All posts by Allyson Locke, M.S., OTR/L

Modifying Games to Address Therapeutic Goals

Games are a useful therapeutic tool; they are versatile, engaging, and so much fun! WIth a few simple modifications games can address a wide range of therapeutic needs.  A few simple modifications can be used for almost every game:

  1. Add Visuals.  Visuals can be anything from simplified directions to communication aids, like “your turn” and “my turn”. Visuals can help those who struggle with sequencing, memory, or communication participate more independently in game play.  
  2. Change the playing position. Playing games on the floor, at a countertop, or with alternative seatings helps to increase participation and access.  Playing a game on the floor allows players to play in alternative positions like laying on their bellies. This position is great for those with postural instability, and helps increase their focus and endurance.  Another option is to use a therapy ball (add a base for stability), Alert Seat, Ball Chair, or air filled cushion instead of a traditional chair.  These types of alternative seating provides movement input which may allow those with shortened attention spans to participate longer and with more focus.  Some games like, Left Center Right, have few manipulatives making these great games to use on scooter boards or swings.  
  3. Modify  the Manipulatives.  Some game pieces are just too small, too big, or too difficult for students to access.  One quick fix is to swap out the game tokens for something more manageable like a jumbo dice.  Another option, insert game pieces into putty for a bigger gripping surface.  Other modifications include using a card holder or book holder.  
  4. Manipulating the manipulatives to target hand skills. To encourage a pincer grasp, place smaller game pieces into an egg carton (or similar small container); the smaller space allows for only a few fingers to access the piece, encouraging a two or three finger grasp pattern every time the player picks up the game pieces.  To incorporate hand strengthening and bilateral coordination, use a tennis ball with a small slit cut into it.  Players must squeeze the tennis ball with one hand while using the other hand to insert or remove their pieces.  To target fine motor manipulation with insertion, use plastic containers (your recycling bin is a great resource); cut a slit in the lid and work on inserting game manipulatives into the containers.
  5. Change the game rules to address specific therapeutic goals. If your focus is social interactions, team building, or cooperative problem solving change game play so players play as a group instead of competing against each other. If you are doing individual treatment sessions instead of group sessions, change gameplay to make it a single person game.  When time is limited or you have participants who struggle with extended attention and focus, add a time rule where game play ends after a set amount of minutes.  When the game is too hard or too easy for players, add more complexity or decrease the complexity.   

With a little bit of creativity, most games can be changed, adapted, or modified in order to use them as a therapeutic tool.  Check out Therapro’s handy games guide to see these modifications applied to some of our great games! 

Review: Nov 16, 2019: Advanced Treatment Strategies for Youth with Complex Behavior

On November 16, John Pagano, PhD, OTR/L presented his Therapro Saturday Seminar, Advanced Treatment Strategies for Youth with Complex Behavioral Challenges, to a captivated audience. The energy in the room was palpable throughout the two hour talk. Dr. Pagano ‘s passion was evident as he discussed assessing and treating children and adolescents who have complex behavioral disorders. He shared clinical examples and anecdotes to highlight his talk, peppered with humor. Leading the audience through many experiential activities provided them with examples of practical tools to use with individuals and groups.

John is an occupational therapist who practices at an adolescent psychiatric hospital and school. He is a certified instructor of Positive Behavioral Support and Movement Based Learning Strategies. His years of experience include working in various settings including adolescent juvenile detention, psychiatric hospital, adolescent group home, and in special needs, regular education and preschool classrooms. He is the author of the recently published book, FAB: Functionally Alert Behavior Strategies: Integrated Behavioral, Developmental, Sensory, Mindfulness & Massage Treatment.

John discussed the importance of setting functional behavioral goals when providing OT, PT, and Speech/Language therapies for students with complex behavioral disorders. He frequently reiterated the value of a team approach, including ABA specialists, to working with this population.

FAB Strategies® are Dr. Pagano’s evidence-based, practical strategies that use “clinical reasoning based on current clinical research and neurology to develop the individualized strategies needed to address complex behavioral challenges.” John reviewed Sensory Processing Disorders, how they interact, and how to treat them using sensory based interventions. In his discussion of Sensory Modulation Disorders, John stated that his research and experience have shown that the olfactory sense is a powerful teaching tool for those with ASD and for those who have experienced trauma. He has found that pairing a scent is very effective for achieving the desired Quiet Alert state of arousal. He advocated using materials like Scented Clay and scented markers as treatment materials.

John disclosed that research supports that mindfulness strategies are an effective and powerful treatment methodology for improving special needs students’ behavior and executive functioning. John led the group in breathing and movement activities that he uses with his students that also increase body awareness. John taught the group a number of quick, easy, and practical strategies to circumvent problem behaviors. For example, his FAB Turtle Strategy involves 4 steps: 1) Notice environmental & body triggers – STOP 2) Go to the sensory coping area 3) Do your individual coping strategy 4) Later problem solve with help. Fidgets like Loopeez, Boinks, Panic Pete, and Theraband were mentioned as some of John’s favorites for calming.

Dr. Pagano is a dynamic presenter who generously shared resources and evidence-based, practical treatment strategies for working with children and adolescents who have complex behavioral challenges. He integrates all that he has learned in his years of experience with current research so adeptly!! Attendees left this seminar with ideas they could put to use immediately in their practice.

Take a look at some of the overwhelmingly positive comments from those who attended John’s seminar:

“I left full of simple/functional strategies to try with my students, all ages. John is simply AMAZING!!!” – Christie H, Speech/Language Pathologist

“John is an excellent speaker who was very helpful, evidence based, and offered suggestions for treatment.” – Renee S., Physical Therapist

“Offered many resources & activities that can be used immediately in my practice & therapy.” – Rose O, Occupational Therapist

“John’s sense of humor made this important topic fun. Many teachers & therapists are struggling in the classroom. These are strategies that can be implemented Monday. In addition, his strategies come from evidence based research of strategies/techniques that help our students make progress.” – Jennifer H, Occupational Therapist

Thank you, John!

Filomena Connor, OT, MS, OTR
November 16, 2019

Review: Oct 26, 2019: Armed and Ready for Monday Morning!

October’s Saturday Seminar speaker, Lisa Mitchell, M.S., CCC-SLP is an expert in Childhood Apraxia of Speech (CAS). She is a pediatric speech language pathologist, Clinical Director and co-owner of Clearly Speaking, a private practice in Hampton Falls, Dover and Londonderry, NH. Lisa has been recognized for extensive training and expertise in CAS by Apraxia-Kids.

On October 26th, Lisa shared her passion with attendees who are speech language pathologists, occupational therapists, OT students, and teachers, with her presentation entitled Armed and Ready for Monday Morning! 26+ Valuable Clinical Tools for Treating CAS (Childhood Apraxia of Speech) from A-Z. She organized her talk in a unique way that highlighted “Tips and Strategies for Treating CAS” in an A through Z format. She discussed some of her favorite publications including those by Pam Marshalla, such as Successful R Therapy, and Apraxia Uncovered.

Lisa explained that CAS is typically part of a broader diagnosis and is a challenging diagnosis to treat. She discussed the importance of collaboration with others on the team, i.e. OTs, who are working with the student on motor issues. Difficulty with motor planning can lead to errors in speech production. With a motor speech disorder, the student has difficulty achieving smooth movement from one sound to another. So, as the complexity and length of words increase, the student has more difficulty. As we can imagine, the child’s level of frustration increases when they are trying to talk.
Wind-Up Toys for reinforcers. Lisa touched on a controversial area for speech/language pathologists’ treatment – oral motor exercises. She discussed how using exercises not attached to speech for children with CAS, such as blowing whistles, bubbles, etc. will not help a child talk. However, using a whistle to help position the lips for speech is useful if the whistle is removed and the student is then given a syllable to produce using lip rounding.

Lisa is a gifted presenter and her passion for her CAS work is evident! She offered a hefty toolbox of ideas and strategies for treating CAS. With such a varied audience today, her tip that was very powerful and resonated with us all was that team collaboration, including parents, strongly benefits a child with Childhood Apraxia of Speech.

Here are some of the appreciative comments from those who attended Lisa’s seminar:

“Very insightful and great ideas for therapy. Enjoyed the insights on co-treating.” – Beth M., COTA/L

“I would recommend this seminar to a colleague. I would like to learn more about collaboration of OT/PT/SLP – how to work together.” – Maria L., Speech/Language Pathologist

“Easily explained and well thought out.” – Tai M., Occupational Therapy Grad student

“Learned a lot and was easy to understand.” – Anonymous, Occupational Therapy Grad student

Thank you, Lisa!

Filomena Connor, OT, MS, OTR
October 26, 2019