Monday, January 16, 2017

How Do You Talk to Parents about Sensory Sensitivities?

How Do You Talk Parents about Sensory Senstivities

After reading a thought provoking blog post from Christopher Alterio,OTR, on Deconstructing the myth of clothing sensitivity as a ‘sensory processing disorder’, it really made me think about how we talk to parents as pediatric therapists.  Not just about clothing sensitivity or other sensory sensitivities but about any concern that a parent comes to discuss with a pediatric occupational or physical therapist.  I strongly recommend that you read the entire blog post.  In general, the goal of the blog post is to “change the online narrative that unnecessarily pathologizes this issue as a ‘sensory processing disorder.'”  I agree with Mr. Alterio’s position in the post but it made me consider the changing job description of pediatric therapists that seems to be evolving.

We frequently read complaints about schools, Common Core and teachers placing some high level expectations on children.  What about parents?  We too have raised the bar of what we expect from our children.  It appears as if society wants every child to fit into a perfect, normal mold which is impossible.  Each and every child is unique with his/her own talents.  We seem to forget this all too often.  Parents quickly do go to the internet to search out answers for behavioral concerns.  And like Mr Alterio said, they are real concerns.

Parenting is a completely different job than it was years ago.  In households with two parents, frequently they both work.  In single parent households usually the parent is working.  This situation alone raises the expectations that are put on children.  Let’s compare a household 50 years ago to today:

Sensory motor experiences as a child years ago (where one parent or grandparent was home to take care of the child) – take a bath once a week, get dressed by yourself at a leisurely pace, decreased food choices, more unstructured free play, more outdoor time, less television time,  no computer/tablet/phone time, etc

Sensory motor experiences as a child today – take a bath every day or every other day, get dressed at lightening speed, increase in different foods and flavorings, little to no unstructured free play, decreased outdoor time, increased computer time,longer school day and increased homework.

Is it possible, that children have not changed over time but our expectations as parents are unreasonable leading to increased meltdowns, tantrums and sensory sensitivities that affect our daily routines more than years past?  There are of course a small percentage of children who do not fit into this category when it comes to sensory processing and these are the children who may need direct occupational or physical therapy services for a period of time.  But the parents of children whose days are disrupted due to sensory preferences and sensitivities can be difficult.  We are constantly in rush mode.  If you work outside the home here is an example of a daily routine that I am talking about –

Get kids ready for day care or school resulting in quick morning meals (if at all), dress quickly, make lunches, gather up all school supplies and get out the door.   “Johnny” doesn’t want to put his socks and what happens?  Chaos!  Tempers are short, Johnny is rushed and the socks might be uncomfortable.  You have to go so you grab Johnny a different pair of socks and try again.  Still no go – Johnny refuses to wear the socks, you are already late for work and the kids may miss the bus.  Forget it – Johnny goes to school with no socks on or you force him to wear the socks he finds uncomfortable and they bother him all day.  Johnny comes home from school tired out from the hectic morning, all day long at school and now homework expectations.  After homework, eat a quick dinner and off to the soccer field for a game.  Now Johnny needs to put on his tight soccer socks, shin guards and uniform shirt.  Again, running late maybe you help or maybe you change the socks.  Sooner or later he and possibly even you as the parent melts down due to fatigue.

I am sure some of the above story sounds familiar to many parents.  It may not be the socks, but shoes, a sweater, lunch choices, etc. Whatever it is, parents do need our help and expertise on childhood development.  It is almost as if this has fallen into the laps of pediatric therapists.  When you think of job descriptions, no one else looks a childhood functions, motor skills and life skills like we do as therapists. Sure there are pediatricians, nurses, early childhood teachers, etc who can help as well but they are usually inundated with child after child and can not take the time to educate parents on how to help their children either through verbal prompts, environmental modifications or schedule changes.

We do need to be VERY careful not to jump to conclusions about every concern a parent comes to us with since there are so many factors that influence a young child’s behaviors and motor actions.   We do NEED to help educate parents on how to make their lives and their children lives more fulfilling.

Please take the time to read the blog post, he offers some very good advice – would love to hear your thoughts.

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Effects of Tablet Use on Fine Motor Skills

Effects of Tablet Use on Fine Motor Skills

Physical & Occupational Therapy In Pediatrics published research on 80 children (mean age = 60.1 months) to determine the effects of touch-screen tablet use on the fine motor development of preschool children without developmental delay. The children were placed in two different groups.  One group of 40 children, who used a touch-screen tablet more 60 minutes per week for at least 1 month, received a 24-week home fine motor activity program using a touch-screen-tablet.  The other group of 40 children, matched for age and sex, who did not meet the criteria for previous tablet use received a 24-week program consisting of manual play activities.  Following the interventioin, the Bruininks–Oseretsky Test of Motor Proficiency was used to measure motor skills.

Data analysis indicated the following:

  • pretest analysis showed no group differences in motor performance and pinch strength.
  • posttest scores showed children in the nontouch-screen-tablet group made significantly greater changes in fine motor precision, fine motor integration, and manual dexterity.

The researchers concluded using a touch screen tablet extensively might be disadvantageous for the fine motor development of preschool children.

Reference:  Ling-Yi Lin, Rong-Ju Cherng & Yung-Jung Chen.  Effect of Touch Screen Tablet Use on Fine Motor Development of Young Children.  Physical & Occupational Therapy In Pediatrics.  Published online: 10 Jan 2017.

Hands First Fine Motor Curriculum


The Hands First! Fine Motor Curriculum is a new, comprehensive, evidenced based program backed by preliminary research that demonstrates its effectiveness in helping students gain in fine motor and fine motor foundation (gross motor) skills. Written for preschool, kindergarten and first grade students, this complete program can be utilized by both therapists and teaching staff. Kids love the activities! Administrators are impressed that the program is written as a curriculum that can be implemented by teaching staff. FIND OUT MORE.

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Saturday, January 14, 2017

Figure Ground and Spatial Reasoning Activities

Figure Ground and Spatial Reasoning Activities

These two figure ground and spatial reasoning activities are free from the Crocodiles, Flamingos and Monkeys Visual Perceptual packet.  Can you count how many crocodiles are in the picture?  This figure ground activity can be printed to provide your students with a visual perceptual challenge.  Can you use spatial reasoning and visual motor skills to complete the monkey picture?

DOWNLOAD 2 FREE Figure Ground and Spatial Reasoning Activities.

Crocodiles, Flamingos and Monkeys

Crocodiles, Flamingos and Monkeys Visual Perceptual Packet – This digital download includes 22 pages of worksheets to practice visual discrimination, spatial reasoning, figure ground, visual closure, form constancy, visual motor skills and coloring.  FIND OUT MORE INFORMATION.

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Thursday, January 12, 2017

Aerobic Exercise Improved Self Regulation and Behavior


Pediatrics published research to determine if structured aerobic exercise during physical education (PE) resulted in improvements in behavioral self-regulation and classroom functioning among 103 children (ages 7-16 years old) with students with autism, attention deficit hyperactivity disorder, anxiety and mood disorders.

Over a 14-week crossover design, students were randomly assigned to receive the 7-week aerobic cybercycling PE curriculum or standard nonaerobic PE.  The cybercycling phase had children use the bikes 2 times per week during 30- to 40-minute PE classes.

The results indicated that following the aerobic intervention phase, children experienced 32% to 51% lower odds of poor self-regulation and learning-inhibiting disciplinary time out of class.   The effects were more pronounced on days that children participated in the aerobic exercise where disruptive behaviors dropped over 70 percent, but carryover effects were also observed.


Bowling, A. et al. Cybercycling Effects on Classroom Behavior in Children With Behavioral Health Disorders: An RCT. Pediatrics Jan 2017, e20161985; DOI: 10.1542/peds.2016-1985

Heasley, S. Study: Exercise May Cut Behavior Issues In Half. Retrieved on 1/12/2017 from

Self Regulation Skills Curriculum

Self Regulation Skills Curriculum: Move – Work – Breathe – This curriculum provides an effective, time-efficient structured system to provide classroom breaks, improve self-awareness and self advocacy and teach specific self-regulation skills so that kids have tools to use in their classrooms. This system will get kids moving, give them the benefits of a brain power boost [from getting their heart rate up], give them heavy work and isometrics to help them calm down, and help them learn techniques to quiet and control their bodies in order to return to their academic work. FIND OUT MORE.

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Wednesday, January 11, 2017

Working Conditions Survey Results for School Based Therapists


The working conditions survey results for school based therapists have been summarized.  As you can see from the results, there were 431 responses the questions about working conditions.  Frankly, I was shocked that close to 79% of the school based therapists felt that a national organization should be formed to establish working condition standards ( caseload, sessions per day, ratio of direct treatment to consultation with teachers etc) to improve outcomes for students receiving OT, PT or speech.  Whether that comes to fruition or not, it seems obvious that therapists need some help or guidance.  You can view the results below.  Following the results are some of the comments that were added to the survey.  Perhaps these results will help motivate additional research on the topic helping to make positive change.  Please take a moment to answer the current survey on handwriting and keyboarding.

Working Conditions Survey Results for School Based Therapists

Here are some additional comments that were added to the survey.  They provide a nice overview and what therapists might experience and some pros/cons for the idea of guidelines:

  • National standards would be nice. I live in a state that has very little school based representation, standards or guidance at the state level.
  • There needs to be a caseload limit. And when the limit is reached the therapist can be expected to look at discharges and if no discharges can be made then additional services need to be contracted out!
  • All states/ districts vary as do students. I think we need to belong to AOTA,APTA and ASHA and communicate with stakeholders. It would be difficult to prove that more time for therapists improves outcome of students as therapist expertise and goals and experience is as variable as the students we work with.
  • I don’t feel there is a national approach as these things vary by state, county, and city. However, I think there is a standard that should and could be placed by AOTA. It likely already is, and I’m just ignorant of it at this point (just started working in schools). I didn’t know what to ask for, and I ended up in a mess with little time and poor accommodations to service students. I do not get the opportunity to do my full frequencies, and push-in is being promoted, but in many ways is not helpful to the actual OT-related items I’d love to do.
    I am the only OT servicing every student in three rural counties driving up to 75 minutes in one direction for one student. We are told it is the expectation as a salaried professional to complete your work at home.
  • State standards not National
  • Practice patterns and work expectations vary too much across the US to try to legislate working conditions. I review IEPs from other states and they are very different from state.
  • To make guidelines for workloads yes.
  • We need to have some sort of standard in order to incorporate all the factors that go into service provision. We used to have a formula that took into account number of schools, number of miles between schools and then number of service hours with number of students. Without a format, school divisions will continue to push for whatever the staff will bear!
  • I think to form established regulatory standards via a national/formal organization for school based therapist is an excellent and much needed idea!
  • I have been a school based PT for 24 years. Over that time, my methods of intervention have ‘evolved’ to encompass inclusion, embedding skills within the natural setting, etc. Unfortunately, our administration still equates IEP minutes with ‘that is all the time you spend with that child’ so therefore you should be able to see this many in this amount of time. Conversations around workload versus caseload are evolving, but in these badly funded school settings with a number crunching administrator, it is a difficult conversation. We desperately need supporting standards, etc to help us provide what we know is needed in order to address the needs of our students and their classrooms. Thank you for starting the conversation with this survey!
  • I have worked in many different school based settings, and I have found that each one is unique in it’s own way. The number if students that are appropriate depends on the types of students you have, and therefore cannot be assigned a random number to determine a caseload. That said, admin does need to understand the need for time for consult, research, observation etc and not look at the 1:1 contact with students only.
  • Group collaboration never hurts.
  • We need guidelines on our case-load size when working in the schools.
  • This could be provided at the state- or county-level rather than nationally.
  • A national organization would be great, but each student receives such individualized service that it would be difficult to establish working conditions that were uniform across the nation. Some areas favor direct pull-out therapy some favor favor push-in therapy of more consultative nature.
  • I feel like school based PT’s are such a small portion of the profession as a whole that we are often overlooked. It would be extremely helpful to have some national guidelines! I am currently overseeing a staff of 12 OT’s and PT’s in a school district so this would be helpful as an administrator as well.
  • This is already encompassed in AOTA or APTA. Not to mention that a group can suggest all they want but it is a long way to laws and financial support. The Feds have yet to fully fund their initiatives for Special Education of the 70’s.
  • I think there should be some sort of a cap on the amount of students on caseload for each occupational therapy practitioner.
  • Dedicated space to see students is a big problem!!
  • The wide variety of service provision across the country causes problems when children move and services change – it would be helpful if we could all be on the same page to determine when it comes to how, how much, where, when, etc for service delivery.
  • We are under teachers contract however do not benefit from all be fits such as allotted prep and planning time, scheduled lunch times, time for conferences. Traveling between multiple buildings sometimes takes lunch times as well.  Scheduling always presents issues…
  • A national organization would be very useful for research.
  • Regarding the last question, guidelines rather than standards might be better. Each child and each classroom environment is unique and we must have the flexibility to adapt.
  • There are currently no guidelines out there that indicate the workload vs caseload for all therapists. We are left to advocate for ourselves in a system that has been notorious for having small budgets. I am constantly performing work at home on my own time, spending money to buy supplies needed to provide services and constantly on the run!
  • Every caseload, just like every student, is unique. The ratio of consult to direct treatment changes with caseloads and from year to year depending on need. Sessions per day can also change depending on the needs of students, special events, length of sessions, etc. Caseloads change depending on needs and could be larger with lots of consult or smaller with lots of direct service.
  • Not sure if we need an actual national organization, but better support at the state level, backed by AOTA.
  • A set of standards to refer to would be helpful because many therapists are working singly in school districts. Also as contract therapists rather than employees we often have very little say the hours that a district is willing to pay for and often little job security.
  • I hesitated to answer the last question. I’m not sure that is the answer, but having standards to refer schools to would give more weight to my one opinion about the quality of services being offered.
  • I find that I am often asked to observe, informally assess, or provide suggestions for students that are not on my caseload. I am happy to do this, but find it takes my time away from planning intervention sessions with my students. I wish there was time carved into my schedule to assist my building in general, in addition to time for my students. I want to be able to do both effectively.
  • Each campus and organization too unique. Goal is to work together to provide services for kids.
  • Although I think collaboration of ideas is always great, the way this question is worded sounds more like someone wants to mandate the situation. Every school district, available staff and caseload is unique and continuously in fluctuation as students move in and out, making set requirements impossible to maintain.
  • Back in the 80’s some practitioners and I began the movement for more organization among school based practitioners. We were instrumental in getting guidelines for best practice written as well as professional development and fieldwork sites for training. I have been actively practicing as a school based OT for over 30 years, never have I witnessed a more greater need than ever for a a national organization to support us and would be willing to help!
  • SLP have a caseload max in the schools. I see their caseloads going down. Caseload standards would be beneficial to our students and to our profession.
  • I have been a school therapist for nearly 20 years and caseload/level of service has been a constant struggle. Nationwide recommendations or guidelines in this area would be extremely helpful.
  • As a school based PT for 20+ years, delivery of services has evolved significantly. When we talk to our administrators about our needs, it would help to have standards to refer to as they still want to tie services to the amount of time on the IEP.
    I am required to pay teachers union dues and benefit very little from those other than salary negotiation. Having our specific practices and related issues supported would be more appropriate.
  • I believe there should be guidelines from AOTA (APTA, ASHA, etc.) to set an appropriate caseload size- based on work load, not caseload. I have been in positions where I was over scheduled and didn’t have the time to provide adequate therapy to students, but the district was unwilling to help in any way. I do not believe in organizations, such as unions, to determine such standards.
  • I am willing to be part of that national organization.

Please take the time to fill out the current survey.

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Tuesday, January 10, 2017

Visual Motor Integration Skills and Speech Sounds

Visual Motor Integration Skills and Speech Sounds

Perceptual and Motor Skills  published research on visual motor integration skills in children with speech sound disorders (SSD).  A SSD is defined as a “persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages”.  Visual motor integration (VMI) is defined as the coordination of visual and motor functioning, which is closely related to academic skills.  Since visual input plays an important role in learning the phonological structure of language, children use multimodal information to determine how to produce a sound by perceiving speech spoken both by themselves and others.

The participants included 65 Turkish children aged from 5 to 6½ years old (31 with speech sound problems and 34 age matched controls without speech problems).  Each child was evaluated with the Ankara Articulation Test for evaluating speech sound skills and the Beery-Buktenica Developmental Test of Visual Motor Integration with its supplemental tests of Visual Perception and Motor Coordination.

The results indicated that the children with SSD scored significantly lower than the control group in Visual Motor Integration, Visual Perception, and Motor Coordination.

The researchers recommend that if a child has SSD there may be visual motor deficits. Even though phonological errors are a natural part of the developmental process, visual motor skills should be examined if the child’s speech sound development falls within a very low percentile.

Reference:  Ercan, Z. G., Yilmaz, Ş., Taş, M., & Aral, N. (2016). Investigation of Visual Motor Integration Skills in Children With Speech Sound Problems. Perceptual and motor skills, 0031512516664894.

visual motor collection

Visual Motor Collection: The 10 visual motor titles includes: Visual Motor Workbook, Visual Motor Exercises, Hole Punch Palooza, Patterns, Follow the Path, VINGO Visual Motor Bingo, Graph Paper Drawings, Letter/Shape Mazes, Grid Drawings and Penguin Pencil Challenges. Get 50% off for this collection of 10 titles via immediate download. FIND OUT MORE.

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Monday, January 9, 2017

January 2017 Digital Magazine for Pediatric OTs and PTs

January 2017 Digital Magazine for Pediatric OTs and PTs

The January 2017 Digital Magazine for Pediatric OTs and PTs has been published.  It is jam packed with information on recent research, activity ideas, tips and more.  View the Table of Contents for the Your Therapy Source Digital Magazine January 2017:


It is a quick and easy way to keep up with updated information.  You can download and view the magazine here.

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