Thursday, November 29, 2012

Signed, Sealed, and Delivered

Deanna Macioce, MS, OTR/L

Now that we have finished up the yummy makings of a Thanksgiving dinner we start to prepare for a month long journey of the HOLIDAYS.  Regardless of what holiday you celebrate, one common task on your list of to do's probably includes sending cards.  Some truly enjoy the task of sending cards, while other dread it and have moved to newer options, such as sending emails and using pre-printed photo cards.  Regardless of what method you use, holiday card sending is a very therapeutic activity.   And this is an easy mobile task that can be done in the clinic, school, and/or at home.

If you are the ambitious type and your list is short, being creative and making your own cards lends itself to address many naturally therapeutic skills.  From working on the fine motor skills of grasp with crayons and markers to decorate, working on visual motor and bilateral hand skills with cutting to add and glue pieces,  to copying skills for writing addresses and generating the greeting.  You can also address tactile sensitivities by having your child do some finger painting, tissue paper gluing or working with foam stickers. Increase the challenge of scissor skills by using old cards to cut out the pictures and glue them to your homemade card. This will present a variety of different textures and thickness of paper to be cut.
If you are using traditional cards, handwriting skills can be practiced by allowing your child to sign the cards.  You may choose to have your child copy a short closing or generate one on his or her own.  If sizing of letters is difficult for your child, provide a designated space with a blank address label to sign.  This is also a great way to work on spacing and overall hand control.   The same method could be used for addressing the envelopes as well.  Work on using those pincers by peeling and placing return address labels and stamps.

For any cards that are sent, stuffing the envelopes is an excellent bilateral hand activity that works on hand control and finger dexterity.  It also is an ideal way to look at proprioceptive needs by assessing the amount of force a child uses to perform the task.  Too much force will result in a bunch of bent cards, so work on using slow, controlled movements.
If you go the non-traditional route of emails or online cards, allow your child to work on his or her typing skills, fine motor speed and dexterity by helping to type them out for you.

As adults, we know that card sending is a long task that we often do over a couple of days, therefore this activity proves itself to be great at working on attention and the ability to focus for a period of time.  After assessing your child's attention and ability to sit for fine motor activities, decided what his or her needs are. Does he need some 'heavy work' before starting?  Play a round of crab soccer, have him bear walk or wheel barrow walk to get the supplies, or provide a hand fidget at the table before starting.  If your child requires ongoing input, this a great time to use those weighted items, such as a lap pad, vest or hat.  Also, look at positioning...does your child attend best while sitting in a chair?  Make sure that her feet are on the floor or use a stool underneath the table.  If she attends best with some movement, allow her to sit on a ball chair, Move 'n Sit, or even stand and do them vertically (this is also and ideal way to get some shoulder strengthening work done!)  And make the focusing side of it fun, play some Christmas music and have them work on the cards until the music stops. Then do a short movement activity or have a holiday treat before starting again.  Use those imagination skills and let them pretend to be an elf and set up an assembly line; from signing, to stuffing, to addressing. And for those children that attend best with oral input, what a great time to let them suck on a candy cane.

As a therapist, you can suggest helping a parent out and partaking in part of the process during the therapy session.  As parents, it goes without saying that this will initially add a bit more work to your plate to set up, but in the long run, it gives you a break on the therapy homework or sensory diet activities that typically are on your to do lists and gives you a bit of relief on this holiday to do! So, make the task of card sending a joint activity and know that you are providing your children with a wealth therapeutic input.

Keeping the "Joy" in the Holiday Travel Season

Deanna Macioce, MS, OTR/L
(Originally Published in October 2012)

As we flip the calendar from October to November, we move away from the fun and spookiness of Halloween, and see that Thanksgiving and the Holidays are next on the agenda. For many, this season brings about traveling to visit family or friends.  And whether it be by car or plane, it can be a stressful time for our children with sensory processing concerns.  The holiday season itself brings about a certain level of 'stress' for these children with the changes in routines and additional sensory stimulation at home and out in public. Therefore, this month we are going to explore some tactics to make the trip a smooth one, focusing on traveling by plane, but many of the strategies will be able to be used for car travel.

Preparation is key!   From using social stories to developing a specialized sensory diet, children with sensory processing concerns need to be prepared to make the trip as comfortable as possible for them, as well as family and the other people traveling.  Initial preparation can be done as you see best fitting for your child.  Whether it be having some sort of count down for a visual guide; such as a calendar, count-down rings, etc. to let him or her know when the trip will happening or by developing a social story to let your child know what they can expect, anything that can ease their anxiety will be beneficial.   In addition, based on your child's age level reading books about taking a trip, traveling or going to the airport may also help in the preparation.  And remember, for many children, these steps may need to be carried out a couple times and regardless of whether or not this is the first time traveling to this extent.

Airports, at any time can be both chaotic and over stimulating, but during the holiday travel season, crowds, noise and chaos seems to be even escalated. If possible, traveling on days and at times with less people traffic can be very helpful.  In addition, delays are often inevitable, making it more difficult on these children. Arrive at the airport with plenty of time, decreasing the need to be hurried through the lines and throughout the airport. In addition, making sure your child dresses comfortably and is only traveling with what is necessary in his or her carry-on, which will include anything to feed the sensory system to keep your child calm and regulated.   So once you do the initial preparations, now you are ready to start the trip.

To help with keeping regulated prior to even boarding the plane and while up in the air, make sure your child has had a proper meal, but in case there is a delay, making sure you have snacks and "oral" input on hand will be key.  It is easy to have gum, hard candy, and chew tubes stashed away in a side pocket of a bag.  Using an iPad, MP3 player or hand-held game system can help keep your child entertained and focused on things other than what is happening around him or her.  Have your child to use ear buds or headphones to assist in blocking out the over-head speaker and all the addition noise.  For your child that uses hand fidgits, having any little squeeze or tactile ball on hand, small Play-doh set, or a plastic baggie filled with beans, dried pasta, or corn kernels may help. Using weighted items can be beneficial and easy to take along with you, from weighted lap pads, vests, or neck pads.

For children on a regular sensory diet, allowing yourself the time to carry out activities before boarding the plane will help with any anxiety and the fact that he or she will stuck in a small seat and area for an amount of time.  Heavy work can be achieved with carrying a backpack, doing animal walks in the waiting area or even chair push-ups and wall pushes while you wait.  Getting a variety of vestibular input may be more difficult, but taking frequent walks, and in less crowded areas trying to do some spinning, fast paced walking, hops may help.  In addition, find the escalator, people mover, or elevator to take a ride on.
Be prepared with activities to keep them entertained keeps down the frustration and nagging.  Making up an 'airport bingo' game where the child has to find different people or objects, going on letter hunts, having travel games, and any electronic device will help keep everyone happy.  In addition, there are now many travel size coloring books, magnetic drawing boards, or Etch-a-Sketch available that tuck neatly in a carry-on.

So, now is the time to start preparing, pack your backs (keeping them under the weight limit), and get ready for a "joyful" holiday trip.

Spicing Up Therapy With a Little Bit of Pumpkin

Deanna Macioce, MS, OTR/L
(Originally Published in September 2012)

Fall is among us...the time of year, for many, that means cooler weather, color change in leaves, apple cider, and PUMPKINS.  Whether you celebrate the Halloween holiday or just the season of Fall, pumpkins are seen decorating yards and windows of homes and businesses everywhere. And who would of guessed how beneficial pumpkins could be to a child's sensory development?  So, let's explore a few ways that pumpkins can spice up your therapeutic activities at home, school or in the clinic.
Carving and decorating are the most traditional activities that involve pumpkins, and probably those that cover a variety of therapeutic areas.  When looking at carving, not only does it offer a fabulous tactile activity with the cleaning out of the guts, but it is also a great way to address bilateral skills. Fine motor, copying, and sequencing skills are focused on when designing, drawing, and cutting (with adult help) the pumpkin.  For older children, using a punch pattern, where you print out a pattern of a design, place it on the pumpkin and then they punch along (with the proper tools from a carving kit) the lines, leaving a carving guide on the pumpkin, is a nice way to work on visual motor skills with a bit of proprioceptive feedback.

When it comes to decorating the possibilities are endless, but you can address tactile and fine motor skills with using foam pieces to complete your child's masterpiece. These pieces are great at working on those pincer skills to pull of the backing and offers just enough sticky tactile input for your defensive child.  Finger-painting and the gluing of sequence, feathers or other small items are other ways to therapeutically dress up your pumpkins.
When decorating, increase your therapeutic benefits by paying attention to the positioning of the child and pumpkin, make sure you are using the most ideal size pumpkin and the child is either in a proper seat or standing at an ideal height.  The proper set up is key for addressing bilateral skills, and overall core strengthening of the trunk, shoulders and elbows.

Movement and proprioception input can be achieved by creatively adding pumpkins into traditional therapy activities.  Use mini pumpkins to have children collect along an obstacle course, obtain at the top of a Climbing Wall or Rope Ladder, or use as markers for starting and stopping animal walks or relay races. In addition, mini pumpkins are ideal for having children obtain for activities in the net swing or balance board.  In group settings, pumpkins can be used to play "Hot Pumpkin" or as a passing game.

Go pumpkin bowling by using a medium to large sized pumpkin to roll and knock down bowling pins.   Get a giant pumpkin and allow children to get their heavy work by rolling it back and forth.  In addition, pumpkins add natural weight, and can be the just the right weight to be carried, pushed or pulled in a wagon, shopping cart, laundry basket or wheelbarrow based on the child's need for proprioceptive input.
Pumpkin itself offers a distinct taste.  Therefore, pulling in any activity that offers pumpkin treats is recommended to address both oral and olfactory input.  From tasty pumpkin cookies, muffins, rolls, and dip, there are many ways to present the pumpkin taste to children.  Increase the therapeutic benefits, by having the child help and prepare the food, addressing sequencing, direction following, and self-care skills.

And getting the pumpkins themselves can be beneficial for many children.  Whether you take a trip to the pumpkin patch as a group or individually, there are many areas of need that can be addressed.  Based on a child's needs, the pumpkin patch offers a way to address social skills, interactions within the community (ie. buying items), and taking in multiple forms of sensory input, especially at pumpkin farms that offer a carnival-like atmosphere.

So now is the time year to let pumpkins naturally spice up a child's sensory diet.  As therapists, help parents analyze activities so that what they are already doing at home can be even more beneficial and rewarding to children.  Have fun pumpkin hunting!

Finding the Right Tools to Transition Back to School

Deanna Macioce, MS, OTR/L
(Originally Published in August 2012)

Transitioning back to school is never easy, but it presents even more difficulty for our children with sensory processing concerns. Daily routines change and the laid-back summer attitude switches gears into the high energy of the school regime.  Some children thrive on going back to school because of re-establishing more of a daily routine.  But often times it is up to the parents, therapists, and teachers to figure out and re-establish how to get our children back into the "just right" state needed to be successful in the classroom for an entire day. This month we are going to touch upon some ways to help at home in the early weeks of heading back to school.  

Getting out the door in the morning is typically the most difficult for a household.  Therefore, making sure you are choosing 1 or 2 strategies that can be easily integrated into the morning routine is ideal. And if you already have an established sensory diet or home program, work with your therapist to figure out which ones are best for you to use.
For the child who needs a little 'gas' to rev up their systems try integrating some alerting activities and foods into their morning. For these children, not only is it frustrating to the parent to always have to help out with each step of the process, but letting them get dressed and plop until the bus arrives is not getting their bodies or brains ready for the day ahead.  So, as they get out of bed have them do a few stretches, jumping jacks, or even bunny hops to the bathroom to get a little cold water to wash their face (what better way to wake up!)  Transition around the house with fast walks, jumps, skipping or galloping.  If possible, let you child be the one to head outside and get the morning paper at the end of the drive or take the outgoing mail to the box.  Use fast tempo music during the morning routine, not only does it help move the body a bit faster, it also helps to put everyone in a good mood.  If time allows, throw in a quick game of Simon Says as you prep breakfast and lunches.  Allow breakfast to include some 'alerting' items.  Such as, a nice cold glass of cranberry juice, a bowl of fruit, or cold cereal.

For the child that wakes up with a high reserve of energy, use those heavy work, proprioceptive activities to get his or her systems calmed and regulated. Transition from room to room with animal walks (bear, crab, etc) and wheelbarrow walks.  Prior to getting dressed, provide deep massage or a brushing program to calm their bodies down.  Keep the morning routine as calm as possible, with lights low and quiet music or background noise.  Warmer foods, as well as chewy and crunchy foods are ideal at breakfast, such as oatmeal, chewy bagels, or apples.  Also, present their morning drink through a straw.  Wearing a backpack, appropriately filled, is another great way to provide a calming, deep pressure to the body.

It probably goes without saying that another key component to help with these morning transitions is organization and calmness of the household.  Have whatever you can prepared the night before to alleviate the morning "rush", allowing more time in the morning to get your child ready for the demands of school.  In addition, staying calm helps to keep your child's system in the 'right' state, decreasing the chances of either shutting it down or revving it up.

Start this school year out on the right foot by choosing the perfect tools in your toolbox to get your children up and going this Fall.

Bringing Out the Inner Artist

Deanna Macioce, MS, OTR/L
(Originally Published in July 2012)

In this day and age, technology offers us so many fun and exciting ways to occupy our child's time, from playing games on a Nintendo DS or Leapster to downloading the coolest new app for your iPad, having the ability to watch a show practically at any time, any place, kids can be entertained with ease. These gadgets have made waiting at a restaurant, a doctor's office or for the next meal at home a bit easier, often replacing traditional activities of reading or coloring.  And although many of these devices offer ways to enjoy these activities, this month we are going to explore the many benefits of coloring and drawing; even for our wiggle worms.

When we think of bringing out the crayons and markers, we initially think of fine motor skills.  In addition, we tend to see these activities ideal for our toddlers, pre-writers, and many times do not encourage them after this stage.  However, coloring and drawing offer us the ability to address other areas than just fine motor skills, and can actually be very fun and rewarding.

For many of our sensory children, sitting to attend to tasks is difficult, especially coloring.   You may be able to get them to do a fleeing stroke here or there, or find that they are just bored.  However, after the appropriate sensory diet activities to get their systems regulated, coloring is an ideal way to address attention, focus, and independent work. And for the child who struggles with multiple step activities, such as crafts that involve coloring, cutting, and gluing; coloring alone is a simple one-step activity to get you started.   Providing the wiggle worms with the appropriate adaptations to keep them focused will help.  From using weighted items, to completing the activity in a smaller space, such as a child's tent may improve your child's involvement.  Think outside the realms of the table and work on core stability by taping the page to the wall and have the child stand to color, move it down to the floor, having them color in prone (what a great way to strengthen that prone extension), or increase shoulder stability by having the child lay on his or her back and tape the page to a surface above their head, such as a small table or bench that they can reach.

Visual motor skills can be strengthened with the use of crayons and markers.  From emphasizing coloring within a designated area to encouraging accurate tracing of shapes and designs, these activities keep the hands and eyes moving together.  And they can be easily graded to increase or decrease the challenge for your child.   Beginning with simple designs is best, those that have minimal inside lines working your way up to more complex pictures.  You can give visual boundaries by highlighting the outside lines, or choosing different colors to outline and having your child color the corresponding color within the area.  For the child that becomes overwhelmed with all the visual input, cover up part of the picture with a piece of paper, offering only small sections to color at a time.

Coloring and drawing are said to be activities that promote calming and are recommended to help deal with stress in adults.  Which in turn make them great for our sensory children.  So many of these children keep their bodies and minds in a high alert state throughout the day as they are working through anxieties of school, friends, and activities.  With the addition of calming background music, and any proprioceptive input, coloring offers an ideal sensory experience.  Also, this may be a great way to start or end a session based on your child's needs.  For the older child who demonstrates difficulty opening up in conversation, pull up a seat and color right beside him, talking about the day.  For parents, this may be a great way to get your teenage child to actually sit down and talk to you!  This allows him to stay focused on the task, not worrying about conversation.

Unlike sports, games or schooling, drawing and coloring have very little boundaries for success. You have the ability to make it as structured or unstructured as you like, allowing children some control over decision-making. In addition, for children who need less structure, giving them an 'open canvas' and some music to move, you never know what new masterpiece will be donning your refrigerator

So, for the rest of your summer when you are spending time unplugged, pull out a coloring book or plain sheets of paper, some crayons and markers, and bring out your child's inner artist while encouraging fine motor, visual motor, and attention skills. It is a great way to keep a child's eyes, hands, and mind working together, with a beautiful, tangible finished product.

Taking a Sensational Trip to the Beach

Deanna Macioce, MS, OTR/L
(Originally Published in June 2012)

As we have become adults, many of us sees a trip to the beach as the picture perfect setting for relaxation.  From basking in the sun to listening to the crashing of the waves, or even getting lost in a really good book, the beach is a place for us to escape from our day-to-day life.  For a child, a day at the beach is a day of fun with lots of ways to exert energy, without realizing the wide range of sensory experiences it offers.  For our sensory seekers, this is an ideal place to receive sensory input to all areas, however for children who present with a lot of sensory defensiveness, the beach may be one of the farthest places from fun and relaxing.   So, how will you make the best of your beach experience this summer, or even have the opportunity to make it a tolerable and fun outing for your child with sensory concerns?

The beach is best known for offering a blanket of sand.  Not only can your child have the experience of building his next masterpiece, he can take it to a whole body experience by burying himself from head to toe.  This provides not only a different, but also fun way of giving proprioceptive input. Who needs a weighted blanket when you have sand?  Playing in the sand is also a great way to incorporate fine motor skills with scooping, dumping and building to construct sand structures.

On the flip side, for the tactile defensive child, time in the sand could be nothing more than uncomfortable and annoying.  Do your best to prepare your child in the regular manner that you do for tactile experiences.  Whether it be with the Wilbarger Deep Pressure Proprioceptive Technique (brushing) or even a good massage of sun screen, this should help make the experience less noxious.  In addition, with the option to wear protective sun clothing, this allows a child to be less exposed than in typical swimming suits to the touch and feel of the sand.  These are often found in stores and catalogs offering a wide range of swimming gear, for example One Step Ahead.  These clothes also provide great protection from the sun.  And don't forget about shoes - not only does the sand get extremely hot to walk in on a hot day,  it can also be uncomfortable for your child to simply walk in bare feet.   Allow your child to wear shoes of comfort and full coverage if need be, with water shoes being a good option as the foot is fully covered.  For your defensive child, using a large blanket with allow him or her ample space to sit and move around versus being confined to the space of a beach towel.  In addition, bringing a beach chair may also help do the trick.  The use of a umbrella will not only help with protection from the sun and the heat, it will also help keep the sand cool, making it more ideal to play in.  And just like anything else, giving your child things in small doses may help.  Therefore, provide sand in a plastic container so that he or she can have his or her own space to play and not have to be fully engaged in the sand.

Water is another key component to the beach.  Whether it be a lake or ocean, swimming is a great way to include proprioceptive input into a sensory diet.  In addition, having the input of the waves provides a very different vestibular experience than you can get anywhere else. This makes it fun to use body boards and rafts while in the ocean. And if you are at the ocean, the salt water offers a different oral, visual, and smell input.  To ease the discomfort that salt water may present, provide children with goggles and have gum or other food available to take away the taste after swimming.

Auditory input is available all around you when you are at the beach.  From the seagulls, to the waves, to all the background noises of the fellow beach-goers, this often is relaxing to many, but may be extremely uncomfortable to many of our sensory children. Allowing your child to wear headphones for sound blocking or to listen to music is a great way to allow them some opportunity to relax while at the beach.

Therefore, this summer use the beach as a way for your children to experience natural sensations all around them.  Use a variety of techniques to make it enjoyable for all children, and take some time to relax with a good book.

Cutting Through Scissor Skills

Deanna Macioce, MS, OTR/L
(Originally Published in May 2012)

Very often we are driven to address working on a particular skill with merely just practicing what it is we are trying to achieve.  It seems as if today, in all realms of life we are always trying to get things accomplished fast, forgetting that if we paid attention to the components, and took small steps to achieving a goal, we would get there faster.  For example, if you wanted to run a marathon, you would not start off running the 26.1 miles the first time you laced up our shoes.  Rather, you would follow a training program that would equip you with the strength and endurance to achieve a run of that distance. And the same is true for so many of the skills we are trying to get our children to achieve.  Therefore, if we take the time to work on the building blocks of a task, building up a child's attention, strength, endurance, etc, success will be achieved. Scissor cutting requires a great deal of individual skills in order to accomplish this task, including ideal attention, core stability, fine motor strength and dexterity, visual motor, and bilateral coordination skills. This month, as we begin to transition into the summer months, we are going to look at how we can work on the building blocks of scissor cutting, so that we are not just merely trying to find success with cutting on a straight line, but focus on the quality of how the skill is achieved so that it can be mastered.

As with any sit down fine motor task we present before our child, one of the first areas we need to look at is attention and self-regulation. For many of the children with Sensory Processing Disorder, this may be the main component to the success with cutting.  Therefore, working on a sensory diet that helps achieve a regulated state is key.  Very often this will include providing proprioceptive input through 'heavy work' activities.  These may include tasks that require pushing and pulling, performing animal walks (bear walk, crab walk), jumping activities, climbing up a slide or rock wall, completing an activity prone on a scooter board, taking a trip through the Steamroller or Resistance Tunnel, or carrying heavy items, such as groceries or weighted balls.  In addition, using weighted items during the activity may also help achieve good focus and attention.  These items could include a weighted lap pad, Bear Hug vest or weighted vest.

Having a strong core is key to the success of many fine motor tasks.  Without a strong trunk or shoulders, children appear floppy and lack the muscle endurance to perform these complex tasks.  In addition to some of the above-mentioned activities for heavy work, have children swing on a variety of suspended equipment including a  bolster swing, disc swing, or your standard sling swing.  Completing activities while sitting on a therapy ball or t-stool, such as throwing bean bags at a target will also help work on these core areas.  To strengthen shoulder stability, performing tasks in vertical will help.  These include standing to draw, write and color, or even washing windows.  You can use some classic activities such as dropping clothespins into a coffee can while standing or performing spoon races, where you have a child carrying an item, such as a marshmallow on a spoon with an outstretched arm and race to the finish line without dropping it. Child yoga activities, swimming, and the martial arts are also ideal for achieving core stability.

To assess a child's core stability in regards to cutting, encourage the child to cut away from a tabletop surface, without resting the paper on the table.

Fine motor strength can be addressed through common activities such as using Theraputty, a variety of squeeze balls, and pinch grasp activities.  To strengthen and encourage proper use of the radial (thumb) side of the hand, place a small object, such as a cotton ball, into the ulnar (pinky) side of the hand during fine motor activities that require a pincer grasp or three-finger grasp. In addition, complete activities of picking up and placing small objects using a variety of tongs, fun tweezers, or strawberry pickers to work on hand strengthening, especially of the thumb-side of the hand.  When working on pre-scissor skills, ripping paper is a great way to encourage the thumb, index and middle fingers to work together.  This is a fun way to allow a child to help get rid of all the junk mail you receive. In addition, have children practice cutting play-dough strips, as well as paper of different thickness such as, construction, card stock, sand paper, etc.

Overall improvement of visual motor skills will help strengthen a child's ability to cut.  Participation in a variety of ball activities will address this, including catching a ball and tossing one at a target.  Zoom ball is also a great way to incorporate visual skills while also working on bilateral coordination. In addition, traditional paper visual motor activities, such as mazes, word finds, and completing interlocking puzzles are also beneficial.

Scissor cutting is truly an activity that uses both sides of the body.  With one hand holding the paper and the other manipulating the scissors, both hands have to work together to cut and rotate paper at the same time.  Many of the activities listed in the above sections tie into improving bilateral coordination skills, but encouraging your child to use both hands during activities is key.

Once you have worked on the building blocks to improve cutting, motor planning comes into play, as well as using the correct tools.  There are a variety of scissors available to help meet your child's needs including loop/squeeze, self-opening, the Benbow Learning scissors, and standard Fiskar scissors.

Cutting, like handwriting is not an activity many children will choose to pull out and work on this summer, but take the time to find various ways to work on the different building blocks and see the transformations that will take place.

Teaming Up for Heavy Work

Deanna Macioce, MS, OTR/L
(Originally Published in April 2012)

April is a busy month with recognizing and celebrating the work of occupational therapists, as well as helping to raise the awareness of Autism.  And for many of us, these two things often go hand in hand, whether we are parents, therapists, or teachers.  Almost every OT in the pediatric field has worked with or been touched by a child with Autism, and in return almost every child with Autism has had some connection to an occupational therapist. Therefore, this month we are going to look at these two areas and highlight a few strategies and products that are used by occupational therapists to enhance the lives of our children with Autism.

Children with Autism often demonstrate a variety of sensory processing difficulties.  From being tactile defensive to seeking out movement, these children typically require interventions to help keep their systems in an ideal regulated state.  Many children demonstrate difficulty with attention or focus, and the ability to sit for activities such as fine motor tasks or circle time.  Providing proprioceptive input is one strategy that can be utilized to help with achieving overall regulation and attention.

Proprioceptive input, or "heavy work", is resistive input that helps to obtain self-regulation, improve attention, achieve an ideal state of arousal and improve muscle tone.  It has also been identified as a way to help decrease tactile defensiveness.   Heavy work activities include a broad range of ideas.  From carrying to pushing and pulling, to jumping or chewing, these are all ways to achieve proprioceptive input.  In addition, proprioceptive input can easily be obtained without the need of a ton of equipment.  Heavy work activities are used ideally as a way to prepare children for tasks that require attention and focus, as well as a way to finish up and regulate the sensory system after vestibular input.

To highlight a few quick ways to incorporate heavy work activities, it is easiest to break them down into areas.  So when looking at activities that use movement, performing animal walks, such as crab and bear walks, or wheelbarrow walks are a great way to provide proprioceptive input.  This is also a fun way to have children transition between activities or from room to room. Many household tasks provide "heavy work" naturally, such as carrying groceries, pushing and pulling the laundry basket, and stacking crates or boxes for the big basement re-organization project.  Jumping itself offers a nice amount of proprioceptive input, so just incorporating various jumping activities into everyday play, as well as climbing will help provide your child with a good amount of input.  Have children climb up the large hill at the park or spend some time on the local playground equipment. For fine motor proprioceptive input, having children hide and find small objects in playdough, clay, or putty helps let the fingers do the "heavy" work.  Kneading dough for bread or cookies is another way to keep those fingers moving that offer a yummy end goal. Orally, proprioceptive input can be provided through sucking thick liquids through a straw, such as a tasty milkshake, or providing snacks that require extra work for biting and chewing, such as sourdough pretzels, carrots, or celery.

Another way to provide proprioceptive input is through the use of weighted items, such as weighted blankets, hats, and vests.  These items are often used when trying to help a child sit and attend for activities, decrease a high level of arousal or assist with achieving a state of calmness.  The outcome of these items may vary with individuals, but they have been shown to be beneficial in many scenarios. And when using these items, it is best to consult with an occupational therapist for a proper wearing protocol.  At this time Southpaw has expanded its line of weighted items that offer the ability to be used with increased ease and in a variety of settings.  Their new Weighted Lap Blanket, Weighted Lap Belt and Weighted Seek and Find are ideal for home, school and clinic use.

So, as we take the time this month to increase our knowledge and awareness for the Autism population, we want to highlight some of the ways that occupational therapists use their sensory knowledge to work with these individuals, helping them learn new skills and achieve higher levels of functioning.

Getting A 'Grasp' on Outdoor Play

Deanna Macioce, MS, OTR/L
(Originally Published in March 2012)

Much of the realm of occupational therapy practice focuses on the hands and the use of the hands.  Very often, especially in the adult population you will hear that physical therapists work on the lower extremities while occupational therapists address the upper extremities.  In OT there tends to be a lot of focus on the hands, even in the pediatric population.  As with all development, there is a natural progression to the development of hand grasps and skills.  You can find a variety of resources available that highlight the progression of the various grasps, including illustrations.   However, this month we will not focus on the textbook information on how grasps develop, rather we are going to take a look at how simple, typical outdoor play helps strengthen a child's hands and fine motor dexterity. Very often we identify much of the playing children do outdoors as gross motor, and overlook the way that it impacts their fine motor skills. So, as we approach Spring let's see how we can incorporate fine motor goals into our everyday outdoor activities.

There are very few children who do not partake in any type of play that involves balls.  Commonly seen as activities that help strengthen coordination skills, ball playing can also been beneficial to fine motor strengthening, especially in terms of thumb opposition and the intrinsic muscles of the fingers.  For example, working with a football and encouraging a proper throw and release, addresses the stability and strength of the fingers, including the thumb.  This is important when trying to increase the opening of the thumb web space.  When performed without the use of the body or chest for stability, any type of ball catching activity from a tennis ball to a playground ball, encourages not only the strength and stability of the forearms, but also the fingers.  In addition, sports such as golf, tennis, Frisbee and baseball help encourage specific grasps and use of the hands. The use of a Velcro ball catch is also a key way to encourage the strength of the hands due to the resistance provided when pulling the ball from the Velcro catcher. So, sign your child up for his or her favorite outdoor sport or gather the neighborhood kids together for a friendly game of baseball, either way, you will be improving your child's fine motor skills and having fun.

Water play with spray bottles, squirt guns, and animal squirters all benefit and encourage fine motor dexterity and finger strengthening, especially by using the thumb, index and middle fingers.  Having increased strength with these fingers will improve overall handwriting and scissor skills.  So, fill up the water table and let the water wars begin. In addition, using the garden hose nozzle to water flowers, the lawn or wash the cars are great activities that will help you reach these goals.

The nice weather provides the opportunity to pull many of those "messy" tasks outdoors.   Bringing out the finger paints, shaving cream and playdough are all activities that help improve fine motor skills.  When finger painting or playing in shaving cream, encourage children to use isolated fingers to form shapes, letters or designs.  Playdough, itself provides the opportunity for strengthening with full hand squeezing, thumb opposition strengthening with pinching, and overall improving of fine motor dexterity to build and design various items.

Digging in sand and dirt, allow children to work on grasping various tools with the use of the wrist. Filling up buckets of various sizes and having children transport them help to encourage the improvement of a hook grasp and overall hand strength.

Another activity to help work on fine motor skills is sidewalk chalk, which is often a favorite activity for children of all ages.  Using the chalk by itself or with a "fancy" holder with encourage the use of a thumb and fingertip grasp.

When it comes to playing outdoors, we often focus on our sensory, core stability and coordination goals, however by taking the time to fully perform task analyses of these activities will prove to you how beneficial these activities are to the overall development of the hands and fine motor skills.  So, now is the time to move your focus away from the table top to the outside when working on fine motor skills.

Tunneling Your Child's Energy

Deanna Macioce, MS, OTR/L
(Originally Published in February 2012)

As parents and therapists, we often find we fall into a bit of a "rut" doing the same things day in and out. It is hard to find fun, creative activities for our children or clients, especially during these winter months.  Most children are itching for Spring to arrive and begin bouncing off the walls with energy to expend.  So, as we trudge through the final months of winter, we are going to take a look at a piece of equipment that can be used easily in your home, clinic, or school environment: a tunnel.

Tunnels are found in various sizes, lengths, and fabrics and offer some nice therapeutic benefits, as well as are a great way to expend energy.  Tunnels provide small spaces for children who crave those dark, quiet areas.  In addition, they enable children to improve their motor planning, bilateral coordination, and direction following skills, while providing a good source of proprioceptive input

By having children crawl in and out of tunnels, a child is receiving proprioceptive input throughout both upper and lower extremities.  In addition, the crawling movements encourage bilateral coordination through reciprocal use of arms and legs. and addresses motor planning skills.  You can increase the proprioceptive input by having a child push a ball through the tunnel. This particularly beneficial with the use of a Resistance Tunnel, and also challenges their coordination skills.  Children can be challenged to negotiate through the tunnel in various ways, from belly crawling, backwards crawling on hands and knees or in a crab walking position.

Tunnels are a great addition to any obstacle course.  And how you place the tunnel can increase the challenge and amount of work a child has to do.  For example, by placing the tunnel over a Cloud Nine, pillows or up a ramp, a child will have to utilize different muscles, increase their motor planning abilities, while receiving increased amounts of proprioceptive input.  In addition, you can set up different activities using the tunnel increasing the number repetitions.  This can be achieved by placing puzzle pieces, pegs, or Mr. Potato Head pieces, for example, at one opening.  Then have the child go and retrieve the items crawling back to the opposite end of the tunnel to complete the activity.

And you do not have to run to the store or log onto your computer to purchase a tunnel for your home.  There are many ways to achieve making a tunnel out some common household objects.  Put a blanket over a coffee table forming a darkened tunnel that will encourage a child to belly crawl under the table.  You can also form a path by arranging couch cushions in an upright position, allowing children to try and crawl between them without knocking them down.   Find a large box or attach several various sized boxes for your child to crawl through.  This option also provides a way for your child to let out some creative energy by decorating the boxes with crayons and markers.
So, now is the to re-energize and allow your creative juices to flow.  Pull those tunnels out of the closets or build one in your home, and expend some winter energy.

Having A Ball With Ball Pits

Deanna Macioce, MS, OTR/L
(Originally Published in January 2012)

There are probably very few parents, therapists, and teachers out there who would not agree that ball pits are enjoyed by children of all ages.  Most children cannot resist the urge to just jump in when they see one.  Ball pits offer pure fun to jump, "swim", throw, and hide.  A once common attraction at many amusement arenas now can be found in almost any toy catalog or store, as well as many therapy settings.  So what make ball pits such a great activity for children, and how are they beneficial for our sensory children?
Ball pits definitely provide a lot of excitement, but also offer many therapeutic benefits.  They are ideal for providing proprioceptive and tactile input, working on body awareness, motor planning, and stereognosis skills, as well as strengthening core stability.  Since the size and set up of ball pits vary, so do the specific benefits.

Large, clinic size ball pits can be used as a crash landing pad.  Position the pit near a swing hook up, and using a trapeze swing a child can pretend to be Tarzan or Jane and crash into the water.  From there they can "swim" across the pit to rescue an item. Negotiating through the ball pit is beneficial for the lower tone child and those with decreased trunk stability.  This also provides a lot of propricoceptive and tactile input.   In addition, larger ball pits encourage peer interaction, allowing 2 or more children to play together.  You can address motor planning by setting up an activity, such as a puzzle, Mr. Potato Head or peg board with the pieces on one end and the board on another end, having the child go back and forth for completion.

Southpaw's new Crash Pit Steps and Slide offer additional fun and therapeutic benefit.  Maneuvering up the steps helps address balance, coordination and motor planning skills..  The steps are great for stair climbing skills, bilateral coordination and motor planning.   And the slide provides vestibular input while improving core strength.  In addition, you can have your child walk or creep up the slide to work on core stability, balance, and coordination skills.

Smaller ball pits or the Sensory Shaker can be a great addition to your home play area to address aspects of your child's sensory diet.  In addition, these offer great small spaces to calm down or do a quiet activity.  The Sensory Shaker is a great way to shake up the fun by playing "popcorn"; popping the balls all around your child.  When the balls find their way out, children can work on their eye-hand coordination skills by tossing the balls right back into the target- the ball pit.

Any size ball pit allows you to hide items on the bottom, having your child use his or her hands to hunt for the items.  A fun way to achieve this is by using matching picture cards of the items and allow the child feel his or her way around to find its match.

Ball pits offer an endless supply of fun, and are especially needed during the months of winter when we find ourselves inside.  They are a great activity for all children, but offer a wonderful therapeutic benefit.