Tag Archives: physical therapy (PT)

Discover evidence-based physical therapy resources,  equipment, tools, strategies, and professional insights to support physical therapists in enhancing mobility, strength, coordination, and overall functional outcomes across the lifespan and in diverse settings.

Getting Creative with Sweatshirts and Seat Cushions!

 Sensory Processing disorders (SPD) impact how children and adults respond to sensory stimulation such as sound, touch, what they see and movement. One basic principle of occupational therapy for individuals with SPD is to provide controlled, graded and individualized sensory stimulation to promote functional skills such as playing catch or writing one’s name. This means that activities such as tossing bean bags into containers while the child is suspended on a swing can be:

  • Controlled – as the therapist responds to the child’s reactions. For example, the therapist might push the swing faster, slower or in a different direction,
  • Graded- as the therapist chooses the type of swing used, how long the activity lasts, how heavy the bean bags are and how far away the container is positioned, and
  • Individualized – according to the child’s sensory, emotional and motor needs. For example, the child may wear a squeeze vest during the activity, name an animal each time the bean bag is thrown or have a special friend hold the container.

What is a Sensory Diet?

Parents can implement individualized sensory strategies at home in what is called a “Sensory Diet”. This is like a recipe book of activities and adaptations that the therapist designs for parents to carryover at home, school or in the community. It is important to frequently discuss with the therapist how these strategies are working out since children grow and change rapidly along with their sensory needs in different settings.

In my book From Flapping to Function: A Parent’s Guide to Autism and Hand Skills, I describe the 6 different subtypes of SPD and some general strategies to use with children who have each type. These strategies usually impact the following 3 sensory systems:

  1. Tactile – uses sensory receptors in the skin to interpret sensations, such as light and heavy touch.
  2. Proprioception – uses receptors in joints and muscles to tell us where the body is and how it is moving in relation to objects and space.
  3. Vestibular – tells our body how to respond to the pull of gravity and movement of the head. It is also called the balance system.

Now for the fun part…

child sitting on a seat cushion

Many children with or without SPD LOVE deep, heavy pressure experiences and movement. This includes children on the autism spectrum or those with other types of developmental disabilities. One very simple strategy is to provide some type of “dynamic seating”. This simply means that the child can bounce, wiggle, rock or move around in some other way while seated. Many teachers incorporate seat cushions and ball chairs in the classroom to help students focus. The Disco Seat is one popular product. An inexpensive alternative is to sit on a deflated ball, as I am doing in the photo. Don’t have one available while eating out or sitting in the movie theater? Consider rolling up a sweatshirt for the child to sit on or curl up inside of to get a full body squeeze.

 
a child using a homemade seat cushion

Speaking of sweatshirts, I have had great success in helping a young lady named Judy to be more focused and less agitated by placing a Disco Seat cushion inside the body of a sweatshirt. The photo shows Judy sitting on the cushion, enjoying some gentle bounces with the sleeves slung over her lap.

 
example of using a sweatshirt to make an innovative seat cushion

The sleeves are heavy because I put bags filled with sand inside of them. Next I sewed the wrist and shoulder ends of the sleeves closed so that the bags wouldn’t fall out. This adaptation can be used in a various of ways. The sweater may be placed over the back of a chair so that the heavy sleeves are draped over the child’s shoulders and body. Placing the cushion inside the sweater is optional.

 

A young man named Eddy, craves extreme movement and is typically agitated unless in a rocking chair, bungee seat or swing. You can see in the photograph that his chair is adapted to not tip over given all of his body rocking. He LOVED when I attached the sweatshirt with enclosed seat cushion to the back of his chair so that he could slam his back into it while rocking. I know that he enjoyed the deep pressure bouncy sensation because he became calmer, quieter and smiled. The heavy sweatshirt sleeves are draped over his lap. I did my best to capture how I set this up in the following video while maintaining his privacy.

example of an  innovative seat cushion

Seat cushions and lap bags that are a lot nicer than the ones I make with a deflated ball, sand and plastic bags are sold by Therapro, Inc. Whether you are reading this blog post as a caregiver, therapist or other type of professional, I hope that adding these simple sensory strategies to your tool box helps the people you love or work with improve their quality of life. This is why I love being an occupational therapist!

 
Disc O'Sit
Disc O’Sit
Weighted Snake Wrap
Weighted Snake Wrap
 
Barbara A. Smith

Guest Blogger:  Barbara A. Smith.

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.

The Peabody Developmental Motor Scales Test

The Peabody Developmental Motor Scales Test-Second Edition (PDMS-2) examines both gross motor and fine motor skills. This test is for children from birth through age 5. The evaluation assesses a child’s development, and also provides training and treatment to improve motor skills. The assessment generally lasts about 45-60 minutes, and provides an in-depth analysis. The Second Edition has been in use since 2000 and is a statistically reliable and valid norm-referenced assessment.

The Peabody Developmental Motor Scales (PDMS-2)When you order the PDMS-2 COMPLETE Kit, you’ll receive an Examiner’s Manual, a Guide to Item Administration, a Picture Book, 25 Profile/Summary Forms, 25 Examiner Record Booklets, the Motor Activities Program Manual and a Peabody Motor Developmental Chart. The PDMS-2 is also offered without the Motor Activities Program Manual (PDMS-2 TEST Kit).

You will also receive the Object Kit and the Shape Cards Kit which both contain sets of test objects to help achieve a standardized administration of the test; the Object Kit includes a black shoelace, six square beads, a wooden pegboard, three wooden pegs, 12 one-inch cubes, a large button strip, a bottle with a cap, a formboard with shapes, a lacing card, a measuring tape, and a roll of masking tape. The Shape Cards Kit includes blackline masters and three shape cards.

The test scores consist of a Gross Motor Quotient, a Fine Motor Quotient, and a Total Quotient. The Gross Motor Quotient is made up of the Reflexes, Stationary, Locomotion, and Object Manipulation subtests. The Fine Motor Quotient includes the Grasping and Visual-Motor Integration subtests. Lastly, the Total Quotient combines both the Gross and Fine Motor subtests.

To reduce scoring and reporting time and errors, the new PDMS-2 Online Scoring and Reporting System has been developed and is purchased separately. It is web-based software that is PC, Mac and iPad compatible. Some of the software Scoring features include:

  • converting PDMS-2 item scores or subtest scores into standard scores, percentile ranks, and age equivalents
  • generating composite quotients
  • comparing PDMS-2 subtest and composite performance to identify significant intra-individual differences

The software Reporting features also include:

  • a printed report of the student’s identifying information and PDMS-2 performance including short-term and long-term treatment goals and objectives
  • score and print reports using as few as one subtest score or only Gross or only Fine Motor scores
  • save or print text or PDF file using two report options:
    • standard clinical report (2 page summary of test scores)
    • detailed clinical report (fully customized 6- to 8- page analysis indicating treatment goals and objectives

Additional features of this web-based software include:

  • pull-down menus to easily navigate among software functions
    fields for storing detailed examiner and testing information
    on-screen subtest and quotient comparisons

A first-time base subscription provides an entire year of unlimited online scoring and report access for up to five users.

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

Girl using gardening tools to dig in dirt as an example of using weight to help body awareness skills 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.
Example activity using weight to help body awareness skills

Sensory Socks and Rings

Weighted item in a box as an example of using weight to help body awareness skills 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.
Ring stack activity diagram

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

Weighted Sensory bag examplePossible 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.