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. 

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, UTA.tmc.edu

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!

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 (www.toyhalloffame.org)  So, pull out that pile of blankets and pillows, and let the fun and therapeutic play begin!

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.

Signed, Sealed, and Delivered

Deanna Macioce, MS, OTR/L

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

If you are the ambitious type and your list is short, being creative and making your own cards lends itself to address many naturally therapeutic skills.  From working on the fine motor skills of grasp with crayons and markers to decorate, working on visual motor and bilateral hand skills with cutting to add and glue pieces,  to copying skills for writing addresses and generating the greeting.  You can also address tactile sensitivities by having your child do some finger painting, tissue paper gluing or working with foam stickers. Increase the challenge of scissor skills by using old cards to cut out the pictures and glue them to your homemade card. This will present a variety of different textures and thickness of paper to be cut.

If you are using traditional cards, handwriting skills can be practiced by allowing your child to sign the cards.  You may choose to have your child copy a short closing or generate one on his or her own.  If sizing of letters is difficult for your child, provide a designated space with a blank address label to sign.  This is also a great way to work on spacing and overall hand control.   The same method could be used for addressing the envelopes as well.  Work on using those pincers by peeling and placing return address labels and stamps.

For any cards that are sent, stuffing the envelopes is an excellent bilateral hand activity that works on hand control and finger dexterity.  It also is an ideal way to look at proprioceptive needs by assessing the amount of force a child uses to perform the task.  Too much force will result in a bunch of bent cards, so work on using slow, controlled movements.

If you go the non-traditional route of emails or online cards, allow your child to work on his or her typing skills, fine motor speed and dexterity by helping to type them out for you.

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

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

Keeping the "Joy" in the Holiday Travel Season

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

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

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

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

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

For children on a regular sensory diet, allowing yourself the time to carry out activities before boarding the plane will help with any anxiety and the fact that he or she will stuck in a small seat and area for an amount of time.  Heavy work can be achieved with carrying a backpack, doing animal walks in the waiting area or even chair push-ups and wall pushes while you wait.  Getting a variety of vestibular input may be more difficult, but taking frequent walks, and in less crowded areas trying to do some spinning, fast paced walking, hops may help.  In addition, find the escalator, people mover, or elevator to take a ride on.
 

Be prepared with activities to keep them entertained keeps down the frustration and nagging.  Making up an 'airport bingo' game where the child has to find different people or objects, going on letter hunts, having travel games, and any electronic device will help keep everyone happy.  In addition, there are now many travel size coloring books, magnetic drawing boards, or Etch-a-Sketch available that tuck neatly in a carry-on.

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