Monday, October 31, 2011

Influence of Gender on Surgical Outcomes in Cerebral Palsy

Interesting research was published on the influence of gender on surgical outcomes in 34 children with spastic diplegia. Initially following surgery there was no difference on the Gillette Gait Scale between girls and boys. The children were followed for 10 years. Over the course of the 10 years, the girls maintained their enhanced walking ability whereas the boys exhibited a constant deterioration of walking skills. The authors conclude that gender may influence surgical outcomes in children with cerebral palsy.

Personally, I have not noticed this with the population of children that I have worked following surgical intervention. Have any of you experienced this - boys and girls performing differently?

Reference: Zwick EB, Svehlík M, Kraus T, Steinwender G, Linhart WE. Does gender influence the long-term outcome of single-event multilevel surgery in spastic cerebral palsy? J Pediatr Orthop B. 2011 Oct 24. [Epub ahead of print]

Friday, October 28, 2011

Halloween Clothes Pin Activity

Download this Halloween mat to match up clothes pin or to practice visual motor skills.
You can download the activity at

Wednesday, October 26, 2011

Video Activity - Cup Challenge

Combine movement and learning with this fun challenge using 3 oz plastic cups and a recycled potato chip can to store them in. Download the template and get directions at

Tuesday, October 25, 2011

Wii and Head Control

Here is an interesting but very small study on using the Wii controller to assist with head control. Two subjects with multiple disabilities used the Wii remote controller to control their favorite stimulation by actively keeping their head in an upright position. The results showed that both participants significantly increased their time maintaining the head in an upright position.

Reference: Shih CH, Shih CJ, Shih CT. Assisting people with multiple disabilities by actively keeping the head in an upright position with a Nintendo Wii Remote Controller through the control of an environmental stimulation. Res Dev Disabil. 2011 Sep-Oct;32(5):2005-10. Epub 2011 May 20.

Monday, October 24, 2011

Pain and Cerebral Palsy

A recent study assessed the pain of 153 participants (8 -18 years old). The majority of the children had bilateral spastic cerebral palsy (55%) followed by 38% with unilateral spastic, 6% dyskinetic and 1% ataxic. Gross Motor Function Measures varied from Level I through V with the majority of children in Levels I and II. The results indicated that 62% of the children experienced pain. The only significant predictor of pain was being more than 14 years old. The children reported their pain to be moderate whereas parents reported their pain levels to be higher. Both children and parents stated that pain impacted walking and general activity.

Reference: RAMSTAD, K., JAHNSEN, R., SKJELDAL, O. H. and DISETH, T. H. (2011), Characteristics of recurrent musculoskeletal pain in children with cerebral palsy aged 8 to 18 years. Developmental Medicine & Child Neurology, 53: 1013–1018. doi: 10.1111/j.1469-8749.2011.04070.x

Sunday, October 23, 2011

Fine Motor Rewards

Previously, I had written a blog post on Positive Reinforcements following therapy sessions. Basically it was some suggestions to encourage compliant behavior and active participation during therapy sessions. I wanted to add a few more suggestions to the list of my 6 previous suggestions: Carnival Party, Olympics, Playground Time, Nature Walk, Gym Time and Free Therapy Play Time. All of those suggestion were sensory motor activities.

Here are a few suggestions for fine motor positive reinforcements:

  1. Button Bags - sew a felt bag that has a few button closures at the top. In order for the children to get the reward they must unbutton the bag to reveal the prize.
  2. Zippered Bags - hide the prizes inside pencil pouches and they have to unzip to reveal the prize
  3. Lock and Key - use a lock on a treasure box. To pick a prize you have to unlock the box.
  4. Unscrew the Lid - paint the inside of a jar to hide what is inside. The children have to unscrew the lids to get the reward.
  5. Shoe Untying - hide the prize inside a sneaker. The child must untie the shoe to get to the prize. Then let the child pick a prize to hide back in the shoe for the next child and tie the shoe back up.
  6. Envelope Cutting - hide the prize in an envelope and the child has to use scissors or a letter opener to cut the envelope open. Good one for small stickers.

Positive Affirmation Posters and Cards for Children
Keep a positive attitude with this download of 25 positive affirmation posters and 25
small cards of the posters.

Find out more.

Awards, Signs and Certificates for Pediatric Occupational and Physical Therapists

Need some inexpensive reward ideas? Just print out one of these certificates for a child!

Find out more.

Friday, October 21, 2011

Make Your Own Action Dice

Here is a fun freebie to create your own dice. At Big Huge Labs you can upload up to 6 images to create your own paper dice. Here is a simple set that I created using locomotor skills. Try rolling the paper dice along with a regular dice to see how many of the locomotor actions you need to perform. Makes for a nice exercise break in the classroom.

Try making your own dice by taking pictures of the children that you work with performing different exercises or stretches. How about yoga poses?

You can download my sample die below.

Need more physical activity ideas for the classroom?

Check out Action Alphabet and more sensory motor activities at Your Therapy Source.

Thursday, October 20, 2011

Fine Motor Game to Print for Fall

Here is a fine motor game to print and play with a Halloween/Fall theme. You can download it at Your Therapy Source.

Wednesday, October 19, 2011

Neoprene Splint and Handwriting

Recent research in Pediatric and Occupational Therapy in Pediatrics examined the use of a neoprene splint on the hand/wrist and its effects on the handwriting of 4 ninth grade students with joint hypermobility and pain. The statistical results indicated that the neoprene splint resulted in a significant decrease in handwriting speed in 3 of the 4 students. No significant changes in pain or endurance was observed while handwriting with the splint on the hand/wrist. When the splint was removed, 3 of the subjects indicated a significant decrease in pain. The authors concluded that the use of a neoprene splint was not indicated for ninth grade students with joint hypermobility.

Reference: Lauren Frohlich, Alison Wesley, Margaret Wallen, Anita Bundy. Effects of Neoprene Wrist/Hand Splints on Handwriting for Students with Joint Hypermobility Syndrome: A Single System Design Study. Physical & Occupational Therapy in Pediatrics. Posted online on 12 Oct 2011. doi:10.3109/01942638.2011.622035

Tuesday, October 18, 2011

Product Review - Kindertools

Kindertools are a set of unique "helping handles" that help children to eat, brush their teeth, clean their nails, paint and color. The interesting part of Kindertools is the handles. On each of the 8 tools there is a specialized handle that allows for different grasp patterns. In addition, for the eating utensils the handles are curved making it a little easier for the children to get the food to their mouths without spilling it. The handles also provide a safety net in preventing the child from choking on the utensil.

This product would be a nice addition to an occupational therapist or speech therapist's tool kit. The different shaped handles allow for different grasps which is extremely beneficial for children with disabilities that affect the function of the hand. The Kindertools offers the child the ability to grasp the utensil or writing implement which they otherwise may be not able to do with a traditional utensil. This allows for the child to achieve success and gain independence.

Here are some positives to the Kindertools:
  • child is able to use various grasps to hold the utensil affording independence
  • increase success rate for younger children in terms of keeping food on the utensil
  • offer choices to children with impaired hand function
  • safe, no choke design (especially nice for toothbrush)
  • the crayon can be placed in two positions to offer more adaptability
Here are two minor issues (not even a negative):
  • handle is short therefore sometimes difficult to get the bottom of a narrow cup or dish (i.e. yogurt container) which you could easily fix by pouring the yogurt into a wider mouth or shallow bowl.
  • they are designed for toddlers so if you wanted to use the tools for older children with a disability the handles may be too small.
Would love to hear from others who have used Kindertools. You get more information at What are your thoughts on the product?

Monday, October 17, 2011

Artist Trading Card Challenge

An OT blogger is hosting a fun artist trading card challenge in honor of World OT Day (October 27, 2011). She is challenging us to create artist trading cards that reflect occupational therapy. If you are unfamiliar with artist trading cards check out lesson plan for a group occupational therapy session. If she gets enough trading cards she would like to vote on the 12 best to create a calender for charity. Pictured below are a few submissions from us. To find out how you can enter your trading card check out her blog.

Submitted by K. (11 year old girl)

Submitted by M. (10 year old girl)

Submitted by me! (age undisclosed)

Thursday, October 13, 2011

Context Therapy and Cerebral Palsy

Great news story in support of context therapy to compliment traditional physical therapy for children with cerebral palsy.

Wednesday, October 12, 2011

Tuesday, October 11, 2011

Cerebral Palsy, Computer Games and Sitting

Research was published to investigate whether sitting balance could be improved in children with cerebral palsy following the use of motion activated computer games. After using the center of gravity game controller in sitting for three months, "statistically significant improvements were seen in two elements of box sitting using the Chailey levels (shoulder girdle position and spinal profile) and in five elements of the Sitting Assessment for Children with Neuromotor Dysfunction across both reach and rest phases of the assessment". The researchers recommend further research in this area.

Have you ever tried using Wii fit in a sitting position for children with cerebral palsy? There is one game on the Wii Fit, Lotus Focus, that is meant to be used in sitting. The individual is supposed to sit on the board and maintain stillness. There is a candle flame flickering for visual feedback. If you move too much, the candle goes out.

Today we tried sitting on the Wii Fit balance board to see if you could still activate the controls for other games. Using the Soccer Heading game, you could control moving the Mii side to side to hit the soccer ball. Of course it was not as accurate as in standing, but it would be viable to use in sitting just don't expect the same scores. We also tried moving the Mii side to side in quadruped only using the upper extremities. This worked as well but was quite fatiguing on the neck muscles. It would work for short periods of time to work on upper extremity weight bearing. I would recommend keeping the TV at a low level to prevent neck hyperextension. I would assume you could also try skiing or other games in sitting that require weight shifting. What have you done to adapt the Wii for children?

Reference: Wade W, Porter D. Sitting playfully: does the use of a centre of gravity computer game controller influence the sitting ability of young people with cerebral palsy? Disabil Rehabil Assist Technol. 2011 Oct 4. [Epub ahead of print]

Monday, October 10, 2011

Free Therapy News and Tips Templates

Here is another freebie from Your Therapy Source Inc. - Therapy News and Tips templates. Create you own monthly newsletter and tips hand outs to provide to teachers and parents. You can either type directly onto the templates (and even save them) or print the pages and hand write the therapy news. The templates are suitable for occupational therapy, physical therapy and speech therapy. Why not share the document between the disciplines to create an informative monthly newsletter from all departments. You can download the templates at

Friday, October 7, 2011

Moving and Feeling Using Only Brain

This is some crazy research from Duke University having monkeys use brain control only to move a virtual arm over the correct target based on sensory feedback (vibration). The researchers are hopeful that in the future this type of technology will not only help individuals with spinal cord injuries to move arms and hands and to walk again but even to feel and touch again.

Read more about this study from Duke University.

Thursday, October 6, 2011

Learning to Glue Freebie

This Learning to Glue freebie is great. I came across it on Pinterest. It has a cute little song about learning to glue. The best part is the worksheets where children can practice little dabs of glue, large spots of glue and glueing a frame. You will need to register to get the freebie but it is worth it if you have children who LOVE to overuse glue. Bonus: great hand strengthening activity and control to get the dabs of glue in the circles!

You can download it here at Teachers Pay Teachers.

Wednesday, October 5, 2011

Spina Bifada and Daily Life Tasks

A dissertation written by an OT doctoral student focused on 50 children (ages 6-14 years old) with spina bifada. Using the Assessment of Motor and Process Skills (AMPS), the quality of performance of everyday tasks was compared between the children with spina bifada, international age norms and a control group of typically developing Nordic children. In addition, the autonomy levels of the children were rated by the children themselves and the parents. Furthermore, the children and their teachers rated their participation in school activities. The School Function Assessment was completed by the teachers. The results indicated the following:
1. Most of the children with spina bifada had difficulties completing well-known everyday activities in an effortless, efficient, safe and independent way.

2. The low quality of task performance, especially the process skills, was strongly related to both the children's level of autonomy in daily life and their level of active participation in school.

3. The children with spina bifada had low autonomy levels in goal-directed situations that needed personal initiation.

4. Parents’ and children’s ratings of the children’s autonomy level indicated low agreement between the two groups.

5. Children with spina bifada participated in more school activities in high school.

The author concluded that occupational therapists need to support and encourage autonomy in everyday tasks for children with spina bifada.

In a school setting therapists can perhaps put techniques in place that will help children with spina bifada initiate activity. Here are some suggestions:
  • visual schedules with steps that are necessary to complete the task - this will allow the student to see what step number one is to initiate the activity.
  • written or visual reminders of what tasks need to be accomplished - at desk there could be a check list of what needs to be done before school begins i.e. put book bag away, hang up coat
Do you observe in your everyday practice that children with spina bifada have difficulties initiating every daily tasks? Do you find that children with spina bifada can perform daily tasks but may not be fully independent in finishing the tasks?

You can read the thesis in its entirety here.

Reference: Marie Peny-Dahlstrand. To get things done, the challenge in everyday life for children with spina bifida Quality of performance, autonomy and participation. Dissertation published in September 2011 for the Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg

Dressing Skills is a 24 page booklet that provides visual directions of how to:

* put on a shirt
* put on pants in standing
* put on pants in sitting
* put on a coat
* put on a coat with the flip method.

Find out more.
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