Category Archives: Uncategorized

Do Gifted But Non-Disabled Children Need Occupational Therapy?

School-based occupational therapists are familiar with receiving requests for assessments or interventions for children with delays of all kinds.  What happens when the service request is for a child that has been identified as gifted or talented, but has no diagnosed disorders?  Will OT treatment help a child whose brain is globally and permanently wired for intense responses?

Some common behavioral characteristics of the gifted often suggest that sensory processing difficulties could be present:

  • Sensitivity to lighting, fabrics, and other sensory stimulation.
  • Seeking strong sensory-motor input throughout the day.
  • Difficulty tolerating school rules such as taking turns or sharing the spotlight in discussions.
  • Pursues interests in isolation or with adults rather than with peers.
  • Resistance to complete assigned projects; pursues personal interests.

Theorists such as Kazimierz Dabrowski have attributed these and other behaviors to multiple “overexcitabilites.”   He identified five primary areas of over-excitability in gifted individuals:  psychomotor, sensory, intellectual, imaginational and emotional.  Not considered to be signs of neurological disorders, they are thought to be the result of a brain that is wired differently than children of average abilities.  Brain imagining studies suggest that the gifted make faster and more complex associations between stimuli.  They perceive experiences and interactions with more depth and intensity than other children, and have an inborn drive to follow their passions.

These brain characteristics are not necessarily problematic for every gifted child. When teachers and parents know how to support children who learn differently, the gifted child can become a positive force and even a leader in the classroom.  Although scores on the Sensory Profile or on other sensory-based assessments may suggest an SI diagnosis, there are gifted children that manage successfully in school and at home without intervention.  They may even come up with their own sensory diet, having identified activities that provide what they need.  For example, a child that seeks sensory input could engage in complex art projects or specific sports activities that provide visual, tactile, vestibular or proprioceptive input.  A sensory-sensitive child may happily use an unoccupied corner of the room with indirect light for free reading time.

Some gifted children will have difficulty in class, especially when their behavior is at odds with school routines and social norms.  A child that takes over discussions or refuses to work on a group project may disrupt a classroom or be unable to complete assignments even though their academic abilities exceed their peers.  A child that refuses to wear a tie or participate in music class may need help to handle the demands of school.

How Does Your Engine Run? - available at therapro.comAnne Cronin, OTR, FAOTA has recommended that gifted children can benefit from sensory diets and modulation strategies found in programs such as “How Does Your Engine Run?”  It is worth noting that gifted children may be able to comprehend and implement programs at earlier ages and stages than typical children. Children who were reading at 3 or creating complex imaginary civilizations at 5 may learn and incorporate a sensory diet almost immediately on accepting its value.  Such students may even improve on your suggested activities with one of their own creation!  This is the time to collaborate with them and provide them with the positive feedback they may need in order to try new ways of responding at school and at home.

Patterned Fluorescent Light Filter
Patterned Fluorescent Light Filter
Fluorescent Light Filter
Fluorescent Light Filter
Attachable FootFidget® Footrest
Attachable FootFidget® Footrest

The same sensory-based equipment that we recommend for other children with sensory processing problems could help gifted children as well.   Fluorescent Light Filters effectively dim harsh lighting, and fidgets for feet and hands can be effective tools that don’t disrupt productive work.  Because gifted children need to learn to manage and modulate their intense and complex responses, there are many ways that OTs could be helpful to these children.

Gifted children may need a wider variety of tools to give them the desired novelty they crave, or they may reject many ideas rapidly.  Always ask for an explanation and be ready with alternatives.  A gifted child may be able to project many steps ahead of you and identify roadblocks that you don’t anticipate…yet!


Cathy Collyer, OTR, LMT, PLLC

Cathy Collyer, OTR, LMT has treated children with neurological, orthopedic and sensory processing disorders for over 20 years. She is the author of The Practical Guide To Toilet Training Your Child With Low Muscle Tone. Learn more about her work at tranquilbabies.com.

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.

Is Your Classroom Ready for Back To School?

Author: Diana V. Mendez-Hohmann BA, COTA

Throughout the summer we ensure that our children have all the supplies they need. We worry about their transitions from one grade to another, but as therapists and educators are we prepared to start the school year? I have created a small list of products that every special educator and therapist should have in their arsenal of education. Most of these items are small and easy to transport from classroom to classroom or school to school.

Here is a list of 15 items you need to start the year off right.

Educational Needs – The products below are perfect for the learning needs of all!

  1. Highlighter Strips are great for visual learners. An ideal tool for those with reading and visual processing difficulties. Brightens any written word. The plastic strips can be placed over any written material and used over and over again.
  2. NOVENOPs! is a hilarious game that teaches sentence structure! A card game for children of ages 6 and up. This game helps develop the player’s ability to understand the basic elements of grammar.
  3. Letter Treasure Hunt is a Pirate adventure with a handwriting twist! A board game with a handwriting component and the pirate theme makes it tons of fun.
  4. Trunks is a game where players move their bodies, make sounds and perform actions from memory!

Handwriting – Slant Boards, Paper & Grips, Oh My! Everything you need for working on handwriting skills you will find here!

  1. Better Board Slant Boards are made for traveling (from home to school, class to class, etc.) and can easily be stacked and stored in a classroom.
  2. Raised Line Writing Paper is perfect for teaching line orientation, and cueing correct letter and word spacing. Graph spacing is also used for teaching numeracy and basic addition and subtraction.
  3. Pencil Grip Samplers let your students experiment and find their most comfortable writing tools.
  4. Highlighter Paper features a highlighted lower writing area and solid lines. Because the paper is visually simplified letters can be formed and spaced correctly.

Organization – An organized classroom helps with transitioning from class to class or task to task.

  1. Time Timers allow students to understand the passage of time so they can monitor their own activities. Better time awareness also relieves the stress and anxiety.
  2. Seat Sacks are a great way for students to quickly gather supplies on a moment’s notice.
  3. Talk Bar is a customizable, versatile communicator that helps students visually display and describe a sequence of events.

Sensory Needs – Don’t forget about your students’ sensory needs, make sure you have all these sensational supplies in your classroom.

  1. Sensory Stories Cards are visual reminders of the various strategies that children can employ to cope with unpleasant sensations in daily life.
  2. Fidget Kit includes a group of the most popular fidgets.
  3. Seating Cushions help promote “active sitting”. Perfect for strengthening the muscles that support the spine and to use when sensory input is needed.
  4. Sensational Fun Cards have over 100 activities for parents and teachers who are looking for some great sensory games using common objects found in the home and school.