Category Archives: Strength & Rehab

Saturday Seminar: Syrian Boy with Bilateral Upper Limb Differences Learns to Negotiate Daily Life in America

Eleven year old Ahmad, who as an 8-year-old suffered trauma in Aleppo, Syria, that left him with bilateral transhumeral limb differences, captivated us. Today’s seminar, presented by Ahmad, his occupational therapist, Sheila Kearney, MS, OTR/L, and physical therapist, Julia O’Connell, PT, was entitled: Syrian Boy with Bilateral Upper Limb Differences Learns to Negotiate Daily Life in America. Attendees were spellbound by Ahmad’s story that took us from his and his dad’s arrival in the USA 3 years ago, his experiences to date, and plans for the future. His therapists work as a cohesive unit with his school and family with the goal of assimilating him into American life as a fully functional boy at home, at school, and in the community. Both Sheila and Julia have extensive experience in a variety of pediatric settings. They met Ahmad through the Sharon, MA public schools, where he is a student.

The therapists provided the framework for Ahmad’s journey through their PowerPoint and video presentation. Hearing about Ahmad’s experiences in his words and demonstrations on how he manages his daily life enriched the seminar infinitely and brought to life the reality of the challenges he faces on a daily basis. Behind the current functional capabilities were months of trial and error, frustration, and success guided by his therapists and sometimes, with his self-designed adaptations. Observing as he demonstrated donning a jacket, writing with Ferby Triangular Colored Pencils, cutting with a knife, scooping from an Inner Lip Plate, pouring himself a drink, and eating a peanut butter sandwich seemed satisfying for him. Ahmad uses a Slant Board to facilitate writing activities. He tried out and loved using Mounted Table Top Scissors today, which provided stability as the scissors were fixed to a plastic base with nonslip pads. Simple materials like Closed Cell Cylindrical Foam, and Velcro Self Adhesive Tape are simple materials that can be used in creative ways to facilitate function for Ahmad. Hearing about his PT treatment for strengthening his upper body in preparation for function was moving. Ahmad has tackled daily life issues along with a talented therapy team who are always exploring new ways to adapt materials creatively to ensure full participation with his peers and siblings.

Currently Ahmad is using primitive UE prostheses that require strength and muscle activation. He removed his shirt and demonstrated how he activates them using shoulder girdle musculature. Ahmad looks forward to the next step in gaining more fine motor control with myoelectric prostheses, which will provide him with increased power and control. He looks forward to using the device glove with fingers, giving him the ability to use a 3 jaw chuck for better fine motor control than his current prostheses offer. In addition, it was exciting to hear that he is eligible for bilateral upper extremity transplants in the near future, with the decision resting with him and his parents.

The commitment and care that Sheila and Julia have provided for Ahmad have been critical for his assimilation into his new life in the US. It was a pleasure for all of us to share his journey. His future is bright with his parents and four siblings now together in the US. Intelligence, confidence, kindness, and charisma are just a few of the qualities that we saw in Ahmad. Seeing how he, his parents, therapists, and school staff work as a team to help him achieve independence is truly inspirational. He is meeting his challenges head-on with determination and an indomitable spirit!

Here are a few appreciative remarks from attendees:

“The amount of adaptations are amazing. What a great team. I love how client driven it is.” – Patricia K., Occupational Therapist

“I would absolutely recommend this seminar to a colleague! This seminar was one of the best – especially because Ahmad was part of the presentation.” – Maura. M., Teacher

“I loved Ahmad telling his own story and supplemented by his therapists.” – Micaela C., Physical Therapist

“Very inspirational. Wonderful to see the student in action. So motivated!” – Beth M., Occupational Therapist

Thank you, Sheila, Julia, and of course, Ahmad!

Filomena Connor, MS, OTR/L
October 14, 2017

Using Movement to Motivate and Develop Hand Skills

By Barbara Smith, M.S., OTR/L

usingmovementtomotivate1Movement, whether on a horse, swing or trampoline, provides sensory stimulation that nourishes the brain and in turn promotes attention and learning. Movement can also be used therapeutically to motivate children to engage in hand activities.

As an Occupational Therapist working at Ironstone Therapy in Andover, MA, I am able to use a horse as a treatment tool to work on traditional objectives such as improving bilateral coordination.

Hippotherapy is often very effective because children love bonding with the horse. Instead of in an office, this kind of therapy takes place in a happy environment where simply sitting on top of the animal is the first of many small successes.

Let’s begin by looking at Amber, a hippotherapy client. When I first met two-year-old Amber she arrived singing “Old McDonald Had a Farm.” She continued to sing while mounting and riding. She never looked at me, and seemed unaware of what her body was doing, and also unaware of the people around her.

Fortunately, Amber loved movement. She didn’t like it when I stopped the horse. I began singing “If You’re Happy and You Know It…Clap Your Hands/Pat the Pony/Blow a Kiss,” etc. At first I used hand-over-hand assistance to help Amber perform the hand movements. When she ignored me, I stopped the movement. Amber soon learned that by engaging and using her hands, she could avoid stopping.

This example describes how movement can be used as reinforcement. A “reinforcer” is anything that makes a person want to repeat a behavior. Examples of reinforcements can be hugs, stickers, special treats, and even paychecks that motivate one to keep going to work.

Movement can function as a “sensory reinforcement” when it:

  • Motivates the child to repeat the desired behaviors (i.e. clapping hands)
  • Provides sensory input that organizes the brain

An important aspect of developing hand skills is learning to tolerate touch. Children receive deep pressure stimulation to joints and muscles as the horse gently bounces up and down during the walk.

usingmovementtomotivate2During hippotherapy, children are encouraged to engage in simple hand activities such as giving high five while prone (on the belly).

Children may assume different positions, such as facing backwards while bearing weight on forearms or hands. Bearing weight helps to decrease touch sensitivities (i.e. tactile defensiveness) so that the child is more willing to grasp and manipulate objects.

Occupational and physical therapists often position children in “prone” position (on the belly) using swings, therapy balls or a scooter board so that children:

  • Develop postural control
  • Strengthen trunk, shoulders, neck and eye muscles
  • Bear weight on hands to decrease tactile defensiveness
  • Receive vestibular (movement that stimulates the inner ears) sensory stimulation that organizes the brain
  • And of course, are motivated – because movement is fun!

usingmovementtomotivate3The smart mom at We Can Do All Things explains how her daughter developed postural control by working on fine-motor activities while on the swing. The movement also made puzzles and ring stacks extra fun.

Scooter boards can also be used to develop sequencing and bilateral coordination as children “scoot” to a desired activity. The child might also be asked to scoot back and forth to bring game or puzzle pieces to a board. The clever mom at Fumbling Thru Autism motivates her daughter by integrating movement activities throughout the day.

Children can engage in a variety of hand activities while on a horse or other movement apparatus to develop basic skills such as reaching and grasping and more advanced skills such as:

  • Stabilizing with one hand while manipulating with the other
  • Orienting shapes to fit through openings (developing visual perceptual skills)
  • Sequencing several steps

For example, the client shown in this photo is inserting Lotto cards into the slots I cut into a detergent bottle. The slots are cut in vertical, horizontal and diagonal orientations so that she can practice positioning the cards to fit. Some of my more experienced clients can use this activity while kneeling or standing on top of the horse!

This child is using a magnetic Bingo wand to catch the goldfish while developing visual attention, postural control and sequencing skills as he removes the fish to place in an attached basket. The fish is cut out of a detergent bottle and has a paper clip attached so that it can be used in magnet games. This activity also helps children to coordinate using their hands together as they remove the fish from the Bingo wand.

Most therapists and parents do not have a horse available to use for sensory stimulation and reinforcement. However, the principles are the same when using other movement equipment – or no equipment at all. Young children may be twirled around after putting rings on a stack and older children may enjoy performing jumping jacks as they spell words. Most children of any age or ability level love to move and are motivated to communicate “go” with gesture, pictures or vocalizations. So what are you waiting for? Let’s get moving and developing hand skills!

* * *

Barbara Smith, M.S., OTR/L has worked with children and adults with developmental disabilities in a variety of settings over the past 30 years- including early intervention programs, public schools, special education collaboratives, day habilitation programs and community residences. She is the author of The Recycling Occupational Therapist, 2nd edition (, 2012) and From Rattles to Writing: A Parent’s Guide to Hand Skills (Therapro, Inc, 2011).

Check out Barbara’s website for information and resources at:

Putty, Putty, Everywhere, Which One is Right for Me?

Our therapy putty is great for many reasons: developing a pincer grasp, picking things up, strengthening muscles, and hand therapy, among others.

Parents will often get instructions from their child’s therapist to get putty for hand strengthening. One of the questions we get the most is:

“Which color putty is best for my child?”

Putty color is dependent on the resistance.

LIGHT BLUE is the softest:

The softest putty is best for people who are very weak in the hands.

You also want to have enough resistance to strengthen the hand, so if this one is too soft you can move up to the light green.

Buy enough putty so you can hide things in it (like mini animals!). Also, when someone has limited range in their hand, we want them to have enough putty to be able to grasp it.

(Be careful – the light blue putty can develop a string when you pull it, and can stain surfaces – see this list for recommendations to get it out.)

LIGHT GREEN is medium/soft

DARK BLUE is firm

DARK GREEN is super firm

We can hardly cut and package the firmest putty!

The firmest putty is great for adolescents with behavioral problems. They are often so agitated, they need that kind of heavy work/proprioception. They use it as a means of intensity. They need that intensity – similar to music.

A less resistant putty doesn’t require the effort that an adolescent might need.

The power fist is also fun for the kids!

“My child doesn’t like this color – can I get the other one?”

We color our putties so it’s easy for you to tell which strength you need – “the light blue one” can be your go-to if you forget the exact resistance.

You can work your way up in resistance/color – once the hand gets stronger, you will need a firmer putty!

“How do I get putty out of [x]?”

We get calls on that all the time – it’s another one of our biggest questions. We suggest using the putty in the kitchen – it is silicone based and will come off of hard surfaces easily!

If you do end up with a stain on fabric, stuck in hair, etc., we have compiled a list of suggestions to get it out!