Tag Archives: OT

Attachable FootFidget® Footrest

Flexible Seating Options in The Classroom & Home Learning Environments

Autism, Sensory, , , , , ,

Allyson Locke M.S., OTR/L

In this post we take a dive into flexible seating options that are available for classroom and home  learning environments.

First, What Does Flexible Seating Mean?

Sometimes called alternative seating, flexible seating is simply a seating option that is different from ‘traditional’ seating arrangements and is often used to address a sensory need. Traditional seating arrangements may be things like the desk chair students use in a classroom, the dining room chair at the eating table or the office chair at a work desk. Flexible  seating arrangements  may be a therapy ball in place of an office chair or it may be a beanbag in place of the traditional student desk setup. Read on to learn more!

classtoom showing traditional desks attached to chairs
Traditional Classroom Seating
Flexible seating arrangement showing a boy sitting on a Kore Wobble Stool and working at a Kore Sit to Stand Mobile desk.
Example of a Flexible Seating Arrangement with the Kore Sit to Stand Mobile Desk

Next, Understand the Importance of Flexible Seating Options in Learning Environments.

Having a variety of seating options helps to ensure all learners have a setup that is most effective for their learning style. Some options may help to address underlying sensory needs while other options  provide the movement that has been shown to be preferred by students when learning (Cole et al., 2021, 72).   Having just the right seating arrangement can make the difference between a successful learning experience and one that is full of distractions, position changes, and learning sessions that don’t  last as long as they should.

Finally, Pick the Right Seating Options. 

Understanding the need (or needs) you are trying to address will help you determine the best seating option(s).

For the wigglers, movers, and bouncers who just need a little extra sensory input to focus and sustain attention, try a seating option that provides movement (vestibular) or light touch (tactile) input. A seating option that provides tactile or vestibular input will help the sensory system that is seeking movement, get it in a way that is more conducive to learning and working. 

chair with wobble feet attached

Wobble Feet: These are simply four, rubber domed shape ‘feet’ that slip onto a standard chair leg.  The Wobble Feet provides a subtle rocking and a soft bounce feel.  These are especially popular for users who are looking for a “low profile” option; they can be slipped onto a regular classroom chair and are small enough that they are not very noticeable in the sea of classroom chairs. 

red and blue senso spot seats, round disks to sit on with a textured side

Sensory Spots: Spot Sensory Seats and Senso Seat Pads are flat pads that have a textured side.  This textured side provides subtle sensory input without much challenge to postural stability. They can be used in just about any seating situation and can easily roll up when moving seats.

wiggle seat sensory cushion, butterfly shape, basketball shape, flower shape, and monster shape

Cushions: Air filled or foam cushions can be added to just about any chair, bench or even used on the floor.  They are usually round or wedge shaped but newer versions now offer fun shapes like monsters or flowers.  The amount of air, that can be added, to the air filled cushions is typically adjustable allowing for users to increase or decrease the amount of movement offered.  Cushions are generally portable making them a great option for those who change work areas throughout the day.  For even more convenience options with handles are now available!

Wobble Stools: The Kore Wobble Chair offers a seating option much like sitting on a stool with the exception of the innovative rounded bottom that allows the user to rock in all directions.  In addition to the rocking movement the stool shape allows more freedom to move the legs in different positions.  

the alert seat a large round ball inside a metal base with wheels for sitting

Ball Chairs: Ball chairs come in all shapes and sizes. At the most basic level a large therapy ball is used in place of a chair. This is a great option for users who need a lot of input but therapy balls are unstable and can be difficult for users with poor postural control.  A base can be added under the ball to help prevent the ball from moving out of position.  Another option is to use a peanut or egg shaped ball; these balls have an elongated shape that increases stability for the user.  The  Alert Seat puts the traditional therapy ball on a wheeled base allowing for more mobility.  The Ball Chair Deluxe  takes the shape of a traditional office chair but replaces the seat with a large inflated ball.

For the fidgeters, hair twirlers and those with a little extra nervous energy try a seating option that provides deep pressure input or gives the big muscles a chance to work. This type of input can help calm an anxious or overstimulated sensory system. Try:

foot swing, a small plastic stand that goes on the floor under a work space. it has two pedals to place the feet. the peals move back and forth

Body fidgets. Unlike smaller, handheld fidgets, body fidgets allow other parts of the body to interact with the fidget leaving the hands free for work.  Foot fidgets can be attached to chair or desk legs, allowing users to kick, push and pull the heavy elastic bands with their feet.  For users who frequently change work spaces portable foot fidgets are available; these can be placed under the workspace and interacted with in the same manner. The footroller is a unique body fidget; fidgeters place their foot on the roller, spinning it forward, backward or both ways. Another unique option is the Foot Swing; the foot swing allows for a silent swinging motion of both feet, independent of each other. 

boy sitting at a desk with ta weighted neck wrap around his neck and resting on his shoulders

Weight. Adding weight to the lap or shoulders is a great way to center, orient and calm an over responsive or anxious system. An added bonus, many offer textured covers for additional tactile input.

For those who just need a change of scenery, setting up an alternative work spot is a great way to refocus.  Some options include: 

  • Standing at a counter height work space or taping work to a wall are options to allow for standing positions while working. To add a little dynamic movement try standing on a foam wedge or air cushion.
  • Laying Down.  Working while laying on the stomach is a great way to provide proprioceptive input through the shoulders joints (perfect for those needing calming and organizing input).  This position also gives students who are struggling with postural instability to get more support so they can focus on their work and not on staying stable!  Use yoga mats or cushions to provide comfort and a clipboard or slant board as a work surface. 
  • Get Cozy.  Another option for a position change is sitting in a bean bag, Howda Designz Chairs or the Comfy Cozy Peapod Chair.  While not the best option for all types of tasks these options are great  when the activity involves reading or listening. The deep pressure input provides calming and organizing input.

Having a  variety of seating options available in any learning space is a sure way to increase focus and attention.  Identifying options that are appropriate for the user and the environment are keys for successful implementation. 

Reference:

Cole, K., Schroeder, K., Bataineh, M., & Bataineh, A. (2021, April). Flexible Seating Impact on Classroom Environment. The Turkish Online Journal of Educational Technology, 20(2), 62-74.

picture of a boy in a wheelchair completing an art project using the functionalhand to help hold his tools.

Executive Functioning – Making Strategies Inclusive

Assistive Technology, Executive Functioning, , , ,

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.  

Do 

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.

Use a picture of the action for “Do”
Use a picture of the item for “Get Ready”

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/

Raised Line Paper… What Is It?

Accessibility, Education, Fine Motor, , ,

Sarah Glovasky M.S. OTR/L

Sometimes called tactile paper, Raised Line Paper is used to help individuals stay between the lines when writing. The raised line paper has raised top and bottom lines to provide tactile, proprioceptive and visual feedback to the writer. There are a variety of types of paper to choose from!

Raised Line Learning Sheets

Do you have a beginner writer? The raised line learning sheets are a good place to start from! There are letters, numbers, alphabet coloring sheets and mazes! The tactile input helps the new learners understand where to keep their pencil and crayon marks! 

Raised Line Writing Paper

There are so many options to help more advanced writers be as successful as they can. There are different sized lines (narrow and wide) depending on the level of the writer. If you need more of a visual cue there is the option to have red and blue lines on your paper. Double the input for a higher accuracy when writing. If spacing or sizing is a problem there is boxed raised line paper to provide a space for every letter to fit in. Pro tip: If all this sounds great but you are not sure what will work best the assortment pack is very helpful!

Staged Raised Line Paper

There is a product line that is able to take a writer from beginning stages right through advanced writing. This is a six stage series of handwriting papers that begins with clearly defined writing spaces and perceptual cues that fade in successive stages as the student gains mastery. The thick, colorful dark blue baselines are raised, providing not only visual cues, but also tactile cues.  Pro Tip: Students advance at their own pace so having all the stages on hand is very helpful!

Stage One: For beginning writers. Clearly defined writing spaces.

Stage Two: Writing spaces are less defined as shading is partially removed.

Stage Three: Shading has been completely removed and replaced with a borderline.

Stage Four: Writing spaces are less structured; fewer distractions than typical notebook paper.

Stage Five: The most popular Stage Write paper! Spacing between blue baseline and gray guideline reduced to 1/4″.

Stage Six: Comparable to standard notebook paper. Still incorporates raised dark blue baseline and clearly defined margins.

Another great aspect of all this paper is it can be used with a variety of reading/writing/handwriting programs! Give your writers the tools they need to be successful independent writers.