Self-Care with Flair!

Creative authors, Bhanu Raghavan, MS, OTR/L and Ginger McDonald, OTR/L developed a unique curriculum for increasing independence with self-care skills. The program instructs how to teach the skills of dressing, grooming, toilet training, and eating by using a uniform approach with pictures and rhyming while employing visual, verbal, and tactile/kinesthetic cues. Each task is broken down into steps through activity analysis. In June of this year, Bhanu shared her expertise with therapists, caregivers, and children in Guatemala. Here is the account of her experience.

Visit the Self Care with Flair! website.

Bhanu Raghavan, MS, OTR/L

Self-Care with Flair! goes international once again…

Teaching basic self-care skills to children can be tedious and is often not prioritized in school or at home, even though these skills are critical for successful transition into the community. Occupational therapists are often consulted for support with this task.  A uniform approach to teaching daily living skills is critical to helping the child generalize the skills to all situations. Learning can be delayed when small differences in method and/or terminology confuse the child or when the number of steps prove to be overwhelming for the child, parent and/or teacher. Occupational therapists, Bhanu Raghavan and Ginger McDonald, authors of Self Care with Flair!, have shared their expertise in teaching self-care skills in a creative, fun way with therapists across the globe. Their methodology involves teaching self-care skills using rhymes to promote mastery and retention within a short period of time. They have based their method on evidence-based research that demonstrates that novel experiences such as rhymes and rhythm trigger the brain to sustain attention. In 2015, they presented at the British Occupational Therapy conference about their effective strategies for teaching self-care skills from their book to a packed audience.

In June 2017, when Bhanu accompanied a team of students, therapists and Professors from Xavier University (Cincinnati, Ohio) to participate in a weeklong volunteer service project in Guatemala at the Missionaries of the Highways, a clinic and residential facility for children with a variety of physical and mental disabilities. Over the course of the week, many questions about teaching self-care skills to children with disabilities arose. Bhanu shared strategies from Self Care with Flair! when she presented an in-service to the staff.  During that week, strategies from Self-Care with Flair! were shared with parents and caregivers as well. Although Spanish is the national language of Guatemala, the illustrations (300+) in the book made teaching/learning quite simple and universal.

Using Self-Care with Flair! Bhanu aided the staff, parents, and caregivers in understanding that the brain learns and retains when visual, auditory and kinesthetic cues are embedded in the teaching/learning process, resulting in success for life.

At the end of the week-long service project, the staff of the Missionaries of the Highway acknowledged the ease of use and success of the Self Care with Flair! approach to self-care activities and requested a copy of the book, which was gladly given to them (See photos).  Much to Bhanu’s delight, one of the OTs at the facility volunteered to translate the rhymes in the book into the Spanish language as needs arose!  The week was a joyful learning experience for all!!

Self-Care with Flair!
Self-Care with Flair!
Self-Care with Flair!


Bhanu Raghavan, MS, OTR/L

Bhanu RaghavanA graduate of Indiana University and The Ohio State University, Bhanu has over 25 years of experience in pediatrics. She is certified in pediatric NDT and the READY Approach (Bonnie Hanschu) for Sensory Integration Disorders. Frequently, she presents workshops on topics related to self-care independence, sensory processing disorders and fine motor/handwriting skill development to therapists, teachers and parents/caregivers. She works at Centerville City schools, OH. She is a firm believer of the following Confucian principle: “I hear and I forget, I see and I remember, I do and I understand.”

I Can Work!

Educator, Rebecca Tock, teaches at the Elsie Allen High School in Santa Rosa, California. She generously gave us permission to share her glowing testimonial about the I Can Work! curriculum, a 5 module pre-vocational program designed by Therapro author, Angela  (Angie) Mahoney, M.Ed. With Angie’s broad experience as a pre-vocational teacher and as a consultant to other schools in developing their pre-voc programs, her I Can Work! program continues to evolve into a practical, exciting course that builds on basic job readiness skills such as how to greet a supervisor, how to dress for work, how to fill out a job application, appropriate job behaviors, etc. Learning those basic skills provides a firm foundation on which to build more advanced skills. The I Can Work! curriculum instructs students in 5 different jobs: clerical, food service, retail, and grocery.

Rebecca Tock‎

I Can Work

I was introduced to the “I Can Work” curriculum at an educational conference I attended in Spring 2015. Immediately, I knew it was special. It was so different from other vocational curriculums I have used in the past and I thought that this may be the piece that I needed to provide a well rounded pre-vocational education experience in my class. After the presentation, I approached Angela Mahoney, the developer of the curriculum, for some clarifying questions about the program. I was impressed by how user friendly the program appeared to be. Angela was clear, concise and knows her stuff! She was very helpful. What was quite amazing was that it was a total of $49.95. That is unheard of in this profession!

I was able to immediately purchase the curriculum due to its affordability and size. The modules provide comprehensive and clear lesson plans that are easy to use and even easier to incorporate into an existing classroom curriculum. The material presented provides visuals and a guide for the use of real world everyday materials. When working with young adults who have severe disabilities the use of familiar objects is imperative for success. I appreciate the way in which “I Can Work” really uses large graphics and touches upon prior knowledge of the students.

The instructions to set up lessons are easy to follow, and really make this an accessible space for my students. It has definitely enhanced my pre-vocational lessons and given my students more ways to participate in pre-vocational activities.

I love ‘I Can Work!’ It was the best class curricular decision I could have made. I recommend it to any teacher who teaches a pre-vocational class to students/individuals with moderate to severe disabilities.


Ms. Tock teaches students in grades 9-12 who have been identified as having severe special needs.  We would like to direct you to her request for funding ADA accessible tables for her students’ use at mealtimes in school, so they can join their peers. Please visit the site to learn more about her project.

Hippotherapy Activities that Help Build Hand Skills

Guest post by Barbara A. Smith.

Hippotherapy is a specialized treatment area used by occupational therapists, physical therapists, and speech and language pathologists.  It involves utilizing the sensory-motor aspects of horses to achieve therapeutic goals such as improving sensory processing to tolerate touch and motor plan sequential movements. Although the horse functions as a therapy tool, it is obviously much more exciting than a swing or therapy ball, offering opportunities to develop an emotional bond, communication and social skills.

Let’s look at the basics of hippotherapy

Although the healing power of horses has been recognized for thousands of years (Hippocrates mentions it in ancient Greek writings), hippotherapy only developed in Europe in the 1960s and soon after in the United states as an adjunct to physical therapy. Therapeutic goals might have included improving the rider’s strength, postural control, balance and coordination. Hippotherapy’s versatility as a treatment tool gradually expanded as SLPs used it to improve communication skills. Occupational therapists recognized the power of sensory stimulation in promoting engagement and functional hand skills, such as manipulating fasteners. For example, this rider enjoys opening the zipper on my glasses case and then handing me the sun glasses. She loves to help out and make both the horse and me happy!child on horse

Hippotherapy is a type of Animal Assisted Therapy

Please note that “therapeutic riding” (TR) is a different type of animal assisted therapy (AAT) that is offered by certified therapeutic riding instructors who teach riding skills to people with disabilities. A TR instructor may or may not be an OT, PT or SLP. However, hippotherapy is ONLY performed by a licensed OT, PT or SLP practitioner. Training and certification requirements vary at facilities and many require that the therapist have certification in both TR and hippotherapy. As an OT, my goal is not to teach my client how to ride a horse, although frequently that is the result and many children transition from hippotherapy to do TR and eventually earn medals at the Special Olympics.

Why are horses special therapeutic friends?

Well, many animals are special in their ability to connect with people nonverbally and provide unconditional love. Cats and dogs also provide great heavy pressure and tactile sensory stimulation as they lie on laps and cuddle. However, a child with cerebral palsy may improve range of motion by straddling a horse and the repetitive, smooth vestibular movement can gradually reduce muscle tone. A horse’s gait is similar to the human gait in terms of timing. Clients who have never walked or have an abnormal gait can kinesthetically experience what normal pelvic movement feels like.

I have primarily worked with very young children who received services through their early intervention programs. Many had developmental disabilities, including Down syndrome and autism spectrum disorders. My goals often focused on decreasing sensory defensiveness while increasing engagement, postural control and hand skills. Of course, this involves using a variety of reaching, grasping and manipulation hand activities.

Hippotherapy Provides controlled and graded Sensory Simulation

Simply being on a horse provides sensory stimulation. Actually, as soon as a client enters the hippotherapy facility, they are impacted by happy sounds, smells and scenery. Bouncing on the horse while walking and bouncing even more when trotting provides heavy duty proprioceptive and vestibular sensory input. I control and grade the sensory input with choices such as whether to:

  • walk slow, fast and for how long before stopping
  • walk in straight, curved lines or in circles
  • walk uphill, downhill or only on flat surfaces
  • the child faces forward, sideways, and backwards or rides in a different position such as in quadruped or kneeling.

child with ballUsing Sensory-Based Materials

  • Hipppotherapy horses are selected for many specific attributes including tolerance for riders who may hit, kick or scream. I also use a variety of sensory materials that must first be introduced when there is no rider so that the horse becomes desensitized to materials such as:
  • rings tossed onto Color My Class Game Cones
  • rings placed on top of a vibrating ring stack (see photo)
  • toys and Sound Puzzles that make funny sounds or vibrate
  • bubbles like Bubble Bear or No-Spill Bubble Tumbler
  • clothespins clipped onto or removed from the mane (this does not hurt the horse)
  • ball play, playing catch with toys like Gertie Balls

child on horseThe little girl in the photo is facing backwards while her hands bear weight on top of a vibrating cushion like a Senseez Vibrating Pillow. This helps to decrease her tactile defensiveness before asking her to engage in more complex fine motor tasks.

 

ring stackThis vibrating ring stack is made by inserting a motorized pen, like a Squiggle Wiggle Writer Pen inside a swimming noodle.

Adapting activities to vibrate is one of the many sensory strategies described in my book From Flapping to Function: A Parent’s Guide to Autism and Hand Skills.
child on horse

Hand Activities to Develop Postural Control

Clients may work on postural control while reach to touch body parts on the horse or therapist. I like to offer sensory materials to pull or squeeze such as Panic Pete (AKA Martian Popping Thing) while the client maintains a quadruped or kneeling position. The child in the photo squats to take rings out of the bag and stands up while stringing them. He typically has difficulty visually attending but it is difficult NOT to focus and be in the moment when standing on top of a large animal!

 

child on horseThe girl in the photo reaches for rings positioned in front of her before rotating her body to place them over a ring stack. This “ring stack” is actually a cat toy and the mouse on top of a spring squeaks when moved.  The sensory aspects of this activity help her to visually attend while developing postural control.

 

Hand Activities that Develop Cognitive and Manipulation Skills

In my book – From Rattles to Writing: A Parent’s Guide to Hand Skills I describe many simple adaptations that make it easier for children with and without disabilities to develop manipulation skills.  For example, lacing boards can be cut out of cardboard and made to have just a few, big holes and thick cord that are easier than string to control.

lacing boardDuring a typical Hippotherapy session, I spend time walking and trotting, followed by stopping to complete a simple hand activity such as this lacing board. When finished I encourage the child to say or sign “go” to continue movement. Most children are eager to resume movement.

 

velcroA horse’s rear end is wide and functions as a convenient work surface. I adapted this puzzle by attaching the pieces with Velcro to the box cover. I encourage the child to use one hand to stabilize the box lid while pulling them off.  Of course, this activity also teaches children to identify animals and imitate sounds. The Pizza Party is another activity that would be fun to use in this position.

 

Creating Functional Hand Skills Objectives

buttonsIt’s a good idea to create OT objectives to improve functional skills such as opening and closing buttons because:

  • occupational therapy is all about increasing independence
  • this skill is measurable
  • insurance companies prefer work on functional, achievable daily living skills rather than abstract goals such as improving coordination

Therefore, I provide activities such as:

  • opening and closing extra large fasteners
  • opening bags and other containers (like my sunglasses case)
  • putting the helmet and gait belt on and off
  • unbuckling and putting away the reins, neck strap or other equipment

Video Time!

Video: Sensory Pull Activity for Children with Autism or Sensory Processing Disorders

The first video shows how I made and use the “Sensory Pull Toy” (that I designed)  during Hippotherapy to develop:

  • reaching, balance and postural control
  • hand strength
  • visual attention
  • eye-hand coordination
  • color identification

bottlesThis toy is made out of detergent bottles and a strip of fabric. It’s simple to use – the child pulls the handle while in various positions.  It can also be used during non horse activities to work on many skills.  Please check out my book The Recycling Occupational Therapist for many other easy to make therapeutic activities. You can also try Stretchy String as another sensory toy.

Video: Hippotherapy with Children with Autism or Sensory Processing Disorders

The second video shows a few of the exciting ways therapists can use hippotherapy to develop hand skills. It is truly amazing how motivated children are to focus and engage in challenging hand activities because they love being cowboys and cowgirls!

 

Barbara A. Smith has worked with children and adults with developmental disabilities for over 40 years! She is the author of the Recycling Occupational Therapist, From Rattles to Writing: A Parent’s Guide to Hand Skills and From Flapping to Function: A Parent’s Guide to Autism and Hand Skills. Learn more about her work at RecyclingOT.com.