Tag Archives: occupational therapy

Supporting Children with Sensory Disorders while Traveling

By: Kelly Nesbitt, MOT, OTR/L, Occupational Therapist

When a child with sensory processing disorder goes on vacation, it may be difficult for their bodies to go into that “relax and restore” mode. Children with sensory processing disorders are constantly “battling” with their environment in many of the following ways:

  • Every sound is too loud and hurts their ears
  • Smells are abrasive and can cause them to gag or vomit
  • New tactile sensations send them into a panic
  • Changes in their normal routine can make them extremely anxious
  • New sights and movement in their environment can startle them

The following are some tips that may help support a child with sensory issues during a summer vacation so they may have a relaxing experience.

Visual Schedules

An example of a visual schedule.

If your child benefits from knowing what to expect in the day, it may be useful to set up a visual schedule revolving around your vacation. This can include the steps you will need to complete going through the airport. (Travelers Aid Chicago has resources to make a visual schedule specific to O’Hare airport).

Some children may also just benefit from going over what to expect on their vacation. You can help them prepare by saying, “We are going to the airport and this is what to expect…”  or “We will be on vacation for 4 days. During those days we can do these activities…”

Long Car Rides

3 kids in the car, reading a map, eating and wearing headphones.

Children that are constantly on the move may find it extremely difficult to sit still during long car rides to their vacation destination. Often times kids who are always “on the go” benefit from heavy work activities that involve pushing, pulling, and carrying. These activities give input to the joints and muscles which can be very regulating. Here are a few heavy work ideas specifically for car rides: 

Squigs are toys that can keep children busy on long car rides.
  • Squigs on the windows: I suggest this for children who need something to keep their hands busy with push and pull component to get heavy work. These small plastic suction cups stick perfectly to car windows and to each other. Children can build and make a picture with them on the windows 
  • Pop TubesThese toys also provide an opportunity for children to push and pull when you are cooped up in the car.
  • Animal walk breaks at rest stops: Just as you need to get out and stretch your legs during a long ride, your child with sensory difficulties will need this break too! At rest stops, take advantage of the opportunity to move by doing silly activities that promote heavy work: walking like a bear, jumping like a kangaroo, playing on a playground if the rest stop has one. 

What to Pack

Girl sitting in a suitcase

Here’s a list of sensory supports that may help your child while you are on vacation. Make sure to consult your occupational therapist about which items may be most beneficial for your child.

Girl wearing headphones.
  • Noise cancelling headphones: Some children benefit from wearing headphones if they are easily overwhelmed by the loud noises of crowds. Noise canceling headphones can range anywhere from $20 to upwards of $200. These might be handy for kids that would get overwhelmed by crowds, traveling on an airplane, or seeing a firework show on the 4th of July. 
  • Comfort item: Bringing a stuffed animal or blanket that your child finds soothing may be beneficial for when they become anxious or overwhelmed while on vacation. You could even add soothing aromatherapy scents such as vanilla, lavender, or chamomile to these comfort items for an extra sensory “treat.” (Always make sure your child tolerates and likes the scent prior to adding it to their comfort item. If the smell is too bothersome to them, they may not want to be around it anymore!) 
  • Weighted blanket or stuffed animal:  Some children with sensory processing difficulties find compression comforting. A weighted blanket or stuffed animal may provide some calming input and tell their body to relax. Weighted items are now available at most stores or online. Click here to read more about the benefits of weighted blankets.
  • Fidgets:  These are small items that kids can fiddle with in their hands to keep them busy and focused when they may feel overwhelmed. Fidgets can be bracelets, putty, pop tubes, etc. 
  • Identification bracelets: Sometimes when a child is overwhelmed, they may run away from the group. Because of this, it may be a good idea to make a bracelet with your phone number on it so that you can be reached in case of an emergency. Options include beads with numbers on them, temporary tattoos that you can specially order with your phone number on it. There are even cute “Disney-themed” buttons and tattoos with emergency contact information that you can specially order. Here are some examples of number bracelets and  temporary tattoos or you can design your own ID bracelet

The Benefit of Breaks

Children are working very hard to stay regulated and calm when they are being bombarded with all this new sensory input that comes with a vacation. They may just need a little break. It is absolutely okay to take some time in your hotel room or find a quiet spot for your child to regroup. Sometimes just a quiet room with a preferred toy or sensory tool is just the break that your child needs in order to enjoy the rest of their vacation.  

You can help your child create a “calm down corner” in your hotel room or wherever you are staying. This spot does not need to be complicated – it can be a little corner of the room with pillows, blankets, and some of the items previously listed in “What to Pack.”

This can be their special area in which they can retreat to take a break if they become overwhelmed and enjoy a moment away from whatever input is overwhelming them.

This is not a punitive space to send them to when they are behaving badly or being uncooperative. This is a calm space that you can offer them a break in or they can elect to go to when needed. Just as you may go sit by the pool after a busy day on vacation to relax and recharge, your child with sensory processing difficulties may need their own unique space to do the same.

Unexpected Meltdowns

Girl who is upset hugs her mom.

Children with sensory processing difficulties can have meltdowns when they get too overwhelmed by the sensory input in their surroundings and/or if they become too fatigued. As well prepared as you may be, you can’t anticipate or prepare for every meltdown.

If your child has a meltdown while on vacation, first try to figure out what elicited the meltdown and remove them from the input that is too overwhelming for them. It may be helpful to go through all 5 senses: Was there a smell, sound, touch, sight, taste that they experienced that caused them to react? Were they in a loud, busy crowd for too long? Did the plan change too suddenly and without warning?  

Once you have removed them from whatever caused the meltdown (as best as you can), give them input to help calm them down. For some children, they like compression from big hugs or weighted blankets. Other children need to put on their noise cancelling headphones and have some quiet time. 

Sometimes children with sensory processing difficulties can meltdown because they are so tired from holding themselves together for so long in a new environment. As a clinician, I have an understanding of the experience, and know it must be exhausting to be bothered by what most people consider “normal” input, such as the sounds of people talking, the feel of your clothes on your body, or the smell of the pool on vacation.

It’s important for parents to understand that their child with a sensory processing disorder is expending a lot of energy processing input from their surroundings. They may need more patience and understanding when they are having a tough time with changes outside their normal routine. It may be helpful for parents to help children label when they are becoming agitated, by saying “It looks like you are not comfortable right now, can we take a break?”  

Summer vacation should be an opportunity for everyone in your family to rest and recharge. If you need help brainstorming what activities/preparations would be best for your child this summer, consult your occupational therapist for more insight into your child’s unique sensory needs.  

Read our previous blog on How to Plan a Sensory Friendly and Accessible Vacation

For more information about Easterseals DuPage & Fox Valley and our Occupational Therapy services, visit: https://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html .

Indoor Play Activities for Toddlers

By: Kelly Nesbitt, MOT, OTR/L, Occupational Therapist

These cold wintry months make us want to bundle up and stay indoors. It’s so hard to keep adventurous little ones entertained on a beautiful day where you can go to the park, let alone a day when you’re stuck inside. It can be especially hard for children with sensory processing difficulties to not go outside and get the necessary input their bodies need to stay calm and focused through climbing, jumping, and tactile exploration. But you don’t have to sacrifice a fun day with your toddlers and young children just because it’s freezing out!

When it comes down to it, a child will love any game in which they have special playtime with a parent or caregiver. But if you’re having a little trouble thinking of some ideas to get you started on a fun indoor day, here are a few activities for your toddler that will help them get the sensory input they crave while having a whole lot of fun!

  1. Build a fort

Make a princess castle, bear cave, dragons lair, or just a creative hideout. You can use whatever material is around the house (cardboard boxes, blankets, pillows, comforters, sheets draped over furniture) to make a fort. Help the younger toddlers (1 year olds) assemble the fort and play games like peek-a-boo as they climb in and out of their fort.
Young toddlers can also take child-safe flashlights into their fort as part of their peek-a-boo game or to play hide and seek with parents.

22_Zach and Amelia Judson

Older toddlers (2-3 year olds) can help you construct the fort as a great way to express their creativity and imagination. Encourage them to play house with their dolls/stuffed animals in their own little home. Or maybe you can join in an imaginative game with them (Be a dragon that is “attacking” the castle that your valiant knight defends with pillows, be a neighbor that brings a snack to your little one’s “home,” or pretend to be the Big Bad Wolf who blows their house down and create a pillow pile for the Little Pigs to dig out of).

Benefits of the Activity: I love having kids build a fort because it gives their body tactile input (input to their skin about the texture and pressure of the pillows and blankets). Also this type of activity helps them build visual perceptual skills needed to stack pillows to get them to stay up and not fall. Finally, children get proprioceptive input (pressure into their joints and muscles as they pick up heavy pillows and push them around). OT’s frequently call this type of input “heavy work.” Proprioceptive input is calming input that helps children who are always “on the go” slow their bodies down and have a better understanding of where their bodies are in space.

  1. Painter’s tape mazes/hopscotch

Jimmy2Use painter’s tape to make shapes on hardwood, tile, or linoleum floor. Older kids can pretend that the circles out of tape are stepping stones in the river that they have to jump between without falling in the water. Kids may even enjoy making a little maze on the floor that they can walk on top of. You can even make squares to make a hopscotch pattern on the floor and practice jumping and balancing on one foot. Finally, make a path on the ground to use as a road for toy cars or animals!

Benefits of the Activity: This activity helps children build gross motor skills through coordinating their body movements to jump in/out of the hopscotch squares and develop visual tracking skills as they have their cars “follow the road” in a tape maze.

  1. Sleigh Rides

Pile pillows in a laundry hamper and place a blanket underneath to make the laundry hamper slippery on hardwood, tile, or linoleum floors. Your child could then climb in and enjoy a fun sleigh or car ride as you pull them around. Make a game out of it by stopping at the “grocery store” and picking up pretend food as you pull them around.  Need your child to burn off a little energy? Have them push a basket around and pick up toys or push around a sibling, if they are able to.

Benefits of the Activity: This game gives their body tactile input (as they are squished by textured pillows in the laundry hamper) and some vestibular input (movement input and understanding of where they are in space) as they are pulled around. Once again, this activity provides proprioceptive input if the child pushes the hamper around the house!

  1. Sensory Bin Hunt

shockSensory bins can be made out of just about any material and is a fun way to help your child explore different textures. Take any large Tubberware or small to medium sized storage bin and fill with whatever sensory materials you child might like exploring (uncooked bowtie pasta, macaroni, beans, and cereal are a few of my favorite not-too-messy options). Don’t want a huge mess to clean-up? Put a fitted sheet underneath the sensory bin that will catch all the little pieces that might spill out during play. That way you can just bunch up the fitted sheet and throw pieces in it away when your child is done playing. Hide little cars inside the sensory bin and help your child dig through to find it. Pretend to give Barbies a bath in this pretend bathtub, play puppies and dig to hide a bone in the bin, or just allow your kid to play with funnels, tubberware, and serving spoons in the sensory bin.

Benefits of the Activity: This activity is a great way to introduce tactile input to the hands as they feel the different shapes, sizes, and textures of the items in the sensory bin. Want to add an extra challenge that OT’s would love? Have your child close their eyes and search around the bin with their hands to find a hidden treasure. OT’s describe the ability to distinguish between the properties of different items with the skin as tactile discrimination. See if your child can feel the difference between the macaroni you filled the bin with and the pennies you hid for them! If they have their eyes open and are searching the bin for their treasures, this activity helps children develop good visual scanning skills.

Note: Children should be supervised during sensory bin play to prevent choking if children place small pieces in their mouth.

  1. Bath time Painting

bathtub crayonsHave a fun water day indoors by playing in the tub! Encourage some creativity and early fine motor fun with fingerpaint soap or bathtub crayons that are easily washed away with water. I found fingerpaint soap at the Dollar Store or in the dollar section at Target.

Benefits of the Activity: This activity promotes tactile exploration as children feel the different textures of the fingerpaint, the temperature of the tub, the pressure of the water around their bodies, and the splashes of the water as they play. Bathtub crayons also provide a play-based opportunity to practice developing an age-appropriate grasp and fine motor development.

**Note: Children should be supervised at all times in the bathtub. Check that fingerpaint soaps are non-toxic and safe.

  1. Puppet show

Use premade puppets or make your own puppets with socks. Show your young toddlers how to play with a puppet (make the puppet say “hi” or give your little one kisses). See if they can imitate what you do! Help set up a little “stage” for a puppet show by draping a sheet over 2 chairs and encourage your older toddlers to put on a show for family and friends!

Benefits of the Activity: This activity promotes imitation through play. A child’s ability to imitate actions is a function of motor planning. Motor planning is the ability of the child to have an idea of what to do, plan the steps needed to accomplish this task, and successfully execute this plan. This activity also promotes imaginative play and helps children receive tactile input as they put sock puppets over their hands and move their hands to make the puppet talk.

  1. Food Stamps or Food Necklaces

orange stamping
Photo from: https://mom.me/toddler/11835-toddler-talk-orange-stamping/

Make stamps out of fruit and veggies and make some artwork! Help prep vegetables and fruits you have around the house by cutting them in half. Apples, potatoes, bottoms of celery stalks, and broccoli make great stamps. Set up an area where your kids can get messy (maybe roll out wrapping paper on the kitchen table or floor and place paper on top to make clean-up easy). Provide some non-toxic finger paint or maybe shaving cream with food coloring and get stamping! This activity not only helps little ones express their creativity, but it also exposes them to new foods in tactile exploration.

Older toddlers might also enjoy making food necklaces. Use yarn or other types of string and help your child string on Cheerios, Fruit Loops, or macaroni onto their necklace.

Benefits of the Activity: Not only does your child receive tactile input through the different textures of food, but it’s a perfect opportunity for your child to play with foods that they usually don’t eat (if your child hates broccoli, it’s helpful for them to just be exposed to it in a context in which they don’t have to eat it, just play with it!)

An Occupational Therapist will tell you that repeated exposures to non-preferred foods helps children become more comfortable with different foods. Finally, children who string Cheerios/Fruit Loops onto string have the opportunity to practice their fine motor skills as well as visual motor skills (can the child identify where the hole in the cereal is and thread the food onto it?)

  1. Silly Instrument Play

Lay a blanket on the kitchen floor and lay out pots and pans. Have your little one use wooden or metal spoons to play on their instruments. (Adults may need earplugs during this game!) Join in the silliness and be the leader of a parade around the house. Sing songs with your little one and practice marching.

Benefits of the Activity: This game provides your child with proprioceptive input as they bang on pots and pans. Your child also works coordinating movements (can they swing their arms to hit the pot). Older toddlers can work on gradation, which is the ability to grade force of movements (can your child hit the pan softly so a quiet song, then hit the pan really hard to produce a loud sound?)

  1. Obstacle Course Adventure

Make a climbing obstacle course around the house using pillows, blankets, and sofa cushions. Help your child climb a pillow mountain or make a “garbage pile” of pillows in which you can hide a toy that your child can climb around to find.

Benefits of the Activity: Similar to a fort activity, obstacle courses provide a great opportunity for tactile input as they move around the cushions and blankets and proprioceptive input as they push/pull pieces to crawl through the obstacle course. This activity also works on body awareness, the ability of the child to feel where they are in space in order to effectively move their body around obstacles. The more a child is allowed to crash and push equipment around, they develop a better sense of where their body is in space.

  1. Dress-Up Play

Pull out old clothes, hats, shoes, sunglasses, socks, and scarves from way back in your closet and have a dress-up day. Older toddlers may enjoy having a fashion or talent show in your living room.

Benefits of the Activity: Not only do kids get to use this as a way to pretend to be just like their heroes (you), they also get practice dressing skills they will need when they are older. Young toddlers may have difficulty putting on different pieces of clothing (which is pretty age-appropriate), but they can work on pulling off pieces that they are all done with playing, such as pulling off a t-shirt, socks, shoes, and pants/skirt.

  1. Indoor “Camping”

Make a tent out of sheets and chairs and drag in a sleeping bag or pillows to make your tent cozy. You can bring in flashlights, story books, toys, and/or some homemade s’mores made in the oven (recipe link below).  See if your little one can use their flashlight to find different pictures in the story you read to them.

Oven S’mores Recipe: https://www.thespruceeats.com/easy-baked-smores-3052398

Benefits of the Activity: Making a small space out of pillows and sheets creates a great opportunity for children to receive tactile input. Some children find small spaces calming because they get “squished” between pillows. Getting “squishes” is a form of deep tactile input, which is very calming for some (think of a big hug or being swaddled). If this sounds like your child, use the tent as a safe retreat in which they can bring their favorite story and get a big hug from a loved one. Finding pictures with a flashlight while reading a story promotes visual scanning. Best of all, reading a story together gives you both the perfect opportunity to bond and spend quality time together.

There are limitless activities you can do inside that can help support sensory play and help children with sensory processing difficulties get the input they need. Feel free to use the ideas above or come up with your own play ideas!

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

Pretend Play Activities

By: Laura Bueche MOT OTR/L

26_Jack and Kathleen

Pretend play is an important piece of development. It promotes social skills, cognitive flexibility, imagination, language, and helps kids process the world around them. When your child participates in pretend play, they are learning the social and emotional roles of life in a fun, hands-on manner. It can stimulate creativity and help them grow to be more comfortable with themselves and the role they play in their everyday lives.

Included below is a list of potential pretend play scenarios to get your creative parent ideas flowing:

Doctor: This is a great pretend game to teach your kids about responsibility, while encouraging them to be proud of “taking care” of someone else!

Kitchen/restaurant/coffee shop/ ice cream shop: This is a great way to help your children learn about food and nutrition, and get them interested in what goes in their bodies and how it fuels their energy.

Grocery store: Another fun way to help them learn about nutrition, while also helping them improve math skills by counting and setting prices for different items being “sold”.

Animal shop/vet: A fun hands-on approach to learn about animals and the important role they play in many peoples lives

Airport: This is a great way to help children understand the different means of transportation and travel people utilize, especially if they have never gone anywhere far from home

Beach vacation: Similar to playing airport, this can help kids understand about travel and the vast and different climates many people live in, especially if your family does not live near a beach.

Brownie Miliana2.jpg

Baby bath time/ feeding baby/ baby diaper/ baby bed time:

Similar to playing Doctor, this is a great way for kids to foster an interest in responsibility and taking care of others, while also boosting their confidence in discovering their helpful abilities!

Camping adventure: This is a way to improve kids outdoor skills, while teaching them about nature and the environment they live in.

Pirate treasure map adventure: This is a fun way to get kids creativity flowing and help them learn about adventures they can take and create in their mind

Haunted house: This can be as scary or safe as your child is comfortable with, and can allow them to explore and set boundaries in their mind for what makes him/her comfortable

Dress up/fashion show:

dress up

This is a fun way to let kids try on a new role for size, and to help give them the experience of “walking in other peoples shoes”

Police man/woman: Similar to playing dress up, this gives kids the impression of what kind of jobs people in their community hold

Gardening/ making mud soup/ building sand castles: A very hands-on way to explore nature and learn about the plants and trees they see everyday

Making toy/Lego cities: This allows kids to be totally free-spirited in constructing what they think a fun space to live/play in would be.LEGO Run Pre-Party 029.JPG

Making puppets/puppet theater: This is a healthy and fun way for kids to express their emotions and feelings, while also allowing them to explore new emotions they may not be familiarized with yet.

Firefighter: Identical to playing police officer, this allows children to try out the role of what a firefighter does for their community.

Pretty mixed race girl and Caucasian boy pretending to be superh

Super hero/ defeat bad guys and save good guys:

This helps kids understand right from wrong and the values you as a family have, while also helping them feel good about the choices they make.

Tea party: This is a fun way for kids to make up their own rules and find out what it means to be “in charge” of a dining situation

Post office: Kids can learn about roles in their community and better understand a job they see people enact daily.

Car washplaying carwash.jpgPerfect for a summer day, playing car wash can show your kids real life chores in a positive way, while also making for a fun water activity.

Fishing boat: This is a great way to get your kids to explore nature in their minds, as well as understand a fun hobby many people enjoy.

Santa’s work shop: If you and your family celebrate Christmas, this is a wonderful way to introduce the holiday to your children and help them understand the tradition of Santa Clause and what that means to your family.

Farmer: Similar to playing police officer or firefighter, this can help children understand a job people either in or out of their community hold, while also helping them develop a healthy relationship with food and animals.

 

Doll house: This is a great way to get your children interested in how a household runs and the work it takes to sustain a healthy lifestyle, as well as be a fun outlet for them to get creative and cultivate different personalities and traits for each doll.

23a_Brady_and_Cooper_CoulterRace track/ train tracks:

Similar to playing airport, this helps demonstrate to children the different means of transportation available to them, as well as foster a desire to explore and travel

Many of these pretend activities/games include props, but always feel free to encourage your children to use their imagination and create props in their mind or with another item in your house, especially if the props are not readily available to you.

From one mom to another: Early Intervention tips

By: Laura Van Zandt, MS, OTR/L

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

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

    will2
    Try calming breaths while giving your infant a massage.
  2. Use your tribe and forget as much as possible about modesty. Your tribe, or your support team, doesn’t care what you look like or that you haven’t showered in several days. They love you for who you are and not anything else. Those first weeks can be challenging, especially if you have a children with medical needs. Let them help so you can a little rest to keep yourself going strong.
  3. Talk to yourself. It might feel funny at first but it can help. It doesn’t matter what you say. I often find myself talking about anything and everything- the plan for the day, what is happening right now, about my son’s family, etc. The added benefit of talking to yourself is your child also gets to hear your voice.
  4. Try to develop routines early. It’s really hard the first weeks adjusting and even thinking about routines. I’m not even sure most newborns have routines aside from eat, sleep, and diaper changes; however, if you can try to establish some routines it will help your sanity and also help your newborn develop. For my little one, we try to follow a little routine of eat, quiet alert/play if he stays awake, and sleep. I try to use similar songs and even sing the same song over and over when he is trying to sleep. You can even plan to take a stroller walk around the block the same time every day. Having routines help signal to our bodies a sense of calmness and can provide a little bit of organization when things are crazy.
  5. baby sleeping on white cotton
    Photo by Pixabay on Pexels.com

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

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

 

 

Improve Children’s Handwriting

By: Laura Van Zandt, MS, OTR/L

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

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

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

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

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

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

Squiggle pen

squiggle

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

Mechanical pencils

mechanical.jpg
Picture by: www.raymondgeddes.com

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

 

Twist and Write Pencil

twist pens.jpg

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

 

Small Pencils, Broken Crayons

color-pencil-drawing-coloring-colored-pencils-159825.jpeg

 

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

 

Beginning Writers

palm eggs

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

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

clover.png

Stylus

 

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

 

Sidewalk Chalk or Small Chalk Pieces

chalk.jpg

One of my favorite outdoor activity is drawing with chalk.

 

Learning Without Tears Flip Crayons

flip crayons
Photo by: therapro.com

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

 

Triangle Shapes

triangular crayons.jpg

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

Forbidden Tools

window crayons  bathtub crayons

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

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

What are Fine Motor Skills?

By: Kelly Nesbitt, Occupational Therapist

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

20150320_ES-LegoRoom-25.jpg

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

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

Babies: Learning to reach, grab, and pinch!

  • 1-2 months old:
    • Bat arms inaccurately toward a toy placed by them and will occasionally struggle to grasp onto toys in an intentional manner.
    • Babies at this stage (from birth to approximately 4-6 months old) have a reflexive grasp, meaning that if an object is placed in their palm, they will automatically grasp around the object.
  • 3-4 months:
    • Grasp onto objects in the palm of their hands without their thumb helping them hold onto the object.
  • 5 months:
    • Reach and grasp onto objects placed by them with greater accuracy.
    • Begin to use the thumb more in grasping with their palm of their hand around 4-5 months. This is called a “palmar grasp
  • Vitiello_Cody_7
    Photo by Lauren Vitiello

    6-8 months:

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

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

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

Kindergarten

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

20_MiraReynaSonia2

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

 

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

References

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

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

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

 

 

 

 

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

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

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

 

 

 

 

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. 

 

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.
28321216_Unknown (1)
• 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.

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.