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Does Your Child Have Poor Body Awareness?

Body awareness relates to knowing where your body is in a defined space. It is also linked to our proprioceptive system (the input that body awarenesswe get from our joints and muscles). Children who have poor body awareness may have a difficult time in functioning at a certain age level due to the subsequent difficulty that they may have when learning new tasks.

Here are a few signs that signify poor body awareness in children:

  1. Prefer to be in small rooms as opposed to wide open spaces. They may also prefer confined spaces, such as forts, closets or being under blankets. Children with poor body awareness feel more secure in small spaces rather than open areas because they have a better idea of where they are in space.
  2. Do not like to be in the dark or do not like to close their eyes. In order to make up for the fact that he or she has poor body awareness, children may rely on what they see in order to know where they are. If he or she is in a dark room, they may not understand where they are in that defined space.
  3. Like big bear hugs. Due to their decreased processing of proprioceptive information, children may prefer to be squeezed tightly because it gives a lot of input to their joints and muscles.
  4. Have difficulty mimicking movements, such as hand games or licking lips. When someone else shows them something they want the child to imitate, a child with poor body awareness may not understand how to move their body in the same way because they have a harder time understanding where their body parts are and how much to move them.
  5. Has a hard time learning new gross motor activities, such as jumping jacks. Gross motor activities rely heavily on the input children get to their muscles and joints when jumping on the ground or climbing. Since children with poor body awareness have a difficult time processing that feeling to their body, learning these activities are more difficult for them. As a result, these children may need to look in the mirror to learn new gross motor tasks. This is because children have to see what they are doing in order to learn how to manipulate their body in that manner.
  6. They may seem clumsy. Children who trip over objects or their own feet do so because they don’t know where their body parts are.

These issues occur because children usually compensate by using their vision in order to know where they are. In order to improve body awareness, occupational therapy can help to improve their ability to process the feeling of movement to their joints and their muscles. In order to learn new tasks, compensatory strategies can be used in order to help them keep up with their peers, such as using visual cues to help them learn new activities or breaking down tasks to make them simpler until they have mastered those skills.

Overall, occupational therapy can help identify solutions for children in order to improve their body awareness so that they may be more coordinated, confident and safe when performing age-appropriate activities!

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Why Is A Full Occupational Therapy Evaluation Beneficial When My Child’s Only Difficulty is Handwriting?

Child practicing handwriting

Handwriting is a complex task that involves many prerequisite skills, including visual skills, ocular motor control, body awareness, fine motor planning, shoulder stability, and hand and finger strength. Each prerequisite skill contributes to efficient and fluid handwriting:

  • Visual skills are needed to accurately distinguish and interpret letters and shapes on a page, essential for writing. Ocular motor control is needed to move one’s eyes across the paper to write in an organized manner.
  • Body awareness is required to accurately move the hands for writing, as well as knowing how much force is needed to make marks on the paper with the pencil or pen.
  • Fine motor planning is needed so that your child can easily identify, plan and execute the task of writing letters, words and sentences.
  • Shoulder stability is required to control the pencil.
  • Hand and finger strength is required for endurance that is needed to write many letters to form words and sentences. Hand strength is also needed for an appropriate grasp on the pencil.

In order to address handwriting in therapy, it is imperative for the occupational therapist to assess your child’s current level of functioning in each of the above areas. The root cause of your child’s handwriting difficulties may be his or her struggle in either one area or multiple areas. A full occupational therapy evaluation is very comprehensive; it allows the therapist to get a baseline level of performance to identify your child’s strengths and weaknesses in the prerequisite skill areas, and unveil the source of your child’s difficulty with handwriting.

Following the evaluation, your therapist will develop goals based on your child’s performance and design a treatment program that concentrates on improving these foundational skills, and ultimately improve his or her handwriting organization and legibility.

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Dressing Skills: Developmental Steps for Kids

Dressing may seem like a simple task, but it is actually a task that requires multiple skill sets from children. Dressing requires skills girl dressing such as fine and gross motor coordination, body awareness, bilateral coordination, right/left discrimination, postural stability, and motor planning. As a parent, it can be difficult to know at what age a child should develop certain skills in dressing.

Developmental steps of self-dressing skills in children*:

1 year:

  • Pulls off shoes
  • Removes socks
  • Pushes arms and legs through garments

2 years:

  • Helps pull down pants
  • Finds armholes in pullover shirts
  • Removes unfastened jackets
  • Removes untied shoes

2.5 years:

  • Removes pull-down elastic waist pants
  • Unbuttons large buttons
  • Puts on front button shirt

3 years:

  • Puts on socks and shoes (though it might be the wrong feet or socks upside down)
  • Puts on pullover shirts with some help
  • Buttons large buttons
  • Pulls down pants
  • Zips and unzips with help to place on track

3.5 years:

  • Identifies front of clothing
  • Snaps fasteners
  • Unbuckles belt
  • Buttons 3-4 buttons at a time
  • Unzips jacket zipper

4 years:

  • Removes pull over shirts without help
  • Buckles belt
  • Zips jacket
  • Puts on socks correctly
  • Identifies front and back of clothing

5 years:

  • Dresses alone
  • Ties and unties knots

6 years:

  • Ties bows and shoelaces

According to Jayne Shepherd (2005), achieving independence in dressing may take up to 4 years. During this time, parents gradually perform fewer of the tasks, and encourage their children to do more, with the ultimate goal of independence.

*Source:

Shepherd, J. (2010). Activities of daily living and adaptations for independent living. In J. Case-Smith, (Ed.), Occupational therapy for children (5th ed., p., 501). St. Louis, MO: Elsevier Mosby.

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The IMPORTANCE of Superman and Silly Bug!

During an occupational therapy initial evaluation, as well as throughout ongoing treatment sessions, a child’s ability to maintain two Girl doing a superman exerciseanti-gravity positions is observed. These two positions are named Superman (prone extension) and Silly Bug (supine flexion). Each position observes how the child moves his body (e.g., body awareness and motor planning), his strength and endurance to maintain the position and his ability to follow directions and attend to a challenging and novel task. Below are the directions on how to assume both Superman and Silly Bug.  The approximate norms which should be seen for children of various ages are shown as well.

Superman (Prone Extension):

Lying on belly with arms and legs extended and lifted off of the floor (Note: a child will bend his knees/elbows to compensate. If necessary, provide touch cues to the legs to get him to straighten them out).

Age Length of time (seconds)
4 18
5 31-60
6 63-77
7 90-119
8+ 120-138

Silly Bug (Supine Flexion):
Lying on back with arms crossed over chest, legs bent and head lifted off of the floor. The child then flexes his legs and lifts his head from the floor (like a “crunchie” position).

Age Length of time (seconds)
4 10
5 25
6 46
7 68
8+ 88

Overall, it should be noted that while the norms may seem high, children should be able to hold these positions for as long as an adult can, possibly longer. This expectation can be attributed to the fact that the functioning of the vestibular system declines as one ages. This is why activities such as roller coasters may become less preferred or less entertaining for adults as they no longer crave the intense vestibular input (unless they practice positions of inversion, such as yoga or pilates on a regular basis. With that being said, it is extremely important for parents to practice these anti-gravity positions with their children at home, as well as in the clinic, in order to see the greatest amount of progress in the child’s strength, endurance, body awareness, motor planning and vestibular processing. LOVE WHAT YOU READ?  CLICK HERE TO SUBSCRIBE TO OUR BLOGS VIA EMAIL!

Swimming- A Fun and Beneficial Sport

Swimming is a great sport and pastime, particularly for children with sensory processing difficulties, as the waterBoy in swimming pool provides a multi-sensory experience for the body. Swimming also addresses a variety of skills, ultimately improving your child’s sensory processing, strength, endurance and coordination.

Proprioceptive/tactile processing: The feel of water on the body gives proprioceptive input, the input to the muscle and the joints, and gives a sense of where the body is in relation to other body parts. The constant sense of the water against the skin provides deep proprioceptive input and helps with developing body awareness.

Vestibular processing: Somersaults under water or headstands at the bottom of the pool provide vestibular input, as the body is responding to the changes in head position and assisting with balance to complete these tasks.

Auditory processing: The pool environment typically provides a loud and vibrant auditory experience, as children’s laughter and happy shrieks are heard while they play in the pool.

Strength: Moving the body against water when swimming is a workout for the muscles! The water provides natural resistance for muscles, which in the long run, builds up overall body strength.

Endurance: Not only does the resistance of the water against the body make the body stronger, it also assists with endurance. As the muscles become stronger, they will be able to endure swimming and other activities for longer periods of time.

Coordination: Swimming strokes are very complex. The brain must take in all of the sensory information from the environment and act quickly to move the arms, legs, torso and head in a coordinated fashion to produce the movement.

So many children find swimming exciting and fun, and love spending summer days at the pool. Parents can also appreciate spending time at the pool knowing that this activity is not only fun, but also good for their child!

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How to Teach your Child with Sensory Processing Difficulties How to Ride a Bike

Learning to ride a bike can be a scary and overwhelming adventure for both the parents and the child involved!  There are many components required for bike riding, such as motor planning, body awareness, trunk control, balance, self-confidence, following directions, safety awareness, timing, and sequencing.  However, one of the best things about bike riding is that the child is typically very motivated and excited to do it, as he sees his friends or other children in the neighborhood doing so already.

SPD Child riding a bike

Below are several strategies on how to get started:

  • Practice lots of balance activities:  balance is a huge part of bike riding; therefore, it is important to strengthen these skills by challenging your child’s ability to maintain various positions including standing on one leg, sustaining yoga poses, walking across balance beams, or kneeling on an unstable surface such as the bosu ball.
  • Incorporate a variety of activities with wheels:  while being able to ride a bike independently might be the ultimate goal, it is beneficial to incorporate other similar skill sets into your child’s play experience.  This will help you and your child to take the emphasis off of the fact that he does not know how to ride a bike and help to focus on the excitement of trying new things (e.g. scooter, skate board, tricycle, roller skates, etc.).  Similarly, your child might really excel at one of these activities, in which this activity can then be used as a confidence booster when the child has already mastered it.
  • Practice inside:  have your child practice simply balancing on the bike/sitting on the bike in a safe environment, such as inside (e.g. basement or playroom/living room if appropriate).  Place large pillows/beanbags next to the bike so the child feels secure, and if he falls, he will crash into the pillows.
  • Involve different family members/friends:  bike riding can be a very complex task; therefore, it can be extremely beneficial to involve different family members/friends to help with the process. Different people have different strategies and ways of motivating and sometimes one strategy will really hit home for your child.  Similarly, then the same parent and child won’t get so frustrated with one another.
  • Visual schedule:  help your child to make a visual schedule/calendar to illustrate when the child will start practicing and what skill he will work on each day (e.g. getting onto bike; peddling with both legs; ride to the corner etc); then the child can put an “x” or a sticker on the chart when he completes a day of practice, or practices a skill etc.  Visual schedules can be motivating for the child, and provide structure.
  • Take the pedals off:  taking the pedals off of the bike helps initially with learning the feel of the bike/balance. Take the bike to a small hill and have the child ride down without the pedals, this provides an introduction to moving and balancing on the bike without needing the coordination to pedal.

Learning a novel activity can be intimidating for a child, as it is a totally new experience and requires a significant amount of following directions and motor planning.  Similarly, teaching  novel activities can be nerve wracking for the parents, especially if it is a skill they have not taught before, like bike riding.  As parents, it is important to keep in mind that every child learns differently and requires different levels of support when learning a new skill.  Make sure to constantly praise your child during this challenging activity, even if it seems like the tiniest accomplishment (e.g. buckling bike helmet independently; putting kickstand down independently).  As always, feel free to talk with an occupational therapist or physical therapist if you need more individualized strategies or have other gross motor concerns for your child.

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5 Swings Used in your Child’s Therapy Sessions

Oftentimes, parents probably wonder ‘what makes the swings and equipment at my child’s therapy different than the swings at the  playground’?  The answer is that each of the swings used in the therapy gym are able to be used in a much safer and controlled Little girl sleeping in hammockenvironment, as the therapists are able to place mats and pillows under and around the swings, and the therapist can therefore challenge how the child engages in the activity and moves and manipulates his body (e.g. hanging underneath the barrel swing).  Similarly, the swings used in the therapy gym are able to be hung on a rotating hook to allow the child and the swing to move in a variety of planes and directions, providing the child with a greater amount of vestibular and proprioceptive input.

Below are explanations of 5 of the swings therapists use throughout your child’s therapy sessions to help best understand the benefits of using the therapy equipment

  1. Superman swing: The superman swing is also referred to as our prone extension swing, meaning that the child is lying in a prone position (on his belly with his arms and legs extended). The superman swing is suspended high enough off of the floor so that the child has to weight bear through his upper body (shoulders, arms, hands). We often refer to this position as using his ‘wheelbarrow’ arms. This position helps to improve upper body strength, neck strength, trunk control, and multi-tasking/motor planning, as the child is typically playing some sort of board game or activity while maintaining this prone extension position in the swing. As the child gets stronger, he shoots to remain in the swing for longer and longer durations.
  2. Cuddle swing: The cuddle swing is mostly used for self-regulation and calming, as it mimics a hammock, in that it completely surrounds, engulfs, and molds to the child’s body. While in the swing children often feel extremely secure and at ease as the swing provides them with a squeezing sensation- much like a big bear hug from mom or dad. The cuddle swing can provide the child with slow rhythmic movement, which can be very relaxing for a child, especially when he is feeling anxious or when his body is moving too quickly. The cuddle swing can also provide a child with more intense vestibular input, as the child can be spun in circles, when he is seeking more fast-paced input.
  3. Rainbow swing: The rainbow swing looks exactly how it sounds, as it has 4 different colored layers, which the child can crawl in and out of. The rainbow swing provides a rhythmic motion when the child lies on his back or stomach in one position, while the therapist swings him back and forth. Similarly, the child can start at one end of the swing and crawl through like a resistive suspended tunnel, until he reaches the other end and can crash out onto a pile of pillows. This serves as a heavy work activity and can ideally help to increase his attention and body awareness.
  4. Frog swing: The frog swing looks exactly like a playground swing, in which a child needs to pump his legs or be pushed by a therapist to get his momentum going. Typically, the child is instructed to listen for a ‘magic word’ before jumping off of the swing to crash into a pile of large floor pillows (e.g. ready, set, and ‘go’). This activity helps to work on following directions and motor planning, as the child must figure out how to get his body off of the swing at the correct timing to land on the pillows.
  5. T-swing: The t-swing looks like an upside down letter “T”, and may also be referred to as a barrel swing. The child is required to wrap his arms and legs around the barrel like a koala bear and hold on as tight as he can while the therapist is pushing and swinging him. This swing helps to work on entire body strengthening and endurance, and it also requires motor planning and body awareness in order to assume the correct position initially to get onto the swing.

As therapists, we find that the swings listed above are extremely motivating for our clients to use, and serve many distinct purposes; as such, equipment truly helps us to better reach our client’s goals (e.g. following directions; attention; body awareness; self-regulation).  The swings are also a great reward for clients to work towards throughout a therapy session, as they see all of the other children playing on them, and they want to partake in the fun too.  Feel free to ask your child’s therapist if you can come-in and peak at the therapy gym during your child’s session to help you to best understand the treatment process.

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What Does my Child’s ‘Engine Level’ Refer to?

Many therapists use the term ‘Engine Level’ throughout your child’s therapy sessions, and possibly within her goals as well.  ‘Engine Level’ refers to your child’s energy level and the way her body is feeling in various environments and in various times throughout the day.  A child’s body is typically functioning at one of three ‘Engine Levels’.   Ideally, the goal is to be at the ‘just right’ level, in which your child can accomplish the most and focus on the task at hand.

Below are some explanations and examples of how your child’s engine level can be moving too fast, too slow, or just rightHappy child jumping

  • An engine level which is too fast means that you might notice rushing; distractibility; decreased body awareness; and decreased organization.  This might look like your child is running around aimlessly, touching her friends and neglecting personal space, or ignoring instructions and what her body should be doing.
  • An engine level which is too slow means that you might notice low energy and decreased endurance, inattention, and that your child is lethargic, sleepy, or unmotivated.  This might look like your child is slouching or falling out of her chair, propping herself up or leaning on a peer, not listening, or not attempting the task at hand.
  • An engine level which is just right means that you might notice that your child is refreshed and energized, that she is alert and ready to focus on the task at hand, and that she is aware of how her body is moving around her environment.  This might look like your child is maintaining an erect posture at the table to complete her homework or engage in mealtime, and she is correctly following directions and using her listening ears.

Try to use this ‘Engine Level’ lingo in a consistent manner so that your child can ideally develop increased body awareness and self-regulation.  Make sure you provide your child with examples of how your own body is feeling, or how you perceive her body to be feeling, so she can best understand what you are referring to (e.g. “It looks like your engine is moving too fast.  Your body keeps falling out of your chair.  Why don’t you stand-up and do 10 jumping jacks, and then try sitting in your chair again.”)  Stay tuned for my next blog on strategies to obtain a just right ‘Engine Level’.

Reference: Williams, Mary Sue and Shellenberger, Sherry. (1996,) “How Does Your Engine Run?”:  A Leader’s Guide to The Alert Program for Self-Regulation.  Therapy Works, Inc.

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