Monday, November 25, 2013

‘Coordinating’ Through the Snow

Deanna Macioce, MS, OTR/L

Snow:  you love it or hate it, and if you are one of those that fall in the grey area, it is best to find a way to embrace it.  Often times we find that for those who live in snowy regions, the winter months put a damper on their physical fitness and therapeutic activity.  However, snow offers many benefits, especially to our older children. That is why it is a great reason to take advantage of the snowy conditions while they are here.  Although play in the snow offers an array of sensory experiences, coordination skills are going to be highlighted because with improved core stability, balance and bilateral coordination, a better proprioceptive system and body awareness are developed. 

Embracing the weather means children can participate in activities such as snowshoe walking, sled riding, and skiing, both cross-country and downhill.  All activities that cannot be done without one thing: SNOW!

Snowshoe walking can be done with children as young as 3-years-old.  By placing on the snowshoes, individuals walk through the conditions requiring an increased amount of balance and strength due to using a more exaggerated gait.  By making crunchy footprints in the snow, children get to take a trip down a path, lifting high each leg and keeping themselves balanced through weight shifting.  It puts a nice twist on something most do every day; walk.

Sled riding is often looked upon as a vestibular activity, which it offers great benefits in this area.  However, when focusing on coordination we see that the sled riding is more then just a rush down a high hill.  Climbing the hill to get to the top involves core strengthening to make it up the incline.  It also addresses those tight hamstrings that many children have.  And the sled needs to make its way to the top as well, so by pulling the sled behind, children get to work on weight shifting with an object.  Balance and core stability are enhanced as children need to maintain their bodies in an upright position while rushing down the hill.

Cross-country skiing offers the biggest challenge when it comes to coordination, mainly in the process of getting the skis on and maneuvering the body to move.  Once situated the bilateral gliding of the legs is a whole body coordination activity.   Both the arms and legs have to move in sequence in order to allow the child to glide across the snow-covered ground with ease. In using the poles (which are optional, and may be cumbersome for younger children or those with decreased coordination skills) stability is provided for increased balance, but they also help encourage the increase use of the arms.  

Down-hill skiing and snow boarding are activities that require a larger amount of skill and coordination. Therefore, children can participate despite their weakness.  They require balance, bilateral use of arms and legs, and weight shifting the body appropriately to avoid a fall. Many places offer these activities in an adapted program.

Being outside and getting some exercise is an added bonus to these activities. And being that children can only participate in them with snow, why not add them into their therapeutic programs.  So, bundle up and have some fun!

Monday, October 28, 2013

How to Stack Up on Play

Deanna Macioce, MS, OTR/L

We find more and more that we are moving away from traditional play with our children. The fun and exciting things that have entered our world of play in the form of technology is amazing, however by partaking less in the toys that require imagination, manipulation, and self-generated play our children are growing up with weakened developmental skills. Typically these days, if it doesn’t light up, talk back to you, play music or require the downloading of an ‘app’, it is not the ‘coolest’ toy or activity. But if we took some time to encourage play with blocks, stacking and building toys, we would not only be improving a child’s fine motor skills, visual motor/perceptual skills, imagination, and attention, we would be giving them a new opportunity to fun. In addition, research suggests that children who engage more in block play tend to perform better in the areas of math and science. Parenting Science (

Blocks come in a variety of shapes and sizes, and it is not only to give companies a reason to market more products. From a therapeutic prospective, the differences enhance various developmental skills while adding some fun. There are cardboard blocks, wooden blocks, Lincoln Logs®, LEGOS®, Duplo blocks®, and many others. As well as, the creative shapes and designs found in building toys, such as those offered by Southpaw; the Better Builder Series, and Totter Tower. And we cannot forget the simplicity of those common household items such as boxes, soup cans, and plastic cups. There are so many ways to incorporate stacking and building into your child’s play, no matter what age or skill level.

Blocks and other building toys play a huge role in fine motor development, especially looking at grasps and hand arch development. Starting with the large cardboard blocks, moving down to the 1-inch wooden blocks and then those similar in size to LEGO® blocks, children progress from a gross grasp to a refined pincer or 3-tip grasp. A well-developed grasp is beneficial in all daily tasks, including eating, performing handwriting activities and manipulating fasteners, such as zippers and buttons.

Breaking apart the task of stacking in more detail, we find that these activities also help with developing improved shoulder, elbow and wrist stability. When children have stronger stability at the shoulder, we find that they are able to perform fine motor tasks such as handwriting, scissor activities, and tool use with increased refinement and endurance.

Visual motor skills are enhanced with building activities. Whether copying a design, stacking or creating a self-generated design, building pulls in 3-dimensional work addressing depth perception. As children continue to develop these skills, moving from plain blocks onto more complex building with LEGOS® or K’nex® systems where they have to follow a book of directions are beneficial.

The nice thing about incorporating more stacking and building into play is that it easily can be done almost anywhere or with anything. Stacking the boxes from the grocery bags (or as my children build vehicles to ride in with the extra large items from the local warehouse store) or building with the jelly packets on the table at the restaurant; building can happen anywhere. Stacking and building have no age limits and the possibilities to creativity are endless. Remember that children learn by example, so if we take a break from those technological toys and spend some time being creative, they will join in with us. Now as we begin the holiday shopping, make sure we add a little ‘building’ to the list!

Thursday, September 26, 2013

"Fall"ing into Calmness

Deanna Macioce, MS, OTR/L

In the last month or so, most people have experienced a ‘season’ of change with the start up of school.  Whether you are a parent, teacher, or therapist, the Fall not only brings a change in weather, but a change in routine, expectations/demands, and behavior.  It is not uncommon for children to be over-tired and worked, resulting in increased agitation, increased arousal level, and overall disorganization of his or her sensory system.  Therefore, we are going to provide some fun Fall activities to help decrease arousal levels and hyperactivity, as well as increase attention and self-regulation. 

The cool, brisk air of the season provides a natural calming component.  Therefore, getting out to play, ride a bike, or take a hike to gather up leaves and acorns for a craft helps use up the extra energy after school.  For ideal success in lowering the arousal level, complete the high-energy activities first, followed by something more calming, such as wheelbarrow walking across the lawn. 

One of the best things about Fall, is the beauty of the changing leaves, however it goes without saying that those leaves bring about a lot of extra work.   Raking leaves is beneficial for all children and they sell rakes in about every shape and size.  The pulling motion provides bilateral coordination, but is an excellent way to get a nice dose of heavy work.  And the hard work is always capped off with a great jump into the leave; also a nice tactile experience in itself.  Although leaves appear to be light, when in a pile they provide a good amount of weight, so complete the whole task by having your child scoop up the leaves with both arms and dump them into a wheelbarrow.   And do not forget that pushing the wheelbarrow is another natural activity that provides therapeutic benefit.

Pumpkins are not just for decoration these days.  They are a nice way to increase the fun to your activities, providing a great amount of ‘heavy work’.  Have your child carry them from one end of the yard to the other in a race, load up a wagon to push or pull them around the yard, or use them to set up an obstacle that they have to wheelbarrow walk, skip, or do an animal walk around (ie. crab, bear, etc).   Arrange some bales of hay for them to set the pumpkins up on. This is a great way to get some extra lifting while strengthening the shoulders.  In addition, the bales of hay are fun to for them to climb and jump off, providing some nice overall proprioceptive input.  Pumpkins can be used for a fun bowling activity, providing a bit more of a challenge then using a ball.

Have a daily costume party by having your child pretend to be a mummy.  Lay them on an outstretched blanket and then roll them up tightly, as you would to be a hot dog or burrito, and you have an instant mummy .  Or use body socks to have her walk around as a monster.

For the older child, have him decorate a large pumpkin using hammer and nails (with adult supervision).  This is great for attention, focus, bilateral fine motor skills, and using the hammer to complete his design provides a nice amount of proprioceptive input
If you have the child who calms with fidgeting or tactile input, filling a large bin with popcorn kernels to run her hands through or to find small objects is both fun and exciting.  Get creative (and work on school work) by hiding foam shaped objects, such as leaves, pumpkins, ghosts, with letters or sight words on them so that they have to find them and then read them to you.

For those creative people, there are a ton of crafts and art activities that complete the Fall and Halloween seasons.  So, once you have done the calming activities and your child is regulated, pull out the materials to do some fun crafts to work on fine motor skills.  Utilizing tools such as bingo dobbers, corks, glitter glue sticks or medicine droppers for painting Fall scenes are both great for strengthening the fingers and hands, but also require a bit of ‘heavy work’.  Increase the calming effect by using a weighted lap pad, vest or other material.

Therefore, beauty of the season can help bring some ‘calmness’ to your life.  It goes without saying, that initially this is a tough time of year for all children with the increased amount of changes, as well as the amount of attention that is required to get through their days.  So take a few minutes to help your child get to the right level of “organization” to  have fun and be successful.

Tuesday, August 20, 2013

Utilizing Social Stories™ in Preparing for Back to School

Deanna Macioce, MS, OTR/L

For years authors have been writing books to help children through new situations.  For example, The Berenstain Bears collection, as well as many others, has a book for every type of situation; going to the dentist, the arrival of the new baby, and practically every holiday.  If you walk up and down an isle in the Children's section of any bookstore today, you will find an array of books featuring the first day of school, whether it be preschool, kindergarten, or just another year.  But when we take a look at our children with significant social difficulties or anxiety to new situations, we realize that sometimes those "off the shelf" books do not really hit home for them, especially if they take things very literally. That is where Social Stories™ become helpful when preparing with the transition of back to school.  They can be helpful in guiding children for riding the bus, participating in recess, eating lunch in the cafeteria, sitting during circle time, etc.

Carol Gray was the first to devise the concept of social stories in the early 1990s.  Based on her work with social stories, she states, "A Social Story™ describes a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and format. The goal of a Social Story™ is to share accurate social information in a patient and reassuring manner that is easily understood by its audience. Half of all Social Stories™ developed should affirm something that an individual does well. Although the goal of a Social Story™ should never be to change the individual's behavior, that individual's improved understanding of events and expectations may lead to more effective responses."   Therefore, it is important that a story not be used in a uniform situation for a group of children, rather it should be developed and used on an individual basis.  To develop a useful and accurate social story, the individual's needs, behaviors and responses need to be assessed so that it can truly depict the difficulty the child is having. (

Social stories stem from a Speech/Language background, but are used within all realms of therapy and education.  However, very often many parents and professionals are fully aware that the concept exists and their success. The Gray Center website offers a lot of hints, suggestions, and instructions for developing an effective social story.  In addition, it provides some sample stories used in some common situations.

Often times we find professionals have simply just developed stories about new situations that do not focus on the social aspects, but introduces the child to them and what to expect.  These can be just as useful and effective.  In addition, it has been found that some parents/professionals have even taken one of those books "off the shelf" books of a child's favorite character and inserted the child's picture and name into the book, increasing the interest for the child. Just as we work together as a team to develop sensory diets, we also need to work as a team to effectively help our children deal with the changes of school.  Whether it be their first year, or just a new year with new schedules, teachers and friends, it is our role to help them make it through the initial hump. Most children on the Autism Spectrum, and those with sensory or anxiety issues benefit from some help in preparing for everything the new school year has to offer.

So, as we pack the book bags with all the supplies, fill the closets with the new wardrobe, let us not forget about the importance of building up their confidence and decreasing their anxiety as we start off another school year.

Wednesday, July 24, 2013

Filling Up on the Right Tools for Success

Deanna Macioce, MS, OTR/L

It goes without saying that you would not try to take a road trip across country without having your car fueled, the proper amount of oil, or working brakes.  Or you would not go backpacking across Europe without hiking boots, a backpack, and the daily essentials.  So, let’s look at things on a smaller scale, why do we not prepare our children with the proper tools and “fuel” to get through the day.  Too many times, especially in the school environment we hear that “there isn’t enough funds for sensory equipment” or “sensory needs are not very important at school”.  BUT THEY ARE.  In essence we are setting our children up to fail, or even more, have to work harder by not having proper sensory diets developed and in place for staff and parents to carryout. 

Children with sensory processing disorder, those on the Autism Spectrum, or children who struggle with attention and self-regulation, need to have the right tools in order to be successful.  That starts with the right sensory diet.   When developed properly and strategically, a sensory diet is more than just a few suggested activities for your child. It should be individualized and developed with your child’s needs, routine, environment, and resources taken into consideration.  Therefore, it requires a team approach, gathering input from all members. 

Too often we find that sensory diets are not developed, let alone carried out.  And there are many reasons behind this.  Whether it be not enough time to develop it, staff or family not having the time or knowledge to implement it, or a child’s lack of interest, there seems to be a reason of why it does not happen.  But if we work together as a team, we will find that it can be done, it should be done, and in return we are helping a child be more success, learn with greater ease, and tolerate the day much easier (for the child, parents, and staff).

First, team members should help complete a behavioral analysis throughout the child’s day.  This will help establish both the routine, and begin looking at his or her needs.  From there, the occupational therapist can help establish some strategies and activities that need to be utilized. In working with the staff and parents, the therapist can determine what will work based on time and other factors during that portion of the day.  For example, it cannot be expected that Mom will be able to do a 10 minute one-on-one task in the morning when she is trying to get three children breakfast, pack lunches, do the send off to school, as well as getting herself ready for work.  Once the strategies and tasks are determined, the therapist can then develop the diet, providing proper instructions, materials and pictures as needed.  In addition, all members of the team need to be trained on their portion of the diet.  For example, it Johnny will need to have an oral protocol completed before lunch, just providing a NUK brush to the aide will not do the trick.  If a team member is confused or feels as if he or she does not know what to do, they will be less likely to carry out the task.  Although time consuming, training and instruction needs to be completed.  Once the diet is developed, everyone is trained and on board, it is time to implement.   Ongoing assessment and changes need to be done based on needs and behaviors.  The occupational therapist should be in charge of making sure new team members are trained, behaviors and needs are assessed and to make changes to the diet as need be. 

And you do not have to have the sensory room complete with equipment to develop an effective diet.  Sometimes that requires extra time transitioning a child in and out of the classroom.  Spark a little creativity…there are plenty of resources both in books and online to help develop activities that are easy to naturally bake in to what is already happening at that point in the day.  Teachers and staff need to be willing to share realistically what can be done in the school environment, but also need to be flexible based on what the child’s needs are.  Remember, the team is only trying to help the child tolerate the day, changes in routines, and be more successful!

So, as we round the corner and begin our back to school shopping and preparations, let’s take the time to fully develop our child’s sensory diet.  Without it, is like sending your child to school “out of gas”!

Monday, June 24, 2013

Water, Water, Water... Everywhere!

Deanna Macioce, MS, OTR/L

Playing in water is a fun part of summer play and a great way to beat the heat on those hot summer days.  For most, it is the type of play that is not allowed in the house, so now is the time to incorporate these activities that offer an array of therapeutic benefit into your sensory diet.

Let’s start with the one that offers some of the most therapeutic benefit-swimming.  Swimming is a great way to provide proprioceptive input and helps with overall body awareness.  Even if your child is not yet able to swim, just providing play in the water is beneficial. So, get a bucket and let them scoop and dump the water while hanging out in the pool.  The activity of actual swimming offers great core strengthening and motor planning.  Moving through the various swim strokes addresses bilateral coordination, as well as reciprocated body movements.  Getting in a pool this summer will be therapeutically beneficial to any child, and a lot of fun.

Just as there are sensory bucket activities with beans, rice, and others items to help incorporate tactile play, there is no reason why water cannot be one of those items.  Water tables and bucket playing offers a tactile media for kids to have a splash in. Increase the fun by having the child scrub cars at the car wash or bath their dolls using shaving cream and then rinsing off in the water table.  Let this summer be the perfect time to get messy!

To address those fine and visual motor needs, have your child use water squirters or shooters for target playing.  From water guns and blasters, to the small hand squirters, everyone’s needs can be met.  Set up a target range, or use a beanbag toss board to have children work on hand-eye coordination by aiming the water at the particular target. For improving fine motor strength, use water guns of various sizes for trigger pulling.  In addition, this activity will help with increasing finger flexion and hand strength needed most for tasks such as handwriting and scissor use.   Using the smaller character or animal squirters are ideal for your younger children or those with a more immature grasp to address grasp and finger strength.

And you can always include stroke, letter, and shape making with water play.  Fill up a bucket and using a paintbrush, have children draw and copy strokes.  Tracing can be provided by drawing the shapes or letters on the cement with sidewalk chalk, and then allowing the child erase it with the paint brush.  With this activity, you can work on shoulder, elbow and wrist stability by having them pretend to “paint” a wall, house, etc. in the vertical position, and you may even get some cleaning done in the process.

Cooling off in a sprinkler or at the spray park allows children some gross motor playtime, with a different tactile experience.  Based on the set up the sprinkler, this activity is an ideal way to work on direction following and motor planning.  In addition, it is these activities allow for peer interaction.

So no matter how you choose to cool off this summer, make water play a way to improve your child’s sensory diet with activities that you cannot do during those cold winter months!

Tuesday, May 28, 2013

Products in Motion: Southpaw's Cocoon Swing

Dr. Catherine Hoyt OTD, OTR/L

In pediatric occupational therapy, we focus on participation in skills and activities appropriate for the age and developmental level of the child. We also have to consider what is important to our client; which in pediatrics is the child as well as the family.  Addressing the child's needs and the family's goals can sometimes be a challenge. The appropriate equipment can help us to foster adaptive responses to engage the child in play, the main occupation of children.

For one 4 year old child, John, his family really wanted him to be able to play with children his age doing typical pre-kindergarten activities such as finger painting, swinging, listening to music, attending large parties and eating treats. John is a happy, energetic and bright little boy, but some of these experiences caused him a lot of anxiety and he would say things like "I'm afraid I won't like it" or "I'm scared".   John was scared of going into any space that was at all dark or restrained his movement in any way.

We used the Cocoon Swing because it provided an experience where he was able to challenge himself while still feeling safe. The swing let him sit comfortably and have a bit of reduced lighting while still being able to see out.  The Cocoon Swing also let him experience a bit of pressure from the fabric of the swing but still have the flexibility to move his body.  The Cocoon Swing was a little scary to him at first, but he was able to manage that anxiety because it provides the just right amount of comfort by being able to see through the fabric and out the top. It also provided the deep pressure around his body, which was calming to him. It helped John develop the capacity to challenge his fears knowing that he is able to overcome them.  John continues to face challenging activities and he is still learning,  but this swing has helped us move forward in therapy.

Bike Riding: Stacking the Blocks to Success

Deanna Macioce, MS, OTR/L

Whether you are driving through your neighborhood, the local park, or down a busy avenue, you will almost always catch someone riding a bike.  Bike riding is a universal activity that is enjoyed by people both big and small.  We tend to think that it is a rite of passage during childhood, moving from training wheels to the ultimate two-wheeler, and often hear the phrase, "it is as easy as riding a bike".  However, that is not the case at all.  Bike riding is one of the most complex activities to master, and for our children with sensory processing difficulties and special needs, it appears to be as challenging as climbing Mount Everest.  May is National Bike Month, and with summer sneaking around the corner, it is the perfect time to focus on this. 

If we take a look at the 'building blocks' to bike riding we see that it involves much more than just progression, growth and development.  Bike riding entails balance, bilateral coordination, trunk and shoulder stability and visual skills, as well as the cognitive abilities to discern safety and direction following. Therefore, we need to be cautious and aware of where the break down of skills are for our children before we just plop them on the seat and tell them to "go".  And we need to ensure their comfort level so that we keep them feeling safe and not losing their confidence. 

Improving a child's core stability, including trunk and shoulder control will help enhance his or her overall balance, which is required for successful bike riding.  This is where many of those therapy ball activities come into play, both in upright sitting and the prone position.  In addition, utilizing the bolster or disk swing helps with improving trunk control, while offering a bit of movement.  Increasing the challenge to the task by including a hand-eye coordination activity is always beneficial for incorporating the necessary visual skills for success.  T-stool and scooter board activities, as well as wheelbarrow and animal walks are just a few other ways to help improve this 'building block'.

When looking at balance, performing activities on a balance board or disk can be beneficial.  Especially those that require a good amount of weight shifting, such as obtaining bean bags from the floor and then having the child toss them into a target.  Performing activities that encourage one-foot balance and utilizing balance beams are quick and easy ways to address this 'building block'.

Bilateral coordination can be addressed with a variety of activities, but those that encourage reciprocated movement are ideal, such as climbing a rock wall, ladder, or rope pulls.  In addition, the Pedal Walker is a great way to help children get the feel and movement pattern needed for pedaling a bike.  Cross-crawls, jumping jacks, and reciprocated jumps are quick and easy and can be done in any environment.

Visual skills often are the ones that tend to impede success.  It is not easy to steer a bike while looking at the ground, as well as visual skills are apparent for balance.  Strengthening them can be incorporated into almost an activity.  As mentioned above, those that require hand-eye coordination while the rest of the body is doing something are most beneficial.  Activities that entail keeping the head upright should be utilized, including target throwing and ball catching.

With just a few suggestions to help improve the 'building block' skills, once these components are strengthened, it is time to work on removing those training wheels.  It goes without saying, but it is always important to make sure that the safety gear is on, including helmet and pads, both elbow and knee.  It is important to show your child how to stop the bike, using his or her feet to regain balance and control.  And do not be afraid to let them feel what it is like to fall.  This will take away some of the fear when it happens, because, it will! Starting off in a grassy area is ideal, and sometimes using a spot with a slight slope will give them both natural movement and encourage them to learn how to use the breaking system. 

Bike riding is not just a physical activity that offers movement and exercise it also allows individuals mobility to get around, socialization with peers, and the ability to explore.  Therefore, finding other options to help your child get the bike riding experience, such as a specialized tricycle, the Southpaw Hand Cycle, or a youth trailer cycle that attaches to the back of an adult's bike, such as the WeeRide Co-Pilot, may be beneficial.

So, now is the time to stack those building blocks, helping our children to get out there and enjoy the fun of bike riding....Happy Trails!

Thursday, April 18, 2013

The Changing Face of Autism

Deanna Macioce, MS, OTR/L

1 in 250…Those were the statistics when I started life as an occupational therapist.  Autism was something that we touched upon during school, but not much different than Cerebral Palsy or Down Syndrome.  And now the numbers are reported at 1 in 50. I have been a pediatric OT treating in a variety of areas, homes, schools, clinic based, and in the community for over 10 years.  However, the face of Autism has changed and intensified during these years.  And based on these numbers, it should not be a surprise that Autism has actually shaped and developed me as a therapist and a person; just as it has our schools, daycares, and so many community programs.

I still remember the first child on my caseload that had the Autism diagnosis. As a new graduate, there was so much that intrigued me and I wanted to learn everything that I could about the child and the diagnosis.  I was thirsting for the knowledge and ready to eat it up.  And although there were many resources, the information often was still vague, and there was not the mass quantity that there is available today.   Websites and organizations such as Autism Speaks, were not yet developed, as well as the knowledge and technology were definitely not where they are today.

In addition, I often reflect on the first parents I worked with trying to figure out why their child seemed “different”.  For one family, it was a child at almost 3 years old that showed no interest in opening up any present at Christmas, or knew the exact route Mom needed to take home from daycare; a daycare that never worked with a child on the spectrum.  For another family, it was a daughter who had a toy room filled with toys, but never interacted to engage in play with any of them.  For me, these were difficult situations, but growing ones.  A major challenge then was that these parents never heard of the word Autism.  They had no clue what characteristics would put their child on the spectrum.  Autism then was not known like it was today.  Therefore, it made the process a bit more difficult and definitely longer.  Today, it appears that we almost all know someone who loves a child with Autism, as well as medical staff, teachers, and daycare workers are all being educated and informed in order to better understand and care for our children.

Today, with increased knowledge and learning about Autism, the signs and symptoms have changed and have become more specific.  The Autism Speaks website ( list the “red flags” for the possibility of being at risk:

•    No big smiles or other warm, joyful expressions by six months or thereafter
•    No back-and-forth sharing of sounds, smiles or other facial expressions by nine months
•    No babbling by 12 months
•    No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months
•    No words by 16 months
•    No meaningful, two-word phrases (not including imitating or repeating) by 24 months
•    Any loss of speech, babbling or social skills at any age

It also offers parents and caregivers the opportunity to complete a screening, the Modified Checklist for Autism in Toddlers (M-Chat), which is a great way for parents to take a quick look at some developmental skills that should be occurring, and indicate whether or not their child is meeting them.  Because, as parents, sometimes we are not fully aware of what is expected of a child at a certain developmental stage.

As an OT, my theoretic knowledge to treat these children is rooted in sensory integration or Sensory Processing Disorder (SPD). The SPD and STAR Center website states, “more than 75% of children with autistic spectrum disorders (ASD) have significant symptoms of SPD. However, the reverse is not true. Most children with SPD do not have an autistic spectrum disorder” (  They also note that by “addressing sensory features (it) is foundational to improving the social and communication problems of children with Autism.”   This is why OTs, with many others help make of the team of people ideal to work with these children.

I like to look at who the child is, and not the “label” he or she carries when developing a treatment plan.  So, therefore it is important to look at where the family is and what their needs are at that point in time at home, in the school, and with whatever community interaction the child has. In my years of treating, I have addressed the concerns and developmental needs of toddlers and young children, however spanning over 10 years much of my focus has now been on school-aged children up through young adults, changing the needs and focus for both these children and the families.

For me, Autism has been part of my “job”, but it has also been a journey.  For the past 5 years, I can honestly say that Autism has shown itself more than 90% of the time on my caseload.  And although I am not a parent of a child on the spectrum, I am a person who has been touched by this diagnosis.  I have walked this journey with many parents and caregivers, and am so thankful for all that they taught me.  As an individual and therapist, I have learned to listen and support these families.  Truly understanding what their concerns are and what they need to function as a family. I know I am only a “stop” on their journey and there are many more that they will make, but while they are “visiting” me, I hope to use my knowledge, skills, and therapeutic use of self to make a difference.    

Tuesday, March 26, 2013

Returning to the Roots of OT

Deanna Macioce, MS, OTR/L

The history of treatment in the profession of occupational therapy found itself rooted in the use of crafts.   Therapists used a variety of crafts to help improve the fine motor, visual motor, coordination, and mental capabilities, as well as others of individuals.  They were a way to assist in improving an individual’s ability to perform their “daily occupations”.  However, due to the demands of insurance companies and the increased focus of “functional activities” you no longer see crafts being using in traditional therapy settings such as hospitals, clinics, and nursing homes.  Crafts were an ideal way to perform task analysis and devise a treatment activity that would address an individual’s need based on a variety of problem areas rather than just one specific activity. 

In the area of pediatrics, occupational therapists focus on the “functional” activities of children.  This includes, play, self-care, behavioral, and educational concerns.  Therefore, it can be easier to justify the use of crafts.

Just as in the ‘old’ days, crafts can cover a wide range of skills and can be adapted to address the various needs of children, while still focusing on their functional activities. The same craft can typically be graded, even if only in positioning and set up, to address most children on a therapist’s caseload.  From sensory needs, fine motor and visual motor skills to bilateral coordination, sequencing, and attention skills, crafts can do it all.

 Tactile sensory skills can be addressed with finger painting, doing hand and foot print crafts, and using glue, as well as using stickers, foam pieces or sequence. 

Both fine motor and dexterity skills can be address by gluing small objects such as marshmallows, dried pasta or pieces to complete a paper lion.  Increase the challenge by having the child use tongs to obtain the objects if grip and strength are part of the treatment plan.  Ripping small squares off a strip of paper to glue onto a template such as a heart, balloon or pumpkin helps to improve the use of the pincer grasp while encouraging bilateral hand skills needed for higher functioning activities.   In addition, the use of crayons, markers, and paint brushes for drawing and coloring help improve hand-eye coordination and visual motor skills, as wells grasp and hand endurance.

Scissor skills can be addressed initially to make snips for grass, a lion’s mane, or the petals on a flower.  Then moving to lines, shapes, and templates.  In addition, changing the type of paper used, such as construction paper versus card stock.

Attention, sequencing, and modeling skills can be addressed through the presentation of the craft and how the directions are delivered.  For some, you may provide just the model and the pieces, and have them form it, while others you may have directions just written out.  Doing the necessary sensory preparation for regulation and organization makes these activities even more fully encompassing of a treatment plan.

So, as we move into to April celebrating Occupational Therapy Month, it is a great time to go back to our roots encouraging the use of crafts in our treatments.  Not to mention it is fun, creative and they make great keepsakes. 

Tuesday, February 26, 2013

Why use Vibro-acoustics as part of your MSE treatment?

Linda Messbauer,  OTR/L

First, Vibro-acoustics is a process using two sensory systems in the body; the auditory and the touch system.  The response to the music through the auditory system is pleasurable based on the individual’s tastes and preferences in music or that which is meaningful to them.  But it is the touch system that plays a major role in response to the vibration and the one that will be discussed here.  Think about it, the skin is really the largest organ in the body with more receptors than any other sensory system.  Skin is the boundary between “Me” and “Not Me” and the “container” for all function, whether that be our organs or skeletal system. It provides our physical connection to the world and serves to keep us comfortable and safe.

One postage stamp size piece of skin contains:  9’ of blood vessels, 30 hairs, 300 sweat glands, 4 oil glands, 13 yards of nerves,  9,000 nerve endings, 6 cold sensors, 36 heat sensors, 75 pressure sensors and 600 pain sensors*1…WOW

One of the sensory receptors is the Pacinian Corpuscles which is a type of mechanoreceptor. It is located in connective tissue of bone, body wall and body cavity. Depending on its location it can be cutaneous (skin), proprioceptive (pressure & movement) or visceral (organs).  It is sensitive to vibration and pressure; it transmits vibration to the brain to allow perception of distant events and is also part of tactile discrimination for feeling smoothness and textures.  It is considered “rapid adapting” meaning its firing potential is generated when force is first applied, and then becomes unresponsive to steady pressure.

Why is this important to know? Well, when using it to affect change of the human reaction to stimuli, we need to be cognizant of keeping variation or novelty occurring to keep the receptor firing. When vibro-acoustic equipment is utilized the music provides the novelty and variation to promote the firing of the receptor. And when the person moves, for example taps their foot to the beat, they receive more input. We know that when two sensory inputs are simultaneously combined the brain gets more than the summation of the two inputs. It also gets secondary and tertiary areas of the brain involved.  “Voila” as the French say, we are getting more potential synapses and possible neuroplasticity and this of course, is what we want. It also feels good to most people.

So why incorporate Vibro-acoustic equipment into your MSE? Using Vibro-acoustic equipment  increases the potential for changing the Brain and as a result, our behavior or response.

Studies have also shown that Vibro-acoustics contributes to:
  • Reduce stress
  • Facilitate the Relaxation Response
  • Decrease pain
  • Relax muscular hyper-tonicity
  • Increase communication potential
  • Increase  social engagement
  • Promote muscle tone
  • Increase range of motion

As with any form of new experience it should always be voluntary. With individuals who cannot verbalize their likes or dislikes, it is imperative to keenly observe their response. In my experience a facial expression in less than 3 seconds will tell you they don’t like it or it is too much. This has occurred only a very few times but, the aim here is to promote joy and fun and this equipment certainly does that.

Some precautionary information:
Always know your client; some contraindications include individuals with pacemakers, thrombus, active bleeding disorders, extreme low blood pressure, severe PDST or psychotic episodes. When in doubt, always consult a physician.

1* Credited to Patricia Wilbarger, M.Ed, OTR, FAOTA
References: Music and Spatial-Temporal Relationships, Rausher, FH, et al., Neurological Research, 19, 2-8
                        Molecular mechanisms of mechanotransduction in mammalian sensory neurons, Nature Reviews Neuroscience 2011 March
                        Somatosensory Systems, Neuroscience Online,

Monday, February 25, 2013

Hunting for the Perfect Therapeutic Activity

Deanna Macioce, MS, OTR/L

Many times we find that we are looking for activities that give us the “biggest bang for our buck” so to say.  Well, scavenger hunts or treasure hunts can offer you just that.  Whether you need to address gross or fine motor skills, sequencing and direction following, coordination, peer interaction or problem solving, you can basically cover all your therapy goals and deliver sensory input in a variety of ways with a hunt. They can take on almost any theme, and can be adapted for various ages and skills levels. 

There are a variety of ways to put together scavenger hunt activities.  A basic approach for younger and lower functioning children that does not require reading is to list the activities numerically, draw a map with picture descriptions or even have them find items by color, shape, or pictured icon.  So, for example, you may have a picture of crab walking to find something that is the color red, followed by a picture of riding the scooter board to find something that is in the shape of a circle, etc. For older children with reading skills, having a clue at different pieces of equipment that will tell them what to do or give them a riddle to find out what comes next.

Scavenger hunts are a great way to work on team building and peer interaction, making them ideal for social groups or class environments.  Working together in pairs or small groups allows children to work on verbal skills through problem solve with others.  In addition, partner activities can be incorporated, such as catching ball, zoom ball, or scooter board pushes within the scavenger hunt.  Incorporate team building by having different puzzle pieces gathered at each spot, and then as a group the children put construct a simple puzzle together. 

Creativity is endless when designing your hunt, and it can be adapted for each child differently if need be.  Making them theme or holiday focus can increase the interest and imaginative play. Fine motor skills can be added by having children gather puzzle pieces, Mr. Potato Head pieces, blocks, or peg board pieces to complete at a table at the end of the hunt.  In addition, you can also use it as a way to gather materials for doing a simple craft of meal.  Or even pull in writing skills by having the child list the steps after he or she are done which is also a great way to work on recalling steps.

Sensory components are definitely intertwined throughout the hunt, and being able to work on so many different therapeutic needs truly makes a scavenger hunt an all-in-one activity…so have some fun planning and gear up for some great hunting!

Wednesday, January 23, 2013

The Possibilities Are Endless...With a Blanket and Pillow

Deanna Macioce, MS, OTR/L

Who isn’t looking for some new and exciting treatment activities and ideas for a sensory diet?  It feels as if we are always being challenged to keep things fun and exciting.   And with a quick scan around our house, many times we overlook the things staring us right in our face.  So, let’s pull out those blankets and pillows and see what fun we can have, while working on some key areas.

Climbing aboard the Magic Carpet children can work on core stability in the upright sitting position while receiving some vestibular input.  This is also a great way to work on dynamic sitting balance.  Children can also lay on their bellies working on head and neck extension, or use a pillow for additional support.  And if you want to provide some proprioceptive input, have children pull peers for a little bit of heavy work.

The possibilities are endless when it comes to designing obstacle courses with both blankets and pillows.  Blankets can be rolled up to be logs or snakes to jump over working on coordination and propriocpetive input.   Or by placing some weighted objects on a blanket, children can pull along their treasure  (for a bit of heavy work and shoulder/core strengthening) to their hide out.  Using chairs or other pieces of furniture it is easy to cover them to make a tunnel that children have to crawl through.  Test their motor planning skill by having them have to get trough the tunnel in different ways, such as “coming through so that their feet exit first”.  Pillows can be used as rocks or lilypads to walk on or over working on balance and coordination.  Pile up a mountain of blankets and pillows to crawl or bear walk over, and increase the challenge by having them belly crawl.  What a fun way to work on trunk stability and bilateral coordination with no expensive piece of equipment.

Using a blanket as a swing is ideal for toddlers and small children to get some great vestibular input, but with the tactile and propriocpetive feedback given to the whole body, this is an ideal activity for those with body awareness difficulties.  With one adult, you can hold the four corners of a large blanket up high, giving children the feeling they are in a cocoon getting some gently linear movement.  When possible, having two adults (one on each end) children can lay inside the blanket and be swung side-to-side, making it is easier to provide more speed and input.  CAUTION:  This activity needs to be done with care, making sure the blankets being used are durable and large enough. Also, pay attention to the area around you making sure it is free from objects that can be hit.

Blankets make great burritos and hot dogs, working on body awareness, tactile and proprioceptive input when children are tightly rolled up to make sure favorite meal. Then topping them with your favorite condiments by rolling a ball over their body or just providing some deep pressure by providing deep pressure down their limbs.  Increases the fun and the input…they will come back asking for more.

Many of our childhoods included hours of play designing our own forts and castles with a couple of blankets, a table, chair, couch, whatever we could find to attach them to.  This activity not only provides the finished product of a small space for children to use a calming area or to do work with less distractions, it also inspires creativity, problem solving and works on sequencing skills.  So, with a little spark of imagination, this can keep them entertained for hours.

Pillows and couch cushions can be used an ideal balance board for sitting or standing.  Stack them to the ideal height and then put them into your activity as needed.  They can also be used to help work on trunk stability in sitting, as well as achieving proper hip and trunk alignment in sitting.

Attach a pillow to a child’s back with a belt for some slight extra input and let them be a turtle to crawl through to the finish line of the race against the hare.  To help improve positioning in crab walking activities, the use of a small pillow on the tummy is great as both a tactile and visual guide.

When working on boundaries and space issues, blankets provide an ideal play area.  Set up activities in the space provided and children have to remain there for a given time.  This is also effective when working on attention and sitting skills needed in school, especially for the younger ones required to be part of circle time.  And when made to the right size, it is a great way to visually cue children on personal space during game playing or doing an activity.

Blankets can bring out any child’s imagination as a cape of his favorite super hero or gown of her favorite princess.  It can be the wrap for a mummy or the veil of a bride.  The possibilities are endless.

And wouldn’t it be good to know that in your treatment and play you are using a toy from the National Toy Hall of Fame?  Yes, the blanket was inducted in 2011 (  So, pull out that pile of blankets and pillows, and let the fun and therapeutic play begin!

Friday, January 4, 2013

Making Creative Play.... Therapeutic

Deanna Macioce, MS, OTR/L

We often find that many of our children we see in the treating arena of sensory processing concerns lack imaginative and creative play skills.  In this case, as parents, therapists, teachers or anyone else that interacts with these children, we tend not to even bring it into our interactions and therapy sessions.  It is true that often times these children work best with direct, concise instructions.  However incorporating creative play can be both fun and therapeutic for these children, giving them an opportunity to connect to you.

With your standard therapy equipment, it is not hard to make a pirate hunt, a jungle adventure, or princess themed obstacle course.  Balance beams and tunnels are tree logs to walk on or crawl through, bridges to cross and underground passages.  Balance boards, bolsters, and rockers make great boats to travel down the river, and avoid the sneaking crocodile by using the trapeze swing to cross the river overhead. Rock walls and climbing ladders allow you climb the mountain or scale the castle wall in an effort to save the princess.  And do not forget the 'jewels' using beanbags or small balls to capture and toss or activities.  Weighted balls are also a great way to incorporate some heavy work to find the treasure and hide into the 'barrel' treasure chest. These are just a couple of ideas to spark your creative juices.

At Southpaw, we have taken some of the guesswork out of being creative.  Our Hot Dog and Hamburger sets are a great way to add some fun, creative play while providing proprioceptive input.  Set up an activity of having a picnic or going to ball game.  Having the child obtain the pieces not only addressed heavy work, but also works on sequencing skills.  And the best part, the finished product is a nice, yummy way to get some calming before doing more refined tasks.

Put together a garden or farm themed activity using our new Weighted Wheel Barrow. Not only does this item add some heavy work to your therapeutic activity, it also incorporates bilateral coordination, balance and spatial negotiation.  With the option of 1 or 2 front wheels, children of all sizes and skill levels can enjoy being "Old McDonald".

What child does not enjoy playing store or racing around a shopping cart.  With our Weighted Shopping Cart, available in two different heights, children of different sizes can participate in fun, therapeutic play.  Having a picture or word-based shopping list that the child has to follow works on sequencing, direction following, and independent work while getting in some heavy work, bilateral coordination and proprioceptive input.  Expanding this play into how they have to achieve the items (ie. wheelbarrow walk, crab walk, etc) and then doing some categorizing expands the therapeutic benefits of this single piece of equipment.

The Linear Glider Tent offers an ideal 'small' space with the additional vestibular input.  This tent can be made into a camping themed activity with the child going through a checklist to gather the materials for an activity to be done in the camping tent, such as finding the matching pieces to Velcro (separatable) food and then having to put it together.  Ideally used for calming, this item allows you to think outside of the box and bring imaginative play into your therapy session.

So, now is the time to get out of your rut and make therapy creative and fun again, and let the world of Southpaw help you achieve this.