Tag Archives: occupational therapy

From one mom to another: Early Intervention tips

By: Laura Van Zandt, MS, OTR/L

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

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

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

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

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

 

 

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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

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Picture by: www.raymondgeddes.com

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

 

Twist and Write Pencil

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

 

Small Pencils, Broken Crayons

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

 

Beginning Writers

palm eggs

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

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

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Stylus

 

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

 

Sidewalk Chalk or Small Chalk Pieces

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One of my favorite outdoor activity is drawing with chalk.

 

Learning Without Tears Flip Crayons

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?

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

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

Babies: Learning to reach, grab, and pinch!

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

    6-8 months:

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

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

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

Kindergarten

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

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

 

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

References

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

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

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

 

 

 

 

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

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

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

 

 

 

 

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.
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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.

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. 

What is Occupational Therapy?

By: Laura Van Zandt, OTR/L

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

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

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

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

ASSESSMENT PROCESS (Person, Environment, Occupation)

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

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

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Photo by Marita Blanken

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By: Maureen Karwowski, OT

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

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

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

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

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

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

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

A Super Sensory Summer

By: Laura Bueche MOT OTR/L

Summertime is the best time for some creative sensory play outside. Your child will have a blast learning and exploring with these sensory summer activities that won’t break the bank.

IDEAS TO INSPIRE YOUR LITTLE SPROUT

Garden Party!

Fill a tub with soil. Hide plastic bugs, coins, or dinosaurs.
Use shovels or hands to find the treasures.

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Paint pots, plant seeds and watch them grow.
Overturn rocks to search for bugs and worms… or play with fake worms. Recipe here.

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Photo Credit: Learning4kids.net

Is real mud a difficult texture for your little one?  Start with “ghost mud”.
Recipe here

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Photo Credit: TreeHouseTV.com

Make a Splash with these Water Activities

Water Fun!

Fill a tub with water beads and ocean animals for an awesome, hands-on aquarium.

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Freeze toy animals, foam puzzle pieces, or pretend jewelry in ice. Have your kiddos use squeeze bottles, and eye droppers of warm water to get them out. Instructions here.

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Photo Credit: LittleBinsForLittlehands.com

Green gross swamp sensory table. Recipe here.

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Photo Credit: NoTimeForFlashCards.com

 

 

 

 

 

 

 

Shaving Cream Car wash. Recipe here.

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Photo Credit: TreeHouseTV.com

 

 

 

 

 

 

 

Let’s go to the Beach!

Feel the sand between your toes with these fun tactile activities.

Sand Slime. It’s ooey, it’s gooey…and sandy? Recipe: Here

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Photo Credit: GrowingAJeweledRose.com

 

 

 

 

 

 

 

Drawing letters in the sand, a perfect pairing of visual motor and tactile. Recipe here.

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Photo Credit: AnyGivenMoment.com

 

 

 

 

 

 

 

Kinetic Sand…semi sticky, and super moldable sand. Get it here.

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Good old sand box play…because nothing beats the classic, pale and shovel.

For more summer sensory ideas, or ways to adapt these activities to your child’s needs and goals, ask your occupational therapist at Easterseals DuPage & Fox Valley. For more information about occupational therapy visit our website.

Have a great summer!