Tips for Left Handed Writers

  • As with all writing/desktop activities make sure the child is sitting in a well supported position
    • Feet are well supported
    • Hips and knees are at 90 degrees
    • Back is well supported
  • Have the child angle their paper clockwise about 30 degrees to the left (the bottom of the paper moves towards the left and the left top corner is pointing upwards)
  • Can place tape on the desk around the paper to form an outline to remind the child of the ideal paper position (a taped outline of one corner works well)
  • Encourage the child to move their grasp up the pencil about 1 – 1.5” so they are able to see their writing and avoid smudging
  • Can place a sticker on the pencil as a visual cue as to where they should have their fingers
  • Instruct the child to keep their hand underneath the line they are writing on
  • Rather than having the paper in the center of their body have the child move their paper to the left of their body so their eyes can see the writing as they move across the paper
  • Make sure they are using their right hand as their “helper hand” to hold the paper in place
  • Try writing on a slant board to help position their wrist appropriately and to help make the writing more visible
  • When using spiral notebooks flip the notebook around so that the spiral is on the right instead of the left
  • When using scissors make sure to use left handed ones
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Tactile Defensiveness

Tactile defensiveness is the hypersensitivity to touch. Children with tactile defensiveness notice touch more than others. They react negatively to unexpected, light touch and even to the anticipation of light touch. The child may react with a fight or flight response by being hostile to those around them or by fleeing from contact with people, finger paints, playdough, etc. Some children will withdraw passively by avoiding the object and people that cause distress. The receptors of the tactile system are in our skin so therefore it is not just our hands that can be hypersensitive to touch but our whole body.

When our tactile system is functioning well we are able to filter out which tactile information is important and which is not. Those with tactile defensiveness have difficulty ignoring input that is not important (e.g. the way their shirt feels, the light breeze on their face, etc.) and may appear distracted. Many children who do not enjoy light touch may actually enjoy deep pressure touch, like bear hugs or heavy blankets.

Signs of tactile defensiveness:

  • Dislike brushing teeth or going to the dentist
  • Dislike getting hair washed or cut
  • Dislike wearing clothing or certain types of clothing, may prefer really tight clothing or baggier clothing
  • Withdraw from being kissed or from a light touch
  • Avoid playing with playdough, finger paints, etc.
  • Immediately want to wipe hands when they get dirty
  • Avoid playing in the dirt, mud, sand, grass, etc.
  • Picky eater

Suggestions when working with children who have tactile defensiveness:

  • Don’t approach or touch the child from behind
  • Avoid light touch
  • Use firm pressure when touching the child
  • Allow the child to have their own space during circle time (sit on their own piece of carpet or on a bean bag chair, rocking chair, etc.)
  • Have the child stand at the front or back of the line to minimize unexpected touch
  • Create a “quiet corner” (bean bag chair, tent, teepee or blanket draped over table) in the classroom or in another supervised room where the child can go if they are starting to feel upset or over-stimulated
  • Provide the child with deep pressure activities/movement breaks throughout the day (easiest to incorporate into daily class schedule as it is valuable for the whole class)
  • Weighted items such as a weighted lap pad or a weighted snake around the shoulders can be used to provide that calming deep pressure touch
  • Encourage the child to participate in sensory play activities
    • It is important to encourage the child to participate but do not force them into doing anything they don’t want to do, we want to gradually incorporate some challenging textures/touch while keeping it fun and enjoyable
    • The child may need to begin by just watching others take part in the activity, then move onto using a utensil (knife, paintbrush, rolling pin, cookie cutters) to play with the substance (fingerpaint, playdough, shaving cream, flubber etc.) and then finally to using their hands to play in it
    • Subtle, gradual exposure is the key to successful sensory play

 

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Core Strengthening Activities

Here are some suggestions for activities that will engage a child’s core muscles (back and front). Make sure the child is breathing and not holding their breath during these activities. Focus on good quality exercises rather than quantity. Be silly and make sure it is fun for the child! If the activity is too hard for the child think of a way to adapt it or find another activity that is the “just right challenge” for them.

Superman

  • Laying on stomach, lift legs and arms off the ground and hold that position

Egg

  • Laying on back, bring knees up to 90 degrees and lift upper body off the ground with arms across chest and hold that position until someone says “pop” and the egg breaks open

Plank

  • Laying on stomach, push up onto forearms or hands while keeping the body straight and hold
  • To make it easier go on knees, to make it harder go on toes

Bridge

  • Keeping their shoulders and head on the ground, knees bent and feet on the ground the child will bring their bottom up and hold that position

Snake Curl Ups

  • Have the child lie on their back with knees bent
  • Pretend to play a magic flute or play some snake charmer music on YouTube and have them sit up until their hands are on top of their knees
  • Stop the music and start over
  • Hold their feet down if they are having difficulty

Crawling Through a Tunnel

  • Any crawling activity is great for engaging the core

Inchworm Walk

  • Start with hands and feet touching the ground with bottom up (legs and arms straight)
  • Walk hands forward until the body is in a plank position
  • Then walk feet up to hands and start over

Crab Walk

  • On hands and feet with bottom lifted off the ground walk around sideways

Yoga

  • Most yoga poses are great for engaging the core, some ideas include boat pose, happy baby pose, downward dog, 3 legged dog, dolphin pose
  • Cosmic Kids Yoga on YouTube is great for kids

Wheelbarrow

  • Child lays on their stomach and adult lifts up their feet
  • Child pushes up onto straight arms and walks around on hands
  • Make sure the child keeps their body as straight as possible
  • To make it easier, the adult can hold onto the child’s legs closer to their hips
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Visual Schedules

Many children benefit from routine in their daily lives. A visual schedule is an easy way to provide a child with a visual reminder of what they can expect for their day. Many children experience less anxiety when they know what to expect before something happens. It is easy to find pictures to make your own visual schedule by searching Google. You can make very specific visual schedules (for example: getting dressed – put on underwear, put on pants, put on socks, put on shirt, put on sweater) or a more general schedule (for example a daily routine – get out of bed, eat breakfast, go to school, eat lunch, TV time, homework, supper, play time, bed time). Print the visual schedule you make and hang it close to where they will use it.

Some ideas to try:

  • Give the child a new paper with their visual schedule on it every time so they can check off the steps as they complete them
  • Laminate pictures of each of the steps and create a schedule with two columns (one column is ‘to do’ and the other is ‘done’), attach velcro to both sides and have child move the picture from the ‘to do’ column to the ‘done’ column when they have completed it

Here is an example of a visual schedule:

Morning Routine

Eat breakfast

Get dressed

Brush teeth

Brush hair

Put on coat

Put on shoes

Put on backpack

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Activities That Help Develop A Pincer Grasp

A pincer grasp is when you use your thumb and the tip of your index finger to pick up an object. As children develop they move from a gross raking grasp involving their whole hand to a more refined pincer grasp as seen in the picture below.

A pincer grasp is important for many functional activities such as zipping a zipper, picking up small objects, using a key, etc. Here are some activity ideas to help develop a pincer grasp:

  • Use tongs to pick up items
  • Set out a muffin pan and give the child small items to sort and place into the cups
  • Stickers – any activity that involves stickers helps practice the pincer grasp
    • Bigger stickers will be easier and small stickers will be more challenging
  • Hide small coins, beads, etc. in playdough and have the child get them out
  • String beads on a pipe cleaner
  • Any game involving clothespins
  • The Sneaky, Snacky Squirrel Game
  • Lite Brite
  • Mr. Ball

There are many different activities that work on the pincer grasp. Be creative and have fun!

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Heavy Work Activities

Heavy work activities are activities that involve the big muscles and joints of the body (pushing, pulling, carrying, etc.). Heavy work activities help release a neurotransmitter called serotonin that helps calm and organize our brain and bodies. Below are some examples of heavy work activities:

  • Carrying heavy books from one room to another at school
  • Playing tug of war with a rope
  • Crawling through a tunnel
  • Pushing themselves around on a scooter board
  • Pulling another student that is holding a hula hoop and sitting on a scooter board
  • Pulling another child around on a sheet or blanket
  • Pushing the cart while grocery shopping
  • Doing animal walks (crab, bear, bunny, kangaroo, elephant, etc.)
  • Wall push ups – stand up with hands against the wall and do a push up
  • Popcorn – sitting in a chair push up on hands so bottom is off the seat, keep popping up and down like popcorn

There are so many activities that would be considered heavy work activities. Any activity that involves the large muscles of the body are great for organizing the brain to help the child be ready to learn. Use these activities throughout the day to help children stay on task and provide them with the movement their bodies crave!

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What is the Vestibular System?

The human body has 8 sensory systems which give us information about the environment and our place within the environment. 

The 5 most commonly known sensory systems include:

  • Tactile – the sense of touch
  • Visual – the sense of sight
  • Auditory – the sense of hearing
  • Gustatory – the sense of taste
  • Olfactory – the sense of smell

The 3 less commonly known sensory systems include:

  • Vestibular – the sense of our head position in space
  • Proprioception – the sense of knowing where our body is in space, this information comes from our muscles, joints, tendons and ligaments
  • Interoception – the sense of the physiological condition of the body (hunger, thirst, pain, temperature, the need to go to the bathroom, etc.)

Today we are going to talk more about the vestibular system. The vestibular receptors are located in our inner ear. The receptors include the 3 semicircular canals (anterior, lateral and posterior) and the otoliths (utricle and saccule). The semicircular canals pick up rotary movement and the otoliths pick up linear movement.

The vestibular system answers 2 basic life questions:

  • Which way is up?
  • Where am I going?

Any movement of the head in any direction (up and down, forward and back, side to side, diagonal and rotary) activates the vestibular system. 25% of the vestibular information received goes directly to the cerebellum which is responsible for balance and posture. The other 75% of vestibular information goes to the brainstem via the vestibular nuclei which then connects to many other parts of the brain including:

  • Reticular formation – arousal, orientation, regulation & attention
  • Spinal cord – postural alignment and control
  • Oculomotor nuclei – head orientation & stability for oculomotor (eye) control
  • Autonomic centers – gravitational impact on cardiovascular, visceral & respiratory control
  • Cerebral cortex – spatial orientation & body movement

Since the vestibular system has so many connections in the brain it is very important that the vestibular system is functioning well. In many of the children that we see in Occupational Therapy their vestibular systems are not functioning optimally. Many children have an under-responsive system or an over-responsive system. A child with an under-responsive system may be able to spin for hours without getting dizzy or sick. A child with an over-responsive system may get dizzy or sick with even the slightest movement.

In Occupational Therapy one of the goals is to help the vestibular system work optimally so that sensory information is processed correctly in the brain to allow the eyes to work well, the ears to work well as well as the many other areas that have been discussed above.

References: From Eyesight to Insight: Visual & Vestibular Assessment & Treatment

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Shoe Tying Tips & Tricks

I have to admit that my daughter who recently turned 6 has not learned to tie her shoes. My mom tells me that when I was in preschool I was the kid tying other kids shoes under the table (not sure why we were under the table but thats besides the point!). I would have been four years old in preschool. It seems that kids these days are learning some of these skills later in life. Is it because of the invention of velcro shoes or are we just not teaching them these skills when we used to? Since my daughter is starting grade 1 really soon I thought now is the time to focus on teaching her to tie her shoelaces. Today I used the video below for the around the tree method and a lacing card I made (picture below) and she picked it up very quickly!

Here are some general tips and tricks I have compiled for children learning to tie their shoes or those that are needing some extra help learning:

  • Replace thin, round shoelaces with soft, wide (but not too wide) shoelaces that are easier to grip (also they stay tighter when tied)
  • Cotton or other natural fibres will be easier then slippery synthetic shoelaces
  • Use shoelaces that are designed for learning – half one colour and half another colour (can make them by cutting two different coloured laces and sewing or tying them together)
  • Try using a double starting knot to keep the shoelaces tight
  • Knot the end of each shoelace to prevent them from slipping through the loops
  • Have the child start practicing with the shoe on a table or on their lap so they are in a good, comfortable position
  • Help your child to make their own shoelace tying practice board out of cardboard

                                            

  • There are commercially available products to help with practicing (e.g. Melissa & Doug lacing sneaker)
  • Try out different methods to see which works best for your child:
    • Standard shoelace knot (around the tree method) – see video here
    • Two loop shoelace knot (bunny ears method)
    • Ian knot – see video here
  • Make sure your child’s shoes are untied every time they take them off so they can practice each time they put their shoes on – repetition is the key to success

Good luck!

 

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What do OTs do?

What do OTs (Occupational Therapists) do? Many people have no idea what an OT is when I tell them what I do! Many people think that we help people get jobs, but that is not the case (mostly anyways!). OTs focus on the areas of self-care, productivity and leisure. So depending where an OT is working they are helping people with very different things. OTs are trained in the areas of anatomy & physiology, neurology, child development, mental health, counselling, older adult disabilities, among other areas.

In acute care (hospitals) we focus a lot on self-care, helping people to be independent in their basic daily activities such as getting themselves dressed, having a bath, preparing a meal or moving around their homes/community. We prescribe equipment and provide education about how they can become more successful completing their activities of daily living in a safe manner. An independent study by health policy researchers published in Medical Care Research and Review (Rogers, Bai, Lavin, & Anderson, 2016) found that “occupational therapy is the only spending category where additional spending has a statistically significant association with lower readmission rates” for the three health conditions studied: heart failure, pneumonia, and acute myocardial infarction. Yay OT!

When working with children as we do at Bright Horizons OT, the focus looks very different. We use play as a means to achieving the child’s/family’s goals. In order to achieve the goals, we either use remediation (treating the underlying deficit) or compensation (adapting activities or environment) to make the child more successful in their everyday activities. The goals of OT can be many different things, here are some examples of general goals:

FINE MOTOR:

  • Increase ability to pick up small objects and release them
  • Increase ability to use both hands together (e.g. stabilizing the paper while writing with the other hand, holding a jar while using the other hand to twist the lid, etc.)
  • Increase handwriting legibility and/or speed
  • Increase accuracy while cutting with scissors

GROSS MOTOR/CORE STRENGTH:

  • Increase core strength/postural stability in order to increase gross and fine motor skills
  • Increase the child’s support while sitting in a chair at school (proper seating in order to maximize their ability to complete school activities)
  • Making adaptations in gym class/sports/leisure activities to increase participation

SELF-CARE:

  • Increase self-care abilities such as getting themselves dressed, doing up buttons, zippers, tying their shoes, etc.
  • Provide adaptive equipment/education to help make bathing independently or with assistance easier

FEEDING:

  • Increase self-feeding abilities (using a spoon, fork, knife, open cup, straw cup, etc.)
  • Expand the number of foods a picky eater/problem feeder will eat

SENSORY PROCESSING:

  • Decrease sensitivities to sensory input (lights, sound, touch, etc.) and/or make environmental adaptations to help them cope with these sensitivities
  • Increase the child’s ability to engage in hair brushing, hair washing, hair cutting, etc. for those that are sensitive to these activities
  • Make adaptations/find clothing that the child will wear without being bothered by tags, seams, fabrics, etc.

SELF-REGULATION:

  • Increase on task behaviour in children who have attention difficulties (teaching self-regulation skills)

These are just some examples of the things that are addressed when you see an OT. One of the greatest parts of our job is we get to look at such a wide variety of areas!

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Auditory Processing Disorder (APD)

In the past year I have been going full steam ahead in my continuing education! My latest education has been on Auditory Processing Disorder (APD). I completed the TheraPeeds “Treating Auditory Processing Disorder” course and I loved it, just like I love all of Julia Harper’s courses. I’m starting to sound like a groupie! Haha. But she uses physiology to back up all of her assessments and treatment which I love.

What is APD? Auditory processing is what we do with what we hear. Children with APD do not have a problem with their hearing, they have a problem with how the sound is processed in their brain. “We don’t hear with our ears, we hear with our brain.” Sound information comes into our ears, moves through the outer, middle and inner ear to the lower brainstem, to the upper brainstem, to the midbrain and finally to the cortex. In children with APD somewhere along that pathway the information is not processed as it should be. The type of APD depends on where the breakdown of processing occurs in the brain. Most of the time the breakdown occurs sub-cortically or below the cortex (i.e. lower brainstem, upper brainstem or midbrain).

Audiologists are responsible for diagnosing APD, along with information from SLPs and Educational Psychologists. Then you may be wondering where does an Occupational Therapist come in? Well one of our areas of specialty is sensory processing. Auditory information is sensory information. As OTs we can use our sensorimotor knowledge to help treat APDs.

Treatment for APD focuses on sensorimotor and auditory (sound) activities. Since most of the APDs occur below the level of the cortex we can use sensorimotor activities to ensure that the proper wiring is set up in the brain to allow the messages to get through.

Please contact me with any questions or if you are interested in learning more about how OT can help your child with Auditory Processing Disorder.

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