Tag Archives: occupational therapy

Brush It Off! Brushing Protocol for Sensory Integration

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Therapeutic brushing may be recommended for your child due to tactile defensiveness, or difficulty tolerating a variety of textures. However, engaging in a therapeutic brushing protocol may also help to ease sensory-based anxiety, promote falling asleep, increase attention to task, increase coordination, and overall self-regulation.

What is Therapeutic Brushing?

The Wilbarger Deep Pressure and Proprioceptive Technique (DPPT), also known as the Wilbarger Brushing Protocol, is often used by occupational therapists to promote sensory integration. It is typically used with children demonstrating sensory defensiveness, or children who exhibit signs of over-responsiveness in the protective responses of the nervous system. Oftentimes, it is used with children who exhibit tactile defensiveness, or difficulty being touched by people or a variety of textures.

What Does the Protocol Look Like?

DPPT begins with systematic brushing of the body, followed by joint compressions to a child’s arms, legs, hands, feet, and head. Brushing is completed using a soft surgical scrub brush, often called a Therapressure brush. The correct brush is required in this protocol, as it provides a specific type of sensation to the nerve endings in the skin. Firm, even pressure is used to sequentially brush the arms, back, legs, and feet. Areas such as the stomach and chest are always avoided, as they are particularly sensitive. Following brushing, 10 joint compressions are provided to the child’s hands, wrists, elbows, shoulders, hips, knees, ankles, and feet using gentle pressure. This provides the child with deep pressure proprioceptive input which is calming to the nervous system. The protocol is repeated approximately every two hours while the child is awake. DPPT must always be taught by a trained therapist to ensure that it is safe, effective, and beneficial for the child.

What Does Brushing Do for Sensory Integration?

The brushing portion of DPPT stimulates the nerve endings of the skin, generally serving to “wake up” the nervous system. The joint compressions provide the body with deep pressure proprioceptive input, which typically calms nervous system. Performing the two elements of the protocol helps the central nervous system to better utilize information from the nerve endings of the peripheral nervous system more effectively. This can result in increased overall regulation, decreased anxiety to sensory triggers, and improved ability to transition between challenging tasks.

Who Would Benefit from Therapeutic Brushing?

Your child may benefit from DPPT if he or she:

  • Demonstrates difficulty being touched, wearing a variety of clothing, or tolerating a messy play.
  • Becomes reactive with grooming activities, including having his or her hair washed, or fingernails clipped.
  • Demonstrates difficulty maintaining a calm, alert, and organized state.
  • Experiences difficulty calming down and falling asleep at night.
  • Demonstrates difficulty transitioning between activities
  • Appears to have trouble noticing when he or she is hungry or needs to go to the bathroom.

Questions or concerns?

If you think your child could benefit from DPPT, please reach out to your occupational therapist or  us at info@playworkschicago.com or 773-332-9439.

Natalie Machado, MS, OTR/L
Occupational Therapist

References:

OT-Innovations.com. (2018). Therapeutic brushing techniques. Retrieved from https://www.ot-innovations.com/clinical-practice/sensory-modulation/therapeutic-brushing-techniques/.

Keep Calm and Messy Play On!

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Ever wonder why most of us have a baby photo with food all over our hands and faces? An important part of processing our world is through touch, even from a young age. Our sense of touch gives us information about our environment and the characteristics of our surroundings. We are able to determine if something is hot, cold, sticky, dry, soft, smooth, and so on! Messy play is a vital part of child development as our touch processing feeds into our skills such as motor planning, body awareness, visual-motor skills, fine motor skills, and more. At the moment with our schools and businesses closed many of us may be stuck indoors as we quarantine at home. While our current focus might be keeping our hands and homes clean, we can find ways to continue promoting our tactile sensory processing and get messy safely!

Our sensory processing abilities determine how we respond to tactile input. Your child may demonstrate sensitivity or avoidance to tactile input, such as withdrawing their hands when they get messy or splaying their fingers outward when they engage with wet textures. Maybe your child craves tactile input and you have a hard time keeping their hands clean or to themselves. Either way, incorporating messy play or multi-sensory experiences into their day can help them learn to process and respond to tactile input in order to better participate in grooming, meal time, bath time, and other daily routines!

Sensory Materials from Home:

You can always try to repurpose materials that you already have in your home to promote messy play. Try filling up a plastic bin at home with any of the following. You can switch out the material weekly to continue providing a range of tactile sensory experiences.

  • Cotton balls or pom poms
  • Feathers
  • Dried foods: pasta, rice, beans, oats, corn, seeds, coffee beans
  • Wet media: shaving cream, frosting, whipped cream
  • Slime, Gak, Flarp
  • Kinetic sand
  • Beach sand
  • Potting soil
  • Beads
  • Small rocks
  • Shredded paper
  • Water with ice cubes
  • Packing peanuts

Messy Play Activities at Home:

  • Have your child help you cook or bake
    • Roll dough, wash vegetables, mix batter
  • Art
    • Finger paint! Paint your child’s hand and make hand prints on paper
    • If your child has a hard time using their fingers use cotton balls, Q-tip, or a paint brush
    • Use halved apples, peppers, or celery to make vegetable stamps with paint
  • Homemade PlayDoh
    • Add essential oils for a multi-sensory experience
  • Hide puzzles or activities inside of a sensory bin
  • Make a mess with shaving cream in the tub during bath time
  • Practice letter formation in wet messy play such as whipped cream
  • Have your child help you garden by planting seeds or flowers in soil
  • Have your child wash their toys in soapy water
  • Hide beads inside of Theraputty or PlayDoh
  • Play barefoot in grass or sand
  • Blow bubbles and encourage your child to pop them with their fingers or toes
  • Make spaghetti or pasta and color with food coloring for edible messy play
  • Make clough dough or moon sand at home
  • Make homemade gak or slime
  • Go on a nature hunt and collect leaves, sticks, rocks for a nature sensory bin

Make messy play part of your child’s daily routine by adding it to their sensory diet activities or designating a day for messy food play at meal time. Increasing your child’s experience with messy play will help them learn how to process and respond to tactile input and tolerate a variety of textures and materials. It can also be a motivating way to engage children when you are stuck indoors.

Questions or concerns?

If you have questions or concerns about your child’s responses to tactile or sensory input, please contact us at info@playworkschicago.com or 773-332-9439.

Robyn Geist, MS, OTR/L
Occupational Therapist

Photo Credit: JBryson via istockphoto.com

Reuse and Recycle for Reclaimed Fun

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Bottles, boxes, and bins…oh my! With everyone quarantined at home for COVID-19, recyclable materials are likely piling up! You may be thinking, “what can I do with all these toilet paper rolls?” Here are a few fun ideas using commonly recycled items. These projects will not only keep children entertained, but also target important developmental skills.

 

Toilet Paper Rolls

With all the toilet paper rolls around the house now, try making binoculars with tape, paper, and string. Play I Spy, and find objects of a particular color or shape to target those early categorization skills. You can also create a bowling set for turn-taking and eye-hand coordination. Decorating the tubes in any way will require plenty of precision and coordination as well!

 

Cardboard Boxes

Round up all of those food boxes and make some new puzzles! If you have older children, have them practice their cutting skills by creating the pieces. The thickness of the cardboard requires a greater amount of strength and coordination to cut. Have your little ones complete the puzzles. You can also use these boxes for imaginative play, like this fun car parking garage.

 

Plastic Bottles

The possibilities are endless with plastic bottles. Put raw beans or rice inside of them for homemade maracas, make a science experiment lava lamp, or use them during bath time for pouring and filling. You can also create animals for container play for young ones to practice fine motor skills. Or have your older children get creative for some cute spring planters.

 

Questions?

If you have questions about how to use other materials or how to adapt an activity specifically for your child, please contact us at info@playworkschicago.com or 773-332-9439.

Kristen McManus, MOT, OTR/L
Occupational Therapist

Don’t Overlook Visual Development in Infants

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Parents often look forward to important milestones in their child’s development such as their first steps or first word. They work to encourage their baby to crawl, sit up, or roll over. What parents may not realize is that many of the foundational skills needed to reach these milestones are visual in nature. Visual skills are an essential part of an infant’s early development.

Why do visual skills matter?

Visual skills are important for learning in all areas, as babies frequently learn from imitation. Age-appropriate visual abilities are necessary for a child to see parents or siblings doing something and want to try it out for themselves. Visual skills also provide the motivation for motor milestones like walking or crawling. Babies are usually motivated to move by looking at a favorite toy or seeing a parent waiting with outstretched arms. Without being enticed by what they see, infants are less likely to explore their environment and develop important motor and coordination skills as they do.

Visual skills are closely related to motor skills in other ways, as they allow babies to see and discover their own bodies. Babies then use this connection between their eyes and their bodies to do important things like picking up and holding objects, planning movements, and developing body awareness. New movements allow a child to be in different positions, which in turn causes a change in perspective that further develops visual skills and provides new sensory experiences. Visual and motor skills continually build on each other and connect in important ways throughout early development.

Vision also plays an essential role in the development of cognitive and social skills. Concepts like object permanence (understanding that objects are still there even when they can’t be seen) come from being able to look at and play with objects. Social skills begin to develop when a child can see that there is someone who they want to interact with in his or her environment.

How can I support my child’s visual development?

Infants need opportunities to explore the world around them and practice the visual skills they are trying to develop. The chart below outlines the visual milestones that you should see at each age and activities that you can do to encourage visual development.

Questions or concerns?

If you have questions or concerns about your child’s visual or visual motor development, please contact us at info@playworkschicago.com or 773-332-9439.

Aubrey Day, Occupational Therapy Student Intern

 

References:

American Academy of Pediatrics. (2009). Babies should sleep on their backs, play on stomachs.

American Optometric Association. (2020a). Infant vision: Birth to 24 months of age.

American Optometric Association. (2020b) Ways to help infant vision development.

Folio, M.R. and Fewell, R.R. (2002). Peabody Motor Development Chart.

The Urban Child Institute. (2012). Seeing the importance of visual development.

 

Photo credit: allaboutvision.com

Employee Spotlight: Caitlin Chociej, MS, OTR/L

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What do you love most about working for PlayWorks Therapy?

One of my favorite things about working for PlayWorks Therapy is having the opportunity to work, connect, and collaborate with such a diverse community of clients, families, therapists, and staff. The warm environment created by every individual provides continual support for clinical and personal growth and self-discovery.

What is your favorite children’s book?

I loved Walt Disney’s 101 Dalmatians. To this day, my mom jokes about how I memorized every word after asking to read it for three months straight and insisted excitedly to “look at all the puppies!” as we drove past cow pastures on the way to and from daycare each day.

What do you enjoy most about living in Chicago?

I love how there is always something to do in this city, from trying new restaurants, exploring diverse neighborhoods, and catching an improv or comedy show, to learning about its historical influence, going to a sports game, or walking along the lake. Opportunities are endless!

What is your favorite childhood memory?

My favorite childhood memories are from family vacations to Cape Cod. Aunts, uncles, grandparents, and cousins would come together for one week every year, renting the same house on Scusset Beach and spending sunny days swimming in the ocean, searching for sand dollars, playing board games, and eating enough seafood to make our bellies hurt.

Would you rather a mountain or beach vacation?

I’d be equally happy with either! It just depends on whether I’m in the mood for taking in panoramic vistas after a high-energy hike or lounging on the sand with a good book after a day spent swimming and snorkeling.

Share a proud “therapy moment” with one of your clients.

There are so many proud moments that I’ve shared with clients and their families since becoming an OT. One moment that stands out was when a little boy diagnosed with Autism Spectrum Disorder noticed me walk into his classroom, smiled, and ran across the room to give me a hug. It was the first time he initiated eye contact and engagement in almost six months of working together.

What is your hometown?

I grew up in Naples, New York.

What do you like to do in your free time?

My favorite thing to do in my free time is travel, whether a few states away to see family or across the globe to experience new cultures! I also love to read, spend time with friends, and cuddle with my kitten, Penelope.

What is your favorite therapy toy?

My favorite therapy toy is Play-Doh as it encourages imagination and creativity while targeting a variety of developmental skills. Homemade options that modify color, smell, and texture also allow for fun sensory exploration.

Share a fun fact about yourself.

I spent 11 years throughout high school and college participating in a performance-based activity called winterguard. We danced a choreographed routine to music while spinning flags, rifles, and sabres in a different themed show each year.

Caitlin Chociej, MS, OTR/L
Occupational Therapist

What’s So Fine About Fine Motor Coordination?

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Do you remember back when you first learned to zip up your own jacket? How about tie your shoes? Write your name for the first time? Color carefully to stay inside the lines? You may not have known it then, but as a child you built many of the fine motor coordination skills you still use every day. When you think of “coordination” you might think of playing sports or swimming, and you would be right! However, when we talk about fine motor skills, we also use the word “coordination” to describe how many different muscles in your hands are working together to accomplish the smallest of movements.

Fine motor coordination involves learning many different skills simultaneously in order to have more control and precision over tools or objects in order to be accurate. These skills include having strength in the small muscles within your hand and fingers, developing a good grasp on tools, moving items around your hand without dropping them, and developing precise targeting. As your child practices these skills, he/she will refine these skills to help learn the foundational skills in many different areas of development. In general, large motor skills (stability of the head, core, controlled limb movements), become more consistently accurate before fine motor skills.

What skills should my child have now?

  • Around 12 months: Pulling off socks, starts to finger feed self with small table foods, can use a spoon to dip, grasps objects of different sizes, uses their whole hand to grasp around writing utensils, places and releases small objects down on a flat surface
  • Around 24 months: Pulling off untied shoes, can use a fork to pierce food, and a spoon efficiently to transfer food, shows an interest in scissors but may not be able to open and close them with one hand, may use a pronated (thumb side of hand down) grasp on writing utensils, they are starting to pick up small items and tuck them into their palm, they are starting to place items from the inside of their palm down by passing them to the finger tips, they consistently rotate items 90 degrees using just their finger pads (such as when taking the top off a small twist top jar)
  • Around 36 months: Unbuttoning large buttons on a jacket, pulling on socks with some help, can open and close scissors, and snip through paper, may continue to use a pronated (thumb side of hand down) grasp on writing utensils
  • Around 3rd birthday: Putting shoes with Velcro fasteners, putting on socks, zipping and unzipping a jacket (help putting both sides together at bottom), buttons large buttons on a jacket, starts to use scissors to cut through paper, over the next year practices pushing scissors forward to cut on a line, starts using a three-finger grasp that is looser and their arms and shoulder move lots when coloring
  • Around 4th birthday: Able to put together jackets that have a snap or hook fastener, some snaps on pants, zipping jacket independently, puts on shoes (needs help with tying laces), can put a belt through loops, pushes scissors to cut out simple shapes, over the next year starts cutting curved lines and circles, your child continues to get more efficient and accurate with drawing with their three-finger grasp, they are able to separate two pieces of paper by rubbing their fingers together
  • Around 5th birthday: Can tie knots, improved accuracy with scissors, the child uses a dynamic grasp (three fingers on utensil near the tip, their shoulder/arm are stable, their fingers and wrist are controlling movements, they are more accurate and efficient with this grasp, they can adjust their grasp on a pencil by moving it between their fingers
  • Around 6th birthday: Can tie a bow, independently manage shoes, other clothing fasteners, can cut more complex figures, they can flip a pencil around to reach the eraser without picking up and moving the pencil, they can pick up small items sequentially while holding other small items in their hands

My child isn’t ready to tie their shoes or write yet; why do these skills matter now?

Fine motor coordination skills are built over a long period of time, and gradually get more complex as a child gets older. Foundational skills in this area, such as grasping tools and moving small items from the palm to tips of the fingers, are key for later important skills such as writing, typing, cutting, money management, using utensils to eat, tying shoes, and managing fasteners on clothing. A child may become successful and efficient with navigating these skills as they continue to develop other skills through play and participation in daily routines.

Why do occupational therapists work on these skills?

Occupational therapists focus on these skills because they are a part of our daily living skills, from putting toothpaste on our toothbrush, to getting dressed, to participating in school, and feeding ourselves! Children use their fine motor coordination skills during daily living activities, in education, and in play, all areas which are covered by the domain of occupational therapy! During an occupational therapy evaluation, a therapist would look more in depth at your child’s fine motor coordination skills for their age.

What can I do?

  • Play games while picking up small items with kitchen tongs, chopsticks attached at the top with a rubber band and paper, or a straw bent in half to form tongs
  • Snap/button art boards
  • Puzzles with different snaps, buckles, locks to open
  • Read books with flaps to lift up to reveal pictures below
  • Practice tearing paper with your child, crumpling it up between your fingers, and using it in an art project, such as gluing it onto a snowman outline to make it 3-D.
  • Make a paper cup lantern by pushing a paper clip through the side of the cup and place an LED tea light inside
  • String beads or pasta on spaghetti noodles, string, or pipe cleaners
  • Make PlayDoh with salt, flour, and cream of tartar. Roll it into snakes, small balls, build tiny snowmen
  • Let your child practice opening items in the house for food consumption, such as bags of chips, twist off applesauce pouches/water bottles,
  • Tape small animals to a baking sheet and practice pulling the small pieces of tape off
  • Cut a slot in the top of an oats container. Have your child practice placing popsicle sticks in the slot; recreate this activity with Q-tips and a plastic lid with a straw hole, sort coins into different piggy banks
  • Stretch rubber bands around the outside of a small jar
  • Pull pom poms or other small items out of a kitchen whisk
  • Decorate cookies and allow your child to pick up the small sprinkles and push them into the dough
  • Let your child have as much practice as possible with fasteners (snaps, buttons, zippers, and shoe tying)
  • Cut through different layers/thicknesses of paper (tissue paper, paper, paper plates, cardboard)
  • Increase your child’s opportunities to practice writing outside of school by having the child write the score of a game, write letters to family members, write the list of items needed at the store
  • Use a stylus if your child plays games on a device. There are apps to practice coordination while using a stylus such as: iTrace, LetterSchool, Dexteria Jr, Writing Wizard, Trace it/Try it
  • Paint using the ends of Q-tips to make small dots on paper to draw fireworks
  • When recycling boxes, have your child cut the box instead of breaking it down for extra scissor practice
  • Allow your child to practice peeling fruit, picking the stems off the ends of beans, etc.
  • Hide toys in small jars and bottles, and have the child practice getting them out by twisting open the top

Questions or concerns?

If you have questions or concerns about your child’s fine motor coordination, please contact us at info@playworkschicago.com of 773-332-9439

Caroline Stevens, MS, OTR/L
Occupational Therapist

References: Fleming-Castaldy, Rita. (2019). National occupational therapy certification exam review and study guide. 8thedition. Therapyed.

Photo Credit: Markus Spiske via unsplash.com

A Set Routine + Family Meals = First Steps to Mealtime Success

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Mealtime can be stressful, often with your child challenging your attempts to have them try new foods. Some days, your child may not go to the table or sit in their chair long enough to even offer new foods! However, establishing a set routine and regular meals may be the first steps to mealtime success.

What can a mealtime routine look like?

Why is mealtime so challenging for my child? And why is a routine and family meals so important?

Eating is one of the most challenging sensory activities for children. When we eat, all eight senses are working and integrating eight new pieces of information. The properties of the food change as we eat, for instance, as part of our five senses, the taste and smell changes as we chew. Additionally, our sense for self-movement and body position is working to use different amounts of jaw pressure. Our sense for balance and spatial orientation is working to re-adjust our balance as we chew. Lastly, our sense of the internal state of the body is being put to the test by requiring that we track the changes to our stretch receptors (on the stomach) to the changes to our appetite. Processing each of those sensory changes can be and is difficult for many children. Furthermore, eating is a multisensory experience; therefore, we need to help children’s sensory systems to be regulated before, during, and after meals to increase their feeding skills and sensory tolerance for new foods.

What can I do?

If your child is demonstrating some behaviors before or during mealtime and/or is a picky eater/problem feeder, consider contacting one of our speech-language pathologist or occupational therapists, who can provide your family with helpful tips and tricks to make mealtime less stressful and more fun!

Questions or concerns?

If you have questions or concerns about your child’s mealtime routine or feeding skills, please contact us at info@playworkschicago.com or 773-332-9439.

Jaclyn Donahue MS, CCC-SLP
Speech-Language Pathologist

Reference: Toomey, Kay A.. 2008/2010. Family Meals.

Kay A. Toomey, Ph.D. & Lindsay Beckerman, OTR/L., 2016. Explanation of The Role of Sensory Therapy In Advancing Feeding Goas.

Photo Credit: Jennifer Murray and amsw photography via pexels.com

Blankets, Vests, and Lap Pads…Oh My! A Guide to Weighted Objects

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What are weighted objects, and how do they work?

In the context of pediatric therapy, a “weighted object” refers to any object or item that is worn, placed on, or carried by the body to elicit a desired sensory response. These objects work by providing deep pressure, or distributed weight over parts of the body through cuddling, hugging, squeezing, and holding, to regulate the nervous system and calm the body. Additional input is processed by the proprioceptive system, which provides information about the position and movements of our muscles and joints, to increase understanding and awareness of where our body is in space.

What are some potential benefits of using weighted objects?
Potential benefits of using weighted objects include:

1. Better attention and focus: weighted objects are often calming for children that seek opportunities for movement and deep pressure and for those that have a difficult time sitting still and attending to structured activities. As weighted objects provide the input these children are seeking, their bodies become more calm and organized, and they are better able to focus and stay on-task, especially in the classroom environment.

2. Less anxiety and improved sleep: the calming effects of weighted objects on the nervous system help to reduce sympathetic arousal, or the fight-or-flight response, and promote feelings of comfort and relaxation. For these reasons, use of weighted blankets at night has also been found to help individuals fall asleep more easily as well as improve overall quality of sleep throughout the night.

3. Smoother transitions between daily routines and activities: when children experience increased regulation and sensory organization due to the effects of weighted objects, they often feel more “in control” of their bodies and are better equipped to handle transitions and changes in their routines, leading to fewer or less intense tantrums and emotional outbursts.

What are examples of weighted objects and where can I find them?

Common examples of weighted objects include:
• Vests
• Blankets
• Lap pads
• Backpacks
• Stuffed animals

Depending on your child’s needs, weighted objects come in a variety of shapes and sizes and can be worn or held during specific activities (vest; lap pad; stuffed animal) to improve attention, carried between environments (backpack, stuffed animal) to improve smooth transitions, and placed on the body (blanket) during quiet activities, such as reading books, riding in the car, and when going to sleep, to provide comfort, reduce anxiety, and promote a calm, organized state of arousal.

Many weighted objects are available for purchase from online and in-store retailers. Weighted objects may also be created by adding weight to items already found in your home. For example, filling a long tube sock with dry rice or beans and tying off the end securely or adding these materials to one of your child’s favorite stuffed toys may work well for use as a lap pad or weighted stuffed animal. Similarly, adding books or bottles of water to your child’s backpack makes for an easy weighted adjustment during transitions to and from school. Research suggests that each object should be about 10% of the user’s body weight plus one pound to promote optimal effects, so be sure to consult with a trained therapist or doctor before trialing weighted objects with your child at home.

Do weighted objects work for every child?
While research suggests that weighted objects have several positive benefits, they may not be appropriate or suitable for every child. Objects are often most effective when implemented with other sensory strategies and should be used only as directed by your child’s occupational therapist or doctor to best target their individualized needs and ensure safe and appropriate application.

Questions or concerns?
If you have questions or concerns about whether your child may benefit from using a weighted object, please contact us at info@playworkschicago.com or 773-332-9439.

Caitlin Chociej, MS, OTR/L
Occupational Therapist

References:

Chen, H., Yang, H., Chi, H., Chen, H. (2013). Physiological Effects of Deep Touch Pressure on Anxiety Alleviation: The Weighted Blanket Approach. Journal of Medical and Biological Engineering, 33(5), 463-470. doi:10.5405/jmbe.1043

Vandenberg, N. L. (2001). The Use of a Weighted Vest to Increase On-Task Behavior in Children with Attention Difficulties. American Journal of Occupational Therapy, 55(6), 621–628. doi: 10.5014/ajot.55.6.621

Photo Credit: Naomi Shi via Pexels

Planning and Sequencing for Success: A Guide to Understanding Praxis

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Does your child have difficulties coming up with a plan for what they want to do, figuring out how they are going to do it, and then carrying out the task? If so, concerns with praxis may be a contributing factor. Praxis is complex and multi-step process that we often overlook, as it typically occurs on a sub-conscious level.

What is Praxis?

Praxis refers to the neurological process through which we plan, sequence, and complete the motor tasks we want to undertake. It can be through of as the way cognition directs movement actions. The planning and sequencing required for praxis are critical for completing everyday tasks such as walking, learning new routines, dressing, and even eating. For children experiencing difficulties with praxis, learning new movement patterns can be especially tricky. Challenges with praxis are referred to as apraxia or dyspraxia. These terms are often used interchangeably; however, dyspraxia is typically used to describe difficulties with planning and sequencing that are largely considered developmental.

The Four Elements of Praxis:

Learning new movement patterns is complex and involves many steps. The four elements of praxis are as follows:

  • Ideation: This involves your child generating an idea for what they want to do. For example, your child may see a bike and decide that his or her plan is to get on the bike to go for a ride.
  • Motor Planning: Motor planning involves your child figuring out how his or her body is going to carry out the plan. For example, your child may plan to stand on one foot, lift one leg, and swing it over the bike in order to mount it.
  • Execution: This refers to the body successfully or unsuccessfully carrying out the movement plan. For example, was your child able to successfully get on the bike, fall over, or get on backwards?
  • Feedback/Adaptation: This element of praxis involves your child reflecting on the feedback from the attempt in order to make changes in subsequent trials. For example, if your child got on the bike backwards, feedback/adaptation would involve your child facing the other way before attempting to mount the bike during his or her next try.

What Do Difficulties with Praxis Look Like?

Children with dyspraxia may:

  • Appear to struggle with coordination or look clumsy.
  • Require more practice than their peers to learn new movement tasks.
  • Seem to struggle with sports.
  • Demonstrate difficulty following multi-step directions.
  • Experience low self-confidence when comparing themselves to peers.
  • Benefit from frequent hand-over-hand assistance when learning new tasks.
  • Appear to be disorganized.
  • Seem to demonstrate difficulty initiating tasks or knowing what to do with novel objects.
  • Demonstrate delays in developmental milestones such as crawling or walking.

What Is Required for Successful Motor Learning?

A variety of building blocks are required for successful planning, sequencing, and execution of motor tasks. Muscular strength, coordination, postural control, and body awareness all play a role in learning non-habitual movements. Moreover, sensory processing, or the ability to register, interpret, and respond to environmental stimuli affects praxis. Executive functioning, or the higher-level reasoning and organizational skills, additionally affect your child’s ability to plan for and problem-solve issues that may arise during trial and error. A skilled occupational therapist can help target where in the process your child may be struggling and implement a treatment plan for improved motor planning and sequencing skills.

Questions or concerns?

If you have questions or concerns about your child’s planning and sequencing of movements, please contact us at info@playworkschicago.com or 773-332-9439.

Natalie Machado, MS, OTR/L
Occupational Therapist

References:

Biel, L., & Peske, N. (2009). Raising a sensory smart child: The definitive handbook for helping your child with sensory processing issues. London, England: Penguin Books, Ltd.

Case-Smith, J., & Clifford O’Brien, J. (2015). Occupational therapy for children and adolescents (7th ed.). Canada: Mosby, Inc.

Photo credit: Photo by Jordan Sanchez on Unsplash.

Min, Mod, and Max Cues: What does it all mean?

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When a child begins therapeutic services, long-term and short-term goals or objectives are developed as a way to guide therapy and gauge progress. If your child is already partaking in speech, occupational, physical, or developmental therapy, you’ve probably seen the words “minimal,” “moderate,” or “maximal cues” written in his or her goals. Amongst sometimes “wordy” goals, it can be difficult to interpret meaning of the specific objective, let alone understand what exactly a “cue” means.

What is a cue?
When helping a child reach his or her therapeutic goals, a “cue” is simply something that is going to aid in that child’s success. When I am providing speech therapy to a child, my goal is ALWAYS for that child to be successful; however, the number and type of cues that child needs to be reach his or her goal may vary. Think of a cue as a hint; as a child becomes familiar with the goal, he or she is going to need less “hints” to be successful and, thus, will become more independent. As a child progresses in therapy, the quantity of cues required for a child to effectively complete an objective will decrease. This is one way that therapists gauge a child’s progress.

What types of cues are there?
Generally speaking, many therapists use tactile, visual, or verbal cues in therapy tasks. Each category of cues has several variations:

Tactile cues: Tactile cues are used when a therapist uses physical touch to guide a child towards successful completion of a therapy objective. In speech therapy, this may be demonstrated by gently touching under a child’s chin in an attempt to help produce the /k/ or /g/ sound, or gently tapping a child’s hand to help him or her produce the correct number of syllables in a word. In occupational or physical therapy, the therapist may tap a child’s arm/leg to remind a child to use that specific body part.

Visual cues: Visual cues are used when a therapist provides a visual reminder that helps the child complete his or her task. In speech therapy, this may be as simple as drawing a snake to remind a child to use his “snake” sound to produce /s/; the therapist may tap the picture if the child omits this sound. Gestural cues are a specific type of visual cue; when targeting this same sound, the therapist may run her finger down her arm to demonstrate the long, fluid motion of /s/. Have you ever used a sticky note to remind you to complete a specific task? That’s an everyday example of a visual cue!

Verbal cues: Verbal cues are used when a therapist provides a verbal reminder that helps the child complete his or her task. Using the same /s/ example as outlined above, the therapist may say, “don’t forget your snake sound!” One specific example of a verbal cue is called a phonemic cue. If a child is working on asking for “more,” the therapist may cue the child by vocalizing “mmm.” A carrier phrase is another form of a verbal cue. Instead of using the phonemic cue, “mmm,” the therapist may say, “I want ____” to encourage the child to finish the phrase. A verbal model may be provided if verbal cues are simply not enough at that time; in this example, the therapist may model the word, “more” before handing the child the desired item.

What does “min,” “mod,” “max” mean?
Now that you have a better understanding of the types of cues used in therapy, what does “min,” “mod,” and “max” mean?

“Min,” “mod,” and “max,” stand for minimal, moderate, and maximal. When developing goals, therapists determine how much cuing a child realistically needs to reach his or her goals. Ideally, the level of cuing necessary decreases as a child participates in therapy. While the criteria of minimal, moderate, and maximal is fairly subjective, many therapists determine that minimal cues are used approximately 25 percent of the time, moderate cues are used approximately 50 percent of the time, and maximal cues are used approximately 75 to 100 percent of the time. Therapists may also report using “faded” cues, which means a child may have required moderate cues as the session started, but required minimal cues as the sessions progressed.

Can I “cue” my child at home?
Of course you can! In fact, you’re probably already cuing your child and you may not even realize it. When your child is about to do something undesirable, do you ever catch yourself counting, “one, two, three…?” You just gave your child a verbal cue, which helped him or her to reflect on his or her behavior and (ideally) change it accordingly. If your child is currently receiving therapeutic services, ask his or her therapist for ideas to best cue him or her to reach his or her goals.

Questions or concerns?
If you have questions or concerns about your child’s therapeutic goals, please don’t hesitate to ask his or her clinician for more information. If you have questions or concerns about your child’s development, please contact us at info@playworkschicago.com or 773-332-9439.

Sarah Lydon, MA, CCC-SLP
Speech-Language Pathologist

Photo Credit: Heriberto Herreravia via freeimages.com