Brush It Off! Brushing Protocol for Sensory Integration

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!

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

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

What’s So Fine About Fine Motor Coordination?

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

Baby Boot Camp: The Importance of Tummy Time

Tummy time promotes development, strength, and a new visual perspective for your baby. Growing babies require many hours of sleep, which means your baby spends a large amount of time on his or her back to maintain a safe position while sleeping. Tummy time is pivotal during waking hours to strengthen the head, neck, and shoulder muscles and promote head control. Tummy time also gives your baby a fresh new perspective on the world as they can interact with toys and reach for objects in the environment. Tummy time is fundamental to your baby’s development and builds skills that promote later milestones of rolling over, crawling, and playing.

Getting started with Tummy Time

Tummy time can be started at any age, it is even recommended for newborns! Tummy time should always be a supervised activity. Gradually introduce your baby to tummy time by placing them on your stomach or chest in a reclined position such as laying on the couch. This allows your baby to continue bonding and interacting with you and may help them tolerate this new position. Start with short intervals on a safe and firm surface, such as the floor, for two to three minutes per day. You can progress up to 20 to 30 minutes of tummy time per day depending on your baby’s tolerance. Aim for tummy time at a time of day when he or she is alert, such as after nap time. Remember to always pay attention to your baby’s needs and look for signs of tiredness, such as crying or laying their head down on the floor.

How can I promote a successful tummy time experience?

  • Provide extra support with a bolster
    • Try rolling up a thin towel or blanket to make a bolster
    • Place the bolster under your baby’s chest with his or her arms positioned over the roll and hands in front
    • Always keep your baby’s chin in front of the roll to ensure their airway remains open
  • Promote weight bearing
    • Make sure your baby distributes his or her weight to both sides of the body in order to equally strengthen
  • Promote reaching for play
    • Get down on the floor with your baby to promote engagement and motivation
    • Hold a toy in front of your baby to encourage head control and reaching
    • Place toys in a circle around your baby to promote reaching in all directions
  • Try out other positions
    • Side-lying: Lay your baby on his or her side and support their back with your hand or a rolled towel. Place your baby’s arms out in front to promote reaching and play in this position.
    • Airplane: Lay down and hold your baby in your arms while he or she is on their belly. This a fun and motivating new perspective for babies with head control.
  • Make tummy time a routine
    • Incorporate tummy time during everyday tasks such as diaper changes, songs, toweling off, or reading a book.
    • Try burping your baby with him or her laying across your lap on their tummy
  • Make it a multi-sensory experience
    • Use a visually stimulating blanket or towel
    • Try placing your baby on a variety of textured blankets or mats
    • Use a mirror to motivate your baby to lift his or her head to see their reflection and encourage self-recognition
    • Alternate between various safe surfaces in your home such as carpet, tile, or wood

What are red flags to look out for? 

  • Pay attention if your baby shows a head preference. For optimal development, your baby should look to both sides equally. Does he or she have a strong preference towards one side?
  • Does your baby have difficulty weight bearing on one side of the body? For development, it is important that your baby strengthen both sides of the body and weight bear equally through both hands and arms.
  • Does your baby have a flat patch on the side or back of the head? Is your baby’s head asymmetrical? Flat patches may develop due to a strong head preference or increased time spent on their back.

If your child is demonstrating some of the observations above, consider contacting one of our occupational therapists or the Illinois Early Intervention system for more information.

Questions or concerns?

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

Robyn Geist, MS, OTR/L
Occupational Therapist

Reference: Pumerantz, Christa & Zachry, Anne (2018). Tips for living life to its fullest: Establishing tummy time routines to enhance your baby’s development. American Occupational Therapy Association.

Photo Credit: Moswyn via iStock.com

Feeding our Senses: What is a Sensory Diet?

Does your child love to run, swing, and jump? Engage in messy play with finger paint and shaving cream or seek out hugs and cuddles? Or perhaps they prefer to watch other children navigate the rock wall at the playground or quickly wipe their hands clean when dirty? Our sensory systems are responsible for how we take in sensory stimuli from our environment, process and interpret the information internally, and produce appropriate responses. We rely on proper functioning of eight senses (yes, eight!) to maintain a regulated state, in which we are better able to understand, interact with, and grow within our environments.

What are the eight sensory systems?

  1. Sight: helps us process what we see
  2. Hearing: helps us detect and process sounds, beats, and frequencies
  3. Smell: helps us detect and process scents and odors
  4. Taste: helps us process and distinguish between different tastes
  5. Touch: helps us process and understand how things feel on our skin, such as soft or hard, hot or cold
  6. Vestibular: provides us with a sense of balance, movement, and an awareness of orientation in space
  7. Proprioception: provides information about position and movements of our muscles and joints, including pushing, pulling, and deep pressure sensations
  8. Interoception: provides an internal sense of how our organs feel, such as hungry or thirsty, our sense of temperature, our feelings of pain, and when we need to use the bathroom

What happens if our sensory systems do not process stimuli correctly or efficiently?

When our brains are unable to make sense of the information our bodies receive, we often respond to the environment in inappropriate or unexpected ways. While the reactions formed in this disorganized state, often referred to as deregulation, present differently for every child and depend on both the type and number of sensory systems affected, responses often aim to find more of (seek) or stay away from (avoid) input. Examples include but are not limited to:

  • Sight: excessively looking at moving, spinning, or shiny objects; appearing bothered by bright lights
  • Hearing: appearing to ignore people when spoken to; becoming distracted in noisy settings; covering ears in response to loud noises
  • Smell: showing heightened sensitivity or aversion to scents and odors; may impact feeding routines
  • Taste/oral: preferring a limited variety of foods; difficulty trying new foods; excessive drooling
  • Touch: difficulty tolerating having nails trimmed or wearing certain clothing textures; refusing to touch or play with various textures, such as grass, sand, finger paint, or Play-Doh; wiping hands clean immediately after getting dirty
  • Vestibular: appearing to excessively enjoy or look for movement opportunities (running, jumping, rocking, etc.); seeming clumsy; appearing fearful of ordinary movement, such as when both feet are off the ground (e.g. swinging)
  • Proprioception: biting or chewing on non-food items; excessive bumping into, pushing, or hitting peers or objects in the environment
  • Interoception: not feeling full after eating; missing the urge to use the bathroom at the appropriate time

These sensory responses may lead to overarching difficulties with a child’s ability to attend to academic activities in the classroom, maintain balance and coordination, plan and sequence novel tasks, build social relationships, perform self-care activities, such as dressing and feeding tasks, and participate in family routines and schedules.

Sensory diet: what is it and how can it help?

A sensory diet is a carefully designed series of sensory-based activities in which a child is encouraged to participate to increase regulation and attention throughout the day. Much like we eat healthy foods to give our bodies the nutrients they need, sensory diets are made to meet the specific sensory needs of each child. While sensory diets typically incorporate touch, movement, and proprioceptive input, strategies targeting any sensory system can be included to promote optimal regulation. Sensory diets are often organized into schedules based on a child’s daily routines, activities, and family plans to maximize participation and success and can be easily modified as the child’s needs change over time. See below for an example of a sensory diet:

If implemented correctly, sensory diets provide consistent access to specific amounts of sensory input needed throughout the day and result in more appropriate responses to environmental stimuli over time. When successful, children are better able to participate in meaningful activities and daily routines, develop important foundational skills, and more effectively understand and engage in the world around them.

Questions or concerns?

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

Caitlin Chociej, MS, OTR/L
Occupational Therapist

References:

Bodison, S., Watling, R., Kuhaneck, H.M., & Henry, D. (2008). Frequently Asked Questions About Ayres Sensory Integration. American Occupational Therapy Association. Retrieved April 14, 2019 from http://www.aota.org/Consumers/WhatisOT/FactSheets.aspx.

Smith Roley, S., Mailloux, Z., Miller-Kuhaneck, H. & Glennon, T. (2007). Understanding Ayres’ Sensory Integration. OT Practice 12(7).

STAR Institute for Sensory Processing Disorder. (2018). Your 8 Senses. Retrieved April 14, 2019, from https://www.spdstar.org/basic/your-8-senses.

Photo Credit: Sharon McCutcheon via Pexels

Home Bodies: Gross Motor Activities You Can Do at Home

What are gross motor skills?

Your child’s gross motor skills allow them take their first steps, play their favorite sports, and sit upright in their chair at school. Gross motor skills involve stabilization of our large muscle groups and active movement of our whole body to carry out these meaningful activities. In order to develop age-appropriate gross motor skills your child will utilize the following body mechanisms: muscle strength, muscle tone, activity tolerance, motor planning, postural control, body awareness, balance, coordination, and proprioception (our sense our body position and body movement).  If your child is having difficulty with their gross motor skills, they may appear to be clumsy, have difficulty completing activities of daily living such as dressing, or avoid physical activity.

Laying the Foundation

In order to develop more refined skills, such as fine motor skills, your child will need to build a foundation of age-appropriate gross motor skills. For example, in order to complete fine motor tasks at school, your child must first demonstrate appropriate trunk strength and postural control in order to sit upright in their chair. Once your child develops appropriate trunk strength and postural control, he/she will need to develop gross motor shoulder stability in order to prevent his/her shoulder from moving when engaged in writing activities. It is when these gross motor abilities of trunk strength, postural control, and shoulder stability are present when your child is able to develop more refined skills. Our gross motor skills lay the foundation for the more sophisticated and intricate small muscle movements.

Home Work

In a literature review of fundamental movement skills conducted, researchers found a positive relationship between children’s development of gross motor skills and health benefits such as increased physical activity and decreased sedentary behavior*.

At-home gross motor activities are just a jump, skip, and a hop away:

  • Obstacle Course: indoor obstacle courses are a wonderful way to get your child crawling through tunnels, jumping over “lava,” and running to the finish line. This also provides additional opportunities for supplemental sensory input for increasing overall regulation!
  • Yoga: yoga is excellent for incorporating whole body movements, core strengthening, and increasing our sense of proprioception. In order to further develop our body awareness, have your child imitate yoga poses in front of a mirror in order to increase his/her understanding of how his/her body is positioned in space. Yogarilla cards are a great resource for various yoga poses in a fun format for your child.
  • Dance Party: join in on the fun with your child and throw a dance party! Choose action-based songs, such as “I’m Going on a Bear Hunt.” Incorporate action-based songs that involve activities requiring the use of both the upper and lower extremities to utilize your child’s motor planning and coordination skills.
  • Play Catch: a simple back and forth game of catch with either a ball, balloon, or bean bag can facilitate development of motor planning, body awareness, and bilateral coordination. Additionally, with the balloon allowing more time to move throughout space, encourage your child to keep it off the floor utilizing different body parts, such as their feet or even their elbows.
  • Simon Says: have your child participate in a gross motor version of Simon Says. For example, you can state, “Simon says jump up and down. Simon says touch your toes. Simon says stand on one leg.”
  • Animal Walks: completing animal walks such as bear walks, frog jumps, crab walks, etc. Your child might even want to create their own kind of animal walk!
  • Bubbles: blow bubbles and have your child pop them with a body part that you designate. Try to blow the bubbles on each side of his/her body in order to promote crossing their body.
  • Tummy Time: If your child is not yet walking, encouraging him/her to spend time on his/her stomach will allow him/her to bear weight onto their arms. For example, you can place your infant’s desired toys around them in a circle so he/she has to bear weight onto his/her arms to reach out for them. If your child is walking, increasing the amount of time your child is bearing weight on his/her arms such as in a crawling position or lying on his/her stomach strengthens his/her shoulders, arms, and hands for the development of more precise fine motor skills. This can be done by playing games or completing puzzles in an all-fours position or army crawling during transitions.
  • Clapping Games: using both hands in coordination to complete clapping games such as patty cake are a material-free way to practice gross motor skills such as bilateral coordination and motor planning.
  • Stand Up: create a vertical surface for your child’s arts and crafts activities. When standing and using a work station in front of him/her (such as a piece of paper taped on the wall) instead of below them, your child is actively engaging and strengthening the muscles in his/her shoulders, arms, and wrists to promote gross motor development.

Questions or concerns?

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

Reagan Lockwood, MS, OTR/L
Occupational Therapist

*Reference: Lubans, D.R., Morgan, P.J., Cliff, D.P. et al. Sports Med (2010) 40: 1019. https://doi.org/10.2165/11536850-000000000-00000

Photo Credit: Photo by Julia Raasch on Unsplash

The ABCs: Strategies for Handwriting

Despite our ever changing world of technology, handwriting remains an essential part of school curriculums and mode of daily communication. Legible and efficient handwriting allows your child to participate in school tasks and keep up with their homework load. Your child may be reluctant to participate in handwriting tasks if it is difficult or if it takes him or her extra time to complete the task. Handwriting doesn’t have to be only copying letters or sentences. Let’s learn how to make handwriting more motivating for your child, so it is less like “work” and more like “play!”

What are the underlying components of handwriting?

  • Fine motor coordination: Handwriting requires the coordination of our small hand muscles and the ability to use both hands for two separate tasks (i.e. holding the pencil and stabilizing the paper).
  • Visual motor and visual perceptual skills: Copying or creating letters requires hand-eye coordination, or using visual input to guide hand movements. Visual perceptual skills also include our ability to discriminate between letters, as well as remember the letters written on the board in order to copy them to our paper.
  • Motor planning: Our ability to use the information in our environment to create, execute, and carry out the motor action of creating letters or sentences. If your child has motor planning difficulties, they may have difficulty with letter formation and legibility.
  • In-hand manipulation: The skill of “shifting” consists of moving the pencil up and down, using your fingers to make small adjustments to your pencil grasp. In order to erase with a pencil, “rotation” is utilized by rotating the pencil to use the eraser and then back to resume writing.
  • Proprioception: The sense of knowing where his/her body is in space allows your child to use the appropriate force on writing utensils.

What can I do to help promote handwriting skills with my child?

  • Promote visual perceptual skills:
    • Mazes
    • Dot-to-dots
    • Word finds
    • Scavenger hunts
  • Do the “Wet-Dry-Try” method:
    • Write a letter on a chalkboard
    • Provide your child with a small wet sponge and a small dry sponge
    • Have your child write the letter using a wet sponge, then using a dry sponge
    • Finally, have your child use chalk to create the letter themselves
  • For older children, try these functional handwriting activities:
    • Write a letter to Santa, the Tooth Fairy, etc.
    • Write a grocery list
    • Help create the family calendar by writing down events
    • Write out a packing list for a trip
  • Promote fingertip grasping patterns by breaking crayons in half. This makes it difficult for your child to grasp the crayon with their whole hand, facilitating a more age-appropriate grasp with fingertips.
  • Facilitate grasping with hand-strengthening activities:
    • Hide beads or coins in Theraputty or PlayDoh and have your child retrieve the small items by pulling apart and pinching the putty
    • Have your child pick up items with a tweezer such as cotton balls, pom poms, or beads. You can also have your child place these items into an egg carton or cut-up foam pool noodles to address fine motor precision
    • Have your child place different sized clothespins on a picture or board
    • Make a 2-inch slit in a tennis ball. Place small items (beads, coins) inside of the tennis ball and have your child retrieve the small items by using their whole hand to squeeze the ball and retrieving items with the opposite hand.

Ways to encourage sensory-based learning with handwriting:

  • Practice forming letters in shaving cream! You can also use food coloring to die the shaving cream.
  • Try sensory bags: You will need a gallon freezer bag. Fill the freezer bag with clear hair gel, then add a few drops of food coloring. Feel free to add glitter! Mix the contents and apply tape over the top of the Ziploc bag. Have your child practice letter formations by tracing over the sensory bag, you can also place a piece of white paper underneath the bag to increase their visual feedback.
  • Write letters on foam sheets for increased sensory input by requiring your child to firmly press their writing utensil into the foam.
  • Encourage letter formation with motivating sensory media: Create letters with Wikki Stix, PlayDoh, beads, or pipe cleaners.
  • Use motivating visual input: Practice letters with a Lite Brite game or using rainbow scratch paper.
  • Turn out the lights and practice forming letters in the dark with a flashlight.
  • Use sidewalk chalk or washable window chalk.
  • For a movement break, have your child attempt to form letters with their body.

Questions or concerns?

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

Robyn Geist, MS, OTR/L
Occupational Therapist

Feder, K.P. & Majnemer, A. (2007). Handwriting development, competency, and intervention. Developmental Medicine & Child Neurology 49, 312-317.

Photo Credit: Robin Brenner via brooklinelibrary.org

Sitting Up Straight: The Importance and Impact of Postural Stability

Whether sitting at a desk at school, eating at the dinner table, or simply playing with toys on the floor, seated activities are an integral part of your child’s life. While we may not think of sitting as a complex task, it provides your child with a stable base to develop essential fine motor, visual-motor, and self-care skills. If you notice your child slouching frequently, propping his or her body against a desk or table, or fatiguing easily during seated activities, your child may be struggling with postural stability.

What is Postural Stability?

Postural stability refers to your child’s ability to achieve and maintain an upright and unsupported sitting posture against gravity. While seemingly simple, unsupported and stable sitting is dependent on a variety of factors, including muscle strength and tone, joint range of motion, the alignment of the body against gravity, and the support your child’s body receives from contact with surface they are sitting on. Core and trunk strength are essential for postural stability. If your child has a weaker core, you may notice slouching, propping of his or her head in the hands, heavy leaning against the back of a chair or the top of the desk, or sliding/falling out of chairs.

Why Does Postural Stability Matter?

While children are often on the move, a majority of their learning time takes place in a seated position. When children have to devote an excessive amount of energy to merely sitting up, the resulting fatigue can affect their ability to focus on classroom learning. Moreover, a strong and stable core allows your child to reach the arms away from his or her body in order to use the hands. Therefore, handwriting, scissor use, table-top crafts, self-feeding, and toileting tasks can all be negatively impacted by poor postural stability.

What Does Poor Postural Stability Look Like?

Some common signs of postural instability include:

  • Extreme or exaggerated slouching when sitting in a chair.
  • Leaning heavily or laying torso on the table or desk.
  • Frequently falling or sliding out of chairs.
  • Sitting in a “W” position.
  • Walking with a wide-legged stance.
  • Leaning against walls or holding onto rails for increased support.
  • Excessive fatigue following prolonged sitting (e.g. after school).

What Can I Do?

You can try to help improve your child’s postural stability through the following activities:

  • Knee walking: Try walking, playing catch, or playing “keep it up” with a balloon with your child standing on his or her needs. This helps to build the trunk muscles necessary for sitting balance.
  • Wheelbarrow walking: Encouraging your child to wheelbarrow walk helps him or her to engage their core and trunk, as well as build upper body strength. If provide support further from the core (e.g. holding the knees instead of the hips), your child will get a more intense core workout!
  • Animal walks or yoga poses: Encouraging your child to bear walk, crab walk, or perform other animal walks promotes core and trunk strengthening. Additionally, a variety of yoga poses (e.g. plank, boat, candlestick, etc.) promote overall strengthening which is great for postural stability!
  • Set your child up for success: Observe your child’s sitting environment. If your child’s feet are dangling in the air when sitting in chair, try providing a step stool or even a pile of books to rest his or her feet on. This will provide your child with a more stable base of support from the sitting surface.
  • Wedges or inflatable discs: There are a variety of tools available to help develop your child’s sitting posture. Sitting on a wedge or inflatable disc encourages your child to engage his or her core and prevents some slouching from occurring.

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

Natalie Machado, MS, OTR/L
Occupational Therapist

Reference:

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

Photo Credit:

Anissa Thompson via freeimages.com

Why OT?: Destigmatizing the Need for Therapy

“Why was my child recommended for occupational therapy, they don’t have a job!” You might have many questions if your child has completed an occupational therapy evaluation and was recommended to receive occupational therapy services. What does this mean, exactly?

What is occupational therapy?

The term “occupational” does not refer to one’s employment, in this instance. Occupationscan be defined as activities that support the health, well-being, and development of an individual (American Occupational Therapy Association, 2014). An occupational therapist’s job is to increase the engagement and participation in meaningful daily activities that support your child’s learning, growing, and most of all, fun! There are a wide variety of circumstances that may affect your child’s optimal engagement in day-to-day activities at home, at school, or in the community.

How is occupational therapy going to help my child?

The benefit of occupational therapy is that practitioners are equipped for focusing therapy on a widevariety of skills required in your child’s daily life, such as:

  • Fine motor skills
    • Your child uses fine motor skills to write their name on their school work and to tie their shoes before heading out to play!
  • Visual motor skills
    • Your child utilizes visual motor skills when playing catch in the park and to copy written work from the chalkboard in the classroom.
  • Self-help skills
    • Self-help skills help get your child out the door in the morning! Your child needs to eat, get dressed, and use the bathroom to start their day.
  • Gross motor skills
    • Gross motor skills are required to walk to the front door and down the stairs safely to begin your child’s commute to school.
  • Sensory processing and regulation
    • Your child’s body is constantly processing sensory information in their environment to attend to and enjoy their world.
  • Executive functioning skills
    • When recalling the steps of their favorite family board game and following their teacher’s instructions, they are using their executive functioning skills, i.e., working memory, sequencing, and problem solving.
  • Social interaction skills
    • Your child utilizes their social interaction skills to make new friends and keep familiar ones.

What does it mean if my child was recommended occupational therapy?

Receiving a recommendation for therapy can be difficult and may bring about many questions and concerns regarding your child. Common concerns after receiving a recommendation for your child to receive therapy are “Will my child be singled-out from their peers?” or “Will my child always need therapy?”  When your child receives a recommendation for therapy, it does not necessarily mean that there is something wrong. A recommendation for occupational therapy does mean that a trained therapist has noted suspected concerns that warrant further evaluation. As an occupational therapist, many times I am asked, “Do you work with children with disabilities?” and my answer is, “Yes I do, but not exclusively!” Just as pediatric occupational therapists work on a wide variety of skills, we also work with a wide variety within the pediatric population. An occupational therapist will utilize a holistic approach to empower your child and your family so they can live their life to the fullest in their daily routines, school activities, and excitement within the community.

Questions or concerns?

If you have questions or concerns about your child’s engagement in meaningful daily activities, please contact us at info@playworkschicago.com or 773-332-9439.

Reagan Lockwood, MOT, OTR/L
Occupational Therapist

Reference: American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain & process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006

Photo Credit: Photo by Thiago Cerqueira on Unsplash