Category Archives: Occupational Therapy

Cinnamon-Scented Ornaments

by Alyssa Brief MS, OTR/L & Rachel Rosenblum MS OTR/L

Occupational Therapy activities can multiple therapeutic benefits…in addition to being fun! Below is wonderful activity that is sure to be a hit!

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Materials:

  1. 3/4 cup Applesauce
  2. 2 bottles of ground cinnamon (2.37 oz each)
  3. Parchment paper
  4. Ribbon or yarn
  5. Cookie cutters
  6. Toothpick

Directions:

Mix applesauce and cinnamon into a mixing bowl, stirring or kneading until material reaches dough consistency. Scoop out a handful of dough and place onto parchment paper on flat surface. Place another sheet of parchment paper over dough and flatten until dough is about 1/4″ thick. Peel top sheet off of dough and stamp cookie cutter into dough, peeling away the excess dough around the border. Use a toothpick to make a hole in dough towards top of ornament. Depending on thickness of dough, ornament will need at least 24 hours to dry into hardened ornament. Once dry, thread ribbon through the hole and tie a double knot at desired length.

Sensory benefits of activity: Using the spice of cinnamon stimulates the olfactory sense, or sense of smell. Kneading and flattening the dough provides tactile input through the sense of touch. It also provides opportunity to explore and discuss the texture if it feels sticky, smooth, wet, mushy, etc. Interacting with the dough provides a sensory-rich play experience.

Motor benefits of activity: Pouring in the ingredients works on using graded movements, or knowing how much force is needed to complete a task, to avoid spilling. Kneading and flattening the dough promotes fine motor hand and finger strengthening. Mixing the dough and stamping cookie cutters provide opportunities to use a variety of grasp patterns during functional tool use. Stabilizing the mixing bowl with one hand while stirring with the other encourages bilateral coordination, or using both hands to complete a task.

Cognitive benefits of activity: This activity requires completing steps in a certain order, or a sequence, in order to be complete. This can promote understanding of how a task can be completed start to finish, and can reinforce the concept of “first ___, then ____” while having fun!

Self-Care benefits of activity: A hand-washing routine can be incorporated in this activity such as before and after to work on this skill. Also the clean-up process provides an opportunity to practice cleaning up after oneself such as wiping the table or making a trip to the garbage.

Hope you enjoy!

Seasonal Sensory Success

by Alyssa Brief, MS, OTR/L

Making PlayDoh from scratch with common household items is a tried and trusted OT activity that can provide opportunities to develop hand skills while providing sensory input. With the holiday season now upon us, my OT group at the Philadelphia division’s Approved Private School recently enjoyed a seasonal twist to the traditional recipe- Gingerbread PlayDoh! This is an excellent (and wonderfully scented) therapeutic activity that is safe to eat since it is made exclusively with baking items. Making homemade Gingerbread PlayDoh can literally add some spice into families’ lives during vacation time off from school or on a Snow Day. Fun and safe for all ages and abilities, Gingerbread PlayDoh offers a fun play experience for children who are sensory seekers. This holiday season, I’m feeling incredibly thankful and lucky that facilitating creative sensory play opportunities is part of my job as an Occupational Therapist at Easter Seals.

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Gingerbread PlayDoh Recipe:
1 Cup Flour
1/2 Cup Salt
1/2 Tbsp Ground Ginger
1/2 Tbsp Ground Cinnamon
1 Tbsp Vegetable Oil
1/2 Cup Water
Mix ingredients together and knead until the ingredients reach consistency of PlayDoh. For longer lasting use, keep refrigerated in a sealed container. Enjoy!

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Motor time is more than just burning off steam

by Anna Lassman, OTR/L &  Laura Corbett

Motor play in most early intervention center programs tends to involve unstructured time in a gross motor room, or playground, to let the kids move around and burn off steam; however it tends to be a crazy, free for all kind of period of the day where both staff and students leave frustrated. Many of our students often feel lost when not directly engaged in a structured activity. We were finding an increase in challenging behaviors in our gross motor room due to the lack of planning and structure.

Staff in the Philadelphia Division EI Center noticed this as a problem and began brainstorming new ways to make our gross motor time more effective. The goal is to provide opportunities for our students to practice a variety of skills including general gross motor play, following directions, waiting their turn, turn taking and social play, making and sticking to choices, functional play, requesting, and entering and leaving the room calm and organized.

In January 2015, we were lucky enough to get a recreational therapy intern from Penn State and we knew this was a golden opportunity. With the help and leadership of our Recreational Therapy intern, Kate Shilkitus, wonderful things have happened. Not only are our children “burning off steam,” but also, they are practicing appropriate and functional play while following a routine and here’s HOW we made it all happen.

We started with gathering the classroom staff together and talking about the importance of motor room and all of its benefits. Cindy Goldberg, PT and Anna Lassman, OT provided support through a workshop where we discussed the program we hoped to create in the gross motor room. Together, we talked about responsibilities of the therapy staff and the Teaching staff members to make this all work. The following was discussed in detail:

  1. Use of motor time with a lesson plan that includes strategies to prevent challenging behavior. Some strategies included:
  • Including their interests to keep them engaged and motivated in the gross motor room (i.e balls, slides, pretend play, cars, etc.)
  • The use of reinforcers (bubbles, stickers, etc.)
  • The use of visuals to communicate expectations before they go to GM room.
  • The use of visuals to show the children “what comes next” and the agenda for the session.
  • The use of choice boards and structured smaller groups within the larger gross motor room space to guide play.
  • Bring/push class chairs down to GM room (heavy work that can be calming and organizing) for students to sit on at start, rather than opening the door and kids rushing in.
  • Gradually go from chair sitting to floor sitting as kids become used to new GM room routine
  • Use “clean-up” as part of the session.
  • Ending session with a calming/re-group type activity by the waiting area to build compliance momentum.
  • Use of time during team meetings to make a plan for the week in the motor room based on the above items.
  1. We discussed the properties of the equipment available and various ways to use them to expand play schemes.
  • Obstacle courses can be changed up mid- session.
  • More than one way to use pieces of equipment
  • Staff modeled creative ways to use a ball or a wedge, for example.
  1. What levels of assistance we use and how to fade or increase as needed based on individuals.

Based on ideas and feedback from the workshop, we began to put together visual materials, including a stop sign at door, marked places in the room for waiting areas, and activity and equipment use suggestions, but the prep work alone can be a very timely task. Fortunately having Kate, our recreation therapy intern, who was ready and willing to lead this initiative, we hit the ground running. We believe that what has made this program even more successful from the start is having Kate dedicate her time and energy in that room.

Following our workshop, Kate spent a great deal of time preparing the environment and doing the prep work. She created several visuals and utilized the strategies discussed to create expectations with the use of visuals. Visual supports are crucial for many of our students so in creating these, Kate helped to set our students up for success.

Here’s an example of our expectations upon entering the gross motor room

expectations

Here’s an example of our choice board that is set up everyday. Staff then model the different activities that can be done with each choice.

choices

Once Kate had everything prepped and ready to go, we rolled out the new program and collected baseline data on two skills: (1) Wait time with an expectation of average wait time to be 30 seconds to 1 minute with 2 or less redirections. (2) Following directions throughout the session with 2 or less redirections. Kate has been collecting data daily and the findings are outstanding! We have seen a dramatic improvement in just a short time. The chart(s) below gives you a clear picture that this new program is most certainly working.

data

Kate’s ability to help strategize, plan, and implement a new program is extraordinary. She spends endless time at school and at home reflecting on individual progress and the program as a whole. Unfortunately, Kate has left us as her internship has come to a close, but her hard work and lasting effects in establishing a consistent routine and program in our gross motor room are here to stay. The last three weeks will consisted of transitioning our teachers to lead and implement the program with Kate’s support. The teachers now feel confident in doing the same.

We look forward to continued success with this program and our students. No longer do our teachers need to “burn off steam” after a chaotic session in the gross motor room. We have successfully implemented a new program that keeps both students and staff calm and having fun.

 

Among friends

by Susan Lowenstein

As we approach the gym, we hear laughing and the beautiful sound of children playing. Ajay turns his wheelchair – teenage mutant ninja turtle green in color, by his choice – adeptly to the left and steers it easily into the gym. He sees many familiar faces in the gym – not those of his classmates, but of his school mates, and he eagerly propels his chair towards them, his curiosity peaked. He wants to see what they are doing, and does not want to miss out on the fun.

As I follow him closely, I see that these friends are walking and jumping and climbing and swinging easily and independently in the gym. Ajay quickly propels his wheelchair towards the group of children that are swinging on the platform swing. He loves to swing, and when he first started attending school and missed his family at home, it is the only thing that would console him. So it makes sense that his eyes gravitate towards the children that are enjoying his favorite pastime, so to speak. Or as our OT’s may call it, his favorite sensory experience.

Never was there a better motivator for Ajay than his able bodied peers enjoying the gym, or enjoying a turn on what he might consider his own prized possession, the platform swing! So I know this is my chance to get him to work – and I offer him a chance to swing – but only if he will try to walk to get there. Ajay is up for challenge, so quickly we get to work.

I retrieve his long leg braces and his walker from the hallway, and before long, Ajay is on the floor, cooperating easily with the tedious process of putting these braces on his legs. He is quite familiar with this routine, and I am amazed at his dedication. He does not refuse, cry or complain. He willingly complies with my requests to “scoot down” , “lie back” as I work to carefully don the braces and ensure a proper fit. All of a sudden, Ajay and I notice we have an audience. One little inquisitive boy named Ryan wants to get a closer look at Ajay’s long leg braces and even offers to help with the Velcro straps. Another friend Andrew asks freely “Why does Ajay need these braces?” . Their curiosity is obvious, their questions are matter-of-fact. After a brief explanation of why Ajay needs braces (“His muscles don’t work the way yours do, so he needs extra support to stand and walk”). Ajay’s friends seem satisfied with these answers and turn their attention to more pressing matters – like the fact that all 3 boys are wearing Teenage Mutant Ninja Turtle shirts!!! All the boys seem to agree that Andrew’s shirt is the coolest because it has actual googly eyes glued to it!

After agreement about the coolest shirt, it is back to work (and play) for Ajay. His friends Ryan and Andrew quickly jump up to their feet to head over the swing. Once I ensure that all of Ajay’s brace joints are locked for stability, I help him attain a standing position and he reaches out for his walker. It takes about 3-4 minutes for Ajay to take 10 steps with my help to reach his friends at the platform swing. Each step is a lot of work for Ajay. He has to lean on his walker with both arms and lift the weight of his lower body and long leg braces against gravity so he can swing them forwards. It is no easy task, but with his friends encouraging him from the swing, Ajay remains steadfast in his determination to walk. Little do his friends know how thankful I am to have them in the room – they are providing the motivation for Ajay to get up onto his feet!

True to my promise, I allow Ajay a nice long turn in his swing after he worked so hard to get there!!!! And the icing on the cake is that he gets to share the swing with his friend Ryan! The smile on all of their young faces while they swing together is a true reminder to me why I work at Easter Seals. I love to watch these kids understand their differences in abilities as well as enjoying what they have in common, which today is threefold: 1) loving the swing, 2) wearing their favorite Mutant Ninja Turtles shirt, and 3) enjoying time on the swing with a friend

Halloween Tips

Halloween is upon us and this is a super exciting time for children….and many adults! But for some children, especially those with sensory processing issues, it can be a challenge.

We found a great article that shares some basic tips for children with sensory processing issues on Halloween. We love Halloween at Easter Seals and hope it is safe and successful time for every child! Read the article…

Happy Halloween!

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Why is messy play so important?

by Anna Lassman

Top 10 Reasons!

  1. Opportunity to practice and refine fine motor – hand/finger skills
  • Opportunity to use hands, fingers in a different way. Practice various grasp patterns, pinching, poking use of both hands to push or pull, etc.
  1. The great experiment: Learning concepts and characteristics of substances and how we can impact it. Grading motor control: how do I control the way I touch and handle substances?
  • Learning about different textures, consistencies, density of materials while at play. Is it thick/thin, heavy/light, lumpy/smooth, cool/warm?
  • Exploring different ways to handle materials: What happens if I squeeze it hard/ medium/lightly? What happens if I stroke my finger very lightly over the surface? Can I poke a hole into it? What happens if I push a car through it? What happens if I blow on it? How can I find something hidden it?
  1. Desensitization for tactile defensive kids.
  • Various strategies to decrease sensitivities to messy materials: Start with dry/smooth textures and gradually add texture; can use tools to touch wet messy materials, gradually encouraging child to use their hands, etc.
  1. Learning to follow steps or sequences
  • Have child be involved with creating the sensory material; following a recipe or multi-step directions
  1. Practice use of tools and what they can do.
  • Learn to pour, stir, scoop and use other tools (ie- scissors, rolling pins, tongs)
  1. Task orientation.
  • Work behaviors involve preparation, starting, completion and clean up. All aspects of the task are just as important as the actual play- helps with task focus, persistence, transitions. Also provides opportunity for grooming practice (washing hands).
  1. Provides opportunity for cooperative play
  • Working alongside peers while engaged in messy play fosters social skills.
  1. Opportunity to explore creativity with a non-structured activity.
  • It fosters imaginary play.
  1. Opportunity to explore ways to add structure for pre-academics
  • Writing letters in shaving cream, drawing faces and/or geometric shapes or forming them with play dough
  1. IT’S FUN!!!

Anna Lassman has been an OT for 35 years, working in a variety of pediatric settings in New York, California and, for the past 18 yrs, in Pennsylvania. She has been with Easter Seals in the Philadelphia Division as the OT department head for 7 years. She has special interests working with infants and young children with feeding difficulties as well as working with children with neurological impairment. Her favorite aspect of her current job is the ability to mentor new practicing OT’s as they begin their career in the field. Anna loves the ocean and misses easy beach access, but loves the Philadelphia area.

Making Sense of How Sensory Processing Difficulties are Addressed in the Early Intervention System

by Anna Lassman

Sensory Processing and Sensory Integration are hot topics these days, particularly with children who have been identified as being on the autistic spectrum. Sensory issues can also affect kids with motor impairments. Families are often faced with many new and sometimes confusing concepts and terms. I hope to clarify some of the confusion.

Our senses play a big role in how we learn, interpret, adapt and cope within our environment. We take in all the information through our senses into our brain. Sensory Integration is the process by which we take information through our senses. The brain then processes that information and helps us determine how to respond. The responses are behavioral reactions that take the form of learning, inhibition, coping, and adapting. Sensory Processing is simply another term for Sensory Integration.

Our brain acts as a processing plant, finding what is important to pay attention to, what is something we need to ignore, and then planning how we respond. In an educational setting the goal is for kids to be calm, alert, focused, so that they can attend, refine their functional skills and learn.

Other terms relating to sensory processing include: tactile (perception of touch); proprioception (“sense of self” understanding how your body is positioned in space); vestibular (perception of movement in space).

Children with sensory processing difficulties seem to have perceived the information in a different way, and / or the inability to make sense of it. They are unable to adapt their response or have limited coping mechanisms Often the result is to underreact or overreact. For example, a child who has a hard time in a busy, noisy store may either hide, or begin to tantrum. They are unable to filter through the stimulation they are being exposed to. Often they either have a delayed or slow reaction and because of this low reactivity, they may “shut down” or avoid. In other cases, they may have an extreme reaction because of hyper sensitivity.

The most common approaches are described below:

Sensory Integration Treatment Approach – is individual OT treatment that involves a specialized setting with suspension equipment. The program is designed to improve the efficiency of the nervous system in how the use of the sensory system is interpreted for functional use through a child centered approach. The evaluation process requires a Sensory Integration certified therapist to administer.

Neurodevelopmental intervention (NDT)- is an ever evolving approach to enhancing overall motor function of individuals who have difficulty controlling their movement as a result of central nervous system deficits. This theory, as most others do, has evolved as our understanding of the brain and how motor learning works evolves. The focus is on improving motor control and motor output to improve functional skills.

Many children with motor impairments (such as cerebral palsy) do not have the opportunity to learn about themselves and their world through movement. They may develop atypical patterns of movement against gravity, and don’t get to experience body exploration, tactile, proprioceptive and vestibular inputs the way typically developing children do. A good understanding of how our bodies work to move in different ways are important for effective motor planning and use of both sides of our body in a cooperative way. These are important for learning new skills for both the gross motor and fine motor areas, as well as for functional tasks (for example: self-care areas).

Both neurodevelopmental treatment and sensory integration rely heavily on the use of tactile, vestibular and proprioceptive stimulation in accomplishing their specific goals. In the educational model, the approach most often utilized is a sensorimotor approach in both direct services as well as in consultation with class team and family.

Sensorimotor– refers to a broad spectrum of both sensory and motor difficulties, combining both sensory integrative theory and neurodevelopmental theories.

Occupational Therapists tend to have different focus of therapy depending on what model of service they are working in. A model of service helps guide the OT in developing goals and plan for therapy. As Sensory Integration intervention requires special certification for the evaluation process, and a specialized clinic, it is considered a medical model of service. The medical model focuses on rehabilitation or remediation in a clinic (private office, hospital, outpatient center) setting. The focus in an educational model of service is educational access/ adaptation/ compensatory strategies for greater success for learning needs within their educational setting.

In the book Autism, a Sensorimotor Approach to Management, consultative model is defined as: “helping the family understand their child’s behaviors and how it relates to sensory processing; helping the teacher and the family modify the environment so that it matches the child’s sensory needs; helping the child organize responses to sensory input”.

So what does sensorimotor therapy in an early intervention educational model look like? It may differ if the child is seen in a center based special education setting or a community based pre-school, head start or early learning center or daycare. Most Early Intervention center based programs have access to a room with some suspension equipment which gives the opportunity to explore more sensory integrative and neurodevelopmental strategies during direct service.

Out in the community, therapy can be limited by whatever equipment the therapist can carry as it relates to sensorimotor strategies; and if he/she has the room to use more motor based activities. These factors will usually drive the session. More often the role of the therapist in the community is consultative; helping to find toys, equipment/, and movement activities that can be incorporated into the daily class routine to help the child improve his/her attention and task focus so they can get the most out of their learning experience. The consultation is ongoing and meets the child’s ever changing needs. Often the therapist will leave a number of sensorimotor activity ideas with the class team for options for arousal or calming to maximize task focus and learning.

Acknowledgements:

Dr. A. Jean Ayres – researcher and founder of Sensory Integration Theory

Winnie Dunn, PhD, OTR, FAOTA- researcher in the area of sensory processing and creator of the Sensory Profile Questionnaire

Ruth A. Huebner, PhD, OTR- editor of Autism, a Sensorimotor Approach to Management

Colleen Schneck, ScD, OTR/l, FAOTA – contributor to Autism, a Sensorimotor Approach to Management

Anna Lassman has been an OT for 35 years, working in a variety of pediatric settings in New York, California and, for the past 18 yrs, in Pennsylvania. She has been with Easter Seals in the Philadelphia Division as the OT department head for 7 years. She has special interests working with infants and young children with feeding difficulties as well as working with children with neurological impairment. Her favorite aspect of her current job is the ability to mentor new practicing OT’s as they begin their career in the field. Anna loves the ocean and misses easy beach access, but loves the Philadelphia area.