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Occupational Therapy Web

Occupational therapy is the only profession that helps people across the lifespan to do the things they want and need to do through the therapeutic use of daily activities (occupations). Occupational therapy practitioners enable people of all ages to live life to its fullest by helping them promote health, and prevent—or live better with—injury, illness, or disability. 

--www.aota.org

General Information and Milestones

In the school setting, occupational therapists focus on the daily occupations of school life.  They work with students who have disabilities to achieve success in the classroom and across all school environments. 

Fine Motor

Fine motor skills refers to using the small muscles in the hands and arms to move objects and complete tasks. Fine motor skills let children perform crucial tasks like reaching and grasping, moving objects and using tools like crayons, pencils and scissors.

 

  • Grasp - Pictured below is a developmental sequence for developing a "preferred" pencil grasp for handwriting.  It's important to note that preferred does not always mean functional.

Stages of hand writing grip development

(http://redbridgeserc.org/resources/entry/stages-of-hand-writing-grip-development/)
  • Dominance - Typically established by age 3

  • Coordination/Manual Dexteriy - all movements should be smooth 4.5yo

Pre-writing and Handwriting

Pre-writing

  • Tracing - 4 years old - should be able to trace simple shapes.

  • Design Copy - Copying the lines shown below are important prerequisites to handwriting letters.

Image result for pre writing strokes

  • Draw a person - 5 1/2 years old - can draw a person with at least 6 body parts

Handwriting

  • Most children can print names - 5 years old

  • Basic handwriting legibilty improves - 6-7 years old

  • Print a minimum of 3 words, numbers 0-9, and the alphabet from memory - 6 years old

Sensory Processing

Sensory processing is the process that our bodies use to take in sensory information from our environment, organize it, and then functionally carryout everyday activities.  Examples of sensory processing difficulties include a child that is sensitive to noise and covers his ears, not noticing when her face is dirty, excessive wiggling during seated tasks...

 

Processing sensory information begins as early as in utero as the sensory systems begin to form and continues to develop during infancy.  Overwhelmed infants begin to learn self regulation in order to calm or self soothe.  As motor skills develop, so do the vestibular and proprioceptive senses, as these sensations of movement come from the body.  As the infant matures into a toddler, and then into school-age he or she will continue to improve sensory processing skills through maturation and exploration of his or he environment.

abilitypath.org

The vestibular system is responsible to provide information regarding movement and balance. Proprioception is the ability of your muscles and joints to determine where they are in space.

Visual Motor Integration & Visual Perception

Visual motor integration, sometimes referred to as eye-hand coordination, is the ability to respond to visual input with a motor action. Catching a tossed ball is an example of this.  Visual motor integration is also inherent in many academic skills such as, drawing and coloring, using scissors, copying from a board, and getting food on a fork.  

Visual Perception refers to what the eyes see and how the brain interprets that visual information. Visual perception consists of 7 separate skills and each one plays a pivotal role in academic skills like, handwriting, reading, writing solutions to math problems, copying from a board, maintaining visual attention, and organizing materials.

 

  • Scissors Skills

    • cut on a straight line - 3-4 years old

    • cut on straight and curved lines, cuts out circles and squares - 4-5 years old

    • cut out complex shapes and a circle without lines - 5+ years old

  • Colors in the lines - 5 1/2 years old

  • Right and Left Discrimination -

    • aware that L and R are on opposite sides but may not yet be able to correctly identify - 6-7 years old

    • knows precisely which parts are right and left on self and in space -  8-9 years old

Daily Living Skills

​​​​​​​Daily living skills, aka self-care or self-help skills are those skills are those skills that we do to ready ourselves for other daily activities.  Basic dressing, grooming, feeding, and bathing tasks are examples of this.  In school, these skills can impact children socially but there are also school specific daily living skills, such as opening a locker, getting food from the cafeteria, and opening and closing a book bag, just to name a few.

  • Removes various articles of clothing - 2-3 years old

  • Zips an initited zipper - 2 1/2 years old

  • Puts on socks and most clothing - 2 1/2-3 years old

  • Drinks from open cup - 3 years old

  • Zips front separating zipper - 4 1/2-6 years old

  • Places shoes on correct feet - 4-5 years old

  • Ties bow on shoes - 6-6 1/2 years old

  • Holds spoon and fork with fingers - 4-4 1/2 years old

For Parents

Many of the skills that are addressed by OT in the schools are best improved in school when supported at home.  However, so many tasks and activities at home use the same processes, muscles, grips, pinches, etc that are used in school.  Below you'll find activity ideas that can be fun and functional, or both, but they should always be fun!

Fine Motor

Pinches, Grasps, and Pencil Grips

  • Color with broken crayons

  • encourage your child to eat small finger foods for snacks (if able to without choking).

  • use tweezers to pick up small objects. use tongs to help serve salad, rolls, ice, etc.

  • when putting items in plastic bags with slide zip top ask the child to seal the bag

  • Water Play! Squeeze water out of small sponges using only one hand, squeeze water up a turkey baster or eye dropper for playtime in the bath or sink

  • use the thumb, index and middle fingers to pop bubble wrap or pull off stickers and place on paper

  • play with play dough and pinch off small pieces of dough

  • play games such as using small building blocks, marbles, wind up toys, peg games (Lite Brite™, Battleship™) and/or travel games with small parts.

  • knead bread or pizza dough

  • squeezing toothpaste onto toothbrush

  • unscrewing and screwing lids onto jars

  • make fresh squeezed juice

  • water plants using a spray bottle

  • squeeze out glue for craft projects

  • play with stress balls or pop toys

  • cut up sponges into small pieces and wash small toys

25 Fine Motor Activities Using Household Items

Therapy Street For Kids

Hand Dominance

 

Sensory Processing

It should be noted that no 2 child's sensory needs are alike and it is possible to provide too much or too little.  Contact your school's OT with any questions regarding what might be "just right" for your child.

 

  • tactile activities such as play dough, sand or water play

  • movement activities on the playground, crawling through tunnels, participating in sports, etc.

  • activities that encourage body awareness such as obstacle courses where the child has to go up, over, in between, through, etc.

  • physical activity where the child has to move through space such as using ride on toys, scooters, swings, rolling down a hill, etc.

  • activities that provide heavy work to the joints and muscles such as pushing, pulling, lifting, squeezing, jumping and bouncing experiences with different smells, sights and sounds

  • pushing (compresses the nerve endings) and pulling (stretches the nerve endings) activities ie push a heavy basket, pull a loaded wagon, etc.

  • jumping and bouncing activities ie hopscotch, hippity hop ball, pogo sticks, bounce house, etc

  • carry heavy objects ie groceries, backpack, stack of books, etc

  • heavy work chores such as raking, shoveling, sweeping or mopping

  • climb playground equipment, use monkey bars, play tug of war, etc.

  • use play dough or dig in the sand to provide heavy work for the hands

  • kitchen chores like kneading bread, stirring or using a rolling pin

  • eating chewy foods or sucking through a straw provides heavy work for the mouth

  • log rolling on the floor or up/down a hill

  • swinging back and forth is linear input to the vestibular system and swinging in circles (ie tire swing) 

  • rocking in a rocking chair or on a rocking horse

  • moving through space on a ride on toy ie tricycles, scooters and bicycles

  • practice moving at different speeds (fast or slow) and in different directions (right, left, backwards, etc)

  • spinning activities ie sit-n-spin, twirling in a circle or riding a merry go round

  • gymnastic activities such as performing forward rolls (somersaults) or cart wheels

Sensory Processing Disorder

Understanding Sensory Processing Issues

Visual Motor Integration & Visual Perception

Visual Motor Integration

  • practice catching, throwing, kicking and hitting. 

  • use large movements to form letters and numbers (i.e. air writing forming the letters large in the air

  • using your whole arm and hand, use sidewalk chalk).

  • use stencils, dot to dot puzzles, mazes and coloring books (emphasizing coloring in the lines)

  • lacing activities, such as stringing beads, simple sewing projects, and lacing cards

  • play movement games that encourage right/left discrimination, avoiding obstacles, stopping/starting, etc.

Visual Perception

  • sort objects from around the house (i.e. LEGOs by color, size or type, silverware, playing cards, etc.)

  • match up pictures that are the same (i.e. matching games, memory games)

  • complete “find the difference” puzzles

  • complete puzzles starting with simple one piece puzzles and progressing to larger puzzles

  • play dominoes, sort coins, play bingo with picture cards, color by number, dot to dot, 

  • complete letter, number or word searches, hidden picture puzzles.

Daily Living Skills

All daily living skills include some sort of combination of the fine motor, sensory processing, and visual skills listed above.  So, completing some of the above listed activities will certainly help to build daily living skills.  However, practice of the actual skill is ultimately the best way to build daily living skills.  Support your child as much as they need but try to fade that support away until they are as independent as possible.  

Tell me and I forget, teach me and I may remember, involve me and I'll understand.

--Benjamin Franklin

For Teachers

Teachers, 

This section is to be used as a guide for interventions.  Please use the Parents and General Information tabs for additional information too.  You should be able to find a number of activities to use as interventions related to your concerns and observations.  Interventions should be completed for AT LEAST 2 weeks prior to submitting a referral for a formal OT evaluation.  However, we highly encourage you to work with your school's OT on these interventions in order to best help your student.

Fine Motor

Common fine motor difficulties reported to OT by teachers include:

Sensory Processing

Important points to consider about sensory processing difficulties:

  • A child’s sensory environment and sensory-filled activities during the day can have a significant positive impact on his or her ability to attend to an activity and learn.  Modifying a student’s environment and schedule to allow calming/alerting activities may enable students to become more effective learners.
  • Because sensory activities are important for students to be able to stay engaged, these activities should NOT be withheld and used as a reward. 
  • Reversely, when a student displays undesired behaviors, sensory breaks prior to undesired behaviors may result in an improvement in behavior. It is helpful to track when a child exhibits undesired behaviors and allow sensory breaks prior to these times. Planning sensory breaks and activities into the student’s daily schedule can be an effective behavior management tool.
  • Each child responds differently to specific sensory intervention therefore it is not appropriate to provide a detailed sensory routine that will work for all students.

If teachers suspect that a student has specific sensory needs, please consult with the OT assigned to your school to discuss particular strategies.

Schedule Modifications:

Most children, especially those with sensory integration difficulties, benefit from a predictable schedule.

  • Each morning, review the schedule for the day. If there are changes from the typical routine, discuss these with the class. It may be helpful to use a picture schedule on the board or on a child’s desk.
  • If possible, discuss unexpected events before they happen (e.g. fire drills, assemblies) to allow the child time to prepare. It may be helpful to come up with a story that describes how the child should act in each situation.
  • To assist students transition from one activity to another, use a “clean-up” song  or “new activity” song to help the child prepare to end one activity and begin another activity.

Organizing Sensory Activities (for those students who seem to have a lot of energy and or have trouble focusing):

  • During independent work times, play classical music in the background.
  • Have a quiet corner in the classroom where individual students can read or listen to music if they are feeling overwhelmed.
  • Instruct the child to take deep breaths prior to transitioning.
  • Have children perform “heavy work” activities such as pushing the wall over, chair pushups,  carry  books  to  the  library  or  carry  “cold  lunch  bin”  to  the  cafeteria.
  • Allow the class frequent movement breaks. These breaks can be short and include stretching,  deep  breathing,  oral  motor  “snack”,  heavy  work,  walks, brain breaks or a change of pace. 

Environmental Modifications (simple changes to the environment can help a student with sensory processing difficulties be a more successful participant in learning):

  • Limit the amount of visual material on the walls or hanging from the ceiling.
  • Store fine motor/math manipulative and other colorful activities in plastic boxes or cubbies out of the child’s sight.
  • Organize the classroom and create a specific place for books, activities, and other items to be stored out of sight. It may be helpful to take pictures of items and tape the picture where the item belongs.
  • Limit the amount of auditory input by closing doors and windows in the classroom. If a child is distractible or has a sensitivity toward auditory input, locate the desk away from doors, windows, fans, or the loud speaker.
  • When possible, prepare a child who is sensitive to auditory input for fire drills, morning announcements, or recess bells.

Sensory Jobs:

Giving a student a job that requires pushing, pulling, carrying objects etc, allows for a break for movement and deep pressure that the students body might need while allowing them to be helpful too.  Examples of classroom sensory jobs include:

  • collect library books
  • washing windows, desks
  • take down chairs
  • staple papers, hole punch papers
  • carry lunch basket

 

(For More Info. See Appendix: “Does Your Student Have Sensory Processing Challenges” & “Sensory Activity Tracking Form”)

Visual Motor/Perception

Daily Living Skills

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