CBOTB

Wednesday, June 26, 2013

Wrist Stability and Hand Arches

Expanding on the "Secrets to Good Handwriting" post from several weeks back, today I am addressing wrist extension stability and the hand arches.  Remember that developing all of the skills mentioned in that original post will positively affect your child's fine motor skills. Think of those skills mentioned as the building blocks of fine motor skills.

Wrist extension stability:
There is no other joint in the arm that can compensate for wrist limitations. Kids with fine motor issues will compensate for poor wrist stabilization of the wrist by flexing the wrist (bending it toward the palm) to "lock" it into a stable position. This is often seen in left handed kids, and I call it “hooking” of the wrist. This position affects dexterity and range of motion in the fingers and thumb.  What you will often observe is that the child moves their whole arm as a unit when they are writing or coloring.  A better position is a slightly extended wrist position (wrist bent back); this allows for a better thumb position, a better arch in the hand, and isolated movement of the fingers.  As a result, strengthening the muscles that extend the wrist can help with working on fine motor skills.

Activities:
-work on a vertical surface/plane. Examples would be an easel, chalkboard, slantboard or just tape some paper to the wall. You can have your child paint, draw, color, do mazes, complete dot-to-dot, stencils, etc.  You can make your own slantboard by using a large 3 ring binder.


-weight bearing activities where your child has to lean on an open hand (leaning on an arm while side sitting, assuming a 4 point position and completing an activity, do animal walks etc.)

-have your child lean his/her forearm on a table top so that their hand extends beyond the edge of the table.  Have them hold a weight or a soup can in their hand and extend their wrist (bend the wrist back).  Complete several repetitions.

Hand arches:
There are actually several arches in the hand, but three main ones; one is rigid and 2 are flexible.  The arches allow you to touch your thumb to your other fingers.  Hand arches provide stability for picking up objects, writing, fine motor tasks and for grasping tightly.

 Activities include:
-use tongs or clothespins to pick up small objects


-cupping hands to shake and roll dice, or scoop up sand, rice, beans
-use the palms of the hand to roll play dough or putty into balls or snakes
-using the side of a crayon, rub a piece of paper with something underneath, such as a leaf or coins
-hold a small piece of chalk to draw pictures or write on a chalk board
-play with sock puppets or puppets
-play with a racquetball or other similar sized balls encourages the natural contour of the hand.  For babies/toddlers or for kids who developmentally fit into this age range, these are great:







Baby Einstein Roller-Pillar Activity Balls, 3-36 Months - 5 balls

I actually found these for my great niece and gave them to her for Christmas because they encourage arch development (always a hidden agenda...).  I got them at Target for $10, but you can also find them online at amazon.com for the same price.



This is my "Great Ava" developing her hand arches!

Wednesday, June 19, 2013

DIY Visual Schedule

If you have a child on the Autism Spectrum, or work with those that are, you know the importance of routine and schedule!  Kids on the spectrum always want/need to know what is happening NOW and what will happen NEXT.  They also like to concretely know when a task or activity is FINISHED. The day goes a lot smoother if you don't make unexpected changes or expect them to do something that they are not prepared for.  Just yesterday we had a new little girl that we were working with that was having a terrible time with transitioning from one activity or area of the building to another.  Because we know that kids with Autism are very strong visually and have difficulty with auditory processing, we know that presenting things VISUALLY from a communication standpoint is important. Remember this if nothing else:  LESS VERBAL, MORE VISUAL.  This little girl did not come to ESY (summer school) with a visual schedule in place already, so to avoid further meltdowns, we needed to make one up for her quickly.  Here's how I did it:

A black plain pocket folder, construction paper and printed images.
You need:
-a plain pocket folder (I just had a paper one, but if you use a plastic one, you will get more wear and tear out of it)
-computer printout of a "Now" picture, and an "All Done" picture (I used a stop sign)
-construction paper
-sticky back velcro
-various pictures of your daily routine (picture of a calendar for calendar time, a bathroom for bathroom time, your car for outings, etc)  We use Board Maker to make the pictures, but if you do not have access to that, just google some images or take pictures in your home/classroom of actual items/objects and print them in small squares).

Making the "Now" and "All Done" areas of the schedule.

-Cut rectangles of 1 or 2 colors and glue the Now picture to one, and the All Done Picture to the other.  I used red and green-  green for the "Now" picture (green means "go" or "start"), and red for "All Done" picture (red signifying "stop").  You can use any colors that you have around, however.

I then laminated each rectangle to make things more durable, but you don't have to.  This laminator is a Scotch brand laminator that you can find at amazon.com, but I bought mine at Menards for $25.

Arrange the schedule order on the velcro strip along the bottom of the folder.

-Attach the construction paper to the front of the folder with the folder opening up from the bottom (the crease of the folder is at the top).  Add a small piece of sticky back velcro loop (fuzzy side) below each picture.

-Cut a strip of sticky back velcro loop (fuzzy side) the length of the folder, and attach it along the bottom of the folder beneath the "now" and "all done" areas.  This is where you will attach the picture squares in a row that is your child's/student's schedule.  My folder is black, so you can't really see the black velcro strip, but if you look carefully, you can see it between the pictures that are stuck to it.

-Cut small pieces of the velcro hook (not fuzzy side) and attach them to the back of all of the picture squares you have made.  You may want to laminate each picture square or at least print them on cardstock so that they are more durable and can be reused.  Arrange the pictures in the order of your schedule or routine.  The cool thing is, you can change the order when you need to, because they are just velcroed on!

Make an area inside the folder to store picture cards.
-Opening up the folder, attach 2-3 more rows of velcro loop (fuzzy side) that are the length of the folder.  This is where you can store the extra picture squares that you will need to finish out your daily routine, adding to the schedule strip on the front as you go about the day.  (I know it's hard to see the black velcro on the black background- sorry!)

Now, you are ready to use the new visual schedule!

Playtime is "all done," and "now" it is time for clean up.  "Next" on the schedule on the strip below is snack time.
Take the first picture of your child/student's routine, show it to the child, and put it on the velcro spot under the "Now" picture.  This is what you are expecting the child do now.  Tell the child what you are expecting him or her to do now.

-When you are done with that activity, move that picture under "all done," and tell the child that you are all done with that activity.  Then, show him/her the next picture from the velcro strip schedule, and move it to the "Now" spot.  Continue on in this manner throughout the day when you are expecting the child to change his/her routine.

This is just ONE EXAMPLE of many visual schedule options that can be used, and it can be added to or changed to meet the needs of your particular student/child.  If you are a parent, there may be a visual schedule that is already being used with your child at school.  Ask your child's speech therapist or occupational therapist if this is the case, and they can help you set something up for home that is a similar format to what your child is already used to using.  They will likely even help you make one or set it up for you with your input.

Sunday, June 16, 2013

The 7 Sensory Systems (yes, 7!)

I haven't really touched on a lot of sensory related information yet, but before I do, I think it is important to review the 7 sensory systems in preparation for that.  Did I say 7?  Yes, I did.  Most people are aware of the basic 5 (vision, hearing, touch, taste and smell), but are not aware of the other 2, proprioception and vestibular.  These systems are the building blocks of the central nervous system and understanding these systems is vital for later understanding sensory processing.  The term ‘Sensory Processing’ refers to our ability to take in information through our senses (touch, movement, smell, taste, sight, hearing, balance) organize and interpret that information for our own use and then make a meaningful response.

Proprioceptive System
-proprioceptors are the neuroreceptors in tendons, muscles and joints.

-proprioceptors are a large source of sensory input because they are getting input whenever we move.

-input can vary in intensity.

-the proprioceptive system is stimulated by active movement of the body, particularly against heavy resistance, during heavy work, joint compression (pressure into a joint, weight bearing), or joint traction (pulling body away from a a joint).

-tends to have a more inhibitory (calming) effect on the nervous system.

Vestibular System
-located in the inner ear and relates us to gravity.

-gives us the sensation of the weight of our body, tells us where we are in space.

-Monitors our head and body movements in any direction.

-to be effective all parts of the system should be stimulated.  This is done by the head in a variety of positions and movement in a variety of directions.

-eyes closed stimulates increased use of this system.

-important in the development of visual skills.

My daughter (on the right) and a friend getting some vestibular and proprioceptive input on the trampoline.
Tactile System
-has 3 different receptors in the skin:  light touch (protective, alerting), discriminative touch, and those that receive info. about heat, cold and pain.

- firm, non moving touch is easier to tolerate than light or moving touch.  Anticipated touch is more acceptable than unexpected.

-deep touch preceding light touch increases tolerance for light touch.

-proprioception and vestibular stimulation help to improve tolerance to tactile stimulation.

Visual System
-The visual system is the part of the nervous system which allows a child to see.  The psychological manifestation of visual information is known as visual perception.

-The visual cortex is located in the rear of the brain above the cerebellum and is responsible for higher-level processing of a visual image.

-Visual perception is the ability to interpret information that the eyes are taking in.

-When a child has a visual processing disorder, he/she has a decreased ability to make sense of information taken in through their eyes. This is not the same as visual acuity, but is rather difficulty with  how visual information is interpreted or processed in the brain.

Auditory (hearing), Gustatory (taste) and Olfactory (smell) Systems
-  spontaneous sound production often occurs during sensory integrative treatment, particularly during vestibular stimulation (so you may hear more vocalizations or verbal output with movement activities).

-Auditory processing does not refer to how well a child can hear, it is how the brain processes/interprets  what it is hearing.

-Our gustatory system can identify at least five different taste sensations: sweet, sour, bitter, salty, and umami (the taste that identifies glutamate, which is found in chicken broth, meat extracts, and some cheeses).  These tastes, along with texture, temperature, and other sensations combine with odors from the olfactory system to produce the perception of flavor.

-The olfactory system, or sense of smell, senses and processes odors.

-Olfactory information travels to areas of the brain that oversee emotions, behavior, and memory, and also affects conscious thought.  (Have you ever smelled something and it reminded you of a memory?)  It combines with taste information in the brain to create the sensation of flavor as well.

Remember, it is our body's interpretation of the sensations from these sensory systems that allows us to interact with and make sense of the world around us.

Friday, June 14, 2013

It's a Balancing Act...


Looking back on some entries, I seem to have mentioned “balance” a fair amount.  We often have kids that we work with who are yet to ride a bike.  And of course, to a kid, riding a bike by themselves is a big deal!  Often times, these kids are having a hard time with balance and spatial awareness, core strength and likely deficits with their vestibular system.  For the sake of just working on straight up balance, I have put together the following activities that I have given to parents in the past:
There are 2 types of balance:  Static and Dynamic.  Static balance helps you to maintain your position while stationary (not moving) such as when you are sitting on a bench or standing in line.  Dynamic balance helps you maintain your position and accommodate to positional changes when moving.
*When working on improving balance, start with static balance first.

Static Balance:
Weight shift- have the child sit on a chair or bench and shift their weight forward and backward.  Progress to shifting their weight from side to side.  Present objects for them to grab and reach at in various directions and at varying distances from their body to challenge their balance.
Variations:
-play catch with a ball (vary the size of it) or bat a balloon back and forth while in a seated position
-perform the same activities while the child is in a standing position, and increase the difficulty by trying to maintain balance on one leg

Dynamic Balance:
Obstacle Course-include uneven surfaces, climbing up inclines, climbing over objects/obstacles, going over/under objects and hopping.

Balance beam, tape line or rope
-walk in a straight line, staying on the line
-walk heel to toe
-side step along the line/rope
-walk backwards along the line/rope
variation:  do them with eyes closed to enhance positional sense

 Balancing box
-Have the child stand in front of a box with their hands on their hips.  Have them lift up one leg and rest their foot on the box.  Challenge their balance by having them rest less of their foot on the box or by having them close their eyes.
Variations:  Have the box behind them, and have them bend their knee and rest their toe on the box.  Use a wobble board.

Stability (exercise) ball
-have the child sit on a stability ball at a chalk board, easel, window, etc and have them paint or color with window markers.  Have him/her make as big a picture as he/she can so he/she has to move outside his/her base of support to draw.

Scooter board
-have the child sit on a scooter board and pull themselves along by their feet, or navigate around an obstacle course of cones, boxes, etc
-have them sit cross legged and pull them using a jump rope or hula hoop

From a sensory standpoint, the vestibular system contributes to our balance and our sense of spatial orientation/awareness of our bodies in space.  It gives us information about our body’s movement, gives us a sense of balance and gravity, and coordinates our eye movements.  It would make sense, then, that we can improve balance and spatial awareness by working through the vestibular system.  However, that is another blog entry for another day.  More on that later.

Tuesday, June 11, 2013

Scissor Types

Some minor scissor drama at ESY (summer school) this morning helped me with this blog entry!  We had a few little people whose hands are just not ready for regular scissor use, and had to get them the appropriate scissors so that they could cut out their chickens with their friends!

Some kids are not ready for regular scissors for a variety of reasons-  it may be that developmentally their hands are not ready for the coordinated open/shut motion, or their hand strength may be decreased, or their hand size may just be too small for a regular scissors.  One thing that is often apparent with young children is that they just may not have been exposed to scissor use prior to starting preschool or kindergarten.  Some parents just don't give their kids scissors to "play with" because of safety, or because they don't have time to sit and supervise their play the entire time they are "cutting" (who knows what might get cut up in the process?!).

There are a variety of ways to work on scissor skills without using actual scissors, which then leads to the progression to being able to use a regular scissors.  Practicing picking up things with various types of tongs or chopsticks is one way of introducing the open/shut motion of using a scissors.  There are also types of scissors that can aide with some of the above mentioned problems areas (decreased hand strength, etc).

-a loop scissors eliminates the need to coordinate hand muscles and/or keep little fingers in the holes of the scissors.  It is great for kids with decreased hand strength as well, because they pop open on their own to alleviate the need for the child to continuously re open them.  There are various sizes of loop scissors so even tiny hands can use them.  I personally prefer the blue loop scissors for elementary age kids, and the red mini loop scissors for the tiniest hands.

-a self opening scissors does much the same, but it has finger holes.  There are several varieties of this kind of scissors as well.  Self opening safety scissors (sometimes called "koopy" scissors) have a little "lever" on the handle that can convert them into self-opening scissors, or you can move the lever for it to be a regular scissors.

A regular scissors, 2 self opening (see the "levers") and a loop scissors.
Chicken by Tanner.  :)
I am not a big fan of "training scissors," which allow an adult to cut along with the child (allows the adult to help the child "feel" the motion and coordination of cutting), mostly because I think it gets too cumbersome to help the child, especially if the adult and child have different dominant hands.  However, you might find that this is helpful for your child.  Sometimes it is good to try several things to determine which works best for your child (or you, for teaching them)

When a child progresses to use of a regular scissors, I like the standard Fiscars brand scissors because of the size of the thumb and finger holes.  Some regular scissors have finger and thumb openings that are the same size;  this promotes just using the thumb and the index finger for cutting, which is more difficult.

You might have a hard time finding these specialty scissors and items in your area (like we do here).  One of my favorite supply catalogs/websites that has all of the above mentioned items and more is:
http://www.therapyshoppe.com/

Just click on "scissors and tongs," but don't forget to browse around, because they have a ton of great stuff available!  Later I will post some ideas for working on and improving cutting skills using a scissors.


Saturday, June 8, 2013

Bilateral Integration/Coordination

My son's tub of legos- great for bilateral coordination

Today we are continuing to build on our “Secrets” to Good Handwriting entry.  Remember that developing certain skills will also positively affect your child's fine motor skills. These other skills are the “building blocks” of fine motor skills.  Last time we addressed postural and shoulder stability; today we will look at bilateral coordination/integration.

The term “bilateral” means coordination between the right and left sides of the body. Even more, it involves movement of the body does across its midline.  When we think of fine motor skills, we often just think of bilateral integration as using the two hands together.  Without going into too much detail, it goes beyond just using 2 hands together.  A child who has difficulty with bilateral integration skills can also have difficulty with balance, with using their 2 eyes together efficiently as well as coordinated use of both hands together.  It could also affect their language skills.  That being said, the following are some activity ideas for bilateral integration:

-Playing catch, using a racket/bat during play (tennis, t ball, etc)

-Opening packages of food/baggies of food.

-Manipulative toys that require use of 2 hands- pop beads, duplos/legos, stringing beads, lacing cards.  Any type of toy that requires pieces to be pushed together or pulled apart, or any toy that you have to use 2 hands together to play with or manipulate.


-Dressing dolls, Barbies, have your child dress themselves

-Some chores help with using 2 hands together, such as emptying the trash cans, clearing the dinner table (carrying plates using 2 hands together), carrying a basketful of laundry, carrying containers of toys and putting them away when cleaning up.

-Art activities:  Coloring (stabilizing the paper with one hand while coloring/drawing with the other), Cutting (holding the paper in one hand while using the scissors with the other)

-drumming, rhythm sticks, etc

-climb a rope at the playground, have your child pull his/herself along a rope with hand over hand motion (sit on a scooter board and pull themselves along)

-Play with playdough: use a rolling pin to roll out the playdough, use 2 hands together to roll pieces into a ball or to roll the playdough out into a snake, use a safe knife or a scissors to cut pieces of playdough, flatten the playdough using 2 hands together.

-Tap into the vestibular system to improve bilateral coordination (the vestibular sense is found in the inner ear and helps the brain to process movement information). Children with poor vestibular processing may well have delayed bilateral integration abilities.  For this reason, it can be helpful to use movement activities to boost bilateral coordination skills.  Any activity that involves movement of the head in space is a vestibular based activity.  Try using a “moving” activity such as: jumping on a trampoline, rolling on the grass, going down a slide, swinging and doing somersaults.

Wednesday, June 5, 2013

Crayon "Tips"



Who doesn't love NEW CRAYONS??!  I love them...just opened a new box for my ESY (summer school kids) today.  And, I keep them in this fun little sparkly blue crayon container that I bought at Staples- that way, the box doesn't get crushed in the OT bag that I drag all over with me.  But, don't you hate it when they get worn down and dull?  Not so much fun to color with anymore.  Well, here's a  nifty little item that I also found at Staples...

Can't seem to turn this picture either! 
Anyway,  note that the crayon is an old one, and has been peeled down.  The Elmer's Crayon Sharpener sharpens the tip of old crayons into looking like the new ones do!  With the little ridge...see that?  And, shorter crayons encourage more refined grasp patterns (the shorter the better), because little kids can't grasp their whole fist around a short little crayon.  So, there's my little crayon "tip" of the day!

Monday, June 3, 2013

Postural Control and Shoulder Stability for Fine Motor Skills


The foundation of fine motor control starts with other factors.  A child can’t have good control of his/her hand if their body, shoulder and arm are not stable first.  If your child has good postural control and a stable shoulder, his/her fine motor skills are bound to improve.  How can we address this?  Activities performed while on their tummies, in kneeling, crawling and bearing their weight through their arms are a good place to start. Remember, you can work on strengthening and improving hand function alone all you want, but if your child continues to have poor postural control and shoulder stability deficits, functional fine motor skills will continue to be difficult.

Let’s look a bit more at core strength for postural control...
The body’s “core” refers to the muscles of the abdomen, pelvis, hips, back and neck.  It is the center of gravity and affects all functions of movement and postural activities.  For building core strength, try some of the following:

Downward Dog yoga pose
-a variation of this would be to have the child assume this pose with his/her hands on 2 frisbees and push the 2 frisbees across the room with their knees slightly bent (but not crawling).  Have them go through an obstacle course in this manner.

 Bridge pose
-have child lie on his/her back on the floor, bend knees and lift their pelvis off of the floor.  Roll a ball underneath them as they sustain the pose, or see how long they can sustain it.

 In a group situation, have the kids sit in a circle and pass a ball to each other using only their feet.  Change the size of the ball for a variation (use a beach ball, balloon, football, etc).

 Curl ups
-have child lie down on the floor, legs together, knees bent and feet flat on the floor.  Put a bean bag between his/her knees to keep knees together.  Hands on thighs, have child raise head off of floor and slide hands up to knees.  Try to hold this position.

 Walk a tight rope
-put a tape line on the floor and practice the following:
walk heel to toe on the line (if too hard, just walk normally along the line without stepping off)  For variations:
have the child balance a bean bag on their head while walking the line
make the path curve
half way down the line, place an object on the floor, and have the child slowly bend to pick it up without stepping off of the line or dropping the bean bag

 Crab/Animal walks
-Have the child push up and raise pelvis off the floor to crab walk (seated on floor with knees bent and leaning on arms behind them).  Have the child crab walk for a distance, or have them balance a bean bag or a plush toy on their stomach while crab walking. Try other animal walks:  bear walk, seal walk, etc.

 Chair leg-lifts
-have the child stand sideways behind a chair and rest their hand on the back of the chair.  Have them slowly lift their leg, bending the hip and knee to 90 degrees.  Hold it briefly, and then slowly lower the foot until it almost touches the floor and then raise it again.  Do it on the other side as well.  For variations:
after raising their leg, let go of the chair and keep their balance
try it with their eyes closed

 Use a playground/jungle gym
-have the child pull themselves up on a knotted rope, chin up bar or hanging rings, cross the monkey bars, etc.
**any activity that requires the child to lift both feet together at the same time addresses core muscles

 Wheelbarrow walk
-child supports self on extended arms with an adult holding at the ankles, and they walk on their hands.  Variations:
roll over a large exercise ball into weight bearing through their hands.  Have them walk themselves forward and backward back onto the ball
in same position over the exercise ball, roll lower extremities up (so that their bottom is higher up in the air and their feet are on the ball)

 Straight body hold
-place a stack of mats (of even height) parallel to each other.  Have the child lay their head and shoulders on one stack of mats, and legs on the other (so that their middle is what is not supported by the mats).  Have the child keep their mid section elevated off of the floor and hold the position.  Variations:
have them try to roll over while sustaining the position
move the mats further apart

Sustaining a position
-have the child balance in a push up position.  Have them lift up one arm to pick an object up off of the floor and put it into a container while sustaining this position (or put a simple puzzle together).  Try the other arm, too.  Variations:
pick up and throw an item at a target while in this position
have 2 children face each other in this position.  Have them each lift up a hand to high five each other
balance in this position, and raise one arm up while slightly turning the body
too hard?  Weight bear through an elbow instead of a hand

Completing activities while kneeling forces kids to use abdominal/postural muscles. Try playing a game of catch or other activity while "tall kneeling", and don’t allow your child to sit back on their heels while in this position.

For shoulder work, have your child make big circles on a chalkboard (or white board, or paper taped to wall), or have him/her erase/wash a chalkboard or window.

Another activity that I do often in therapy sessions is to have the child tailor sit (sit with legs crossed) on a scooterboard and pull them with a jump rope (they hold the jump rope while you are pulling them).  This makes them have to sustain their balance as well as use muscle co contraction in their upper extremities.

Bat/ball activities work on shoulder control as well, and are activities that you can try in your yard while playing with your child.

Some of these activities may be too hard for your child to start out with, and you may have to modify them to make them easier for them to complete (do them less times, for a shorter duration, etc.).  Make it about playing, not about work, because if it is perceived as work, it’s just not as much fun!