Thursday, June 30, 2016

Be Inspired – Motivational Tools for Pediatric Therapists

Always Remember Brave Strong and Smart

During this age of social media, we are bombarded with inspirational messages of which some hit home more than others.  I think this quote is perfect for pediatric therapists.  As a profession, I think we live and breathe this everyday for the children and their families.  When children want to achieve a certain skill (no matter how big or small) it is our job to teach and motivate them to reach their goals.  Part of that job is encouraging children to believe in themselves and for us as therapists, teachers and parents to believe in their own abilities as well.  To me this is the core of what we do – teach children to be just a little braver, stronger or smarter.

Think about it with some task analysis using some common therapy goals:

  1.  Walk across the room independently – the child needs to take the risk that he/she will not fall and get hurt (bravery), strengthen the trunk and legs to physically make it across the room and make choices about what obstacles to avoid (smarter).
  2. Tie your shoes – the child has tried hundreds of time to tie his/her shoes and needs to be brave and try one more time to face that fear of failure, strengthen the fingers and hands to be able to physically pull the laces tight and must be able to sequence the order of shoe tying.
  3. Pump a swing – have the courage to try and face the fear of falling off the swing, strengthen the arms, trunk and legs to hold on, balance and pump your legs and understand when to lean back and when to extend your legs.

I could go on and on with task analysis of almost every therapeutic goal.  So remind the children that you work with of the wise words of Christopher Robin (aka A. A. Milne) – Always remember, you are braver than you believe, stronger than you seem and smarter than you think.

Check out some other motivational tools for pediatric therapists.

Collage of Pediatric Therapy Posters

More of my favorite therapy quotes (click on the link to download a free poster) –

Life is like riding a bicycle.  To keep your balance you must keep moving. – Albert Einstein 

The most important thing to do as a therapist is to educate.

Move your body, grow your brain.

The best way to predict the future is to create it.

The greatest gifts you can give your children are the roots of responsibility and the wings of independence. – Denis Waitely

Do you have a favorite motivational quote you would like to see on a poster?  Let us know.

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Tuesday, June 28, 2016

Why Do Children Need Opportunities to Use New Motor Skills They Learn?

Children Need Opportunities to Use the SKills they LearnDuring therapy sessions, we frequently break down activities into smaller parts or chunks to make it easier for children to learn new motor or life skills.  As the child progresses with those individual parts of the skill, the child then practices the entire activity as a whole. Sometimes this is done in an isolated environment (ie therapy room) and sometimes in the real environment (ie classroom).

Keep in mind, in order for the child to learn and retain the skill, the child must apply that skill in meaningful and functional activities.  This helps to lay the neural networks to achieve and retain the skill.

After the child completes the skill provide formal and informal feedback to help them improve. Use self assessment techniques allowing the child to determine what needs improvements.   This will again help lay the groundwork for strong neural networks for the skill.

So why do children need meaningful opportunities to practice new motor or life skills?  It creates strong neural networks in order to transfer the skill in different situations or to learn additional new skills.

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Sunday, June 26, 2016

Leisure Activities, Modifying the Environment and Children with Disabilities

Leisure Activities, Modifying the Environment and Children with DisabilitiesIt can be a challenge at times to encourage children with physical disabilities to participate in leisure activities.  The Canadian Journal of Occupational Therapy published a small study to determine the effectiveness of environment-based interventions on participation of  6 adolescents with physical disabilities.  A 12-week intervention occurred with a focus on removing environmental barriers and coaching parents.   The Canadian Occupational
Performance Measure was used to establish performance on 17 goals that were set.  Occupational therapists delivered the intervention which included the following: (a) Review baseline participation goals; (b)  evaluate environment-based barriers/ facilitators to participation, including the setting in which these activities take place; (c) work together with the adolescent and parents to explore and implement strategies to modify environmental barriers and/or activity demands and (d) provide knowledge about useful strategies to search for information and advocate for the child’s inclusion.

Some strategies that were used included: adapted bicycles, educating instructors, pre-teaching, assisting with acquiring transportation and more.

The results indicated:

  1.  clinically significant improvement in performance scores was observed across all 17 goals.
  2.  statistically significant treatment effect was replicated in 13 goals (76%).

The researchers concluded that environment-based interventions are effective in promoting youth participation, but larger studies are required.

Reference:  Dana R. Anaby, Mary C. Law, Annette Majnemer, and Debbie Feldman
Opening doors to participation of youth with physical disabilities: An intervention study: Favoriser la participation des adolescents ayant des handicaps physiques : √Čtude d’intervention
Canadian Journal of Occupational Therapy April 2016 83: 83-90, first published on October 21, 2015 doi:10.1177/0008417415608653

Teaching Catching, Throwing and Kicking Skills from http://ift.tt/28VZj3B

Need to pre-teach ball skills?  Check out Teaching Catching, Throwing and Kicking Skills.  Help children learn how to catch, throw and kick with this packet full of information of age progression of skills, visual picture cards, tips, letter to parents and more!

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Thursday, June 23, 2016

Dried Bean Stress Balls

Dried Bean Stress BallsHere is a new twist on a do it yourself stress ball – dried bean stress balls.  You might be wondering what make these any different than others?  Well until you make one and feel it you will not understand.  These dried garbanzo bean stress balls feel more like a deep massage in the hands.  It definitely steps up the tactile input!  The secret ingredient is the garbanzo beans (also known as chick peas).  You can read more about how I colored the garbanzo beans for a sensory bin in a previous post.

To make the garbanzo beans stress balls you will need dried garbanzo beans, balloons, scissors and the top of a plastic water bottle.  I came up with (in my opinion) the most AMAZING hack ever to keep the balloon open.  If you have ever tried to make these it can be so hard to keep the top open to get the ingredients in the balloon.  It is usually a two man job.  So my idea was to cut off the top of a plastic water bottle.  Simply slip the balloon inside and over the lip of the bottle.  Presto chango your balloon stays open so you can put the beans in!!!!  I know, not that amazing but it sure did impress me.

Dried Bean Stress Balls hack

Moving on… now all you need to do is fill the balloon up.  Have the kids help using a nice pincer grasp to get all those beans inside.  Dried Bean Stress Balls pincer grasp

Once the balloon is filled up, tie it off.  Cut off the top of another balloon and insert the bean ball into the balloon with the top cut off.

Dried Bean Stress Balls balloon

Now you are ready to use the stress balls.  Since these provide a heavier tactile input that your typical stress ball some children may dislike the feeling.  Some children may crave it.  Here are some suggestions:

  1. stress ball – use it to relieve stress by squeezing it.
  2. fidget – keep the hands busy so you can sit still squish and squeeze the ball (it is a little noisy).
  3. warm ups before handwriting – rub this between your hands to wake up the small muscles and get them ready to write.
  4. foot massage – place it under your foot and roll it back and forth to work out any small muscle cramps in the foot (alert – this is some serious sensory input).
  5. coordination skills – these make excellent juggling balls.  The garbanzo bean balls are a nice weight providing some extra input to catch and toss.
  6.  challenge your balance – try to stand on one foot and roll it back and forth.  Kick it to a friend.

picture card1Need more ideas for sensory breaks, stress relief and tactile input? Check out the Sensational Brain membership for creating effective sensory diets.

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Wednesday, June 22, 2016

Gross Motor Skills and Scissor Use

Gross Motor Skills and Scissor Use

GROSS MOTOR SKILLS AND SCISSOR USE

When you think of activities like jumping jacks, monkey bars, Simon Says or obstacle courses we think of fun, physical activities.  What you might not realize, is that these gross motor skills help children develop the skills necessary to use scissors.  We continue the Functional Skills for Kids Series with scissor skills.  This post is part of a series written by occupational and physical therapy bloggers on developing 12 functional skills for children.    Each month we will discuss the development of one functional skill in children addressing the many components of that skill.  The ability to complete the functional task of using scissors requires fine motor skills, visual perceptual skills, coordination skills and gross motor skills.

Gross motor skills involved in scissor use refers to the postural control and bilateral coordination that is required for scissor skills.  Efficient control of the larger muscle groups in the neck, shoulder and trunk is necessary to maintain stability in order to place the fingers and hands in the scissor holes, open and close the scissors and cutting across the paper.  For the cutting hand, you must stabilize the trunk, flex the shoulder slightly (lift up), internally rotate the arm, bend and straighten the elbow and wrist all while moving the scissors across paper.  For the opposite hand that holds and helps to guide the paper, you must also stabilize the trunk, flex and rotate the shoulder and the elbow remains generally fixed.  Higher level bilateral coordination skills are needed since the opposite hands and arms are doing slightly different motions with different timing while using scissors.

Body awareness is the ability to recognize where your body is in space. Your muscles and joints send your brain information about your body and how it moves.  When using scissors, you must be able to understand where to move your shoulders and arms to stabilize while your hands and wrists move across the paper to cut lines and shapes.

Motor planning is the ability to create an idea, plan an action and execute that action.  It is a complex process that requires cognitive thought, sensory input and a motor action.  In order to complete all of the steps of cutting along a line or cutting out shapes one must plan and execute the motor action.

For normal childhood development skiils, control and stability begins at the trunk, progressing to the elbow, wrist and finally the hand.  With normal development, fine motor skills are developed from gross motor skills.  For example, a baby will first learn to swat, then reach, then grasp and then manipulate a toy.  Children need to develop the proximal muscles (closer to the center of the body) of the trunk and shoulder girdle in order to use the distal muscles (further from the center of the body) in the fingers and hands.  These proximal muscles develop in children with gross motor movements such as reaching, tummy time, rolling, all fours position, crawling, standing and walking.  The continue to develop as children learn locomotor skills where you must stabilize the trunk to move the extremities in coordinated movements.  This develop of postural control helps to keep the trunk and shoulder stable to utilize the hands for fine motor movements like scissor use.

DEFICITS IN GROSS MOTOR SKILLS AND THE EFFECTS ON SCISSOR USE

As mentioned previously, proximal muscles function as a stabilizer during cutting tasks.  Children with low postural muscle tone may have difficulty sustaining contractions in the proximal musculature.  One small study indicated that 31% of children with developmental coordination disorder exhibited immature prehension of scissors (Roger, 2003).  Research indicates muscles that work primarily as stabilizers, display less variability than muscles that work dynamically (Pepper & Carson, 1999).  When the proximal muscles are unable to stabilize correctly, there may be increased variability in the distal muscles which may affect the ability to cut on a line or intricate shapes.

Gross Motor Skills Activities and Scissor Use

10 GROSS MOTOR SKILL ACTIVITY SUGGESTIONS FOR SCISSOR SKILLS

Gross motor activities that will improve postural control and muscle strength in the proximal muscles are beneficial when it comes to developing scissor skills.  Suggested activities:

  1. Hanging activities – practice monkey bars, chins ups, pull ups or swing from the tree limbs to increase the muscle strength in the shoulder girdle muscles.
  2. Climbing activities – climb the ladders and ropes on the playground.
  3. Pushing and pulling activities – pull a heavy wagon or push a child on a swing.  These pushing and pulling motions help the shoulder learn to coactivate to produce the right amount of force and stability.
  4. Weight bearing activities through the arms – animal walks, wheelbarrow walking, crawling, and push ups/planks all help to increase muscle strength and improve coactivation of the shoulder and postural muscles.
  5. Yoga Poses – provide muscle strengthening and postural control
  6. Large art projects – hang some paper on a wall or use an easel.  Children can reach up, left and right while painting.
  7. Bilateral coordination activities where one hand is stabilizing while the other hand is moving – activities such as using a fishing rod, using a hand mixer, stirring ingredient in a recipe, hammering a golf tee into Styrofoam, etc.
  8. Overall symmetrical bilateral coordination activities (both sides of the body are doing the same thing as the same time) such as jumping jacks, jumping rope, dribbling a ball with both hands at the same time, etc.
  9. Overall asymmetrical bilateral coordination activities (both sides of the body are doing different things at the same time) such as cross crawls, windmills and hand clapping games.
  10. Games or activities that require the forearm to be in a neutral position such as tennis, badminton, zoom ball, throwing/passing a large ball with two hands overhead or opening/closing an expandable ball.

If you are looking for minimal prep scissor practice check out Step By Step Shape Projects, Cutting Cards, Cut and Paste, Cut and Fold, Tangrams for Kids and Cut, Create and Play.

Functional Skills for Kids - 12 month series by OTs and PTs

This post is part of the Functional Skills for Kids: 12 Month series by Occupational and Physical Therapists. You can read all of the functions on childhood HERE. Read all of my monthly posts in this series HERE.

Looking for more information about the development of the functional skills of scissor use in childhood? Stop by to see what the other occupational therapists and physical therapists in the Functional Skills for Kids series have written.

Developmental Progression of Scissor Skills: 35 Best Tips for Teaching Kids to Use Scissors | Mama OT

Fine Motor Considerations for Learning to Use Scissors |  Miss Jaime,  O.T.

Gross Motor Skills and Scissor Use  | Your Therapy Source

Sensory Processing and Scissor Skills – a Surprising Link  | Kids Play Space

Teach Kids How to Slow Down to Cut on Lines |Sugar Aunts

5 Tips for Difficulties with Scissor Skills  | Growing Hands-On Kids

Creative Cutting Practice for Kids | The Inspired Treehouse

Visual Motor Skills and Cutting With Scissors  | Therapy Fun Zone

Animal Puppets! Cut. Create. Play.  | Your Kids OT

 

 

Reference:

Roger, S. et al. (2003).  Motor and functional skills of children with developmental coordination disorder: A pilot investigation of measurement issues.  Human Movement Science. Volume 22, Issues 4–5, November, Pages 461–478

Peper, C. E., & Carson, R. G. (1999). Bimanual coordination between isometric contractions and rhythmic movements: An asymmetric coupling. Experimental Brain Research, 129, 417–432.

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Tuesday, June 21, 2016

Manuscript, Cursive or Keyboarding?

Manuscript Cursive or KeyboardingThe Journal of Writing Research published a study on developing writers in grades 4-7 to compare manuscript , cursive and keyboard letter formation.  One study instructed the children to write the alphabet from memory as quickly as they could without sacrificing legibility since previous research indicated that the number of legible manuscript letters in correct order during the first 15 seconds is an index of automatic letter access, retrieval, and production. Each of the 113 neurotypical participants were instructed to form the letters of the alphabet from memory for 15 seconds as manuscript letters, cursive letters and keyboarded letters.  In addition, two spelling measures and one composition measure were administered in order to establish their relationship with handwriting.   For the study one the following results were found:

  1. only the cursive mode uniquely, positively, and consistently predicted both spelling and composing in each grade.
  2.  for composing, in grade 4 manuscript mode was positively predictive.
  3.  for composing in grades 5-7 keyboard selection was positively predictive.

A second study was performed comparing 88 students : 27 with dysgraphia (impaired handwriting),  40 with dyslexia (impaired word spelling), or 11 with oral and written language learning disability (OWL LD) or  10 controls without specific writing disabilities in grades 4 to 9  on the same alphabet 15 modes, manner of copying, spelling, and sentence composing.  The results from this study indicated:

  1.  all letter production modes correlated with each other and the participant’s best and fast sentence copying, spelling, and timed sentence composing.
  2.  groups with specific writing disabilities differed from  the control group on alphabet 15 manuscript mode, copy fast, and timed sentence composing.
  3.  the dysgraphia group scored lower than the dyslexia group on copying sentences in your best handwriting.

The researchers concluded that students need continuing handwriting instruction as well as explicit keyboard instruction (touch typing) beyond fourth grade.  They recommend that the continuing handwriting and keyboard instruction is provided once or twice a week with students doing warm-ups such as (a) writing the alphabet from memory, (b) copying interesting target sentences containing all the letters of the alphabet, (c) writing letters that come before and after other named letters, or (d) exchanging papers and circling letters that are illegible and discussing how to make them legible to others for purposes of written communication. These warm up/reviews should be followed by more cognitively engaging writing tasks.

With respect to study two, the authors recommend that students with specific learning disabilities that impair writing skills (handwriting, spelling, and/or composing) may need need accommodations (e.g., allowing more time to complete written work or using a laptop)
and continuing explicit instruction in alphabet letter access, retrieval, and production and copying words in sentence context and using multiple modes of letter production in spelling and composition instruction.

Reference:  Alstad, Z. et al (2015).  Modes of alphabet letter production during middle childhood and adolescence: Inter-relationships with each other and other writing skills. Journal of Writing Research, 6(3),199 -231

Handwriting Stations from http://ift.tt/28QvSRO

Handwriting Stations includes the materials to create a handwriting station on a tri-fold or in a folder. The station includes proper letter formation for capital and lower case letters, correct posture, pencil grip, warm up exercises, letter reversals tips and self check sheet. In addition, there are 27 worksheets for the alphabet and number practice (Handwriting without Tears® style and Zaner-Bloser® style). This download is great for classroom use, therapy sessions or to send home with a student.

Handwriting Stations encourages:
1.  handwriting practice
2.  visual motor skills
3.  visual reminders for proper letter formation.

FIND OUT MORE AT http://ift.tt/28QvSRO

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Sunday, June 19, 2016

CO-OP for Children with Cerebral Palsy

CO-OP for Children with Cerebral PalsyCognitive Orientation to daily Occupational Performance (CO-OP) is defined by Polatajko and Mandich as a “a client-centered, performance based, problem solving approach that enables skill acquisition through a process of strategy use and guided discovery”.   Physical and Occupational Therapy in Pediatrics published a small single case study series on 18 children between the ages of 7-12 years old.  Nine participants were in a CO-OP group and the other nine participants were in Current Usual Practice Approach group.  All participants received ten 1 hour sessions of intervention about one time per week at home.  For assessment the Canadian Occupational Performance Measure and the Performance Quality Rating Scale were used.  Teh results indicated that:

  1.  the children in the CO-OP group were able to learn the strategies and achieve their chosen goals.
  2. both interventions equally promoted skill acquisition and skill maintenance at follow-up.
  3. effect sizes suggested that CO-OP may show some advantage for transfer and maintenance.

The researchers concluded that more research is needed to further support the benefits of CO-OP for children with cerebral palsy.

Read more about Cognitive Orientation to daily Occupational Performance (CO-OP).

References:

Cameron, D. et al. Cognitive Orientation to daily Occupational Performance (CO-OP): A New Approach for Children with Cerebral Palsy. Phys Occup Ther Pediatr. 2016 Jun 9:1-16. [Epub ahead of print]. DOI:10.1080/01942638.2016.1185500

Polatajko & Mandich (2010). Cognitive Orientation to daily Occupational Performance
(CO-OP). Retreived from the web on 11/18/15 from http://ift.tt/1Y2um56.

Teaching Motor Skills to Children with Cerebral Palsy - http://ift.tt/28OvrAD

Teaching Motor Skills to Children with Cerebral Palsy and Similar Movement Disorders – FIND OUT MORE INFORMATION AT http://ift.tt/28OvrAD

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