Executive Functioning – Making Strategies Inclusive

June 20, 2022Assistive Technology, Executive Functioningaccess, adapted equipment, executive function, inclusion, OTGuest Blogger

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”

Alistair references done while he uses the Functionalhand to paint his cow.

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.

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/

Keeping Skills Sharp All Summer Long: Summer 2022 Edition!

June 8, 2022Activities, Fine Motor, Gross Motor, Occupational Therapy, Sensorimotor, Sensoryfine motor, hand skills, Handwriting, sensory, summer funAllyson Locke, M.S., OTR/L

Allyson Locke M.S., OTR/L & Sarah Glovasky M.S., OTR/L

Summer is fast approaching but that doesn’t mean kids need to lose the skills they developed over the last academic year! Last year, we posted a blog filled with summer activity ideas geared toward preventing the “summer slide”. As therapists, we know summer activities provide numerous opportunities to develop and build skills that will be needed for the upcoming school year in fun and non threatening ways. So we are bringing back the topic with this new post. New this year are more activity ideas and contributions from Sarah Glovasky M.S., OTR/L! As always appropriate supervision is recommended!

Get Messy!

Messy play is a great way to develop the sensory skills needed for important school tasks like handwriting and social interactions. Summer is the best time for these messy activities because they can be done outside leaving the mess outdoors. An added bonus is that it is usually warm enough for a quick wash with the hose before going back inside. A few ideas to try:

Hide objects (like rocks, sticks, or mini animals) in a pile of mud, shaving cream, or leaves. How fast can you find them? How many can you find in 10 seconds? Not only is this a great sensory activity it helps strengthen the visual perceptual skills needed for academic tasks like reading!
Stomp in rain puddles, roll down a grassy hill, or skip through a soft patch of dirt. These big body movements help develop the vestibular and proprioceptive systems which are so important for self regulation!

When it is too hot or too rainy to go outside there are still plenty of opportunities for sensory exploration that are a bit less messy!

Make a sensory collage with items found in the recycling bin or use the Sensory Collage Kit! How many different textures can you incorporate? What textures do you like to feel? As a bonus, ripping, crumpling and rolling paper, tissue, and cardboard are all great ways to strengthen the muscle of the hand. For more ways to use recycled materials check out Second Hand Therapies.

plastic container scooping water and dumping it into a yellow bin filled with water — **Jug Scoop**
From: *Second Hand Therapies: Recyclable Strategies & Useful Tools*

Make Art!

Art projects afford great opportunities to develop the small muscles in the hand. This muscle development is critical for academic tasks like writing with a pencil and cutting with scissors. Get creative with your art projects, try:

blue turtle made of playdough with a green shell and colorful dots

3D Art. Three dimensional art helps kids build form and space concepts. Building a fairy castle outside is a great way to learn about size concepts. Inside, building with blocks, clay or even pillow cushions is a great way to explore how these concepts work. To add a sensory component try using scented dough!
Tie-Dye Prints: This is a great outdoor activity! First color an old bed sheet or large piece of paper with washable markers. Next use a spray bottle, filled with water, to squirt the drawing. Watch the colors mix and swirl together! Using a spray bottle not only helps build the muscles in the hands it is also great for bilateral coordination! For a smaller scale version, use an eyedropper to wet the paper!
Draw pictures in the dirt or other mediums like pudding (great for kids who like to explore with their mouth!) Use a stick, rocks, or fingers to draw with! We still love the Ed Emberly drawing books when you need drawing inspiration, stencils are another helpful tool! Drawing is so important for early writers and is great for visual perceptual development!

Play With Bubbles!

Many skills can be targeted with simple bubble activities. Eye hand coordination and oral motor development are just a few! Blowing bubbles is also great for attention and regulation; to learn more about this check out the book M.O.R.E.: Integrating The Mouth With Sensory And Postural Functions. For fun with bubbles, try:

Making Bubble Art! Make bubble paint by putting a small amount of bubbles and a dab or two of food coloring in a bowl (use different bowls for different colors). Use a bubble wand and dip it into your favorite color. Blow the colored bubbles right at plain paper and watch the designs come alive!
Play Catch! Chasing after, stomping on, and catching bubbles are great ways to get some extra energy out. It is also a great way to develop eye-hand coordination and the visual skills needed to complete academic tasks like copying from the board. To make bubbles easier to catch try using Touchbubbles!
Make A Mountain of Bubbles! For a fun indoor activity, fill a small dish bin or other similar size, shallow bucket with lots of dish soap and a few inches of water. Use a straw to slowly blow into the water to make a mountain of bubbles. To really work the muscles in the mouth try a long straw or one with lots of twists like the Krazy Drinking Straws or Connector Straws.

With these fun activity ideas the learning doesn’t have to stop when school is out. Keep skills sharp and be ready for the upcoming school year!

Developing Sensorial Skills

May 18, 2022Sensory, Uncategorizeddevelopment, play, sensoryAllyson Locke, M.S., OTR/L

Allyson Locke M.S., OTR/L

Porch, the home services platform, recently reached out to Therapro for help with their latest article, Expert Advice to Design the Ultimate Kids Playroom at Home. The question needing an answer was, what toys and products can help kids develop sensorial skills? Therapro’s team of experts had a lot to say on this topic! Read on to see what Therapro shared and be sure to check out the full article!

Read the Full Article!

Sensorial skills encompass the five well known sensory systems tactile/touch, gustatory/taste, olfactory/smell, auditory/hearing, and visual/ sight as well as the lesser known vestibular and proprioceptive systems. With so many different systems the answer to this question is quite extensive.

Fidgets and chews are typically well known and well associated with sensory and sensorial development. Chews, as their name implies, are a category of items that are designed to be chewed. Chewing provides great proprioceptive input through the jaw area; this type of input can be very helpful for soothing but also great in the development of this system. Some chews have added textures (like bumps or ridges) that add a tactile component. Therapro offers a free handy guide, Choose Your Chew, to help make it easier to find the perfect chew. Fidgets are generally small objects that are held or manipulated. There are many fidget options available; depending on the fidget’s characteristics, they can help alert (wake up) or calm the sensory system. Therapro offers a free handy guide, Find Your Fidget, to make it easier to find the perfect fidget.

Games and activities that involve movement and body position sense are great for targeting the vestibular, tactile, and proprioceptive systems. Some examples of games include; Trunks, Spark Action Floor Game, and the Body Awareness Fun Deck. Movement based activities include playing with a parachute, riding a scooter board, completing sensory paths, doing yoga, and making obstacle courses with things like balance beams or stepping stones. Adding music enhances the movement experience by adding an auditory component. The resource Sensational Fun: Recreational Activities For Sensory Diets And Fun, includes over 100 activities for parents and teachers who are looking for some great sensory games using common objects found in the home and school (free sample activities are available!).

Games and activities that involve touching and feeling are great for targeting the tactile sense. Games and activities that have a specific tactile focus include; Tactile Search & Match, Feel ‘n Find, Sensory Collage Kit, Ruff’s House Teaching Tactile Set, and Gel Activity Pads. Playing with clay/ playdough is another great option and scented dough has the added benefit of bringing in the olfactory sense.

Multisensory environments are another option for immersing in the sensorial experience. Unlike traditional multisensory environments, the Luminea line of products offers an interactive component through its app or optional switches. With this, Luminea allows for true interaction between the user and components which is essential for sensorial development.

Play is a necessary component in the development of sensory skills. There are a vast variety of toys and products available to enhance the development of play. In choosing the most appropriate toy or activity considering a child’s interest, developmental level, and skill areas you wish to target are key!