Activities to Help Fine Tune Early Fine Motor Skills

Deanna Macioce, MS, OTR/L

Being back at school means that as therapists, teachers, and parents we start to pay a little closer attention to educational needs. We go from making sure our children are getting enough outside play during summer to what the needs are for them to breeze through their school day with ease. This includes attention and focus, handwriting and visual motor skills, as well as, social skills. From preschool through high school, much of a student's day involves utilizing their hands. Therefore, it is important to establish good fine motor and dexterity skills early on in order to set them up for success. Strong foundational hand skills help establish proper handwriting and scissor skills.

Some children naturally develop typical fine motor skills. Moving from a mass grasp to the ideal tripod pencil grasp through everyday play. However for many, especially those lower tone, sensory children this does not always happen. Without proper attention to developing these skills, it can have a long-term affect, making handwriting, coloring and scissor skills more difficult, especially in the realm of endurance to carry them out.  

Highlighting some activities and developmental needs will help to focus on how you can work on these with your child, especially the younger ones who are starting to piece together the fine motor puzzle.

Infancy offers a time of exploration. Pay attention to the toys that they are presented with, making sure the toys are of varying sizes. This will allow the child to develop different grasp patterns, strengthening the muscles of the hands. In addition, play with these toys in varying position, such as on the belly or sitting upright.   As a child begins to move by crawling always encourage crawling with opened hands to ensure proper weight bearing through the elbows, wrists, and hands. To strengthen palmer arches set up activities that allow them to crawl with objects in their hands. Such as crawling through a tunnel to obtain a puzzle piece and then crawling back through to place it into the board.

Moving through the toddler stage, grasp and fine motor development begin to take on the focus of using writing tools and scissors. Giving children the opportunity to play with manipulatives is key. From stacking blocks of varying sizes and shapes to negotiating different pieces into a shape sorter, many of the early hand skills are developed through play. Therefore, pulling out those traditional toys of puzzles, snap beads, lacing activities and blocks offers more opportunity for fine motor development than just the push-button toys. In addition, with supervision allow your child to explore with crayons and markers. And once again, utilizing ones of various sizes is beneficial. There is no need to throw away those broken crayons, using them while drawing and coloring helps to encourage the development of a triad grasp.

To help develop finger strength, activities using play dough, putty, and items such as Moon Sand provide opportunities for play, while improving fine motor skills. Hands working to knead and mold these substances encourage individual finger and grasp strength. Rolling out the dough and pinching both help improve palmar arches and pinch grasp. You can also work on these skills in the kitchen with cookie and bread baking. Finger strengthening and dexterity can naturally be addressed in day-to-day tasks, such as opening and closing small plastic containers and bags. By placing snacks and toys in these, children are naturally working on fine motor skills, and they are easy to take on the go.

In regards to grasp development, early on we look at how a child develops a pincer grasp (using the tips of the thumb and pointer finger together). As toddlers, presenting them with small objects to safely eat, such as Cheerios, Gerber Puffs, etc. helps to encourage them to use a pincer grasp. To assist in the process, you can gently hope their hand allowing them only use of the thumb and pointer finger. In addition, at this stage, it is important to pay attention to isolated index finger use. This means that as children are pointing at objects in a book, activating push button toys, etc. they are using a single pointer finger and not the entire hand.   As children grow older, you can help to encourage the use of the thumb and index finger only by placing a small object or cotton ball in the palm of their hand to hold during activities, such as writing, coloring or game playing. This helps them improve finger grasp strength and use the thumb and pointer finger on their own.

Providing activities that directly work on these skills are beneficial. Magna Doodle boards and Aquadoodle Mats allow them to work on grasping and holding different tools to perform drawing and pre-writing activities. In addition, crafts are an ideal way to pull in fine motor skills, from ripping small pieces of paper to glue onto a template, crumbling tissue paper, and using pincer grasps to obtain objects to glue such as macaroni and buttons. Another way to work on finger strengthening through ripping paper is by allowing your children to rip up your daily junk mail.

Playing and using large tweezers, strawberry hullers, or even kitchen tongs to obtain and move objects, such as blocks, pom poms, or beads and place into a bowl or egg carton container. In addition, there are games and toys on the market that provide these items, such as Operation.

So, it is never too late to fine tune your child's fine motor strength. It will be only make the daily tasks they face at school easier.

Homework Buddies

Deanna Macioce, MS, OTR/L

With school starting again, we are back to having to help our children muddle through the task of homework.  Although this can be unpleasant for many students, this becomes extremely difficult to tackle for a lot of children who suffer from Sensory Processing Disorder, ADHD, and other conditions.  These are the children that work so hard to  "keep it together" all day at school, that when they come home, sitting down to do homework is the last thing they want to do.  It is common to see these children, who sat and struggled to attend at school, come home with poor behavior, be anti-social, and resort to "down time" on their own. Whatever it is, parents fight this constant battle and want to get it done and out of the way "as soon as possible!  If not, then more fatigue and lack of focus sets in making it worse.  For some parents, this battle causes them to already start counting down the days until winter break!

Our bodies are made to move and children spend so much time sitting throughout the day at school, not allowing their brains and bodies to connect.  Many children are kinesthetic learners, so coming home from a day at school to sit down at the table once again to focus on schoolwork won't work. We are going to take a look at a few strategies that may help to lessen the homework battle.  Although, they will not all work for your child, here's to hoping that a few will help ease the pain.

1.  Break away from the "you don't do anything until your homework is done" mode of thinking.  Allow your child 20-30 minutes of outside playtime to ride their bike, shoot baskets, or even go to a playground.  When this isn't possible, work on some indoor ideas, such as a mini trampoline, doing some exercising, or running a few errands that encourage some walking.

2. When choosing after school snacks, try to make sure they are "feeding" your child properly for focus on attention.  It has been found sometimes that chewing gum, having crunchy or chewy snacks, or having a sucker help maintain attention when doing work.  Allow children these supports at home where it is easier to carry out than in the school environment.

3.  Have a space that works for your child.  Based on your child's needs, does it matter after sitting at school all day whether or not they are at a table or desk?  Allow them to work in prone or a small tent, whatever fits their needs.  However, make it a space that is free from a lot of distractions and more importantly, make sure they have a caddy with all supplies they are going to need.  Breaking their focus and attention to get up to obtain supplies makes it more difficult to keep them on task once you get them there.  Use tools such as weighted lap pads, ball chairs or seat discs as needed.

4.  Work with the school and teachers to try and "adapt" some of the homework.  Kids need to fit a mold when at school to complete work because they are part of a class.  Find out if your child's teacher will allow you to work on spelling or math facts by playing games, utilizing ball activities, etc. but then allow you to complete the worksheet if your child mastered the skills..  This is more difficult and time consuming on your end, but if you can provide evidence and get the school team on board, it will enhance your child's learning in the long run. In addition, be on top of the game.  For longer projects, upcoming tests or things that need a lot of attention, ask for extended deadlines, but not after the fact.  As a team, we all want our children to learn, so it is not always important when the assignment gets done or that it got done, but whether or not the child learned.

5.  Giving your child work breaks is crucial.  Their attention spans of true focus only last about 20 minutes on average.  So, break work up into chunks.  Allow them some time to get up and move, but reel them back in after about 10-15 minutes max until all the assignments are done.  Find what your child needs to re-group and provide it.

6.  Visual prompts are very helpful for many children.  Using a small dry erase board to list what needs to be done, showing them the breaks help them maintain focus once they get started.  Also, using a visual timer when they are doing independent work helps keep them on track.

7.  Get creative on setting goals/motivation.  Earning video game time, a treat, or even to the point that each day they get so many pieces to a puzzle, Lego set, etc. working hard to complete the toy.

It is in known that for many utilizing these strategies come with a lot of constraints, siblings, work, and other activities.  Therefore, they cannot be done all the time, but when possible setting up a routine that works will offer your child success and take stress off of you.  Think about what can be done "on the go", such as when you are driving in the car or when you are waiting at a sibling's practice. Carry along the visual and oral supports. And work to integrate homework into the hectic after school schedule.  In the end the battle will lessen, and keep the stress lowered for you.

Building the Foundation for Learning

Deanna Macioce, MS, OTR/L

It seems as everywhere we turn there is discussion about our education system.  From standardized testing to the Common Core, there is so much focus on scoring and benchmarks that as parents, therapists, and even teachers we sometimes feel that our children are not really learning.  And this is true for all children, not just those with a diagnosis.  We tend to put so many demands and stressors on our children about learning from an adult perspective at such an early age, that we are, in fact, at times hurting their overall development.  Based on Piaget's Cognitive Theory, a child's brain learns and thinks differently than an adult's brain.

From an occupational therapy perspective, a child's 'work' is play.  Therefore, when a child's brain and body are developing, the biggest impact comes in the form of play.  Allowing children the opportunity to learn through the manipulation of objects and toys, using creativity and imagination, and performing self-initiated problem solving, sets the foundation for ongoing learning.   However, we are found to judge our early education centers and preschools on their overall "curriculum", often faulting the extra time given for self or explorative play.  We, as a society, want to see activities and lessons focusing on the learning of academic skills, such as colors, letter, and numbers.  With the advances of technology, we are often "wowed" by the environments that perform learning activities with iPads, computers and smartboards.  While these are all important and beneficial, they should not be seen as the foundation to learning.  Children who are given the opportunity to develop the proper cognitive foundation, will easily pick up the technology, and will not "fall behind" as we often hear.

In addition, from the sensorimotor standpoint, children need to move.  Movement plays a key role in strengthening the vestibular and proprioception systems, while also developing bilateral coordination, core stability, and balance.  And believe it or not, these are needed for a child to be a successful student.  Children are expected to sit and attend for long periods of time always being in the upright position.  And those who lack core stability, find it hard to maintain this position, and are found to be the fidgeting, slouching child.

Therefore, children need the to opportunity to play and learn through movement.  Unlike adult brains, they cannot sit for the three-hour lecture class, and take in information that comes only in the form of listening and writing.  When we allow their brains to develop early on in the proper developmental environment, we will be able to build strong critical thinkers and learners.  That means that lessening their recess and physical education time is not beneficial to the educational curriculum.

So, our job as parents, teachers, and therapists, is to work hard to find that balance.  Give our children the time to move and play, while reaching all those educational benchmarks.  As a therapist working on handwriting, move away from the tabletop and find other creative ways to achieve the same goals. Parents, instead of always using electronics as a form of down time, especially when children come home from school, encourage them to participate in 20-30 minutes of play or outside exploration before even asking them to focus on their homework. Do not over-schedule children with organized sports and extra-curricular activities.  And teachers, find ways for children to learn new concepts using their bodies, manipulatives, and allow children movement breaks, not just those on an IEP. This takes extra effort on all parties, but if the team works together we will be setting our children up for success.

Filling Our Sensory Buckets at the Beach

Deanna Macioce, MS, OTR/L

Summer has arrived, and we are often found filling our days with trips to the beach to soak up the sun, water, and sand.  Going to the beach is a great way to embrace summer. It offers so much fun for children of all ages, despite developmental needs, and much peace for adults.  When looking at the beach experience in terms of sensory inputs, we typically hone in on the tactile benefits that it offers. However, it provides the perfect landscape for meeting the proprioceptive/heavy work needs of any child.

As we sit back and watch the joy that comes on many of the faces of the children playing in the sand, we are taken back to our own childhood.  The laughing, giggling, and excitement reminds us of a time when we were able to let go of any inhibition of sitting in the sand, having it all over our bodies, and in our suits to just have a little bit of pure fun.  The best part of playing in the sand is definitely the end product of the castle that is built or the hole that is dug, but in working hard to achieve this our little ones' sensory systems are being fed buckets full of proprioceptive input.   As they dig through the sand with any type of shovel, or even the use of their hands, the resistance of the sand to fill their buckets or dig a moat provides a good amount of feedback.  And typically, those buckets need to be carried or dumped which helps to offer some great 'heavy work'.  Since this is pure fun, you can watch your child do this over and over again, unlike when Mom or Dad tries to achieve getting this input at home (with those 'great' sensory diet activities provided by their OT)!  Running to the shore to fill up buckets of water, or the wet sand (which build the best castles) intensifies the input our children receive.  So next time you want to help carry that bucket, take a step back and let those sensory systems be fed. For those who like to dig, digging a hole just the right size for some body burying in the sand, not only is a nice tactile experience, but it is a built-in weighted blanket!

And to beat the heat, or remove all that sand from our bodies, 'diving' right into the water is another great way to meet our proprioceptive needs. Swimming alone provides a full body experience.  Whether you are at the ocean or a lake, the swimming, bouncing, and just overall movement within in the water offers great benefits.  And when those waves come crashing in, our bodies get a rush of proprioceptive input.  Water play is especially ideal for our older children, so grab a ball or Frisbee, and play some catch in the water...with all the fun that is happening they will not even realize the 'work' their bodies are doing.  In addition, using a body board can also help those older children work through some motor planning needs.

Therefore, whether you are lucky enough to have a beach near your home, or you are packing up the family car for vacation, it is great to see that a trip to the beach is not only fun and relaxing, but also very beneficial for our sensory systems.  It is not just the heat that tires our children it out, it is all the excellent 'heavy work' they do while having fun!

'Steamrolling' Through Proprioceptive Input

Deanna Macioce, MS, OTR/L

As teachers, parents, and therapists, we learn more and more each day about sensory processing, especially in our everyday life.  We see how the world around us is always feeding our sensory systems, and how it effects our interactions with the environment and others. In turn, we begin to get a better understanding of what it means for our children, especially those who have Sensory Processing Disorder (SPD). We all love a good bear hug or that great deep pressure massage, right?  Well, that is not true for everyone however, we have found that providing activities that elicit proprioceptive input offers a realm of benefits.

Proprioception plays a major role in overall self-regulation for children who demonstrate difficulty with tactile input, focus, attention, and body awareness.  Understanding proprioception and the effect that it has on the body is sometimes very complex since it also affects the tactile and vestibular systems.   Having a functional proprioceptive system helps improve body awareness, postural control and stability, and motor planning.

So often we hear about trying to find ways to address proprioception with heavy work activities. With success, these activities will help our children motor plan with greater ease, understand where their bodies are in space, attend better, and demonstrate improved postural control.   These activities help with organizing and calming a child's sensory system. There are numerous activities that help provide proprioception, especially in our day-to-day routines.   Carrying a backpack, climbing at the playground, loading and unloading groceries, as well as participating in yard work, just to name a few.

Within the therapy setting, there are many pieces of equipment out there to assist with the various needs of children who demonstrate sensory processing concerns, but one that is very successful and versatile at providing the proprioceptive input so often desired is the Southpaw Steamroller.  The Steamroller is a great addition to any obstacle course, providing the necessary deep-pressure input for a calming effect. It also is an ideal place to have your child hang out to complete an activity such as a puzzle, reading a book, or doing a maze for continuous input. The Steamroller allows you to be creative because is easy to attach to a theme, such as making pancakes or going through a car wash.  Set out cars on one end and have a child go in and out of the Steamroller multiple times to take the cars through the car wash. In addition to providing deep pressure, it is an excellent way to address improving shoulder strength and stability, as well as motor planning.  As a child negotiates his or her way into the machine, they pull themselves out with their arms giving them just enough support to work on shoulder strength.

Whether you have direct access to the Steamroller or not, take the time to focus on proprioceptive input for our children this month with new ways to use the Steamroller or finding ways to provide it in those activities already happening naturally at home.

Pulling Together Your Team

Deanna Macioce, MS, OTR/L

Johnny hates to wear jeans, Kelly seems to be 'on the go' all the time, Michael covers his ears when he hears the lawn mower, and Melissa cries when her mom puts her on a swing. We have all heard about and seen these children, and for those who are experienced in working with Sensory Processing Disorder (SPD) these are common statements. However, for many, especially parents it is very difficult for them to understand and grasp the concept of the sensory system and the role it plays in our day-to-day life.

Many people feel that we all have sensory concerns, which is true, but it is when it gets in the way of our "functional" living that it becomes an issue. Sensory processing is used to describe how the nervous system receives information from the body's senses and then turns that information into a response. When discussing SPD, individuals who are affected by this present with disorganized or inappropriate responses, often times being described as 'behavioral'.   It is difficult for parents to truly discern what is sensory and what is age appropriate. For example, two-year-olds often try to gain control of situations, such as refusing to eat or dress when asked by a parent, but for a child with SPD, they often do not make the choice of how they respond. There is a reason they may not want to eat, whether it be texture or taste, and they may struggle with transitioning between short sleeve and long sleeve shirts due to tactile defensiveness.  

Many children who exhibit sensory processing concerns often have another diagnosis as well, such as Autism Spectrum Disorder, ADHD, or Down Syndrome, however for others, it is purely a stand alone diagnosis. It is these stand alone situations that are often the most difficult to identify, and for parents to understand. Children appear to be 'typical' but there is some reason that life is not going smoothly at home or school, or situations just seen too difficult for a child to cope with.

As professionals we often become frustrated when we feel parents are not "pulling their weight" at home, or that they are not taking the time to help carryout suggestions, however we need to realize that most parents are tired, overworked, and often just don't understand. In addition, we say we work as a "team" but then feel it is better not to have the parents be part of the therapy session or the activities in the classroom. How could we expect them to be "team" players when we are not educating, including, or encouraging them. And it does not go with out saying that it is known that not all parents strive to be participants. However, this does not mean they do not want the best for the child, we just need to find out at which level we need to interact and connect with them.

Therefore, using strategies such as pulling parents in for portions of sessions, using video, or even teaching sessions will help the parents to become more comfortable, have a better understanding, as well as see how things are performed in the school or therapy setting. Today's technology with smart phones, make it easy to take video and send snippets to parents. In addition, communication is key. So having some regular way of communicating whether at the end of session, via email, or log is very important. Once the parents are on board to be a team player, they will help with the facilitation of strategies at home and the child will make progress as a faster pace. Making it a win-win situation for everyone.

We need to realize that the number one players on any child's team are the parents. Whether a teacher or therapist, realizing that the importance of pulling the parents into treatment planning, and teaching is the most beneficial for the child involved.    They are the ones who are the constant in the child's life. Teachers change each year, therapists are seen in small doses and often are every-changing, so it is important to pull in the child's number one fan-their parent or caregiver!

'Weighing' In On the Use of Weighted Items in Therapy

Deanna Macioce, MS, OTR/L

With so much discussion in the realm of treatment for Sensory Processing Disorder (SPD), we find that there is little research to support many of the techniques, protocols, or methods used.  If you are an occupational therapist (OT) you find that you use the methodology you were taught, enhanced by the things you have learned from attending continuing education courses, picked up ideas from co-workers, or just used your creativity to find something that works through experience to address a sensory need for a child. And you find it to be effective by the changes noted in the child's underlying neurological system, so you use it.  This is seen with treatments such as listening programs, spinning and brushing protocols, and the use of weighted items. It is known that if two individuals demonstrate issues in the same sensory areas, their needs, behaviors, and treatments are going to be different.  That is why OTs are known for using their little "tricks" be make treatment be successful, regardless of the research. If you are a parent, caregiver, or teacher you have seen the effects of some of these treatment techniques making a difference in the life of your child who is now more regulated, able to tolerate a movement he or she once couldn't, attend better in school, or even sleep better at night.

In regards to the use of weighted items, such as vests, blankets, or other items, we find that there is little research, and sometimes it is less than convincing that these treatment tools are effective. However as therapists we know that for some children the use of weighted items has been beneficial for calming, improving body awareness, or increasing alertness.  We have seen children increase their focus in school, sit better during circle time, calm when frustrated and be able to move into the sleep cycle with ease. Therefore, we have continued to keep these items as part of our treating repertoire, knowing that they may not work the same on every child.  Since these positive changes have been noted, we are able to find items from vests, to blankets, to hats, and so on because the use of weighted items can be effective in children.

Most often weighted items are used in therapy to address proprioception.  This is the sensory system that "senses the position, location, orientation, and movement of the body muscles and joints. Proprioception provides us with the sense of the relative position of neighboring parts of the body and effort used to move body parts"  (STAR Center).   And when we see improvements to the proprioceptive system, we see changes in body awareness, focus and attention, and calming.  We know that performing tasks the require heavy work and resistance are beneficial to work on the proprioceptive system, and weighted items help us obtain this.

The use of weighted vests are commonly seen in schools to help children sit and attend during activity.  In addition, the "just right" input could help these children remain regulated during play, interacting with peers or with transitions.  They are also beneficial to use during movement activities to help improve body awareness and position in space.  Lap pads and neck wraps are used during sitting tasks and are great for desk work.  Just a bit of weighted input helps children stay focused and attend while giving them the proper input to help keep their bodies seated.  Blankets are best to use when addressing a calming state.  They also help during stationary tasks to provide input over the body or during tasks performed in prone, such as playing a game or completing a puzzle.  In addition, weighted blankets have been found to help children calm and regulate their bodies for sleep, and provide good input to help them remain in the sleep cycle. Southpaw has recently worked to improve their weighted hat.  Not only do we now offer a trendy hat that can be worn by either males or females, we have improved the shape and size of the weights allowing it to be better dispersed.  Therefore, it is easy for children to wear it in a variety of settings, with ease during movement, and appear to have a common item on, versus a vest, lap pad, or neck wrap.

With the use of weighted items, or any type of sensory treatment method/protocol it is important to consult an occupational therapist to help determine wearing procedures, timing, and the proper needs to be addressed.  This will help establish an effective wearing program meeting the child's needs, while avoiding the child accommodating to having it on which in turn lessens the effect of using a weighted item.  It is also important to establish the right amount of weight with your therapist.  Typically is will range from 3-10% of the child's body weight.  But this is dependent on the item being used, the need trying to be met, and the overall weight distribution.  Also, it should be noted that it is important to use weighted items proactively, rather than as a reaction to when a child begins to meltdown as an attempt to calm.

Despite the research weighted items can be beneficial in a child's sensory program.  Therefore, whether you are a teacher, parent or therapist, it may be time to re-visit these "weighty" tools!