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.

Tips to Help Special Needs Kids Tolerate Grooming and Hygiene

April 4, 2018Daily Living, Sensoryparent resources, self-care, sensory strategiesGuest Blogger

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.

Guest Blogger: 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.

Teaching Utensil Use Beyond Mealtime

January 11, 2018Daily Living, Early Learning, Feeding Toolsadaptive utensils, feeding, occupational therapy (OT) tools, speech therapy toolsGuest Blogger

It seems as natural as can be; use a child’s meals and snack times as opportunities for teaching utensil use. In this atmosphere of “least restrictive environment” and push-in treatment, this sounds like a great plan for your therapy session. Although it seems like a good idea, there are circumstances in which separating utensils beyond mealtime, at least initially, can be more effective in treatment:

Children with tactile aversions and oral sensitivity may find combining manual and intra-oral exploration to be too overwhelming.
Children with both motor and sensory issues may find that they cannot work on practicing multiple skills at the same time.
Children with behavior issues can be faced with a difficult situation: they want to eat and they want to exert control over their body or an adult’s behavior.
Kids with minimal endurance or tolerance can lack the ability to complete a meal, leaving them dependent on adults or frustrated with their fatigue or a sense of failure.

Teaching utensil use without the expectation of food ingestion can solve these problems. As skills and tolerance grow, the two experiences can be joined successfully. Here are some suggestions to make practice effective and weave it back into functional experience as seamlessly as possible:

Have the child feed an adult using child-friendly utensils and foods. A child may decide to take a bite instead of feeding the adult, so a food’s size and texture should be safe for the child’s developmental level.

Playfully scooping and piercing non-food objects such as non-edible dough with utensils and other “real” tableware may extend practice sessions while decreasing the stress of multi-sensory exposure with food.

Shape, Model, and Mold toy to build hands skills for Utensil Use — Shape, Model, and Mold

Pizza Party, a great option for Teaching Utensil Use Beyond Mealtime — Pizza Party

Cutting Food Box, a great option for Teaching Utensil Use Beyond Mealtime — Cutting Food Box

Watching the therapist eat food that the child has prepared or served with utensils reinforces the social and nurturing aspects of meal preparation and eating.
Using strategies such as backward chaining or graded exposure, activities that begin by separating utensil use from eating can become more like a typical mealtime experience over time. When children are given a “just-right” level of challenge, they make faster progress with ease.

Cathy Collyer, OTR, LMT, PLLC

Self-Care with Flair: A Curriculum

July 26, 2017Daily Living, Life Skills and Transition Planningoccupational therapy (OT) tools, parent resources, product spotlight, self-careGuest Blogger

Creative authors, Bhanu Raghavan, MS, OTR/L and Ginger McDonald, OTR/L developed a unique curriculum for increasing independence with self-care skills. The program instructs how to teach the skills of dressing, grooming, toilet training, and eating by using a uniform approach with pictures and rhyming while employing visual, verbal, and tactile/kinesthetic cues. Each task is broken down into steps through activity analysis. In June of this year, Bhanu shared her expertise with therapists, caregivers, and children in Guatemala. Here is the account of her experience.

Visit the Self Care with Flair! webpage.

Bhanu Raghavan, MS, OTR/L

Self-Care with Flair! goes international once again…

Teaching basic self-care skills to children can be tedious and is often not prioritized in school or at home, even though these skills are critical for successful transition into the community. Occupational therapists are often consulted for support with this task. A uniform approach to teaching daily living skills is critical to helping the child generalize the skills to all situations. Learning can be delayed when small differences in method and/or terminology confuse the child or when the number of steps prove to be overwhelming for the child, parent and/or teacher. Occupational therapists, Bhanu Raghavan and Ginger McDonald, authors of Self Care with Flair!, have shared their expertise in teaching self-care skills in a creative, fun way with therapists across the globe. Their methodology involves teaching self-care skills using rhymes to promote mastery and retention within a short period of time. They have based their method on evidence-based research that demonstrates that novel experiences such as rhymes and rhythm trigger the brain to sustain attention. In 2015, they presented at the British Occupational Therapy conference about their effective strategies for teaching self-care skills from their book to a packed audience.

In June 2017, when Bhanu accompanied a team of students, therapists and Professors from Xavier University (Cincinnati, Ohio) to participate in a weeklong volunteer service project in Guatemala at the Missionaries of the Highways, a clinic and residential facility for children with a variety of physical and mental disabilities. Over the course of the week, many questions about teaching self-care skills to children with disabilities arose. Bhanu shared strategies from Self Care with Flair! when she presented an in-service to the staff. During that week, strategies from Self-Care with Flair! were shared with parents and caregivers as well. Although Spanish is the national language of Guatemala, the illustrations (300+) in the book made teaching/learning quite simple and universal.

Using Self-Care with Flair! Bhanu aided the staff, parents, and caregivers in understanding that the brain learns and retains when visual, auditory and kinesthetic cues are embedded in the teaching/learning process, resulting in success for life.

At the end of the week-long service project, the staff of the Missionaries of the Highway acknowledged the ease of use and success of the Self Care with Flair! approach to self-care activities and requested a copy of the book, which was gladly given to them (See photos). Much to Bhanu’s delight, one of the OTs at the facility volunteered to translate the rhymes in the book into the Spanish language as needs arose! The week was a joyful learning experience for all!!

Self-Care with Flair!

Bhanu Raghavan, MS, OTR/L

Bhanu Raghavan A graduate of Indiana University and The Ohio State University, Bhanu has over 25 years of experience in pediatrics. She is certified in pediatric NDT and the READY Approach (Bonnie Hanschu) for Sensory Integration Disorders. Frequently, she presents workshops on topics related to self-care independence, sensory processing disorders and fine motor/handwriting skill development to therapists, teachers and parents/caregivers. She works at Centerville City schools, OH. She is a firm believer of the following Confucian principle: “I hear and I forget, I see and I remember, I do and I understand.”