Category Archives: Fine Motor

Using Weight to Improve Body Awareness and Motor Skills

October 1, 2013Fine Motor, Gross Motor, Sensorybilateral hand use, body awareness, deep pressure, fine motor, gross motor, motor planning, proprioceptive input, sensory processing disorder, spd, vestibular movement, weighted materialsTherapro

By Barbara Smith, M.S., OTR/L

Many individuals with a sensory processing disorder (SPD) have poor body awareness. This means that they have difficulty perceiving where their arms and legs are in relation to other objects and people. They easily trip, knock things over and lack a sense of personal space. Possible signs of decreased body awareness include:

sitting or leaning on others curing circle time
awkward gait
clumsiness during ball play and other gross motor activities
poor fine-motor skills.

Children with poor body awareness often have motor planning difficulties. It’s challenging for them to plan and perform skills such as riding a bicycle or cutting out shapes when challenged to perceive:

how much force to use
the spatial relationships between oneself and objecs
the spatial relationships between objects,

Occupational therapists use a variety of strategies to improve body awareness and motor skills. Let’s take a look at a few that involve adapting with weighted materials.

Weighted Materials

usingweight1 Many children love to snuggle up in heavy and/or tight blankets. Weighted vests, toy animals, collars and other products increase body awareness and also have a calming affect. Gross motor activities (such as wrapping up inside a blanket while rolling across a mat, or rolling across cushions and pillows) combine heavy pressure and vestibular movement stimulation. This helps children interpret how their bodies are moving.

Using heavy materials such as shovels during activities provides proprioceptive sensory input to joints and muscles. The girl shown in the photograph is not only using a heavy shovel but she is also moving around heavy dirt. This is an ideal activity to increase body awareness!

When materials are not naturally heavy, we can adapt them. For example, the “pegs” used in this board (made out of cardboard boxes) are not only extra large because they are made out of bottles, but extra heavy because they are filled with water. The “pegs” provide visual, auditory and proprioceptive cues that helps guide the individual’s hand during placement.
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Sensory Socks and Rings

usingweight3 Filling socks or tights with sand creates “Sensory Socks.” (To increase length, you may sew several small socks together. To prevent sand leakage, place the sand in a plastic bag before placing inside the sock.)

Many children with decreased body awareness neglect one side of the body and try to do everything using one hand.

Using large, long, heavy and awkward materials such as “sensory socks” encourages bilateral hand use. Begin by offering a container with a large opening and grade, then graduate to using containers with smaller and smaller openings so that the child needs to manipulate and push with the fingers.

Some children with decreased body awareness will try to insert the sock by dangling the distal end. This activity is a great way to help children problem solve by grasping the socks at the end closest the container opening.

Note: Smaller sensory socks can also be used during tossing activities.

Sew the ends of the socks together to create rings! Explore the variety of heavy objects that can be used to weight these, such as:

pennies
marbles
dried beans/lentils/rice.

Some of my clients enjoy the sensation of putting these rings on and off their arms.
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Occupational therapists often recommend weighted products such as the following to promote function during daily living skills:

spoons, forks or cups
pencils and pens
gloves to aid in handwriting
balls.

In addition, wrist weights can be used during any fine-motor activity to increase body awareness.

Sensory Bags

usingweight5 Possible homemade adaptations include adding sand to stacking boxes and tossing/catching a “sensory pillow.” This pillow case filled with foam and small bags of sand is easy to grasp, fun to hug and won’t roll away.

Many children naturally meet their sensory needs during play as they wrestle, have pillow fights and crash into mounds of leaves. Here are a few more fun “weighted” activities to add to a child’s sensory diet:

placing heavy toys on a blanket or in a wagon to pull
carrying buckets of water or sand to fill sensory tables
hiding heavy toys inside the tables to remove and bring to another area.

As you can see, there are many ways to adapt environments and activities with weight. Let’s review why: pushing, pulling, squeezing and lifting heavy objects stimulates the muscles and joints, increasing body awareness. Deep pressure is calming and may improve focus. Improved focus and body awareness help children to plan movements so that they can play and learn to the best of their ability. So now that you know the scoop – let’s get weighting!

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Barbara Smith, M.S., OTR/L has worked with children and adults with developmental disabilities in a variety of settings over the past 30 years- including early intervention programs, public schools, special education collaboratives, day habilitation programs and community residences. She is the author of The Recycling Occupational Therapist, 2nd edition (RecyclingOT.com, 2012) and From Rattles to Writing: A Parent’s Guide to Hand Skills (Therapro, Inc, 2011).

Check out Barbara’s website for information and resources at: RecyclingOT.com

Special thanks to the model and her mom at Fumbling Thru Autism.

Illustrations are from the author’s book The Recycling Occupational Therapist.

Using Movement to Motivate and Develop Hand Skills

September 4, 2013Fine Motor, Hippotherapy, Occupational Therapy, Strength & RehabBarbara Smith, fine motor, hand skills, Hippotherapy, Occupational Therapy, OT, Sensory ReinforcementTherapro

By Barbara Smith, M.S., OTR/L

usingmovementtomotivate1 Movement, whether on a horse, swing or trampoline, provides sensory stimulation that nourishes the brain and in turn promotes attention and learning. Movement can also be used therapeutically to motivate children to engage in hand activities.

As an Occupational Therapist working at Ironstone Therapy in Andover, MA, I am able to use a horse as a treatment tool to work on traditional objectives such as improving bilateral coordination.

Hippotherapy is often very effective because children love bonding with the horse. Instead of in an office, this kind of therapy takes place in a happy environment where simply sitting on top of the animal is the first of many small successes.

Let’s begin by looking at Amber, a hippotherapy client. When I first met two-year-old Amber she arrived singing “Old McDonald Had a Farm.” She continued to sing while mounting and riding. She never looked at me, and seemed unaware of what her body was doing, and also unaware of the people around her.

Fortunately, Amber loved movement. She didn’t like it when I stopped the horse. I began singing “If You’re Happy and You Know It…Clap Your Hands/Pat the Pony/Blow a Kiss,” etc. At first I used hand-over-hand assistance to help Amber perform the hand movements. When she ignored me, I stopped the movement. Amber soon learned that by engaging and using her hands, she could avoid stopping.

This example describes how movement can be used as reinforcement. A “reinforcer” is anything that makes a person want to repeat a behavior. Examples of reinforcements can be hugs, stickers, special treats, and even paychecks that motivate one to keep going to work.

Movement can function as a “sensory reinforcement” when it:

Motivates the child to repeat the desired behaviors (i.e. clapping hands)
Provides sensory input that organizes the brain

An important aspect of developing hand skills is learning to tolerate touch. Children receive deep pressure stimulation to joints and muscles as the horse gently bounces up and down during the walk.

usingmovementtomotivate2 During hippotherapy, children are encouraged to engage in simple hand activities such as giving high five while prone (on the belly).

Children may assume different positions, such as facing backwards while bearing weight on forearms or hands. Bearing weight helps to decrease touch sensitivities (i.e. tactile defensiveness) so that the child is more willing to grasp and manipulate objects.

Occupational and physical therapists often position children in “prone” position (on the belly) using swings, therapy balls or a scooter board so that children:

Develop postural control
Strengthen trunk, shoulders, neck and eye muscles
Bear weight on hands to decrease tactile defensiveness
Receive vestibular (movement that stimulates the inner ears) sensory stimulation that organizes the brain
And of course, are motivated – because movement is fun!

usingmovementtomotivate3 The smart mom at We Can Do All Things explains how her daughter developed postural control by working on fine-motor activities while on the swing. The movement also made puzzles and ring stacks extra fun.

Scooter boards can also be used to develop sequencing and bilateral coordination as children “scoot” to a desired activity. The child might also be asked to scoot back and forth to bring game or puzzle pieces to a board. The clever mom at Fumbling Thru Autism motivates her daughter by integrating movement activities throughout the day.
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Children can engage in a variety of hand activities while on a horse or other movement apparatus to develop basic skills such as reaching and grasping and more advanced skills such as:

Stabilizing with one hand while manipulating with the other
Orienting shapes to fit through openings (developing visual perceptual skills)
Sequencing several steps

For example, the client shown in this photo is inserting Lotto cards into the slots I cut into a detergent bottle. The slots are cut in vertical, horizontal and diagonal orientations so that she can practice positioning the cards to fit. Some of my more experienced clients can use this activity while kneeling or standing on top of the horse!
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This child is using a magnetic Bingo wand to catch the goldfish while developing visual attention, postural control and sequencing skills as he removes the fish to place in an attached basket. The fish is cut out of a detergent bottle and has a paper clip attached so that it can be used in magnet games. This activity also helps children to coordinate using their hands together as they remove the fish from the Bingo wand.
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Most therapists and parents do not have a horse available to use for sensory stimulation and reinforcement. However, the principles are the same when using other movement equipment – or no equipment at all. Young children may be twirled around after putting rings on a stack and older children may enjoy performing jumping jacks as they spell words. Most children of any age or ability level love to move and are motivated to communicate “go” with gesture, pictures or vocalizations. So what are you waiting for? Let’s get moving and developing hand skills!

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Check out Barbara’s website for information and resources at: RecyclingOT.com

Getting it Write: Wrist Extension in Handwriting

October 23, 2012Fine Motor, Handwritingfine motor, Handwriting, Write Slant BoardsTherapro

gettingitwrite Here at Therapro we have a BIG focus on handwriting – from Programs, to Practice Worksheets, to Grips and Tools for maintaining proper positioning. Since positioning is the foundation for good handwriting, we recommend emphasizing these skills right from the beginning.

The best position for handwriting is with the wrist in extension. This extension provides the support necessary to get the hand into a tripod position to hold the pencil.

We’ve noticed two trends recently that can hinder proper handwriting development:

Children have been learning to write, and using pencils much earlier
Children have a tendency to “hunch” their shoulders due to poor muscle tone
People don’t put babies on their stomachs anymore, meaning they don’t learn to push up – leading to weaker arm and shoulder muscles

The reason these can be an issue is because they’re using the wrong muscles of the hand – what happens is they get a “death grip” on the pencil from holding it wrong, and keeping the wrist in the wrong position.

If babies don’t gain arm and shoulder strength, this can manifest itself when first grade teachers introduce handwriting. Low muscle tone leads to poor posture and grip, which become evident when the child first learns writing skills.

The way to get out of these bad habits is to put the wrist into extension. Since you don’t want them writing all over your walls (we don’t, at least!), the solution is a slanted surface. Having an incline of at least 20 degrees is the ideal angle for wrist extension and proper handwriting technique. Getting the writing surface more toward vertical will straighten the wrist and provide the support needed to hold a pencil correctly.

Our Write Slant Boards were first developed for the adult market, but are great to use with kids, and in the classroom. The slant board not only puts the wrist in extension, but it is also good for vision, visual tracking, and strengthening posture.

In the same vein as our Write Slant Boards is the Preschool Board, which not only is excellent for learning handwriting, but is also a versatile desktop tool. The idea was developed by an Occupational Therapist. It can be converted from a 30 degree angle for handwriting, to a 60 degree angle to be used as an art easel. The Preschool Board also comes with built-in storage for all of your writing and art supplies!