Category Archives: Daily Living

Find daily living aids and strategies that foster independence in essential self-care activities like dressing, grooming, hygiene, and managing routines in daily life.

picture of a boy in a wheelchair completing an art project using the functionalhand to help hold his tools.

Executive Function – Making Strategies Inclusive

Daily Living, Therapist Resources, ,

Linda Merry, OTR/L, NDT/C

What is Executive Function?

The phrase “executive function” as described in the Harvard Journal, Developing Child, refers to a set of skills.  These skills underlie the capacity to plan ahead and meet goals, display self-control, follow multiple-step directions even when interrupted and stay focused despite distractions, among others.  

No one is born with executive function skills but nearly everyone can learn them.  Adults set up the framework for children to learn and practice these skills over time by establishing routines, breaking big tasks into smaller chunks, and encouraging activities involving rules, directions and planning skills.  

As our child becomes more competent and these areas of the brain develop, it enables them to plan for themselves.  It also allows them to focus and stay engaged with information to complete tasks.  Research has shown by 12 months of age, a child’s experiences are helping to lay the foundation for the ongoing development of executive function skills. 

Get Ready, Do, Done

Sara Ward and Kristen Jacobsen’s  framework, “get ready, do, done”, to support skill development provides a process to develop the executive functioning abilities.   This system is easily incorporated into all activities.  

Implementation

The first step is to help your child or student visualize what the project will look like when it is done i.e., what does the end look like.  Children need the opportunity to visualize the end before they plan their steps. This is especially true for a child who lacks the motor control to move their body or communication skills to verbalize their intent.  A child may have the ability to plan a task but lack the opportunity when others bring materials to them, place them on their surface and physically help with each step.

Next, you want the child to visualize the steps they need to take.  It may involve cutting a circle, drawing a picture, gluing, etc.  You want your child to think through the process. Let the child tell you what steps they want to take before beginning.

Last, to “get ready” the child should tell you what materials they need.  Is it markers, paper, ruler, glue stick, etc.?

Accessibility For The Child With Special Needs.

When a child can visualize what their completed project looks like, they can talk through the process and collect needed materials as independent as possible.  What if a child is unable to communicate verbally or walk over to get what they need?  Here are strategies that provide inclusive opportunities to use this framework.  It allows the child with neuromotor difficulties to participate in opportunities that lay the foundation for executive functioning.  The goal is to support their abilities and not allow their impairments to limit their learning.

Get Ready, Do, Done provides a visual or template to clearly demonstrate the thinking process.

Strategies To Support Inclusive Learning

  • Positioning Needs of the Child: When completing activities that require attention, concentration and upper extremity control, optimal positioning is important.  A child seated upright so they can view what their project looks like when completed.  Positioning  the child at 90:90:90 for the hips:knees:ankles  with feet supported is usually preferred.  
  • Tray Surface: Supporting the upper arm on a table surface provides a base of support for upper extremity control.  By increasing the contact surface of the forearm and hand, it provides stability and increased sensory awareness of movement in space. We have found a tray surface that supports the elbows, by curving around the body, makes a significant difference. The work surface should be large enough to fit materials and support the upper body.  Common errors are elbows falling off the table or not enough room for materials. 
  • Organization of Work Surface:  For the individual with motor coordination, it can be helpful to have a container where materials are placed avoiding knocking them off the tray.  This can be a small bowl or box that serves as a “waiting area” for items such as scissors and glue.
  • Vision Considerations: The size, colors and position of the project are important.  Placing the project that is “done” and showing what the end looks like should be of a size, position and contrast that supports vision needs.  Placing it on an easel, on the wall or at an angle that allows for easy viewing is helpful and allows the child to visually reference the project that they are completing.  Adjusting the size by enlarging pictures or having a black contrasting background may help the individual with vision impairments.
  • Activity Selection/Material Considerations:  Using templates and/or pre-made cut outs may help the individual with motor impairments.  If the end is a picture of a farm, using a template that supports coloring inside can be helpful.  Using stickers that allow the individual to place or glue them reduces the motor demands.  Forming Wikki Stix into shapes that allow the child to color inside simple shapes is another option.
  • Tool Use: Using adaptive crayons or adapted markers, glue sticks and other materials may allow the child to do the task without hand over hand assistance.  You want to reduce the motor demands when you increase the cognitive requirements.  There are many options to help children hold their own tools.  The Functionalhand allows children to hold objects in either the  horizontal or vertical orientation.  Any size crayon, marker, glue stick, dry erase markers or school tools can fit into the flexible cord system.  For children who are unable to sustain a grasp on the Functionalhand independently, the Eazyhold strap is the ideal complimentary product.  
Finished project displayed on a slant board as a visual reference for "Done"
Finished project displayed on a slant board as a visual reference for “Done”
Alistair references done while he uses the Functionalhand to paint his cow.  
Alistair references done while he uses the Functionalhand to paint his cow.  

Do 

Keeping the activity initially simple and building on the concept once the child is familiar is important. Initial activities may be to color pictures and glue them in position.   Having two sets of icons, one showing the action and the other showing the tool helps them to understand the difference.

Visual of a girl cutting- an example of an inclusive executive function strategy
Use a picture of the action for “Do”
Scissor Visual- - an example of an inclusive executive function strategy
Use a picture of the item for “Get Ready”

You may start by showing  the pictures and asking, “do we cut first or color first”.  Using “first” and “then” concepts allows your child to know there is a progression to activities and reflect on the order.  The child can point, answer or place the icons in order. 

Get Ready

Several strategies will assist the individual to be actively engaged in the “ Do” and “Get Ready” process.

  • Use picture icons that allow the child to point to or grasp to put in the “Get Ready” column. Using Velcro to keep the pictures in position may be helpful.
  • Use an augmentative communication device with a page that lists options and allowing the child to point to or use a stylus to access their selections individually. The child can then grasp the item to put into their “waiting area” bowl or box or you place them upon making their selection.

Summary

How does a child with neuromotor impairment that may lack the postural control to move, reach and communicate get the same opportunities to develop executive functioning skills as other children?  Structuring the learning opportunity and providing activities in a manner that supports their thought processes to plan and participate in the execution of tasks is important. Incorporating alternative strategies to minimize hand over hand assistance is the start.  The key is to  let the child do as much for themselves as possible both in terms of thought process and motor participation.  Learn more about Executive Functioning by listening to Therapro’s Lecture series on this and other topics.

References

Ward, S., & Jacobsen, K. (2014). A clinical model for developing executive function skills. Perspectives on Language Learning and Education, 21(2), 72-84.

What Is Executive Function? And How Does It Relate to Child Development? (N.D.) Center for the Developing Child Harvard University. https://developingchild.harvard.edu/resources/what-is-executive-function-and-how-does-it-relate-to-child-development/

PowerLink 4 Control Unit Assistive Technology Solution

Enhance Access with the PowerLink

Assistive Technology, Daily Living, Therapist Resources, , ,

A PowerLink is a game-changer for enhancing access, especially for users who rely on switches to interact with the environment around them.  With a PowerLink, users can take everyday, corded, electrical appliances and make them switch accessible.  The concept is simple: plug a corded appliance into the receiver of a PowerLink, pick your interaction mode on the PowerLink, and add a switch. With this setup up users can control the on and off function of whatever corded appliance is plugged in.  The PowerLink opens the door for participation in a variety of everyday activities.  

  • Enhance Access with the PowerLink in Classrooms and Offices: Tools commonly used in the classroom or in an office setting are easily made switch accessible using a Powerlink. Try plugging in an electric pencil sharpener, electric stapler, electric hole punch, or paper shredder to allow switch users to become an active participant in vocational training opportunities or classroom jobs.  
  • Enhance Access with the PowerLink in the Garage: In woodshop class or in your home garage some simple, corded tools like an electric screwdriver or hand held sander can be made switch accessible with a Powerlink.  
  • Enhance Access with the PowerLink in the Kitchen: In the kitchen, plugging in simple appliances like a blender, hand mixer or can opener to a PowerLink can help users increase their participation in cooking activities.
  • Enhance Access with the PowerLink for Self Care: A well-positioned hair dryer plugged into a Powerlink can give users more independence with self care tasks like drying their hair after a shower or fingernails after a manicure! 

Looking for fun and creative ways to use your PowerLink? Download these activity ideas:

  1. Accessible Splash Art
  2. Make Music!
  3. Stimulate the Visual Senses!
  4. Switch Adapted Car Wash
  5. Switch Adapted ‘Bowling’

Self Care with Flair

Self Care with Flair: Webinar Recap

Dressing & Hygiene, Therapist Resources, ,

On Tuesday, July 28, Therapro was happy to host another successful webina, Self Care with Flair. Presenters Ginger McDonald, OTR/L and Bhanu Raghavan, MS, OTR/L spoke to viewers about Self Care With Flair and teaching independent living skills. These wonderful ladies have over fifty years of combined experience working with students across a variety of settings. Throughout the presentation they drew from these years of experience to provide illustrations of how a consistent, step by step approach works for teaching self care skills. Viewers left the webinar with helpful takeaways, including: 

Mastery of self care skills is critical for a child’s self esteem. The presenters spoke passionately about the importance of mastering self care skills early on and how this can  improve a child’s self esteem. To exemplify this they discussed toilet training: a skill needed for acceptance in a school setting, community involvement, and employability in later years.  

Use a team approach. The presenters described what they called the partiship triad, where parents or caregivers, teachers, and therapists work together in the teaching of both the self care skill itself and the prerequisite hands skills needed for successful participation. As one viewer noted, “Lots of information for both OT, teachers and parents. Love the team approach and having more information in the book will be an asset for every classroom.” – KF

Use a uniform approach. The presenters discussed the importance of consistency between everyone involved in the teaching process; from grandma, to the therapist, to the classroom teacher. Using consistent language and teaching approaches promotes learning and retention.  In the Self Care With Flair program, the same steps, the same pictures, and the same cues are used, leading to successful learning outcomes. Another useful aspect of Self Care With Flair is that the visuals can be shared with everyone working with the child, ensuring consistency across settings! As one viewer stated, “This is an excellent resource. The work has been done – rhymes, pictures, repetition. It speaks for itself!” – AH

Use rhythms. Rhymes are easy to memorize and make learning the steps of a task so much easier. Rhymes are also a great way to promote consistency across multiple environments and to help with self correction. The presenters pointed to research that supports the use of rhymes for teaching the steps of a task.

Teach Prerequisite Skills. Another important point that was covered in the webinar was the importance of addressing the foundational hand skills needed for success with self care tasks. In the book Self Care With Flair, each prerequisite skill needed for the given self care task is listed with the self care task itself. The final chapter in Self Care With Flair includes activity ideas  to address the essential hand skills needed (finger strengthening, finger to thumb opposition, forearm strengthening, lateral pinch, power grasp, thumb strengthening and wrist extension).  
The presenters also discussed modifications to meet the needs of all users, teaching tips to use when introducing these tasks, and ideas for personalization. Check out the recording of the webinar, and be sure to check out our free resources page for examples from the book!