Kneeling during table work

When you come into my occupational therapy studio or classroom, you'll find that all the tables are coffee table height and without chairs.  This seems to puzzle the kids I work with.

So, why no chairs?  Well, I found out that little kids really have a hard time sitting in chairs.  They fall out of the chairs, they wiggle in the chairs, they rock them back and forth..they do anything but stay in chairs.  Kids don't want to sit !  They need to move.   While we are working on fine motor or handwriting, we sit at my "kneeling tables".  While working, the kids have the freedom for movement AND for working on trunk stability and core strength via long kneeling.  So, bring out the kneeling tables and see better developmental skills!

Preschool fine motor and handwriting development

Today in our Mini Charmer's Pre-K class, we continued our focus on numbers.  Our class contains ten gifted kiddos ready to learn formal handwriting prior to kindergarden.

After spending the first several months on uppercase letters, working on numbers is a nice change of pace.   Boys especially like numbers as they relate to numbers often better than girls ( girls often have an easier time with letters).

Our first activity is for the kids to find the numbered gingerbread men in the gym.  Each child is assigned a number to find.

This format helps kids to increase skills in visual perceptual, visual memory, and number recognition.  This also helped with team building, as we heard "Jack, here is your number!", "thanks!", and so on.   Next we took all of the numbers and laid them out on the floor one by one.  I asked "is a 4 bigger or smaller than a 12?".   As we continued this process we ordered them from 1-20 on the floor and then counted forward and backwards.  Many kids this age do not consistently recognize numbers in the teens and so this repetition is great for them.  

After some good gross motor action in the gym, we settled in the classroom and did centers that warm up and increase fine motor skills. 

Wind up toys were a big hit. Wind up toys help so much with translation (stabilizing something with one part of your hand and mobilizing with the other part) as well grip strength. 

Pop beads were another center.  These pop beads are quite hard, but the kids had no trouble at all with it!

Pop beads of this size are super because they force a child to utilize a stable pincer grasp while using strength in pushing together.   This carries over into grasping a pencil correctly.  

Another fun center was the textured stencil and rubbings of dinosaurs and sea creatures.  This would also be a super Christmas gift (kids love these).  They are made by Melissa and Doug and can be found at Toys and Company, whom we partner with.  The stencils are two part-  they first can be used to stencil amazing animals, insects or dinosaurs and then they can be used as a rubbing plate.  

In this picture, he is completing the stencil side.  Next, he will put the textured stencil under the paper and then rub the crayon to make the drawing come to life.  As an occupational therapist, this is one of my all time favorite activities to develop hand and handwriting skills WITHOUT doing handwriting.  Great fun for all.  My 11 year old even likes doing these stencils.  

Lastly, I teach the direct skill of writing numbers.   We use our Handwriting Without Tears book and the kids lay on their stomachs (it works on core strength but also makes sure that the wrists are stabilized appropriately).  

I give everyone a slate chalkboard and demonstrate how to write each number 1-3 today and then each child practices it.  I was truly amazed at how well they did and they were so proud of their accomplishment.  It is a wonderful experience to see children learn to love handwriting and to gain such confidence.  

Sit still, keep hands to yourself, & stop bumping into me!

Children often get in trouble at school for being "wiggly", not keeping hands to themselves or for personal boundary issues.  In late pre-k and kindergarten it becomes more important for students to learn these concepts.  When children do not master these concepts, they often get in trouble more and more and may start to dislike school.   Why do some children have problems in these areas?

Any of these issues may stem from a number of non-behavioral reasons. These are the major ones that I see:

Core Strength:  this affects sitting still in line, staying seated in a chair, and sitting upright in the floor during circle time.  Our core strength is a perfect synergy between our extensor muscles (in our back) and our flexor muscles (in our stomach).  When one, or both of those muscles do not have good enough strength to maintain an upright position for sustained activities, then a student will basically tire out.  The child may lean on others, attempt to lay in the floor, change positions, fall out of their chair, and be "wiggly".  In addition, kids with less than adequate core strength will often have reduced endurance and may be quite fatigued after an elementary school day.

Proprioception: this is one of our body's sensory systems that allows us to sense our body's position in space.  Our joints, tendons, and muscles contain the receptors that allow for accurate proprioceptive feedback.  When you lift weights, you feel each muscle that is being exercised.  If you work out well, you'll have awareness of those muscles long after your workout is over.  During and after this workout, you have a keen sense of where these sore muscles are.  In fact, if you close your eyes, you could likely point right to the place that you are the most sore.  This is proprioception (and maybe some lactic acid setting in too!).  Everyone has different thresholds for senses.  Kids that seem to be a bull in a china store most likely have very high thresholds for proprioceptive input.... meaning that their nervous system needs much more input before it can register the input. Kids that may have a high threshold for proprioceptive input are the ones that bump into everything, seem to be accident prone or clumsy, constantly seem to touch others, may hug or play too rough, or may crave  jumping/bouncing.

What to do?  For core strength, swimming, karate, and yoga are great activities that help.  You have to stay after it so that you can build on the core strengthening.   For proprioception, a sensory diet works wonders.  Activities that allow a child to get this input prior to school will help the child to succeed.  Sensory diets have to be allowed during and after the school day too.  They don't have to be obvious activities though.   A sensory diet activity can be carrying books in a crate to the library, jumping on a trampoline for 20 minutes prior to school, monkey bars,  sitting and bouncing on a yoga ball, climbing up a rope,  and other heavy work activities. 

If you need help, then get a pediatric occupational therapist involved.  Often, it is helpful for the connection at school as an O.T. can explain why a child's behavior is an attempt to activate the nervous system, not an attempt to drive the teacher crazy.  :-)

Executive Skills- had to practice what I teach

NOTE:  not for the weak at heart or for parents that don't like to see messy rooms.  

Executive skills coaching /therapy takes a child's strengths and weakness's in mind when working toward the ultimate goal of improved achievement at home and at school.  Executive skills are those frontal lobe skills.  In children with ADHD, studies have found that executive skills may lag by as much as 5 years.  Wow.   Here is the list of executive skills.  Want the definitions?

Response Inhibition   

Working Memory          
Emotional Control
Sustained Attention
Task Initiation
Planning/Prioritization
Organization
Time Management
Goal-directed persistence
Flexibility
Metacognition

I got a good dose of using my training last week when my son got really upset at me and completely wrecked his room.  He threw everything off the bed and shelves and threw in the floor.

a wrecked room for sure

Brain Training at Learning Charms..and a little vent

"Brain Training" (also called cognitive training) is a hot topic of interest for parents of children who are struggling in school, or who have  ADHD, learning disabilities, attention/focus issues and sensory processing difficulties.  There are many franchises that offer brain training.  Brain training is not new, but is a new "hot word".  Occupational therapists have been helping clients to rewire their brains for decades.  We just called it "occupational therapy".   Occupational therapy increases achievement of students by working on the underlying and foundation issues of development, such as core strength, sensory processing, bilateral use, fluency, motor planning and so on.  Therapists practice increasing left and right brain integration every day because that is part of therapy. This increase in foundation skills increases academic performance.   In the past several decades, new high tech systems (such as Interactive Metronome) have come along that can assist therapists with improving and refining areas of focus, attention and timing.

So, my clients have asked me about these brain training franchises and what they do. I cannot say that I can personally review their effectiveness.  But I will share some insight.  I recently met a student that worked at one of the franchises and I asked what she did there.

Jumping rope in occupational therapy

Why do we jump rope in O.T. and handwriting tutoring?


My students always want to know why I make them jump rope so much.  If you come to see me at Learning Charms then you'll definitely be leaving being much better at jumping rope. 

Why is it important?  Jumping rope is beneficial mostly for fluency.  Fluency is part of motor praxis (meaning "planning") and is basically the ability to keep a steady pace and rhythm. It can be seen in reading fluency, math fluency, and even fluency in independent working pace.  I especially like jumping rope for children with ADD/ADHD.   Fluency is an executive function of the brain, meaning that it is a high level skill.  I teach jump rope to kids as young as 3 years.  As they get older, we learn to jump rope backwards, one footed, with rhymes, and counting backwards by 2's or 3"s.  Jumping rope helps with academic skills, timing, sensory processing and motor coordination too.  Bring out the jump rope this summer!

Occupational therapy for poor handwriting: why it works

Most of our clients come to us to improve some component of handwriting or writing skill.  Parents often question why occupational therapists work with handwriting so much.  Handwriting is a very complicated neurological and anatomical process.  Usually poor or inefficient handwriting or penmanship is simply the symptom of a developmental process that is not functioning smoothly.   When a well trained pediatric occupational therapist evaluates handwriting issues, they should be evaluating specific developmental areas. 

Optimal handwriting skills also require fundamental skills such as:
core strength
sensory processing
fluency praxis
processing speed
trunk stability
bilateral integration
upper body strength
visual motor integration (also known as eye hand coordination)
visual perception (vision to brain processing)
pencil grasp, finger strength and
postural stability

This is why traditional handwriting tutoring by someone other than an occupational therapist may not give your child the improvement that they need.  Once a trained occupational therapist has helped a child to improve these underlying fundamental skill sets, then a child's handwriting will quickly improve. 

Letter recognition, visual perceptual and rock salt

Kids love digging in odd textures and after having left over rock salt I decided it would be fun to utilize it during therapy.   I added some colored alphabet letters (they are actually beads) to the salt.

Then I wrote a few letters that they would be looking for on the grey boxes (Handwriting Without Tears paper).

I allow the alphabet letters to be upside down or backwards in the rock salt, as being able to find them in this manner increases form constancy which is a  visual perceptual skill.  Form constancy just means that a leaner know that a letter turned sideways/different color/various size is still that letter and can pick it out. Form constancy is a skill needed for reading.

To modify this activity to make it harder, I could actually write a few letters on the grey boxes, let them look at it for a few seconds, and then turn the sheet over and have them see how many letters they can find that I had written down.  If they can put them in order then this increases the challenge.  I often may ask the child to write the letters in the extra boxes.  Asking a child to find a certain number of letters in a specified time is a great way to increase the challenge.  If I want to test letter recognition, then I could ask them to give me certain letters but not write them down. 

To modify this activity to make it easier, I could decrease the number of letters in the rock salt and decrease the letters that they are looking for.    If the child doesn't like the tactile feel of the rock salt, then they can pull out with tongs or use thin gloves to pull the letters out of the salt.

numbers, letters, shapes and handwriting on chalkboard

I love using my chalkboard that I have painted on the wall in my gym and throughout my center.  To make the activity more therapeutic, I always have kids use broken chalk pieces (encourages proper grasp), have them kneel while writing (trunk stability), and let the kids use a spray bottle to clean their work. 

The activity I use with many 4 and 5 year olds helps with letter recognition, drawing shapes, and counting and writing numbers.  This method also helps kids to learn to follow and remember multi-step directions.

First, write several letters on the board.  I do a variety of capital and lower case letters--this time it was some of those "tricky" ones that are commonly reversed.

Notice the right side of the board-  this is the "key" which the kids will refer to finish the task.  For example, the "B"'s should be found and surrounded by a triangle.  This is a great time to reinforce shape drawing. 

Next, the child will start finding the letters and surrounding them with the shapes as indicated on the key.

I usually put 2-3 copies of each letter on the board so that it gives the child more opportunities to find the letter and to practice the shape.  If the child is too overwhelmed by a lot of letters, then you could do less. 

When they have found and surrounded each letter by its shape, I ask them to then count how many times they found each letter and then write it in the box beside it.  The box helps them to define the area that I wish them to write and is familiar to the kids that are learning handwriting with the Handwriting Without Tears program. 

At the end, the kids get to use the spray bottle to clean the board. They love it! 

My son started Interactive Metronome yesterday.  I waited until this year to have him start because at the age of 6 and being extra wiggly, he just couldn't focus on it last year.  This year, he understands the program more and is motivated to do it because he know that some pro athletes complete Interactive Metronome training as well.  Since he wants to be a pro soccer and pro baseball player, it was the perfect time to get him started.  My sons's ADHD symptoms have not been affected much by medications or nutritional changes, so the I.M. training is something that I have high hopes for.  I'll keep you posted!

Spaghetti for fine motor and motor control

Dry spaghetti noodles stuck in Styrofoam was a fun activity today to improve fine motor control, pincer grasp, as well as proprioception.

First, stick noodles in Styrofoam. These show beads on noodles. I used the very small fun fusion beads plus beads made from cut up straws.

Next, I asked children to sort and put 5 beads of each color on noodles.

Kids had to be careful and grade their force when putting on noodles or else they would break!

Next, I asked them to take off  the beads one at a time with tongs. To make it more difficult, you could put them on or off in a pattern of the therapist's choice.

 Taking the beads off the long noodles were the most challenging, as the kids had to squeeze the tongs longer but also had to not bend /snap the noodle.

The Need for the Extreme in kids with ADHD

Kids that have the need for the extreme.  You know the ones, like my son, who are risk takers.  They are the ones that constantly push the limits for movement and balance.   You'll find these kids swinging upside down, climbing trees higher than they should, and often excelling in sports.  They may have reduced impulse control as well.  Our control of impulses are the ones that keep us from saying things that we do not mean, trying physical activities that are risky, and even waiting to enter a conversation without interrupting.   The impulsive part of ADHD is the part that attributes to these children having a higher risk of injury than other kids.  We used to half laugh (half gasp) that my son never looked when he crossed a street...all part of impulsivity.  In fact there have been studies regarding the higher incidences of kids with ADHD getting hurt. 

Many kids like my son have ADHD and are also on the "go" constantly.  It really is like he is being driven by a motor.  Although exhausting for the parents at time, I have found that is is necessary to embrace the really positive things about ADHD.    Kids with ADHD need lots of movement as it centers them and allows them to learn.  Some kids (like my son) need pretty extreme movement (vestibular and proprioceptive input) which can be seen by the types of activities he chooses to engage in.  Once he gets all sweaty, climbs up and down trees, wrestles the dog, plays soccer, stomps all around the house, rides his pogo stick with one hand and one foot, growls loudly like a bear, and dribbles the basketball until all of the neighbors are jarred out of their beds THEN he is ready to learn.  Oh, and that all happened in an hour. 

Mini Charmer's Preschool

The Mini Charmer's Preschool for kids aged 3-5 begins this Fall.  This school will be an opportunity for children to enrich their fine motor, gross motor and handwriting skills prior to kindergarten.  I'll be using the Handwriting Without Tears curriculum, to teach handwriting to this eager bunch of children.  With more and more private schools (such as Charlotte Latin, Providence Day and Charlotte Country Day School) requiring advanced motor skills prior to admission, this is a great opportunity to make those schools smile.