All posts by Guest Blogger

What Helps Special Needs Kids Tolerate Grooming and Hygiene?

April 4, 2018SensoryGuest Blogger

by Cathy Collyer

Occupational therapists are the “ADL specialists” on a treatment team. Building independence in self-care isn’t always the problem we are addressing. For younger kids or multiply challenged children of any age, simply tolerating experiences like nail cutting, haircuts and face washing can be the hardest part of the day. Helping children and their families to make grooming and hygiene less of an issue can improve children’s sense of safety and control. It can even build the relationship between caregivers and children.

When evaluating a child’s aversion to ADL’s, look to the comprehensive OT evaluation. While the Sensory Profile or the SPM will highlight specific challenges in oral or tactile domains, looking at a child’s level of motor, visual-perceptual and behavioral functioning provides a more complete picture of the child. Postural issues, issues with endurance, attention, or identifying unique behavioral/emotional expression of frustration will suggest potential treatment pathways or complications.

Prior to Grooming And Hygiene Activities:

Directly address sensory-based issues in a comprehensive manner. Use of the Wilbarger Protocol, creation of a sensory diet and selecting tools to desensitize aversive response can support even the most agitated child. Brief activity on a Therapy Ball can increase postural activation while modulating arousal prior to ADL’s. Other children benefit from a NUK Brush or other oral/facial input before tooth brushing or having their face washed.

During ADL’s:

The use of sensory and behavioral activities can help increase and lengthen tolerance. Some children benefit from sitting in a Beanbag Chair during grooming to provide calming input and postural stabilization. A visual timer supports a child to understand that the activity will end and provides an objective measurement. This could reduce the child’s use of whining or aggression directed at the caregiver. A Weighted Lap Pad can be helpful calming input to an agitated child. Children with sensory seeking as well as sensory sensitivity often prefer a weighted object with texture.

When the ADL Task is Completed:

Aversive responses can continue long after a child demonstrates minimal or no observable aversive response in a treatment session. Why? Because children are more than a stimulus-response cycle. They develop a sense of anticipatory anxiety and have habitual reactions that can be triggered even without sensory input.

Replacing old behaviors with more functional new habits may require slowly adapting ADL routines to decouple sequences that elicit aversion. An example of this would be allowing a child who is agitated during feeding to briefly play with washable items after a meal but before cleaning his hands. Any residual agitation from distressing feeding experiences could dissipate partially or totally before the caregiver uses deep pressure input to wipe the child’s hands.

Supporting children for ADL tolerance and eventual independence requires us to use our task analysis and evaluation skills in creative and complex ways. Building tolerance and independence is our initial goal, but successfully navigating daily ADL experiences will have wide-ranging effects. Improving grooming and hygiene experiences helps families feel calmer around ADL’s in general, improves communication, and deepens trust between caregivers and children.

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.

Creative Uses for the Elevated Writing Surface, Handwriting Tools and Positioning Cushions

March 12, 2018Fine Motor, Handwriting, Occupational Therapy, UncategorizedGuest Blogger

by Shoshanah Shear

Handwriting and writing position are often discussed in a school setting but what about our other clients. Let us consider a patient who is in hospital. Enabling a patient to engage in drawing, art, a pre-writing task, or writing itself following an illness or injury is invaluable. However, it can be a challenge to provide the necessary angle for a writing surface when working at the bedside. Some hospital-based OT departments have a table surface that adjusts in height as well as the angle of the writing surface. But such equipment is not always available or, if it is, there are times that a portable version is preferable.

The various slanted writing surfaces available through Therapro offer the solution. I particularly love the Collapsible Writing Surface. It opens the door to varying both the activity used in treatment as well as the location for the session.

Imagine for a moment a patient in an orthopedic ward following an MVA. The patient has multiple fractures with exoskeleton / P.O.P. and is depressed and uncooperative with all staff members. After persuading the doctor to refer to OT, a brief history reveals that the patient is an artist and the thought of not being able to draw is what depresses them enough to interfere with function on all levels.

As an OT, we can build up the grips of a pencil or paint brush. Another option to easing use of writing implement is through Triangular Crayons and Pencil Crayons. Triangular writing implements can also enable a patient of this nature to return to drawing by easing the demands of the small muscles in the hand. Although strengthening these muscles will be important, the first step might be to encourage return to meaningful activity, hence the need for an easier means of holding the writing or drawing implement.

Using the portable, collapsible slanted writing surface or easel, one can now take the patient out of the ward (whether on a trolley or in a wheelchair) and into either the OT department or, better still, the garden. A change of environment does wonders for the patient psychologically, not to mention the hope offered by enabling an artist to return to what they love best – drawing, painting or creating. Many artists gain inspiration from nature, hence being able to get into the garden can literally be a breath of fresh air that instills a desire to regain function.

Through this brief example, we can see that writing and being involved in creative pursuits is a necessary skill and activity for various age groups and types of clients, not only for children at school. The tools and equipment that are beneficial in the classroom can be equally important in a hospital or other setting.

The write slant boards or Better Board Slant Boards are also of benefit to:

a woman who is expecting and is placed on bedrest.
the elderly who has limited space due to downsizing and increasing need to take care of their backs. The fact that the slant boards are light and collapsable makes handling and storage easy for an older person.

Still related to positioning, two cushions that I have used quite often in my practice are the Disc‘O’Sit and the Movin’ Sit Air Cushion. I love the fact that they are portable and adjustable in terms of air pressure. This makes it possible to take these cushions to a treatment or evaluation in a home or workplace.

One group of clients I have found to benefit from these cushions is a pregnant woman who is experiencing lower back pain. Pregnancy related lower back pain is a common complaint which can be alleviated with appropriate exercise and positioning.

Shoshanah Shear

Occupational Therapist, healing facilitator, certified infant massage instructor, freelance writer, author of “Healing Your Life Through Activity – An Occupational Therapist’s Story” and co-author of “Tuvia Finds His Freedom”.

Move Mindfully Card Deck and Sensory Systems

February 7, 2018Body Awareness, SensoryGuest Blogger

by Stephanie Kennelly

Therapro is excited to offer the Move Mindfully Card Deck, available at our store. This product helps integrate physical fitness, mindfulness and social emotional skills into practice. The deck not only offers individual poses, but also routines to address a variety of common needs, such as “accident prone” and “lethargic”.

As a Blog Bonus, we are offering a free download of three poses from the card deck to get you started with a simple routine. Read on to learn more about each pose and how it relates to your Occupational Therapy goals.

Belly Breathing

Belly Breathing

Getting into the Pose:
Belly Breathing is often taught with the Hoberman Sphere. The brightly colored, collapsible tool offers a visual tracking point to feel the diaphragm expand and contract. However, hands can simply be placed at heart and belly when teaching belly breathing as well. To start, we recommend a seated position in a chair, for back support. As a modification, this pose can also be completed laying on the floor. In this position, try a small object or toy placed on the belly for extra visualization of the up and down movement.

Therapy Resource:
Belly breathing is a great way to work on postural stability while maintaining an upright position without a collapsed trunk or slouched shoulders. This pose also taps into interoception and body awareness as breathing is tracked.

More Info on Belly Breathing

Tree Pose

Tree Pose

Getting Into the Pose:
Tree Pose is an introductory balancing pose that all body abilities can enjoy. We start by cueing the heel to touch the ankle. As balancing progresses, the foot can be placed on the calf or thigh. However, make sure to avoid any pressure on the knee joint. The hands press together at midline, palm to palm, providing additional input.

Therapy Resource:
Like belly breathing, this pose works postural stability through core activation in a static hold. It also works on bilateral coordination as hands and feet press towards midline while maintaining balance and focus. The stacking of joints over the anchored foot (ankles, hips, wrists) taps into theproprioceptive system. If you need additional proprioceptive input in this pose, try stamping feet before attempting to hold static. Activate the vestibular system by experimenting with the foot and hand placement.. Also, try small movement, such as swaying, within the pose. Work on vision by providing various focal points experimenting with gaze up, out, down and even eyes closed. If you see the MORO Reflex in this pose, return to Belly Breathing.

More info on Tree Pose

Child’s Pose

Child's Pose

Getting Into the Pose:
Child’s pose is often used at the beginning or the end of a session. However, it can be used whenever there is a need to decrease overstimulation. It can be completed on the floor or at a table.

Therapy Resource:
As you cue stacked fists, you are working on bilateral coordination and proprioception as joints are stacked together at midline. On the floor, there is the additional tactile input from the legs and arms on the Earth. Seekers may need to rock, or add extra movement to the pose, while avoiders may have to stay more upright. Offer a vestibular system modification of seating in a chair, hands stacked on forehead and chin slightly tucked.

More Info on Child’s Pose

About Us-

This blog post is a collaborative effort of Sweet Inside Yoga and 1000 Petals.

Sweet Inside Yoga is a company providing resources for occupational therapy, physical therapy, mental health practitioners, classroom teachers, yoga teachers, professionals, parents, and others in the community to use with individuals who can be found seeking and/or avoiding yoga activities.

1000 Petals is a well-being training and consulting company based on the science and practice of mindfulness and movement. They provide integrative mindfulness and movement solutions in workshops, events, retreats and self-care classes. Subscribe to their newsletter to receive weekly tips and resources on integrating mindful movement into your therapy.