Tag Archives: fine motor

Saturday Seminar: OT Rubrics for Fine Motor, Visual Motor and Handwriting Skills

Valorie Todd, MA, OTR/LWhen a group of OTs get together to brainstorm, there’s bound to be some exciting “stuff” that is the outcome. Valorie Todd, MA, OTR/L and her school-based practice colleagues in the New York and New Jersey vicinity had a goal in mind. They wanted to devise a way to monitor quarterly progress in performance skills they identified as “OT goals” or “Areas of Need” on the IEP that was based on normative data. Valorie discussed the rubrics her group developed during her Therapro Saturday Seminar Series workshop on August 22, 2015 entitled:  OT Rubrics for Fine Motor, Visual Motor and Handwriting Skills.

This seminar was the kick-off for the Fall Saturday Seminar Series and attracted about 60 attendees who listened closely, commented freely, and shared thoughts. Valorie and her colleagues were determined to conceive a way to assess a student’s performance against predetermined criteria, in which a student is measured against his own performance.

Valorie’s group identified 7 areas for assessment including:

  • Postural Control
  • Sensory Modulation
  • Ocular Motor Skills
  • Object Manipulation: Fine Motor/Hand Skills
  • Controlled Tool Use: Color, Trace, Cut
  • Design Copy: Graphics/Objects, and
  • Handwriting.

In her seminar, Valorie discussed Object Manipulation, Controlled Tool Use, Design Copy, and Handwriting. Fine Motor Rubrics for Kindergarten and Grade 1 were identified.

Valorie offered a thoroughly researched plan on how to assess function and address the skill through worksheets that acknowledged how a student was expected to progress sequentially in each area.  She made clear distinctions in skills expected of a kindergartner versus a first grader.  For example, when assessing “Tracing,” specifically Pencil Control:

kindergartner would receive a score of 4 if he:

  • “Controls lines with min. errors 90-100%”
  • “Stops/turns at corners (angles/arcs)”

A first grader would receive a score of 4 if he

  • “Has good control within/on lines in all directions (90-100%)”
  • “Starts/stops on dots with 1-2 errors”

Valorie’s rubrics were well-defined and can be easily replicated. She was very enthused about sharing her work, including worksheets, and encouraged therapists to use her rubrics and provide her with feedback so that the rubrics can further be developed with input and use over time. As a result, a meaningful assessment of quarterly progress can be obtained and insufficient areas can be addressed systematically and meaningfully before the student is due for the next standardized evaluation.

Attendees comments were very positive and encouraging:

“It was excellent! So much info, well related to school based OTs. This will be helpful in writing goals, tracking progress, presenting at meetings, and for my Teachpoint eval.”  Amanda B., Occupational Therapist

“It helps so much to have these rubrics to support our clinical observations when IEPs are moving toward data driven/measurable goals and objectives. It will help with tracking and also guide thinking when working on skills.”  Anonymous, Occupational Therapist

“Love the practicality of the Rubrics.  Anything we can take away & use is terrific!”  Amanda H., Occupational Therapist

“Looks at detail of task performance and observation of foundational skills which students have or need to build on.”  Anonymous,  Occupational Therapist

“I would recommend this seminar to a colleague because it was well researched and the information was very comprehensive.  The material is very current and I can readily apply this information.”  Anonymous, Occupational Therapist

Thank you, Val!

Filomena Connor, MS, OTR/L

Using Weight to Improve Body Awareness and Motor Skills

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

usingweight1Many 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

usingweight3Filling 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

usingweight5Possible 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

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

usingmovementtomotivate1Movement, 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.

usingmovementtomotivate2During 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!

usingmovementtomotivate3The 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.
usingmovementtomotivate4

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!
usingmovementtomotivate5

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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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