Category Archives: Fine Motor

Teaching Utensil Use Outside of the Mealtime Experience

January 11, 2018Feeding Therapy, Fine Motor, Life SkillsGuest Blogger

It seems as natural as can be; use a child’s meals and snack times as opportunities to teach them how to hold and control their fork or spoon. 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 utensil use from food consumption, 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.

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

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.

Helping Little Kids Cut: Set the Stage with Demonstration and Positioning

October 18, 2017Fine MotorGuest Blogger

by Cathy Collyer, OTR, LMT

OT goals on IEPs and IFSPs for young children commonly include some form of scissor use. There is a good reason for this: using scissors independently and safely is an important preschool classroom skill. For OT’s, it is also a benchmark for bilateral control, dissociation of the sides of the hand, and the ability to control and grade force. But what do you do with kids that aren’t interested or prepared to cut?

Many young children are eager to learn to cut with scissors. They are excited to control such a grown-up tool and they like to see the immediate effects of their actions as the paper bits fall to the floor. Not all interest results in a good outcome. At times, they are so enthusiastic that they act in unsafe manner or use scissors in inappropriate ways.

Some kids fear scissors; they are often the children who fear failure and shrink from a challenge. And finally, there are children who have little interest or excitement in participating in any fine motor tasks. Whether due to frustration or a preference to act on their environment with sensory-based or gross motor skills, their behavior suggests that they couldn’t be bothered by learning to use scissors.

Children that struggle to cut can become discouraged and lose their initial excitement for mastery of this important skill. By allowing them to observe and practice pre-training skills before you introduce the act of cutting, you can improve your chances that they will develop and sustain enthusiasm and good safety skills with scissor activities.

There are children over 3 who have never been allowed to use a scissor due to adult safety concerns, lack of appropriate tools/assistance or developmental delays. A child’s initial exposure to scissors can be as simple as directing a child’s visual regard to your use of scissors as part of a therapy activity.

Make sure that you narrate your actions in short phrases with emphasis on action words.
Use an enthusiastic tone and gestures that sustain the child’s attention and interest.
Make practice short: in fact, end practice before a child is frustrated or bored.
Finally, make it clear that you expect that the child will be able to use scissors as they grow and develop more hand skills.

Children benefit from being able to see an adult’s hand movements while cutting. Your students may have been discouraged from being too close to an adult model due to safety concerns. Some adults are unaware that children need exposure to develop interest and excitement in the use of scissors. Use the safest scissors available with impulsive children who may reach for your scissor blades in their eagerness to learn about this exciting tool.

Once interest has developed, you may want to assist children as they open and close the blades. Scissors that are spring-loaded or have finger spaces for an adult can help, or you could place your fingers between the handles to facilitate movement. The sound of the blade movement is fascinating to young children, even without bringing the blades to the paper for cutting. Practicing alternating opening and closing the blades may be your entire activity for the therapy session. By breaking down the actions of scissor use into their precursor parts, you are decreasing a child’s frustration and increasing the likelihood of later success. Hand-over-hand assistance can be helpful when combined with independent scissor use. Gradually fade out this assistance out to allow maximal proprioceptive and kinesthetic input.

Children with hand and wrist weakness or poor sensory registration and discrimination benefit from scissors that provide more support and allow more of their hand to be involved in cutting. Create textured handles with tape on classroom scissors or use Fiskars Total Control Kids Scissors that provide more digital control and encourage activation of intrinsic musculature to support development of the horizontal and vertical arches in the hand while cutting.

Provide additional postural support to children with instability and core activation issues. They may require more proximal stabilization than they appear to need for other tasks. Well-chosen classroom chairs or even a corner sitter may give a child the motor support needed to achieve optimal stability for learning a new motor skill. Beanbag chairs diminish sensory-based distractibility while providing full-body support. Once the new skill is mastered, the degree of support can be decreased gradually.

By focusing more on pre-scissor activities and thereby maintaining a child’s enthusiasm and attention to task, you will increase their ability to persist with practice, and have a more productive therapy session!

Cathy Collyer, OTR, LMT, PLLC

Getting Creative with Sweatshirts and Seat Cushions!

March 27, 2017Fine Motor, Gross Motor, SensorimotorGuest Blogger

Guest post by Barbara A. Smith.

Sensory Processing disorders (SPD) impact how children and adults respond to sensory stimulation such as sound, touch, what they see and movement. One basic principle of occupational therapy for individuals with SPD is to provide controlled, graded and individualized sensory stimulation to promote functional skills such as playing catch or writing one’s name. This means that activities such as tossing bean bags into containers while the child is suspended on a swing can be:

Controlled – as the therapist responds to the child’s reactions. For example, the therapist might push the swing faster, slower or in a different direction,
Graded- as the therapist chooses the type of swing used, how long the activity lasts, how heavy the bean bags are and how far away the container is positioned, and
Individualized – according to the child’s sensory, emotional and motor needs. For example, the child may wear a squeeze vest during the activity, name an animal each time the bean bag is thrown or have a special friend hold the container.

What is a Sensory Diet?

Parents can implement individualized sensory strategies at home in what is called a “Sensory Diet”. This is like a recipe book of activities and adaptations that the therapist designs for parents to carryover at home, school or in the community. It is important to frequently discuss with the therapist how these strategies are working out since children grow and change rapidly along with their sensory needs in different settings.

In my book From Flapping to Function: A Parent’s Guide to Autism and Hand Skills, I describe the 6 different subtypes of SPD and some general strategies to use with children who have each type. These strategies usually impact the following 3 sensory systems:

Tactile – uses sensory receptors in the skin to interpret sensations, such as light and heavy touch.
Proprioception – uses receptors in joints and muscles to tell us where the body is and how it is moving in relation to objects and space.
Vestibular – tells our body how to respond to the pull of gravity and movement of the head. It is also called the balance system.

Now for the fun part…

Many children with or without SPD LOVE deep, heavy pressure experiences and movement. This includes children on the autism spectrum or those with other types of developmental disabilities. One very simple strategy is to provide some type of “dynamic seating”. This simply means that the child can bounce, wiggle, rock or move around in some other way while seated. Many teachers incorporate seat cushions and ball chairs in the classroom to help students focus. The Disco Seat is one popular product. An inexpensive alternative is to sit on a deflated ball, as I am doing in the photo. Don’t have one available while eating out or sitting in the movie theater? Consider rolling up a sweatshirt for the child to sit on or curl up inside of to get a full body squeeze.

Speaking of sweatshirts, I have had great success in helping a young lady named Judy to be more focused and less agitated by placing a Disco Seat cushion inside the body of a sweatshirt. The photo shows Judy sitting on the cushion, enjoying some gentle bounces with the sleeves slung over her lap.

The sleeves are heavy because I put bags filled with sand inside of them. Next I sewed the wrist and shoulder ends of the sleeves closed so that the bags wouldn’t fall out. This adaptation can be used in a various of ways. The sweater may be placed over the back of a chair so that the heavy sleeves are draped over the child’s shoulders and body. Placing the cushion inside the sweater is optional.

A young man named Eddy, craves extreme movement and is typically agitated unless in a rocking chair, bungee seat or swing. You can see in the photograph that his chair is adapted to not tip over given all of his body rocking. He LOVED when I attached the sweatshirt with enclosed seat cushion to the back of his chair so that he could slam his back into it while rocking. I know that he enjoyed the deep pressure bouncy sensation because he became calmer, quieter and smiled. The heavy sweatshirt sleeves are draped over his lap. I did my best to capture how I set this up in the following video while maintaining his privacy.

Seat cushions and lap bags that are a lot nicer than the ones I make with a deflated ball, sand and plastic bags are sold by Therapro, Inc. Whether you are reading this blog post as a caregiver, therapist or other type of professional, I hope that adding these simple sensory strategies to your tool box helps the people you love or work with improve their quality of life. This is why I love being an occupational therapist!

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.