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:
Put on coat
Put on shoes
Put on backpack
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!
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!
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
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:
- 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
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:
- 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
- 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
- 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
- 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.
- 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!
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.