'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!

Creatively Enjoying the 'Thaw'

Deanna Macioce, MS, OTR/L

With the thawing out from this 'Polar' winter coming soon, everyone is ready to be outside, burning energy.  Regardless of where you are in the country, this winter has been unlike any others.  And although just getting outside and being active would meet most needs, this month we are going to look at a few fun, creative ideas for outdoor play that meet a variety of therapeutic needs.  So, put on your coats and leave your boots at home...and let's have some fun!

Scavenger Hunts- These can be done in a variety of ways to address different skills.  First, you can give the child a list of things to find, such as an animal, something that is a particular color or shape, and an item in nature.  Once it is found they can mark it off the list or to address handwriting skills, have them write what they found. Using a small clipboard to hold the list will also provide a writing surface for them, while helping to address bilateral skills.  Or, if your child has a camera, have them use the camera to take a picture of the item that has been spotted.  This is particularly fun for toddlers who have the "kid tough" cameras.   These activities allow children to get outside while strengthening their visual and direction following skills.

To incorporate movement you can set up the hunt so that clues need to be found.  This is ideal for older children.  Once a clue is found, it could instruct the child to move in a particular manner to the next spot.  For example, bear walking, walking backwards, skipping, etc. This not only helps children to problem solve finding the next clue, it helps with motor planning and spatial awareness skills while adding in some vestibular and proprioceptive input.

Obstacle Course- For those children who get bored easily with riding their scooters and bikes, or just need a little bit more help getting their bodies moving, turn your backyard into a fun and challenging obstacle course.  Use boxes to jump over, crawl or jump through hula hoops, do animal walks, perform side jumps.  What ever you can do to get them moving.  Obstacle courses are a great way to provide vestibular and proprioceptive input while addressing motor planning, core strengthening, bilateral coordination, balance and direction following skills.  For higher functioning individuals, you can work on speed and agility by timing the trials.

Basketball- Basketball playing can take place in the drive or at the park, wherever a hoop is found.  In addition, it can be an individual activity or performed with one or more peers.  Basketball by itself is an excellent therapeutic activity.  It pulls in bilateral coordination, hand-eye coordination, upper extremity stability and overall strength and endurance when just working on shooting baskets.   For individuals who demonstrate difficulty interacting with peers or overall conversation, playing a game of HORSE where each child has to ask the other a question before shooting is both fun and beneficial.  It gives these children a chance to work on initiating conversation, but not so focused on it because of the distraction of anticipating "making the shot"!

Sidewalk Chalk-  A favorite by children of all ages allows you to have an open canvas with your creativity and activities.   Children can work on their handwriting skills by writing words, letters, or forming shapes for pre-writing.  And due to the typical positioning when using sidewalk chalk, shoulder stability is often strengthened during these tasks.  So, taking a tedious of activity of writing outside to see a change in motivation to perform the task.

With school still in session for a few more months, you can add movement while using sidewalk chalk by writing sight/power words or various numbers randomly over the ground, leaving space between them.  Then children can move to the word when it is called out and catch a ball.  With numbers, giving a math problem with the child to solve in their head and then hop, twirl, or walk to the answer.  Spelling can also be worked on in the fresh air in this manner too.  Just write the letters out on the ground and then children have to move to each letter to spell the word- an excellent idea for your kinesthetic learner!

So on those brisk, but sunny days take some time to get some fresh air before the Spring rains hit!

T-ing Up Activities

Deanna Macioce, MS, OTR/L

Regardless if you are a teacher or a therapist, you find that as you plan activities in the clinic or classroom you often focus in on just one or two benefits to the task at hand.  For example, what is the skill being addressed, what will a child learn or what will they improve or focus on?  Often times, the one component that is very key and overlooked is positioning.  For example, we tend to think that children should always have their work placed on the desk in the middle, but for some children with visual perceptual issues, a simple shift in positioning can make a world of difference.  In addition, we think that most seating arrangements should work for all children regardless of height or comfort, strength or stability, and we tend to perform most therapeutic tasks in standing or sitting at a table or desk. However, you may find that just a slight change of using a T-stool, therapy ball or Southpaw's new Togo seat can increase the benefits by addressing core strengthening, balance and vestibular input.  Therefore, seating and position are important!

Therapy balls are commonplace in most therapy settings, and more and more schools have them available for seating options.  Therapy balls come in a variety of sizes and can be inflated differently offering various amounts of vestibular input.  When used for sitting and positioning, balls offer just enough movement and bounce to increase alertness, addressing focus and attention.  They help improve trunk stability and balance when used dynamically during activities.  Having a child sit upright on a therapy ball that allows the child to comfortably place her feet on the floor and participate in Zoomball allows you to address balance, trunk strengthening, and weight shifting with additional vestibular input.  So now, an ideal activity for bilateral coordination, shoulder stability, and visual attention just got better!

Anyone who has ever heard Carol Kranowitz (author of The Out-of-Sync Child) speak, knows that early on, once seeing the benefits of t-stools, had all of her preschool children sitting on them during circle time.  T-stools are a very beneficial piece of equipment that are often overlooked.  They are great because anyone of any size can use a properly fitted one.  T-stools hone in on really activating the core trunk muscles increasing a child's balance.  Because they require so much stability and weight bearing through the legs, when you add an activity with them, such as a bean bag toss where the child has to obtain the bean bags off the ground and toss at a target, the challenge and benefits are numerous.  They are also ideal for sitting with increased focus and attention, much like Carol has her preschoolers doing.  They do not allow for much slouching and slacking, and a slight wrong shift of weight can cause a child to tip. 

Southpaw's new Togo seat offers the benefits of both a therapy ball and t-stool in one.  It is great at addressing core strengthening and balance with a little bit of vestibular input improving focus and attention.  In addition, the seat also comes in two different seat bases, allowing a slight difference in support.   In a classroom, the Togo seat offers the ability to keep the wiggly child paying attention to the teacher with a slight bit of movement that is now distracting to the whole class, and takes up less space then a therapy ball.

So before you finish your plan on your next activity, see how you can increase the benefits with these fun pieces of equipment.

‘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!

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!