EDU Healthcare Blog
7 Writing Tools to Try for Children with Special Needs...
One of the things I work on as a pediatric occupational therapist is improving handwriting skills in children of all ages. There are a variety of reasons children come to see me when they have been identified as having trouble in this area. More often than not, parents tell me that their children have no interest in writing or they tire easily during these activities. The most important thing I can do is identify exactly where the handwriting breakdown is taking place and provide kids with writing tools to build up their confidence and self-esteem.
Finding tools to help with handwriting is one of my favorite parts of my job. Over the course of my career, I have found a variety of tricks that can be easily done at school or at home to help children develop better handwriting skills.
1. Discovery Putty
Hand strength and manipulation skills are required for good handwriting skills to develop. Before I begin handwriting activities with kids during their sessions, we always do some kind of strengthening activity. Discovery Putty by Fun and Function is a motivating strengthening tool. There are six different sets to choose from with varying levels of resistance (based on your child’s strength); the big hit in my office right now is the Dino Dig set, which is great for the youngest/weakest kids. Not only does it help build grasp strength, kids can work on building up their manipulation and bilateral coordination skills.
2. Mechanical Pencils
Many of the kids I work with apply too much pressure when using pencils and end up getting frustrated by having to constantly sharpen their pencils. I have found that use mechanical pencils (my favorite is the Zebra Cadoozle pencils) help kids work on regulating how much pressure they use during handwriting. They start to learn that if they use less pressure, the tip of the pencil won’t keep breaking.
3. Broken Triangular Crayons
For younger children who are struggling with developing an age-appropriate grasp, the first thing I recommend is buying Crayola’s Triangular Crayons and breaking them into two or three shorter pieces. First of all, the smaller the writing instrument, the more likely kids are to use a tripod-like grasp. Secondly, the triangle shape helps to naturally get kids to use only three fingers to hold them.
4. Egg-Ohs Pencil Grips
There are a lot of different pencil grips to choose from—so many that sometimes it gets too confusing. The Egg-Oh grip is a great choice for children who may over-flex their joints due to increased pressure while writing.
5. Slant Board
Working on a slight incline can help children who struggle with handwriting by putting their wrist in extension while allowing the fingers to flex and fall into a more efficient writing position. For kids who have difficulty using two hands, the clip will hold the paper in place so they can write without the paper moving all over the place.
6. Graph Paper
There are many kids who have visual motor and perceptual delays that cause them to have handwriting difficulties. Some of the things that I see is that they have trouble making their letters the same size and spacing letters properly. I have found that using graph paper gives kids a visual prompt on how big a letter should be and how much space should be left between words. There is a great website that allows you to print out graph paper with different-size boxes depending on the age or skill level of the child.
If motivation is your child’s biggest problem with writing, a journal is a fun way to inspire practice. There are a ton of fun books out there that provide simple writing prompts for kids who are struggling to come up with something to write about.
10 Best Benefits of a Sensory Swing...
From the time they are in utero, kids’ bodies and brains are developing from the movement they experience. Whether it’s flipping around in amniotic fluid, toddling around as a new walker, jumping on a trampoline, or swinging on the backyard playset, the brain is interpreting movement through its vestibular sense.
While most people are familiar with the five senses, the sense of movement (or vestibular sense) is unfamiliar to most parents. The vestibular sense gives a child information about where their body is in space, if they’re moving or still, how quickly they’re moving, and in what direction.
Vestibular receptors are located in your inner ear and are activated by the fluid in the ear canals moving as you move. This allows your brain to detect changes in head position to know whether you are moving with or against gravity. These receptors give your body information on where you are in space so you can be safe while navigating through your environment.
With a well-developed vestibular sense, your child develops eye/head coordination, muscle tone, balance, and bilateral coordination. Think about all that your child will do as they grow – catch a ball, zip a coat, cut with scissors, copy from the blackboard in school, ride a bike, play a sport – without a developed vestibular sense, these activities would be a challenge!
Swings for Vestibular Input
If you’re lucky enough to live in a sunny, warm climate year-round, it’s easy to find outdoor activities that provide vestibular input. Running, biking, climbing, jumping, swinging, and sliding are all fun ways to provide movement opportunities. For some kids who need more intensity of sensory input, or for those of us who are limited by variable outdoor weather, sensory swings are crucial to providing necessary vestibular stimulation all year round.
When you can’t provide your child with outdoor vestibular activities, there are alternatives you can add to your play space indoors. Ideally, a sensory swing allows for rotational movement (in all directions) as well as linear movement (back and forth, side to side). Some swings even have a vertical component that allow for up/down bouncing as you swing!
10 Benefits of Sensory Swings
1. The vestibular sense informs body awareness, safety, muscle tone, balance, and coordination.
2. Different types of swings target specific vestibular receptors through different movement patterns:
vertical – up/down
linear – side/side
rotary – all directions
3. The addition of a rotational safety device such as this one from Southpaw allows for movement in all directions and must be added to a fixed mount if you intend to allow for spinning.
4. Swings can challenge core strength, balance, righting reactions, and motor skills in different ways, depending on the design you choose. Using swings within therapeutic activities can build these skills in novel, fun ways. For example, a trapeze swing challenges upper body strength but add a crash mat and now you’re challenging timing skills to swing, release, and crash onto a target! Change that simple trapeze into a rope swing style and add a rotary component to the same activity.Another example is using a platform-style swing that challenges balance in a seated position. Swinging and throwing beanbags to a target will help with visual motor, timing, and righting reactions. Use that same swing and activity while lying prone on your belly and see how you can challenge muscle strength and endurance to hold yourself up against gravity!
5. Some swings allow for combined vestibular input like this Frog Swing or this Moon Ball Swing. Sometimes you can simply add a vertical stimulation device to turn your favorite swing into a combined input swing. Some kids tolerate combined-input swings better because of the additional proprioceptive input.
6. 15 minutes of swinging can have effects on the brain for up to 6-8 hours! Consult your occupational therapist to better understand how to monitor and include spinning in controlled doses!
7. Swings allow for varied intensity of movement that may be needed for kids who under-respond or over-respond to vestibular input. The ability to meet individualized movement needs depends on the type of swing you choose: rotary swinging and inverted or upside down movement is the most intense! Linear movement (like jumping or bouncing) is the most tolerated vestibular input because it combines proprioceptive input as well. Predictable, rhythmic swinging promotes calm and organization while unpredictable, arhythmic swinging is alerting.
8. The vestibular system is closely linked to the visual system, so improvements (or deficits) in processing are often noticed in both areas. It is common to address visual processing issues with a vestibular or movement component because we use functional vision while our bodies move to inform our body awareness. Sensory swings challenge and develop the functional use of vision by allowing the use of vision to see while moving, or give kids the option of being completely immersed in a swing and eliminating visual feedback. The pod swing is an example of a swing that can be used with or without vision.
9. Installing a sensory swing in your home can be as simple as finding a spare doorway, setting up a pop-up tripod stand, or recruiting a handy friend to drill into a ceiling beam. For more information on swing installation, check out Southpaw Enterprises.
10. Sensory swings can support sensory diet planning for self-regulation purposes. Whether the intention of your sensory diet is to calm and reorganize, or alert and stimulate, there is a sensory swing that can meet your child’s needs.
Swings are fun! The possibilities for therapeutic activity with swings are inspiring and endless.
Your vestibular system supports your body awareness, coordination, balance, and visual skills from birth through adulthood. Some children do not process this sensory information appropriately and require therapeutic supports to help them make sense of movement. Sensory swings are a wonderfully functional and fun addition to your home sensory toolbox. With consultation from your child’s occupational therapist, you can choose a sensory swing that meets your child’s individual needs for vestibular stimulation or a combination of sensory systems to promote regulation.
What Is Integrated Therapy?...
Integrated therapy, like traditional therapy, is governed by the guidelines and policies of the related services professions. Also like traditional therapy, integrated therapy includes various levels of support and degrees of service. Related services accommodate, modify, compensate for, and reduce effects of a disability so a student can participate and benefit from the special education program. As in traditional therapy, goals are written based on individual student needs.
So how is it different? In integrated therapy, a student's related service needs are planned, provided, and assessed ecologically, in natural settings, across disciplines. Skills are found and thus addressed in the clusters which serve functions in a student's real life. The IEP is collaboratively written and priority skills are determined for student participation, functional independence, and overall benefit from the educational program.
Integrated therapy can include direct (therapist works with a student), indirect (therapist works with a class or group including a student), and consultation-style (therapist meets with teacher(s) of a student) therapy. However there is usually an increase in indirect therapy and consultation with a decrease in direct therapy sessions occurring in isolation, or "down the hall in the therapy room." The teacher, therapist, and paraprofessional work and learn together, sharing their knowledge and expertise. They work to serve the student in a "whole" fashion focusing in on parts as they relate specifically to the student's total school program. The teacher gains an understanding of therapy techniques and strategies to follow-through the entire school day. The therapist gains understanding of the inter-relatedness of the needed supports or skills with the complete scope and sequence of the educational curriculum.
The integrated therapy occurs in various locations based on the relevant or natural setting for the skill to occur. If there is a need for service in isolation because of privacy or distraction issues, it can be provided. If service needs to occur in a social setting or be integrated into coursework, then the instruction, assessment, and service is completed in that location. For example:
The Physical Therapist (PT) works during a general education PE class to assist with accessibility ideas for games.
The therapist assists during math, designing and trying a menu of accommodations needed for Lonnie's handwriting difficulties.
The Occupational Therapist (OT) assists in art class with modifications needed for Mario to use a paintbrush and scissors effectively.
The Speech/Language Pathologist (SLP) works during language arts within the general education class to assist with augmentative communication devices.
The PT, OT, and SLP alternate accompanying Ms. Nygun's students on their community trips to the mall.
The number, frequency, and length of integrated therapy sessions can be flexible based on changes in the student's needs. For example, a new teacher, a new school, or the beginning of the school year may require more assistance and therapist time for modeling, training, and sharing. As the accommodations and strategies become part of the everyday program, the support may change to more consultative sessions for planning and monitoring. If a new piece of equipment is needed or new challenge occurs, more direct therapy can be increased again. Teachers who have worked together with a therapist in adaptations and integrated therapy may not need as much consultation as a newer team member.
With integrated therapy, the IEP is a trans-disciplinary process allowing for goals and objectives to be written jointly and monitored across all settings. The IEP is not prepared ahead of time with separate sections for each related service. The IEP team works collaboratively to write all objectives, which address motor, language, mobility, sensory, or physical needs integrated throughout various subjects and settings. The IEP team uses an ecological assessment from a variety of sources, then prioritizes the needed interventions. The team uses discussion and consensus to make decisions.
The trans-disciplinary IEP present level of performance looks different than the traditional list of strengths and weaknesses. It emphasizes student strengths and support needs. It documents the types of supports and interventions that have been successful.
By planning together, teachers and therapists design open-ended activities, alternative communication or mobility goals, language opportunities, and support strategies which the educators then add to their repertoire for future use with many kinds of students.
Teachers, therapists, and paraprofessionals all work in various combinations to provide support in integrated therapy. Roles are expanded to incorporate co-teaching and a variety of collaborative styles. For example:
The OT shows the whole class an organizational strategy for note taking, which is not only useful for Patrice, a student with a learning disability, but for the entire class.
The teacher may facilitate cooperative groups, while the PT assures correct positioning of Raymond in a stander within his group. She answers student questions about the equipment, modeling awareness and understanding of disabilities for his peers.
The SLP is present during reading class to determine if Shevone's hearing impairment is impeding her participation and understanding, and whether she needs alternative support to benefit from the class.
The SLP co-teaches a social studies lesson with the teacher. They demonstrate steps for preparing and presenting an historical character report. Afterwards, in smaller groups, the SLP specifically guides and monitors two of her students as they plan for their oral character reports.
The PT observes Hun's class, noting physical barriers to some learning centers in the room.
The SLP observes during a class social activity to assess frequency and effectiveness of Celina's social skills with initiating conversations with peers and requesting assistance or more information.
Between visits, the therapists and teachers can use a communication log to discuss concerns and ask questions. The educators share ideas and record attempted interventions and results. The log is initialed at each session. While this log should never replace discussion and physical meetings, it can bridge disciplines, eliminating the frequently ineffective "questions on the fly" (in the workroom, hall, or even during class instruction time).
Occupational Therapy for Cerebral Palsy...
Occupational therapy can help with managing everyday activities and functions, like eating, getting dressed and using the bathroom. It does so by improving physical and cognitive ability and fine motor skills.
How Does Occupational Therapy Help?
Occupational therapy helps people develop or recover the skills needed to lead independent, satisfying lives. The “occupation” in occupational therapy does not refer to one’s profession. Rather, it refers to the everyday activities that give life meaning.
For a child, these meaningful activities include playing and learning. Pediatric occupational therapy focuses on improving the child’s ability to play and learn, which are important for development and becoming independent.
For children with cerebral palsy, occupational therapy can help with muscle and joint coordination issues — issues that can make everyday tasks difficult. Some of these tasks include eating, brushing teeth and bathing. Occupational therapy can help to improve physical, cognitive and social abilities, as well as fine motor skills and posture. This therapy can also help address difficulties with processing sensory information.
Benefits of Occupational Therapy
Occupational therapy is beneficial for children with cerebral palsy in many ways.
By optimizing upper body function and improving the coordination of small muscles, occupational therapy can help children with CP master the basic activities of daily living.
Occupational therapy can help children by:
- Increasing their chance for independence
- Improving their ability to play and learn
- Boosting their self-esteem and confidence
- Helping them develop a workable routine
- Giving them a sense of accomplishment
- Improving their quality of life
Parents and caregivers spend a lot of time helping children with cerebral palsy perform basic day-to-day activities. As the child begins to see the benefits of occupational therapy, the parents and caregivers do, too.
For parents and caregivers, occupational therapy helps by:
- Reducing the demand on them
- Reducing stress
- Providing a sense of security
- Improving their quality of life
- Allowing them to watch their child improve and become independent
Each type of cerebral palsy presents different symptoms that may hinder a child’s ability to live independently and complete daily activities.
Occupational therapy can help with the following issues related to each type of CP:
- Spastic – Muscle stiffness in the upper and/or lower limbs and jerky movements characterize spastic cerebral palsy. Among other things, this can lead to difficulty getting dressed, bathing, using the bathroom, eating, drinking, writing and holding objects.
- Athetoid – Children with athetoid cerebral palsy are unable to regulate muscle tone, which makes it difficult to control their movements. Trouble with grasping objects, posture, drooling, swallowing, and speaking are common among children with athetoid CP.
- Ataxic – Problems with balance and coordination are common among children with ataxic cerebral palsy. These children often struggle with precise movements and have tremors or shakiness. This makes it difficult to perform tasks like writing or eating that require precise finger movements, or repetitive movements like clapping.
What to Expect in Occupational Therapy
As with physical therapy and speech therapy, occupational therapy is different for every child with cerebral palsy. Each child’s occupational therapy treatment plan is highly individualized and tailored to their individual physical, intellectual and social-emotional abilities.
During your child’s first therapy session, the occupational therapist will perform a complete evaluation. This includes testing the child’s fine motor, perceptual and oral-motor development, and observing how the child responds to touch and movement. The occupational therapist will also interview the parent to find out about the child’s strengths and weaknesses when performing daily activities, as well as pinpoint the specific goals for the child to work toward.
Most children with cerebral palsy need to be reevaluated every six to nine months. After these evaluations, the occupational therapist will tweak the treatment plan accordingly based on progress and change.
Exercises Used in Occupational Therapy
Occupational therapy involves using functional activities to progressively improve functional performance. Occupational therapy exercises focus on the following skill areas:
- Fine Motor Control – Improves hand dexterity by working on hand muscle strength, finger isolations, in-hand manipulations, arching the palm of the hand, thumb opposition and pincer grasp. Activities include squeezing a clothespin, playing with water squirt toys and pushing coins into the slot of a piggy bank.
- Bilateral Coordination – Play/movements teach the child to control both sides of the body at the same time, like drumming, pushing a rolling pin and pulling apart construction toys (Legos).
- Upper Body Strength and Stability – Play focuses on strengthening and stabilizing the trunk (core), shoulder and wrist muscles through exercises, such as crawling, lying on the tummy while reading, playing catch in a kneeling position and pouring water from a pitcher into a cup.
- Crossing the Midline – These activities, like making figure eights with streamers and throwing balls at a target to the right or left of center, teach the child to reach across the middle of their body with their arms and legs to the opposite side.
- Visual Motor Skills – Improves hand-eye coordination through activities, like drawing, stringing beads or macaroni and catching and throwing a ball.
- Visual Perception – These activities improve the ability to understand, evaluate and interpret what’s being seen. Activities include alphabet puzzles, playing with different shapes and matching games.
- Self-Care – Improves the ability to perform activities of daily living and prepare the child to be more independent at home, at school and in the community. Exercises can be as simple as practicing these ADLs, like brushing their teeth, getting dressed and self-feeding.
Occupational therapists use specific techniques to help children reach their goals, including:
- Pediatric Constraint Induced Movement Therapy (CIMT) – Improves the ability to move weaker parts of the body by restraining its stronger counterpart. For a child who has difficulty moving one of their arms, the stronger arm will be completely restrained for a period of time while the weaker arm is strengthened and trained.
- Sensory Integration Therapy – Improves the ability to receive, register, interpret and act on information that comes to the brain through sensory receptors. These activities provide the child with different sensory experiences and can include playing with balls, play dough, silly putty, sand and water, walking on different carpet textures and finger painting.
Equipment Used in Occupational Therapy
Many different tools and assistive devices are used in occupational therapy. Equipment can range from common household items to high-tech assistive technologies.
- Everyday household items (straws, clothes pins, tweezers, sponges, etc.)
- Adaptive scissors (with spring closures or grips for easier use)
- Writing utensils
- Adaptations to clothing (zipper pulls, button hooks, reachers)
- Toys to help with the development of motor skills
- Games and toys that help with motor and cognitive development
- Pencil grips
- Specialized feeding utensils
- Seating and positioning equipment
- Computer software and accessibility
- Household aids and equipment
- School chairs and tables
- Toilet and bathing aids
Occupational Therapy by Age
Occupational therapy helps people of all ages. For children with cerebral palsy, treatment will be based on the child’s physical, intellectual, social and language abilities, as well as their age.
- Toddlers – Treatment for toddlers revolves around play and learning. Games and toys are used to improve the child’s cognitive and physical development.
- Young Children – Therapy for young children works on improving cognitive and physical development, as well as the child’s ability to perform daily living activities. Occupational therapy can also improve the child’s performance in school and their socialization skills.
Finding an Occupational Therapist
Occupational therapists are licensed healthcare professionals. Finding an occupational therapist who has experience working with cerebral palsy patients is very important to ensure your child gets the best treatment possible.
If you need help finding an occupational therapists, ask your child’s pediatrician if they have any recommendations. Occupational, physical and speech therapists often work together to create comprehensive treatment plans. If your child is seeing a physical or speech therapist, they may be able to connect you with an occupational therapist.