April Showers Bring Sensory Powers!

Not only do April showers bring May flowers, but with these rainy days also come the perfect opportunity to have your child engage in fun and exciting indoor sensory activities to get their creativity flowing!

At-Home Olympics

Photo Credit: PublicDomainPictures via Pixabay

Do you love watching the Olympics? Now you can create your own version at home! At home Olympics can be a creative and fun way to provide your child with proprioceptive input as well as vestibular input. Proprioception is the sensory system that allows our body to understand where we are in space through our joints. Have your child participate in tug-of-war challenges to squeezing pillow challenges to provide this input. The vestibular system allows our bodies to understand what orientation our body is in space, how fast we are moving, and in what direction. Creating challenges from animal walk races to long jumping challenges can provide your child with the vestibular input they are seeking!

Scavenger Hunts

Photo Credit: iheartcraftythings

Scavenger hunts are a great way to provide your child with sensory input when cooped up inside from the rain. Have your child go on a scavenger hunt for different colored items, textures, or even smells. Provide additional sensory input by using animal walks to search room to room for the hidden items!

Crunchy Snacks

Photo Credit: Foodlion

Rainy day munching with a movie or game night is a great opportunity to provide your child with sensory input! Have your child help you prepare a crunchy snack to target their various senses, from interacting with different textures and smells to proprioceptive input from the big crunch. The crunchier the snack the more sensory input to their mouth!

Questions or concerns?

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

Urooba Khaleelullah, MOT, OTR/L
Occupational Therapist

Just Go to Sleep: Strategies for Improving Sleep Habits in Your Family

We all know sleep is important for maintaining a healthy, happy lifestyle. Unfortunately, sleep doesn’t always come easy, even to children. Some children, especially those with sensory processing issues and other difficulties, struggle to get to sleep and remain asleep through the night. What’s more, chances are, if your child isn’t sleeping, you aren’t either. The result is a cranky, sleep-deprived child and a cranky, sleep-deprived adult. Here are some strategies for improving your child’s “sleep hygiene,” or habits that promote healthy sleep.

Importance of a bedtime routine:

The first piece of advice that most people get about improving their sleep hygiene is to have a consistent bedtime routine. Maintaining a consistent bedtime routine is one of the best ways to help your child’s body know when it’s time to sleep. They will start to associate a particular time and set of actions with sleeping, which prepares their body for sleep before they even get into bed.

Establishing a routine goes beyond just having a set bedtime and wakeup time (although these should be as consistent as possible as well). A bedtime routine could start as early as a few hours before bed. Before bed, your child will need to brush their teeth, change into their pajamas, potentially take a bath or shower, and partake in whatever calming activities your family chooses. All of these activities should, ideally, be as consistent as possible from night to night. Try to make sure that all of these activities occur in the same order, at the same time, every night to help your child’s body recognize that bedtime is coming up.

Many experts recommend that beds not be used for for any activities other than sleep. If the bed is the place where your child sleeps, but also where they watch YouTube videos, play board games, hear a bedtime story, and do homework, then their body might be confused about what’s happening when it’s time to sleep. Consider moving those activities to a different location to help your child’s body understand that when it’s in bed, it’s time to sleep.

While it may be difficult to establish a highly structured bedtime routine every single night, establishing a routine and sticking to it as much as possible is one of the best ways to decrease sleeplessness for your child.

Using sensory regulation strategies to make a routine effective:

To make your bedtime routine as effective as possible, you might want to consider adding sensory regulation strategies into your normal routine! Sensory regulation refers to the body’s ability to take in information in the form of sight, sound, smell, taste, touch, proprioception (the feeling of where the body is in space) and vestibular awareness (a sense of balance and motion). When your body receives sensory information from the environment, that information can wake them up or calm them down.

Everyone’s response to sensory input is different, but generally, children find fast movement activities, like running or jumping jacks, exciting, while “deep pressure” activities, like being wrapped up in blankets, calming. Again, everyone’s different, so for some kids the opposite is true! However, this rule of thumb might be a good place to start: Try getting all of your exciting movement activities out of the way earlier in the day and stop them after dinner time, then, engage in some calming touch activities like a warm bath or massage as you start to get ready for bedtime.

It can be helpful to get a baseline idea of what calms or excites your child, so consider experimenting! Over the course of a few days, you can try out different activities and see how your child reacts to them. Is your child more active when you sing to them, or does it calm them down? Do they get energized by drinking a cool glass of water, or less? Here are some activities you could try to get a handle on your child’s personal preferences and responses.

Generally calming activities:
-Massage
-Being “squished” under pillows, or a weighted blanket, or having blankets wrapped tightly around them
-Taking a warm bath
-Slow rocking
-Chewing chew toys or gum

Generally energizing activities:
-Fast moving like running, jumping, or swinging
-Chewing something crunchy
-Drinking a cold glass of water
-Seeing bright lights, like a computer or television screen
-Hearing loud noises, including loud music

Once you know how your child responds to input, try to build a schedule that comprises of more energizing activities earlier in the day, then transitions to calming activities before bed. You can also try to incorporate these types of sensory input into activities you’re already doing; for example, if you usually read a book before bed, try having your child chew a chewy while you’re reading! This will help ensure you can develop a routine that’s effective for your individual child.

Other strategies for improving sleep hygiene:

If you’ve already implemented a sleep routine that incorporates calming input and your child is still having difficulties getting to sleep there are some other basic sleep hygiene techniques to try. Here are just some strategies you can use with your child to encourage appropriate sleeping habits:

-Make sure your child’s room is conducive to sleep. In general, people sleep better in environments that don’t have a lot of alerting light, aren’t too warm, are quiet and don’t have a lot of toys and objects to be distracted by. Your child’s room should be dark, cool, quiet, and uncluttered.

-Turn off screens before bed. TVs, cell phones, tablets, and computer screens produce blue light that tricks the brain into thinking it’s daytime. Try to limit your child’s screen time in the evening and stop all screen access for about an hour before bed. Once your child is in bed, take all screens out of their room to remove the temptation to get out of bed and start playing.

-Get enough exercise during the day. Children need a lot of movement to remain healthy and in control of their bodies! Make sure they have a lot of time outside, and a lot of time moving and playing before you start your calming routine after dinner.

Questions or concerns

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

Corrine Pratt, OT Student
Occupational Therapy Fieldwork Student

Photo credit: Simon Berger on Upsplash

Snow Day! Heavy Work Activities to Promote Sensory Regulation in Your Child

Snowy days provide great opportunities for heavy work proprioceptive input! Proprioception refers to our sense of awareness of body position, which our bodies process by receiving input through the muscles and joints. This type of input is typically calming for most children, but can also be alerting for some children. Proprioceptive input generally occurs through heavy work activities that involve deep pressure or weight through the muscles and joints.

What is heavy work?

Heavy work is a strategy used by therapists to target the sense of proprioception, helping children to understand where their bodies are in space. Heavy work refers to activities that push and pull on the body, specifically on the joints. When participating in heavy work activities, messages are sent from receptors in our joints to receptors in our brainstem. These messages serve to remind the brain and the body where we are in space. For children, this type of input is specifically helpful in promoting a calmer demeanor, increased attention and regulation, body awareness, improved sleep, and more organized behavior.

Try the following activities in the snow for increased opportunities for heavy work!

  • Have your child pull or push a peer or sibling on a sled. Heavy work is most effective when done until you child seems visible tired, so try supervising a trip around the block if your child seems up for it!
  • Have a snowball rolling contest! Compete with your child to see who can roll a bigger snowball. Pushing a large object, such as a snowball, provides excellent heavy work proprioceptive input to the shoulder joints.
  • Make a snow castle. Have your child pack snow into buckets, carry them to the other side of the yard or park, and flip them out to create a tower or castle. The body retains feedback from sensory input for about 90 minutes at a time, so you can always have your child go back and add on to his or her snow castle later in the day, when he or she may need more input.
  • Shovel! Shoveling is excellent heavy work. Give your child a shovel and allow him or her to help you clear off a porch, driveway, or some steps. Having your child carry the shovel full of snow over to make a snow pile will also be a great test of balance.
  • Explore some snow mounds. Supervise you child while he or she climbs up snow mounds made from shoveling or plowing. Walking uphill and through the snow provides plenty of resistance that makes for great heavy work!
  • Play snow hide and seek! Use a shovel to dig a hole and place a waterproof toy inside before covering the hole with snow again. Make sure this is a toy you wouldn’t miss in case it gets misplaced until spring! Have your child dig the toy out using his or her hands, a shovel, or a bucket.
  • Have your child pull a rake through the snow to create snow art!
  • Bury your child’s legs in the snow and let him or her move against the resistance of the snow to get out.

Questions or concerns?

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

Natalie Machado, MS, OTR/L
Occupational Therapist

Photo Credit: Katie Gerrard on Unsplash

What’s Inside the Mystery Box?!

Let’s make a mystery box!

It’s no mystery that families and children been spending more time at home than ever before. When we are constantly surrounded by the same scenery, including the same toys and games, it can be difficult to brainstorm ways to mix it up (without constantly rushing to the store or clicking ‘buy now’ on Amazon).

As a pediatric therapist, I am always seeking new ways to turn every day household items into fun, motivating, and enriching toys. I’ve found that some of the best toys are not ‘toys’ at all. One of my favorite non-traditional toys is a do-it-yourself mystery container/box!

This language-rich activity is appropriate for children at every developmental stage AND it only requires a few common household items. There are endless outcomes, variations, and possibilities with this activity!

Materials

  • An empty box or container (plastic flower pot, clean mini trashcan, big bowl, toy bin)
  • A short sleeve t-shirt
  • A rubber band to secure the t-shirt (optional)
  • Small items from around your home

Directions

  1. Collect the materials
  2. Pull the t-shirt over the top of the box/container, so that one of the sleeves lines up with the top or opening of the container.
  3. (Optional) Secure the t-shirt onto the box/container with a rubber band
  4. Place objects from around your home into the mystery box/container through the sleeve hole at the top. Choose objects that are safe to the touch- avoid sharp/pointed items.
  5. Take turns reaching inside of the mystery box. Encourage your child to use his or her hands (or even feet!) to feel the objects in the box/container. Ask your child to pull the objects out. *BONUS: Create a silly song to sing while you pull objects out! This song is to the tune of “Mary Had a Little Lamb”

What’s inside the mystery box?

Mystery box, mystery box

What’s inside the mystery box?

I wonder what we’ll find!

 

How to target speech, language, and social development during this activity:

  • Play ‘peek-a-boo’ with objects in the box! After modeling this phrase a few times, pause and wait for your child to fill-in-the-blank. Encourage your child fill-in-the-blank with the object label by modeling the phrase “It’s….a…”. Pause, look expectantly at your child, and wait for him/her to fill-in the blank.
  • Increase your child’s eye contact and joint attention by holding the box and objects by your face! Tickle your child with the objects or place box on your head to increase shared attention.
  • Encourage your child to follow 1-2 step directions (grab the bear, then put it in the box; pull a soft toy out of the box). If your child needs extra support, provide a model or use gestural cues to show your child how to follow the direction
  • Model grammatically correct phrases and sentences throughout the activity. Label and describe what you feel, see, and hear. Incorporate different word types into your models, including:
    • Exclamations (uh oh, wow, ooooh!)
    • Object names (box, bear, shoe, stick, spoon, playdoh)
    • Pronouns (my, your, his, hers)
    • Action words (shake, pull, feel, reach)
    • Location words (in, out, under, up, down)
    • Descriptive words (big, little, hard, soft, squishy, smooth, bumpy)
  • Practice turn-taking by taking turns reaching inside of the mystery box. Identify whose turn it is by pointing and/or using turn-taking language (It’s my turn! Now, it’s your turn!). Encourage your child to wait and watch while you take a turn.
  • If your child is working on specific speech sounds, place objects in your mystery box/container that contain the target speech sound in the object label. Each time your child pulls an object out, you can practice the target word 5x together! For example, if your child is working on the “b” sound at the beginning of words, you can include objects such as a ball, bird, balloon, bib, baby, bell, banana, etc.
  • Ask your child to guess what objects are inside based on what he/she feels! Once the objects are out of the box, compare and contrast how the objects feel and look. Make a list of similarities and differences between the objects.
  • Sort the objects into categories based on color, shape, size, or object function (things you eat, things you wear, animals, vehicles, etc.)

Not only is this activity great for building language, but it also targets many occupational therapy skills, such as the ability to discriminate and identify objects based on touch without the use of vision, increasing focus and attention on the hands and the sensory system, and increasing impulse control (as your child has to wait until he/she finds the right objects, via touch, before pulling it out of the box).

 

Questions or concerns?

If you have questions or concerns about your child’s speech, language, and/or play skills please contact us at info@playworkschicago.com or 773-332-9439.

Nicole Sherlock, MA, CCC-SLP
Speech-Language Pathologist
Photo Credit: Nicole Sherlock

Interoception: The Eighth Sense

Our sensory system is how we experience the world around us, and when we have difficulty processing one or more of these senses, our daily experiences can be hugely impacted. Children also use their senses to take in the world around them and learn new skills, whether through watching a bubble float by with their eyes, feeling gooey slime squish between their fingers, or tasting that delicious piece of cake with their tongue. While some of the senses are better known, there are others that are “hidden,” but equally as important in your child’s development. Some children have difficulty processing sensory information and producing a response that is appropriate, which can be seen through a variety of challenges in completing important daily activities. Understanding what our senses do for functioning is the first step in improving our ability to process them!

What is interoception?

It is likely that you learned about the “five senses” sometime early in your life: touch, taste, smell, sight, and hearing. These senses help you initially interact with the world around you and are important in helping you participate in everyday activities as an infant and young child. As you got older, you may have learned of the next two senses that are not as obvious but still very important to daily functioning: the proprioceptive and vestibular sense. Proprioception is the sense that identifies the position of your body in space with the use of receptors in your joints and muscles, and the vestibular sense helps us with movement, balance, and controlling our posture.

Interoception is the eighth sense we have; it is often called the “hidden sense” because it is not something we can see, but what we feel on the inside of our bodies. Imagine it is 2:00 in the afternoon and you have not eaten since 7:00 in the morning. Your stomach starts to make a growling noise. That is your interoceptive system working to let you know that you are hungry and that your body needs food to maintain a balanced state. When responding appropriately, you would recognize that sound and feeling to mean hunger, and you may go to the kitchen and get a snack.

Our interoceptive sense allows us to feel important body functions like hunger, pain, nausea, itch, needing to use the bathroom, coldness, and even emotional states such as nervousness, fear, or excitement. This sense uses internal signals that tell us how our body is feeling and can give clues to how we can respond to restore balance and find a place of comfort. Our bodies want to feel regulated, and how we get there may be different for everyone.

What does it look like when a child has difficulty with the interoceptive sense?

When the interoceptive sense is not processed appropriately, your child may have difficulty understanding what the signals inside of his/her body are trying to communicate and then will have difficulty responding appropriately to these messages.

Generally, this means challenges with:

  • Bedwetting, constipation, and frequent accidents
  • Identifying appropriate ways to dress for the weather/temperature
  • Not being able to identify hunger, thirst, sickness, pain
  • Self-regulation, self-awareness, and emotional outbursts
  • Having flexible thoughts and behaviors
  • Problem-solving
  • Social skills and participation

Self-regulation, or the ability to monitor and manage your emotions and behaviors, is a vastly important aspect to consider with your child who may be struggling with interoception. For example, your child may not be able to feel or recognize getting angry; that is, a faster heartbeat, the face getting hot, or muscles tensing. Your child will then have difficulty identifying that these feelings mean anger, possibly not even until the emotion has already produced an inappropriate response. Without understanding and being aware of how these body sensations are making us feel, it will be difficult to identify the emotion being experienced and react in a way that is appropriate.

How can occupational therapists address interoception skills in children?

As daily occupations (i.e. using the bathroom, dressing for the weather, interacting with friends) are often affected by our understanding of our internal body sense, occupational therapists have a role in working with children who may have difficulty with the interoceptive sense. Occupational therapists (OTs) at PlayWorks follow guidelines from the Interoception Curriculum, a program designed by Kelly Mahler, a licensed occupational therapist and expert in interoception.

Using a step-by-step framework, OTs work to improve awareness of sensations within the body by introducing body experiments and body checks. These activities seek to improve your child’s understanding of how his/her body feels and can enable him/her to respond appropriately to improve participation in daily activities. Following this curriculum, OTs may also use a visual representation of the body to aid in recognizing and understanding body signs. This can be accomplished by using a visual drawing of a person with different body parts, combined with a list of different sensations or describing words. This will enable your child to practice matching the descriptor words to different body parts to increase understanding and connection of internal body cues and daily activities.

What can I do to support interoception in my child?

While interoception should be addressed in therapy, you can also support these challenges while at home. It will be helpful to start labeling body language as you notice it during different activities. For example, you can say, “I see that your breathing is getting heavy and your face has become a little red. I think you might be feeling angry.” This may help to link specific body language to emotions that they are feeling.

Additionally, you can try out some mindfulness activities, such as meditation, yoga, or reading a book centered around being mindful. While doing so, you can point out or ask how their body is feeling when they are doing these different activities to bring awareness to internal body cues. While this may be a challenging sense to understand for some children, there are many ways we can work with you and your child to increase his/her knowledge and recognition of these cues to improve participation in daily activities!

Questions or concerns?

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

 

Molly Ross

Occupational Therapy Student Intern

 

References:

Interoception: The Eighth Sensory System (2016). Retrieved from https://docs.wixstatic.com/ugd/b303b5_ab07aaedc04c45b3a96e519fc262ecd1.pdf

Mahler, K., McLaughlin, E., & Anson, D. (2020). Interoception Across Varying Degrees of Mental Wellness. American Journal of Occupational Therapy74(4_Supplement_1), 7411505251p1-7411505251p1. https://doi.org/10.5014/ajot.2020.74S1-PO9513

 

Photo Credit: Ketit Subiyanto via https://www.pexels.com

The FUN in Executive FUNction

Have you ever heard someone say that your brain is not fully developed until age 25? When someone mentions that, it’s usually to explain how teenagers can still make risky decisions, even when they feel like near adults because their “decision making warehouse” in their brain is still making new connections. That’s true! The frontal lobe of your brain is responsible for many of your executive functioning skills! So, what does that have to do with your child? Executive functioning skills that are required for all those complex adult decisions begin with foundational skills that emerge in early childhood that are necessary for your child to pay attention, finish tasks by themselves, and stay in control of their body and reactions. All children need to develop well-rounded executive functioning skills for success in the classroom and at home.

What are executive functioning skills?

Executive functioning refers to a complex collection of skills across areas of neuropsychological development that include how your child’s brain is able to focus on one subject, plan ahead, organize, follow steps in order, follow familiar routines, have self-awareness, hold thoughts in our memory, switch between activities, and control our responses to events. In general, executive functioning skills are responsible for our general external and internal organizational and attentional processing. In general, executive functioning skills help us make a decision or goal, plan how to achieve that goal, carry out the steps in the plan, and check that we were able to do it right.

What does it look like when a child has difficulty with executive functioning skills?

Executive functioning develops typically in children who are participating in learning opportunities with gradually decreased support from an adult, everyday social interactions, games that challenge inhibition or memory, and lots of trial and error with activities. Early signs of difficulty with executive functioning skills may look like any of the following:

  • Having difficulty staying on task and avoiding distractions
  • Becoming easily frustrated, at times resulting in outbursts
  • Needing frequent reminders to slow down with work or think before acting
  • Forgetting directions almost immediately
  • Skipping steps from directions with more than one step
  • Trouble getting started with instructions or finding the materials they need for an activity
  • Disorganized when re-telling a story or event that happened
  • Getting stuck on one idea, or becomes frustrated when having to transition from one activity to another
  • Needing more reminders to complete daily routines than same-aged peers
  • Difficulty adjusting to in the moment changes

What can I do to support my child’s executive functioning?

Infancy:

  • Anticipation games such as peekaboo, “1-2…….3!” with any silly action, and this little piggy
  • Pausing during their favorite familiar fingerplay song for them to fill in the blank with a gesture or word
  • Hiding games with their favorite toys to search beneath a cup or cloth for them

Toddlers:

  • Increasing gross motor challenges such as a one-step obstacle course for them to control their bodies during movement
  • Movement songs and dances that they can follow along with and remember all the steps
  • Exposure to emotion words such as happy, mad, sad, and scared on themselves and on characters in books
  • Completing simple matching puzzles or sorting games

Early Childhood:

  • Have your child “read” a familiar story to you while looking at the pictures
  • Play freeze dance
  • Sing backward counting songs such as the three little ducks and have the child keep track of how many ducks are left
  • Play games where your child has to identify which object is not like the others

School Age:

  • Help follow simple cold meal recipes with a plan ahead of time. Your child can help gather the materials and put them together in the provided order.
  • Play games such as Spot it, Quick Cups, and cooperative board games
  • Play Red Light, Green Light, Musical Chairs, or Simon says to increase the child’s attention and impulse control
  • Play games such as Guess Who, where your child has to keep track of characteristics already said

Executive functioning challenges are common in children with Attention Deficit Hyperactivity Disorder (ADHD), autism, anxiety disorders, and learning disabilities. However, not all children with difficulties in these areas may have one of those diagnoses. If your child is demonstrating persistent problems with some of the skills above, consider contacting one of our occupational therapists, who can provide your family with helpful tips and tricks to build your child’s executive functioning skills.

Questions or concerns?

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

Caroline Stevens, MS, OTR/L
Occupational Therapist

References:

Center on the Developing Child. (2020). Enhancing and Practicing Executive Function Skills with Children from Infancy to Adolescence. Retrieved November 5, 2020, from https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2015/05/Enhancing-and-Practicing-Executive-Function-Skills-with-Children-from-Infancy-to-Adolescence-1.pdf

Cramm, H., Krupa, T., Missiuna, C., Lysaght, R., & Parker, K. (2013). Broadening the Occupational Therapy Toolkit: An Executive Functioning Lens for Occupational Therapy With Children and Youth. Retrieved November 06, 2020, from https://ajot.aota.org/article.aspx?articleid=1863088

Photo Credit: Olav Ahrens Rotne via https://unsplash.com

Falling in Love with Fall Sensory Activities!

Photo Credit: Mel Bailey via KneesBees

Fall is a season full of creative activities to do both indoors and outdoors. Use this season to expose your child to creative and different sensory play activities to get their imagination flowing. Sensory exploration can occur through different textures, smells, visual input, and even using something ordinary in a new way.

Paint a pumpkin 

Finger painting a pumpkin exposes your child to a whole new world of painting. From the slippery textures of the paint to the rough texture and ridges of the pumpkin your child will be able to allow their imagination to run wild on this novel canvas!

Photo Credit: Shaunna Evans via Fantastic Fun and Learning

Pumpkin carving

Gooey gooey goodness! Pumpkin carving is a great way to encourage your child to get hands-on with a mixed texture…the gooeyness of the inside of the pumpkin mixed with the firmness of the pumpkin seeds. This activity is a great way to promote your child to engage in more messy play!

Photo Credit: Cat Bowen via Romper

Crunching and jumping in leaves

Crunching in your hand or even stomping with your feet, fall leaves are a great way to engage your child in sensory play using a familiar object. Have your child help in creating a leaf pile to jump into to get their senses ready for the big jump. The crunchier the leaf the better!

Photo Credit: Sarah Clouser via Herviewfromhome

Fall sensory bin

Creating a fall sensory bin is a fun and exciting way to explore the different textures and smells of this season! Have your child help in creating the bin to increase their excitement. This bin can be created using all sorts of textures and everyday items from dried corn, popcorn kernels to pine cones and even cinnamon sticks to get their senses ready for the season.

PlayWorks Therapy

Questions or concerns ?

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

Urooba Khaleelullah, MOT, OTR/L
Occupational Therapist

 

Crossing Midline: What, Why, and How?

What does it mean to “cross midline,” and why is it important?

The ability to cross midline involves moving a body part across the center of the body (midline) to the opposite side in a smooth or fluid manner. This movement is essential for learning to use both sides of the body together. This skill is closely associated with brain development, as the two sides, or hemispheres, of the brain must communicate to coordinate learning and movement. Crossing midline promotes a child’s ability to reach for and explore new toys or objects, learn to creep and crawl, develop patterns for self-feeding, and interact more fully with the environment as infants and toddlers. As children continue to grow, crossing midline becomes an important skill needed for the development of fine and visual motor coordination.

If a child is unable to cross midline, they may tend to use their left hand to complete activities on the left side of the body and their right hand to complete activities on the right side of the body, impeding their ability to develop a preferred or dominant hand. Hand dominance impacts a child’s ability to use tools effectively, including pencils, markers, and scissors, so difficulty crossing midline often affects handwriting, cutting, and other school-related fine motor tasks. A child’s ability to smoothly cross midline with their eyes, arms, and legs also plays a significant role in developing reading skills, eye-hand coordination, gross motor skills, and independence with self-care tasks and impacts overall quality of movement within age-appropriate activities and routines.

Difficulties with crossing midline may be present if your child:

  • Uses their left hand to complete tasks on the left side of the body and their right hand to complete tasks on the right side of the body
  • Switches writing utensils between hands to avoid crossing midline during writing, drawing, or coloring activities
  • Demonstrates difficulty coordinating smooth gross motor movements that involve both sides of the body (for example, skipping, catching/throwing/kicking a ball)
  • Rotates their trunk to retrieve objects during play or seated activities instead of reaching across midline

How can midline crossing and coordination be encouraged at home?

You can support continued development of your child’s ability to smoothly cross midline during a variety of daily activities, using toys and items you likely already have at home:

  • Pour water back and forth between two cups while in the bathtub, ensuring the second cup is positioned on the opposite side of the body as the first cup.
  • Color with crayons or markers, ensuring one hand stabilizes the paper and the other is used to draw or scribble. Larger paper will encourage a greater reach across midline.
  • Dig in the dirt or sand. Have your child sit, kneel, or squat on the ground. Place a bucket on one side of your child and a shovel on the other side. Encourage your child to dig with the shovel and then transfer it to the other side of their body to dump the dirt in the bucket, ensuring they do not switch the shovel to the other hand as they cross midline. This activity can also be modified by using one hand to pick up small stones and placing them in the bucket on the opposite side of the body.
  • Play tennis or baseball, which require the arms to work together to cross midline during each swing. Encourage your child to hold the bat or racquet with both hands and ensure that both arms and hands cross the body during the swing.
  • Play tug-of-war or have a pillow fight. Your child’s arms and hands will naturally move back and forth across midline during each activity while promoting overall strength and coordination.
  • Play with a large car mat, draw roads across a large piece of paper, or use tape to create a figure eight pattern on the floor. Encourage your child to use one hand to push cars along the road or path while their body remains in place.
  • Set up activities to specifically target crossing midline by positioning pieces on one side of your child’s body and positioning the container on the opposite side. Encourage your child to use one hand to retrieve a piece and then place it in the container or on the designated space. This works well when participating in container play, completing shape sorters and puzzles, and placing objects, such as coins into a piggy bank or pompoms into a jar.
  • Play Twister! This game will naturally encourage your child to cross midline with both arms and legs as they match body parts to the colored dots on each turn.
  • Play Simon Says, ensuring that when you are Simon, you direct your child to engage by crossing midline and using both sides of their body to complete each task (for example, “Simon Says, touch your left hand to your right knee” or “Simon Says, skip around the table”).
  • Place stickers on one of your child’s arms or attach clothespins to the clothing on one side of their body and encourage them to use the opposite hand to remove them.

Continued practice with crossing midline will promote overall fine motor, visual motor, and gross motor coordination for improved independence in self-care, recreational, and school-related activities throughout your child’s day.

Questions or concerns?

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

Caitlin Chociej, MS, OTR/L
Occupational Therapist

 

References:

Cermak, S., Quintero, E.J., and Cohen, P.M. (1980). Developmental Age Trends in Crossing the Body Midline in Normal Children. The American Journal of Occupational Therapy, 34(5), 313-319. https://dx.doi.org/10.5014/ajot.34.5.313

Photo Credit: Pragyan Bezbaruah via Pexels

Teletherapy 101: What to Expect and Common Questions

PlayWorks Therapy Inc. is committed to ensuring your child receives quality services during this time of uncertainty and have transitioned to all online teletherapy sessions. We are looking forward to this virtual experience with you!

What is Teletherapy?

Teletherapy, also referred to as telehealth, is a type of therapy provided by your child’s therapist online through video chat, much like FaceTime, Skype, or Gchat. Although teletherapy is a new offering at PlayWorks Therapy, it is a model of therapy that has been used and researched in the field for several years. PlayWorks Therapy is remaining current with best practice and continuing to provide evidence-based therapy through this mode of therapy.

What can I expect from a Teletherapy appointment?

Depending on the type of therapy your child receives, the structure of the therapy session may differ slightly than the in-person appointments. The session itself may consist of the therapist reviewing goals and techniques with caregivers as well as assisting in choosing appropriate toys, games, and materials to target those goals. The therapist would then provide recommendations for how to use each material, including specific prompts to use throughout the activities. We realize that your child may not be as engaged or motivated to sit in front of a video so we require a parent or caregiver to be present or nearby for the majority of the session.

Will this really be a productive mode of therapy for my child?

Many providers have been using teletherapy as their primary mode of therapy over several years with success. Because the structure may look different than usual the in-person appointments, our expectation of what makes a “productive” or “successful” session may also change. Your child’s goals may shift slightly in this period but just know that every and any interaction your child has with their therapist informs their continued work. With a strong partnership, both the therapist and caregivers can use techniques with the child to reach targeted goals.

Won’t it be awkward that my child and the therapist are in different rooms?

At first, some children do find it slightly awkward or uncomfortable to work with therapists virtually. Below are strategies we recommend trying to increase your child’s comfort level with this new type of appointment:

  • Find a space that works for you and your child. This does not need to be the quietest or cleanest room in your home; however, be mindful of the visual distractions (e.g. toys, games) in the room as this may affect your child’s attention. We recommend that you choose a favorite place or comfortable space you usually spend time in as this may help your child with the transition.
  • Help your child settle in by allowing them to have a favorite toy or other comforting object with them.
  • With supervision, allow your child understand the technology by gently touching the screen and exploring the different functions, provided by the therapist.
  • Check in with others in your home to see if they want to be present or out of view for the session and ultimately let your child know who will be with them.

I’m not great with technology. Will this be challenging to set up?

In most cases, your teletherapy appointment will take place on a website or app platform. Your therapist will communicate with you about your child’s specific platform, and whether or not to download an app, based on what type of therapy they receive. Your therapist will then send you a confirmation email with the link and any other information you will need to access the appointment. It will be as simple as opening your email and selecting the link! You will then be directly connected to your therapist’s video chat.

I am in the appointment, but now I am experiencing a problem with the connection.

Below are technology tips to help you get the most of your therapy sessions:

  • Be sure to switch on audio and video settings at the start of the session.
  • Confirm a plan with your therapist in case the connection is abruptly ended.
  • Check the use of additional devices. Streaming or heavy use on another device at the same time as your session may slow your connection and video quality.
  • Having multiple tabs open on your device may also impact video quality.
  • If possible, try not to sit in front of a bright window or light.
  • Let your therapist know if you cannot see or hear them clearly – we want you to get the most of your session!

Questions or concerns?

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

Amanda Deligiannis, MSW, LSW
Licensed Social Worker

Photo Credit: GSCSNJ via photopin.com

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/.