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 (http://www.parentingscience.com/toy-blocks.html)

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!

"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.

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. (www.thegraycenter.org).

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.

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”!

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!

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!