laura Van Zandt, OTR/L

peblog2Around 2 years of age, children enter the age of autonomy where they become aware of their individuality and become increasingly independent. This is also the age where they become increasing comfortable testing limits. Around this age, kids are most likely to start becoming “picky eaters.” By the time children enter preschool, many have begun to move past this phase and start to expand their food preferences; however, some children don’t move out of the picky eating stage and continue to refuse foods. Foods once liked may become dropped and not added back into their diet. The big difference between typical picky eating and avoidant /restrictive food intake disorder (AFRID) is that typical picky eating fades away in conjunction with repeated food exposure and a positive mealtime environment.

Children with ARFID may also have other health issues or conditions such as attention deficit hyperactivity disorder, autism, sensory processing, food allergies, constipation, and/or anxiety. Some children who were born prematurely may have required breathing and feeding tubes during hospitalization which can increase oral sensitivity. A child who had a choking episode in the past, was forced to eat, or who had multiple respiratory infections at a time when she was learning to eat may have developed negative associations with eating. Some children may have a sensory system which is offended by the texture, smell, odor, or appearance of food. These sensitivities may alter how kids experience food and result in their refusing to eat many foods. Anxiety can stem from the food itself, especially if it’s unfamiliar or disliked, or it can result from other factors such as pressure to eat at mealtime or a negative memory of eating. Older kids may experience social anxiety around their peers.

Parents often have good intuition and know when something is not right with their child’s eating patterns. Some signs of AFRID include refusing food due to its smell, texture or flavor, or a generalized lack of interest in eating. Children may have poor eating or feeding abilities, such as preferring pureed foods or a refusal to self-feed. They may be underweight or demonstrate slowed growth due to inadequate or poor nutrition. They may also show signs of anxiety or fear of eating. If you feel like your child’s eating patterns is moving beyond typical picky eating, please schedule an appointment with a pediatric occupational or speech therapist that specializes in feeding.

What can be done:

  1. Schedule a comprehensive evaluation with an occupational or speech therapist can assist you in helping rule in/out other medical conditions which may also be influencing your child’s eating behaviors and patterns. A therapist may also be able to make recommendations to further evaluate nutrition or evaluation for gastrointestinal issues causing discomfort or pain influencing feeding. They will help develop a comprehensive treatment plan that addresses all different angles of feeding.
  2. Read occupational therapists Maureen Karwowski’s blog regarding playing with your food. Research suggests that when too much negative pressure is placed on the child for eating, the child’s appetite may also decrease and could spur an emotional response leaving the child to dread mealtimes. Vice versa, additional research also suggests that when children are allowed to mess with their food and are given permission to touch, handle, and even squash foods they are actually more likely eat them. Allowing your child to handle food without the expectation to eat the food allows them to gradually desensitize their body to the sights, smells, and feeling of a variety of food. Allowing your child to play with food helps to build new brain pathways that help to reshape prior negative experiences with food.
  3. peblog1Recruit your child’s help. If you do not already meal plan, start meal planning and involving your child as much as possible in the process. When at the grocery store, ask your child to pick out food on the grocery list (even if it is not food your child regularly eats). At home, encourage your child to help rinse fruits and vegetables, stir batter, use scissors to cut herbs, or set the table. During mealtimes, serve dishes family style where everyone passes the different food bowls.
  4. Be patient and start very small. Your child might need repeated exposure to try a new food. You may also need to start by presenting a single bite of a vegetable or a fruit versus presenting a lot of the food immediately off the bat. Sometimes, even reading books about different foods, might be the place to start with your child.
  5. feast for 10.pngThink of fun and creative ways to present the same food. For example, if you child is learning how to like pizza, you can try serving pizza on a tortilla shell or on an English muffin. The following are a few books on food that are good to read with children:
  • Eating the Alphabet: Fruits and Vegetables from A to Z by Lois Ehlert
  • Cloudy with a Chance of Meatballs by Judi Barrett
  • I Will Not Ever Eat a Tomato by Lauren Child
  • The Seven Silly Eaters by Mary Ann Hoberman
  • Growing Vegetable Soup by Lois Ehlert
  • Feast for 10 by Cathryn Falwell
  1. Enroll your child in a food group. Easter Seals has routinely been offering an occupational therapy and speech therapy group called “Fun with Food” that helps children learn how to explore foods using all their senses, including touch, smell, sight, and taste. Each session will utilize sensory “warm up” games prior to heading to the kitchen for our snacks. Parents are encouraged to continue with food exploration at home based on weekly recommendations following each session.

Learn more about our occupational therapy services at http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

My Child Needs Deep Pressure! What Do I Do?

By: Laura Bueche, MOT OTR/L

Sensory Processing

Our bodies are constantly receiving and processing sensory information around us. Our senses give us the information we need to function in the world. We receive information from stimuli both outside and inside our bodies. Our sensory systems include auditory (hearing), vision, olfactory (smell), vestibular (movement), tactile (touch), gustatory (taste), and proprioceptive (body awareness). Sensory processing is the neurological process that organizes and interprets all the sensations we receive so we can function effectively within the environment.

What is Deep Pressure?

CatherineDeep touch pressure is a combination of a tactile and proprioceptive input which is often provided by firm holding, firm stroking, cuddling, hugging, and squeezing.

The proprioceptive sense refers to the sensory input and feedback that tells us about movement and body position. Proprioceptive receptors are located within our muscles, joints, ligaments, tendons, and connective tissues. It is one of the “deep senses” and could be considered the “position sense” (as Carol Stock Kranowitz refers to it in her book entitled  The Out-of-Sync Child.

If a child is having difficulty processing proprioceptive input, they’re brain isn’t receiving proper messages regarding whether muscles are being stretched, whether joints are bending or straightening, and how much of each of these is happening, children may seek out more intense forms of proprioceptive or deep pressure input. Kids with tactile and/or proprioceptive sensory processing dysfunction may seek out deep pressure input to send a stronger message to their nervous system. Deep pressure may help them “dampen” averse tactile sensations or may give them a greater sense of where their body is in a space.

 

Indicators of Deep Pressure Seeking

  • Tensing/squeezing muscles of the body
  • Crashing into furniture
  • Enjoys climbing into small spaces
  • Head banging
  • Grinding teeth
  • Pushing on chin
  • Stomping feet
  • Mouthing non-food items
  • Toe walking
  • Leaning into people

brushingDeep Pressure Input Activities

Deep Pressure Input Benefits

Deep pressure touch has been found to have beneficial effects in a variety of clinical settings (Barnard and Brazelton 1990, Gunzenhauser 1990). In anecdotal reports, deep touch pressure has been described to produce a calming effect in children with psychiatric disorders. Deep pressure stimulation, such as rolling up in a gym mat, has been used to calm children with autistic disorder and ADHD (Ayres 1979, King 1989). Lorna King (personal communication, 1990) reports that children with sleeping problems appear to sleep better inside of a mummy sleeping bag, which adapts to fit the body snuggly. It also has been used to reduce tactile defensiveness in children who cannot tolerate being touched. McClure and Holtz-Yotz (1991) found that deep pressure applied by foam-padded splints on the arms reduced self-injurious behavior and self-stimulation in an autistic child. (Ayers, 1992)

Deep touch stimulation is beneficial to typically developing babies (Barnard and Brazelton 1990, Gunzenhauser 1990). Institutionalized babies who received supplemental tactile stimulation, mainly deep touch pressure, developed more typically (Provence and Lipton 1962). Premature babies who receive stroking and tightly bound swaddling also are reported to show definite benefits (Anderson 1986, Field et al. 1986, Lieb et al. 1980). (Ayers, 1992)

If you think you child is seeking deep pressure input or has a sensory processing disorder, schedule an occupational therapy evaluation before trying to implement a sensory program at home. For more information on our occupational therapy program visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

 

Benefits of Outdoor Play

By: Laura Van Zandt, OTR/L

While visiting my family recently, I was reminded of the importance of outdoor play. I was lucky to grow up with a two-acre yard and large untamed wood behind my house. It granted me endless hours of exploring and freedom. Now, children have highly-scheduled lives and don’t have the opportunity to play outside as often. Safety is another legitimate concern for families reluctant to allow their children unsupervised play time outside.

But the whole family can benefit from play time outside. The benefits for children include:

9_DyeAsherLGross Motor Skills: The outdoors is one of the very best places for children to practice and master emerging physical skills. Children can freely experience gross motor skills like running, skipping, and jumping. It is also an appropriate area for the practice of ball-handling skills such as throwing and catching. There are also tons of opportunities for strengthening and coordination through sensoriomotor and heavy work activities such as sitting on a swing, pushing a swing, pulling a wagon, and lifting/carrying objects.

Fine Motor Skills: When children are playing outside they are constantly using their hands to pick up and hold an endless number of items. Each time they pick up something new, they must form their hand around a variety of different shapes. In turn, they learn to separate the two sides of their hands as well as learn how to develop grasp patterns.

27_Sims_McKenna_3.jpg

Sensory Processing Skills: The outdoors are full of boundless sensory processing opportunities. Each of our seven different senses (vision, auditory, tactile (touch), olfactory (smell), gustatory (taste), vestibular (balance), and proprioception (body’s ability to sense itself) are constantly given a vast array of opportunities.

Just close your eyes and listen to all the different sounds. Can you identify the different birds? Open your eyes and now look. Can you find the bird that made that sound? Sit down and feel the grass on your skin. Talk a walk down to a neighborhood garden and smell the different flowers. Which one is your favorite? Can you find the fresh vegetables and fruits? How do they taste? Bend down and simulate your vestibular sense as you pick the different vegetables and fruits. Put them in your wagon and give your proprioceptive system a workout as you pull it up the hill.

Cognitive and Social Skills: Without all the bells and whistles of electronics, children are more likely to invent games as they learn how they can interact within the outside world. Who can jump the furthest over the stick? Who can run the fastest to the biggest tree? Where can I find the best hiding spot for hide-and-seek? Inventing games offers children the possibility to test boundaries and invent rules. In the process, children learn why rules are therefore necessary. They also learn the fine art of flexibility, and give and take with others. Children learn how to work together for a common goal and how to problem solve and use materials in new ways. They can also learn how to take turns and wait while playing on the playground.

Health: Playing outside is also a natural way to relieve stress. Sunlight provides vitamin D, which helps prevent bone problems, heart disease, and diabetes. Our vision is also known to be helped by playing outside (Optometry and Vision Science, 2009 January). Believe it or not, playing in the dirt also helps boost the immune system and handling bugs can help with auto-immune diseases.

Studies show that as many as half of American children are not getting enough exercise, and that risk factors like hypertension and arteriosclerosis are showing up at age 5. So simply going for a walk can greatly help children. Studies have also suggested that playing outside may help to reduce the signs and symptoms of ADHD in children by reducing attention deficit symptoms (American Journal of Public Health, 2004 September).

Activities by Age for the Great Outdoors

Infants:

08_Finn
Photo by Petra Ford
  • Lay a blanket down and have tummy time outside
  • Introduce grass, leaves, and sand in their hands as they exercise fine motor skills of touching and holding
  • Face the infant toward children at play to stimulate their eyes
  • Place the infant in a safely secured swing
  • Push an infant in a stroller around the neighborhood or park

Toddlers:

  • Blowing bubbles and trying to catch
  • Peek-a-boo around trees, bushes, and playground equipment
  • Explore in a sandbox
  • Encourage exploration on small playground equipment
  • Water play with cups and plastic containers
  • Push and pull equipment

Preschool:Gardening Blog1

  • Create a garden or plant some flowers
  • Go on a nature hike with a scavenger list of items to find
  • Use sidewalk chalk to create pictures
  • Collect twigs, branches, and sticks
  • Collect pinecones for making nut butter bird feeders
  • Fly a kite
  • Allow free time/ independent play

 

School Age:jorge-on-bike

  • Running outside
  • Kick a ball
  • Jump rope
  • Hop-scotch
  • Go on hike
  • Plant and maintain a garden
  • Ride a bike
  • Build forts outdoors

Easter Seals DuPage & Fox Valley’s therapy is modeled on play. If you have concerns about your child’s development or want an evaluation, visit www.eastersealsdfvr.org for more information.

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.

13_Calvin_Calforio

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!