Category Archives: Sensory

Dyspraxia: Tips for Treating and Teaching Children with Coordination Challenges

Guest post by Barbara A. Smith.

Dyspraxia is one type of sensory processing disorder (SPD) that makes it difficult for children to plan and perform motor tasks such as stringing beads or riding a bicycle. Children with dyspraxia may

  • Appear clumsy
  • easily break things because they use too much force or
  • struggle to fit their arms into sleeves or sequence steps to shoe tying

Children with SPD often have more than one of the 6 subtypes that impact how their brains interpret and respond to what they see, hear, feel, smell, taste and how they move. They may seem extra active or lethargic, super sensitive or oblivious, have difficulty controlling their body while using their hands or can’t discriminate what part of their body was touched or is in pain.  Let’s take a look at a few strategies that may help children with dyspraxia and other types of SPD as well as children who are typically developing.

Simplify for Success

Nobody likes failure; especially young children who have poor coordination to stack rings, string beads or lace boards.  Consider purchasing, making or adapting these types of activities to make success easy and frequent. Try using

  • an extra large tube as a ring stack and rings to stack. The one shown in the photo is made by wedging a swimming noodle into a juice container and has a motorized pen inserted on top to make it vibrate.  Vibration helps children to focus on what their hands are doing.
  • thick cord and shower curtain rings for stringing instead of offering string and beads. Many toddlers will find this an easier introduction to stringing.
  • lacing boards with a few extra big  holes and thick cord. I attached the photo of a horse to this lacing board that I used with clients during Hippotherapy (therapy using a horse as a therapeutic tool).
Vibrating Ring StackLacing Board

Practice Makes Perfect

Design activities to require repetition. When a child closes a jacket there is usually only one zipper to connect or a few buttons. Many children benefit from the repetition of closing several button squares. As I describe in my book From Rattles to Writing: A Parent’s Guide to Hand Skills, these are made by sewing a large button or round plastic piece (see photo) to fabric. Then cut a slit into another piece.  As your child develops skill, offer button squares with smaller buttons.

Button Squares

ZippersMany children are able to close a zipper once the slider is connected.  But connecting the slider onto the zipper is very tricky. In the photograph you see me wearing an old jacket and attaching several zipper sliders.  The sliders are sold in zipper repair kits or you can remove nice big ones from broken backpacks and suitcases. I have taught adults with developmental disabilities to zip their own jackets after practicing connecting and pulling up several slider every day.

Let’s Take Apart

Button BoardOpening buttons, screw caps, zippers and knots seems to be a lot easier than closing them.  One of the strategies I describe in my book From Flapping to Function: A Parent’s Guide to Autism and Hand Skills is to teach children to “ take- apart” before teaching them to “put-together”. In this way they will become familiar and successful with the materials before learning the more challenging motor skills of tying, buttoning, snapping, screwing lids etc. It is much easier to remove the fabric pieces from the “buttoning board” shown below and children will have many opportunities to practice. This board was made by drilling holes into a book stand and tying the “buttons” onto cord that is knotted through the holes.

Manipulation BoxIn my book The Recycling Occupational Therapist I describe how to make activities that are perfect for opening and taking apart. The Manipulation Box shown in the photograph has screw covers, Velcro strips, pull lids, and magnets attached to a cookie sheet so that children can remove a variety of objects to drop inside.

Keeping It Fun

Yes, practice is important but we need variation and to add sensory stimulation to keep it fun. That’s why I love

  • form boards and ring stacks that make music
  • adding a motorized pen inside containers to make insertion tasks vibrate
  • using materials such as Velcro and elastic cord that feel good to pull
  • toy animals with clothing fasteners to manipulate
  • using pretend play toys such as “Feed the Bunny”

Bunny Insertion TaskI covered an oatmeal container with fur, attached a face to the lid and photocopied some food items. Now “Feed the Bunny” is more than a plain old shape sorter. This great for working on choice making (i.e. shall we feed bunny a carrot or tomato?), identifying pictures, counting and of course promoting a healthy diet.  I hope that you have fun implementing some of these strategies!

Here are some great Therapro products I recommend that you might use in addition to the activities I’ve discussed:

Squiggle Wiggle Writer Pen
Squiggle Wiggle Writer Pen
Sound Puzzles
Sound Puzzles
Giant Plastic Nuts and Bolts
Giant Plastic Nuts and Bolts
Learn to Dress Monkey
Learn to Dress Monkey

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.

Saturday Seminar: Weighted Blankets and More

Kristi Langslet, OTR/L ended the 2017 Spring Saturday Seminar Series with her enlightening presentation: Weighted Blankets and More for Use in Your Sensory Room or Sensory Carts! She discussed benefits and applications of weighted, compression and fidget products in Sensory Rooms and Sensory Carts.

General confusion and misconceptions abound regarding the use of therapeutic weighted materials, which Kristi dispelled with her seminar. She is an experienced therapist, having worked in a variety of primarily pediatric settings. Kristi began designing and making products for her clients to meet specific needs related to sensory processing. With her sister, Heidi, she developed and launched her therapeutic products company Sommerfly, in 2005, with the goal of “Calm, Sleep and Focus for All.”

Kristi’s review of research findings regarding sensory rooms and weighted blankets was thorough. The research reviewed came primarily from studies in adult psychiatric settings, but was still applicable to broader settings and age groups. Sensory rooms have been validated as safe, effective, anxiety and distress reducers, with weighted blankets being particularly useful for decreasing anxiety. She emphasized the recommendation for the best way to use a weighted blanket is for the child to apply it on himself/herself. Research cited from Tina Champagne, MEd, OTR/L indicates that weighted blankets should weigh more than 10% of the wearer’s body weight to be most effective – with 15-25% of a person’s weight as the guideline for use. She cited studies that indicate the rise in pediatric admissions for behavioral health problems. This fact points to the need for treatment strategies that are accessible, powerful, sensory-based, and research supported.

Sensory rooms are defined as a voluntary, self-managed place to decrease stress; they empower people to care for themselves. In these rooms you might find a Sit Tight Weighted Lap Pad, a Relaxer Blanket, and a variety of other calming sensory materials such as a white noise machine, lava lamp, chewing gum, exercise bandsyoga position cardsnoise cancelling headphonescalming music CD, etc., depending on the child’s age and needs. Kristi referred to Karen Moore’s Sensory Connection books as a having a wealth of information for developing sensory rooms and carts.

In her discussion of compression garments and muscle work, Kristi reminded us that compression garments have a similar effect as deep pressure applied to the skin and heavy work on joints/muscles. Both compression garments and weighted products provide similar touch pressure sensation, with a rapid response time, but heavy muscle work response time varies. The guideline for weighted vests provided was 3-5% of the wearer’s weight is optimal with wearing times of between 15-30 minutes at a time throughout the day; accommodation occurs with longer wearing times.

Kristi reported that since the hands and mouth have a high density of touch and proprioceptive receptors, the perception of sensation in these areas is greater than in other body areas. This may explain why we naturally fidget with hands and mouth with activities like nail biting, smoking, doodling, hair twirling, etc. Hand fidget research evidence shows that distraction reduced anxiety and pain after surgery. She advocated the use of a fidget as a “tool” versus a “toy” with examples like a Wristful Fidget or a Fidgety.

In our stress-filled society, the popularity and use of mindfulness techniques has alerted us to the value of being calm and centered. Sensory strategies we employ personally give us a sense of well being and regulation. Kristi asked us to imagine what effect they might have on a child who is “at risk.” As occupational therapists, we understand the value of and can use self-regulation practices to help people function optimally. After Kristi’s presentation, we understood the application of weighted products and fidgets more thoroughly, particularly with the pertinent research cited by her. When caregivers are given tools designed to help with self-regulation, coupled with other cognitive-behavioral strategies, we can look forward to seeing the effects with our students/patients as they reengage in life occupations.

Take a look at some of the glowing comments attendees provided:

“Great to have research to back up findings. Simple facts and Ideas to pass on to school colleagues and administration.” – Fredda T., Occupational Therapist

“I tend to be relatively skeptical about these issues, but I found Kristi extremely knowledgeable and approachable, and her presentation very informative. Lots to think about!” – Maura K., Teacher

“I liked the trauma informed approach, evidence based and practical suggestions. Really appreciated the update on weight guidelines.” – Kim B., Occupational Therapist

“Great intro course for new therapist and/or parents, teachers, related fields. Most useful for experienced OTs was the research/weight & wearing prescription/demo of products. Organized, straightforward presenter. Warm, open, compassionate, available for questions and pertinent case studies. Thank you!!” – Bernadette W., Occupational Therapist

“Great answers to questions, great products, great suggestions. I like the non toy look for fidgets.” – Anonymous, Occupational Therapist

Thank you, Kristi!

Filomena Connor, MS, OTR/L
May 6, 2017

Saturday Seminar: Sensory Differences and Mealtime Behavior in Children with Autism

Jeanne-Zobel-LachiusaEvidence based practice (EBP) involves the integration of:

  1. Clinical expertise,
  2. Scientific research, and
  3. Patient/caregiver perspective.

The goal of EBP is the improvement of patient outcomes. It holds us accountable for our treatment plans, strategies and outcomes among our peers and other health care professions. According to the AOTA, generating research in the field of occupational therapy is “critically important for advancing the field and ensuring the viability of the profession.”

Jeanne Zobel-Lachiusa, EdD, OTR/L was the featured December Saturday Seminar Series speaker, who shared her research on Sensory Differences and Mealtime Behavior in Children with Autism (AJOT September/October 2015, Vol. 69, No.5).  In summary, the study results helped to identify problem eating behaviors in children with ASD that may be associated with sensory differences. Children with ASD were compared with typically developing age-matched peers. The study concluded that children with ASD who receive occupational therapy that offers sensory strategies might result in less stressful mealtimes.  The findings supported the need for further research in this area of self-care with children who have been diagnosed with ASD.

The seminar attendees were from varied backgrounds, including occupational therapy, speech therapy, special education, social work, psychology, child care, medicine, and parents. They engaged in a lively brainstorming session on sensory strategies in the different sensory domains that might provide mealtimes with less stress for both the child and family. They shared innovative as well as tried and true ideas with the group.

Just a few examples of the many suggestions include ideas for tactile and oral sensitivity:

Hush BuddyFor auditory sensitivity Jeanne suggested:

For children with sensitivity to fluorescent lights that flicker and glare in the cafeteria or classroom, Fluorescent Light Filters, which are magnetic were recommended. Another suggestion was for the student to wear a visor to reduce vision sensitivity.

Jeanne suggested a number of resources for the group including the book, Autism Interventions, and recommended the AOTA website for its user-friendly handouts on mealtime and feeding.

Producing research is essential for validating assessment and treatment strategies. Jeanne shared that her research was motivated by the question of whether interventions are actually effective.  Her current research demonstrated that there was a statistically significant difference in sensory differences and in mealtime behaviors between children with ASD and the typically developing group she tested.  This groundbreaking research paves the way for further studies to investigate specific treatment strategies discussed today for their effectiveness in helping make mealtimes a pleasurable experience for children diagnosed with ASD and their families.

To view Jeanne’s PowerPoint slides, click here.

Following the seminar, attendees provided feedback about the seminar.  Please see a few remarks below:

“It provided an opportunity to review recent literature and share strategies with other therapists.” Kristyn S., Occupational Therapist

“Loved the topic and the format. Jeanne was great!!   Diane H., Occupational Therapist

“Informative, interactive, insightful. It was interesting listening to other OTs experiences and suggestions.”  Sylvia K., OT student

“Helpful to organize sensory treatment with a food tolerance/mealtime behavior perspective.”  Anonymous Occupational Therapist

Thank you, Jeanne!

Filomena Connor, MS, OTR/L