In-Hand Manipulation Skills: What are they?

In-hand Manipulation refers to the ability to move and position one or more objects within one hand without using the other hand to assist. Below, are explanations of the terminology often used for In-Hand Manipulation Skills.

In-Hand Manipulation Examples:

Translation: Refers to the linear movement of the object or objects from the palm to the fingers or the fingers to the palm.piggy bank

  • Picking up marbles with the fingers and thumb and moving them into the palm.
  • Moving coins from the palm of the hand to the finger tips to insert into a piggy bank.

Shift: Refers to linear movement of an object on the finger surface to allow repositioning of the object on the pads of the fingers.

  • Adjusting the pencil grip so that the fingers are on the tip of the pencil.
  • Dressing skills including snaps, lacing, and buttoning.

Complex Rotation: Refers to the turning or rolling of an object with finger pads between180-360 degrees.

  • Turning a pencil to use the eraser

Simple Rotation:  Refers to the turning or rolling of an object with finger pads no more than approximately 90 degrees.

  • Unscrewing a bottle cap
  • Puzzles

Why are In-Hand Manipulation skills important?

In-hand manipulation skills are important in the efficiency of every day tasks such as:

  • Drawing
  • Handwriting
  • Cutting with Scissors
  • Eating with a fork, knife, and spoon
  • Dressing skills such as buttons, zippers, and snaps
  • Manipulating small objects for crafts and games

Children who are experiencing difficulties with in-hand manipulation, may be observed using both hands for skills that should only take one hand, changing or transferring objects to the other hand for repositioning, and/or may hold an object against their body during activities.

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Why Does My Kid Sit Like That?

You may be asking yourself the question “why does my kid sit like that?” frequently enough to drive yourself crazy.  As kids are growing, they are experimenting with their posture muscles, may be having growing pains, or are just sometimes tired after a long day. teenager sitting As adults may want to put their feet up on the couch after a long day, kids may just want to slouch in their chair when they get home from school.  Below are some common postural bad habits of children and how to correct them.

How Backpacks Affect Poor Posture:

Teenagers are the best at showing poor posture.  Between backpacks that weigh 20 plus pounds and fatigue from growth spurts, you may notice their posture ‘slacking.’  To help combat scoliosis, make sure that your child wears his backpack with both shoulder straps that should fit snuggly on the lower back.  According to the American Occupational Therapy Association, a backpack should weigh no more then 15% of the child’s body weight.  For example, a child weighing 100 pounds should not wear a backpack weighing more then 15 pounds.  Also, consider a roller-bag if your teen’s chemistry books are literally weighing him down.

The Best Position For Your Child To Sit In:

With children who are able to sit at the table, make sure that their feet are on the floor with their hips and knees at 90 degree angles.   Many children’s chairs are adjustable for this reason.  This will make sure that there is no unnecessary pressure on their lower back and leg joints.  If needed, use a stool under their feet to reach that 90 degree position.

The Affects Of W-Sitting:

W-sitting is a common way to sit for kids with low muscle tone and/or low core strength.  Instead of their legs crossed in front of them, kids with low tone or low core strength will sit with their legs splayed out to the side.  W-sitting is a way for kids to widen their base of support so they feel more stable when sitting and reaching for toys.  However, W-sitting can cause strain on the hips, knees and ankles and can also lead to in-toeing. Many children are able to correct the w-sitting habit with just a reminder to sit “pretzel” sitting or “criss-cross applesauce”.

Please refer to my backpack blog for more information on how to properly fit and wear a backpack.  If your child w-sits and you have concerns about their muscle tone or core strength, please contact a physical therapist at North Shore Pediatric Therapy.

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Enhancing Right-Left Discrimination Through Play

There is a high emphasis on building children’s handwriting skills at an early age in order to prepare for kindergarten expectations. This is a wonderful encouragement for your children!  There are multiple recommendations from occupational therapists on how this can be done, including building fine motor muscle strength, improving isolated finger movements, advancing graphic skills, girl pointing left handand practicing bilateral coordination tasks.  However, did you know what impact a knowledge of right-left discrimination can have on your child’s performance?

Typically, children have established hand dominance for pre-writing and drawing activities by four to five years of age.  Yet, their knowledge of right-left discrimination may still need some work.  Here are some fun ways you can help boost their knowledge of which side is which.

5 Activities To Teach Your Child Right and Left:

  1. Play “Hokey Pokey,” which utilizes fun auditory and visual cues to help the child identify the correct sided limb(s).
  2. Play a game of “Twister”, which also has a great impact on motor planning, isometric strengthening, and bilateral coordination. Visual and auditory cues are also helpful hints with this game.
  3. Maneuver through an obstacle course and focus on the concept of turning right or left.
  4. Practice connecting dots with left to right strokes. This task also addresses pre-writing skills, visual motor skills, pencil/marker grasp, and upper extremity control.
  5. When playing board games, if applicable, request of the child to use a particular hand to play his/her next move (i.e. When playing Connect 4 with your child, say “With your next chip, use your left hand to put it in the slot!”)

Play is a child’s primary occupation, and so we need to make all teaching efforts fun within the realm of play!

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Helpful Tips to Get Your Child into a Bedtime Routine

Many parents struggle with getting their children to bed on time. Parents often give their children a bedtime that is not met. To help get your child following a routine and eliminate a bedtime battle, try the following tips.

5 Steps to Creating a Stress-free Bedtime:parents and child at bedtime

  1. Create a picture schedule to help your son or daughter complete their bedtime routine. If it is age appropriate have them help create the schedule with you.
  2. You want to make sure that the schedule is accessible and being used throughout the different bedtime steps. After your child completes each step have them put a sticker or a check mark by it to show that it was completed successfully. Your child will feel a sense of accomplishment and pride for completing these tasks, as well as, have a visual reminder of what steps are done and what are still remaining before lights out.  Some activities that you can include on the schedule are:
    1. Take a bath
    2. Put on pajamas
    3. Brush teeth
    4. Get a drink of water
    5. Pick a friend to bring to bed (i.e., teddy bear, doll, or another favorite stuffed animal)
    6. Pick out a book to read
    7. Go to bed
  3. It is very important to keep in mind that you should start the bedtime routine at the same time every night about an hour before your child should be sleeping. For example, if you want your child to be sleeping by 8:00pm, start the bedtime schedule at 7:00pm. This ensures you will have enough time to complete all the steps and your son or daughter will not be rushed.
  4. When creating the bedtime schedule, make sure the activities picked are calming. You do not want to have activities that will make your child hyper and therefore, more awake. The point of the bedtime steps are to help them start to wind down and get ready to sleep.
  5. Once you are finished reading a bedtime story to your child, say your goodnights. Be sure to let your child know that you will be back in a few minutes to make sure they are sleeping. Being aware that you plan to come back may help to ensure they do not try to play quietly with toys or look at books. If your son or daughter is still awake when you come back, tell them goodnight again and let them know you will be back later to check on them.

This routine will most likely take multiple tries, and perhaps even some adjusting of steps, before your child will complete the steps without attempting to prolong the process. Remembering to stay consistent is key, and before you know it your son or daughter will be off in dreamland!

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Promoting Your Child’s Independence with Everyday Tasks

Have you ever done something for your kids when you know that they can or should do it for themselves?  Some examples include, tying their shoes for them, zipping or buttoning their coat, cutting their food, making their bed, making their lunch, and doing their laundry. boy in capeEvery parent is guilty of doing this every once in awhile, but this can actually be detrimental to your child’s development and their ability to gain skills needed for other tasks.

It may be so much easier for you to do it for them, take a lot less time, or be the easiest way to avoid a meltdown from your child, but this only prolongs them from learning valuable skills. Additionally, you are using your time when you could spend it doing other activities. In order to learn these skills, your children need to be granted the opportunity to problem-solve through a task and succeed. By doing so, this process may transfer to learning other skills, make them feel more independent, improve their proficiency with completing new tasks, and make your life as a parent easier as well!

Here are some tips to help your children gain independence:

  1. Add an extra 10-15 minutes for each activity. This will allow for the increased time needed for your children to complete tasks. If you build in extra time before you have to leave the house in the morning or during the bedtime routine, there should be fewer instances needed to intervene to help your children get ready in order to stay on schedule.
  2. Leave the room! No parent likes to watch their children struggle to do something. If you simply leave the room it may allow you to suppress the need to help them figure something out on their own. If they really need the help, they will come to you and ask for it.
  3. Demonstrate the task to them and then allow them to try it. In order to understand how to open a container or lace their shoes, for example, children are going to have to see it done first. You may have to show them how to do it a few times before they are able to accomplish the task.
  4. Give him or her verbal prompts. Providing step-by-step verbal directions will allow your children to navigate the steps of a task. By allowing them to try the steps out themselves, it helps their body learn the motions needed to complete the task.
  5. Provide written directions. This will allow you to help your children without having to repeat the directions every time. This way, they know where they can go if they forget the steps of the activity while still being able to practice it themselves.
  6. Help only when needed. If you sense your child is about to get frustrated after numerous failed attempts to finish the task, then give him or her the help they need. After practicing, he or she will eventually learn how to do it independently but they may still need a little help along the way.
  7. Give your child the expectation that he or she has to do things for himself or herself. Sometimes children simply do not want to put on their own shoes and socks because it is hard for them, but that is exactly the reason they should do it themselves! If your child knows up front that they are expected to try something before asking for help, there will be less likelihood for a meltdown or tantrum.

It may be difficult to implement these ideas at first, especially if your child is used to being helped each step of the way. However, if you use these strategies consistently, your children will learn how to become more independent and a responsible member of the family!

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What is Motor Planning?

Motor planning is a process that encompasses the ability to come up with an idea, plan how to complete that idea and then finally, execute that idea. mother helping daughter brush teethChildren with sensory processing disorder often have difficulty motor planning for various gross motor and fine motor tasks, as motor planning is a complex procedure that relies on the efficient integration of sensory information.

A child with decreased motor planning may be observed to have difficulty with self-care tasks, such as dressing and grooming, may have difficulty identifying one activity to do when presented with many options, such as when first arriving at the playground, or may have difficulty producing coordinated movements to play games with peers. Until your child completes a novel activity enough times for it to become a skill, he/she may need assistance to engage in a task.

Below are strategies to help your child develop motor planning abilities:

  1. Break down the task into smaller parts.
  2. Provide a variety of cues to help complete the task, including tactile, verbal and movement.
  3. Explore a variety of ways to play with the same toy or game. For example, a balloon can be used for catch, volleyball, baseball, or soccer. Have your child identify other items that would be needed to play these different sports with the balloon (i.e. bat, bases, net, etc).
  4. Assist your child with hand-over-hand support during the first few attempts to complete the task.
  5. Provide your child with the language to promote success, such as “I’m going to try my hardest” or “I can do this!” rather than “I can’t”. Help to show your child that he/she can do the things they want to do!

Source: Ayres, A. J. (2005). Sensory integration and the child: Understanding hidden sensory challenges (25th ed.). Los Angeles, CA: Western Psychological Services

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10 Ways to Encourage Handwriting Practice Without a Pencil

When handwriting is challenging for a child, getting a pencil in their hand can be a difficult task. There are many ways to practice letters without using a pencil. The motor planning component of handwriting can be reinforced through the following activities.

10 Fun Activities For Practicing Handwriting:

  1. Pour cornmeal onto a cookie sheet. Then an adult draws a letter in the cornmeal. Have the child trace the letter a couple times. Then the child can draw the letter in the finger paintingcornmeal themselves. If needed, an adult can guide the child’s hand to make the letter appropriately.
  2. Buy cheap hair gel and put it in a large Ziploc bag. Lie the bag on a flat surface and the child can use their finger to draw letters.
  3. Put shaving cream on the bathtub wall and have the child write letters with their finger.
  4. Use sidewalk chalk or a paint brush with water to make letters outside.
  5. Use blocks to make large letters on the floor.

 For the following five activities, click here to print out large letters as a guide if helpful.

  1. Create letters out of playdoh.
  2. Use Wikki Sticks or pipe cleaners to make letters.
  3. Make letters out of a snack food, for example, raisins, cereal or marshmallows.
  4. Make letters using push pins in a cork board.
  5. Have the child crumple tissue paper, then glue the tissue paper on to cover the letter.

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The Use Of Visuals For Speech Development | Pediatric Therapy Tv

In today’s webisode, a Pediatric Speech and Language Pathologist gives details on how different visual aids can help children develop speech.

 In This Video You Will Learn:

  • What is a speech visual
  • What types of visuals can help with the development of speech
  • What ages and conditions the visuals work best with

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide
audience, this is Pediatric Therapy TV, where we provide experience and
innovation to maximize your child’s potential. Now your host, here’s Robyn.

Robyn: Hello and welcome to Pediatric Therapy TV. I’m your host, Robyn
Ackerman. Today I’m standing here with Deanna Swallow, a
pediatric speech and language pathologist. Deanna, can you tell
us what visuals are and how they help children with speech?

Deanna: Sure. A lot of research has been done to find out which ways
children learn the best. It’s been well-documented that children
learn well with a multisensory approach. Because speech and
language rely so heavily on an auditory system, we try to use
the visual system to help enhance a child’s ability to process
and use spoken language.

There are a lot of different ways and reasons that visual
support can be used, depending on the child’s needs. I’ll show
you an example that I made for one of my kids who has difficulty
following directions. I made a schedule for them that had each
different step visually presented so I could speak each step to
the child and then point to it as I spoke. In this example
visuals are used to help process.

For developing toddlers, oftentimes people will use baby sign to
enhance their development of speech. For older children or
children who don’t have means to verbally communicate at all,
sometimes we will use an entirely visually-based communication
system such as PECS, the Picture Exchange Communication System.
This system was developed for preschool-aged children with

There are a lot of augmentative communication devices that rely
wholly on visual input. Here’s an example of a binder I made for
my kids that has a lot of different activity choices. I’ll use
these in a variety of ways to help children to let me know
different activities they want.

Robyn: Thank you so much, Deanna, and thank you to our viewers. And
remember, keep on blossoming.

Announcer: This has been Pediatric Therapy TV, where we bring peace of
mind to your family with the best in educational programming. To
subscribe to our broadcast, read our blogs, or learn more, visit
our website at That’s

Home Alone: How To Know When Your Children Are Ready

Deciding when your child is ready to stay home alone can be challenging.  Some young children may insist that they are ready before you think they are, whereas some teenagers may feel nervous even though you feel confident in their abilities. While most experts agree that children should be at least 10 years old to stay home without adult supervision, there is no magic number of when children will be ready. Before determining whether your children are ready to stay home alone, ask yourself the following questions.

Is Your Child Ready To Stay Home Alone:girl happy

  1. Does my child show responsibility?
  2. How does my child handle unexpected situations?
  3. How aware is my child of safety procedures?

If you feel confident in your child’s abilities to show responsibility, stay calm in unexpected situations, and use safety guidelines, then the next step is to prepare your child to stay home alone. Below are 8 practical tips.

8 Ways To Prepare Your Child For Staying Home Alone:

  1. Check in with your child about how he/she feels about staying home alone.
  2. Explore any anxieties or fears your child has and provide active listening, support, and problem solving.
  3. Create a consistent safety plan with your child (i.e. emergency numbers, home security system, ways to reach you).
  4. Review with your child what is expected during the time he/she stays home alone (i.e. homework completion, can/cannot have friends over, can/cannot use certain appliances) .
  5. Give your child tasks or activities to do while you are gone (i.e. crafts, new movie, game).
  6. Role play with your child various scenarios (i.e. someone comes to the door, someone calls the house, smoke alarm goes off, someone gets hurt) that could happen while you are gone to help him/her feel confident and prepared.
  7. Practice with your child by leaving the house for 30 minutes and discussing how your child felt.
  8. Give praise whenever your child is able to stay home and follow all of the rules and guidelines!

We would love to hear your thoughts and ideas! What have you used to gage your child’s readiness to stay home alone? What tips would you give to other parents?

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How To Teach Your Preschooler To Cut With Scissors

Snip snip snip! Cutting is a skill that may take a good amount of time for a child to perfect. Cutting requires many components including: fine motor precision, bilateral skills, visual motor skills, grasping, problem solving, and attention to detail. Cutting can also be intimidating for parents to teach, as safety can be a definite concern! Here are some simple tips in order to work towards increased success with cutting:girl using scissors

Teach Your Child To Use Scissors:

  • Find an appropriate work station.  Seat your child at a table, with his feet flat on the floor, and with minimal distractions, so that he will be able to best attend to the activity at hand
  • Make sure your child is using his dominant hand to manipulate the scissors, and his non-dominant hand to hold the paper. If your child has not yet chosen his hand dominance, present the scissors at midline (the center of the body) so that your child can independently choose which hand to use. **Note: often times scissors are made more comfortably for right hand use.
  • Help your child to set-up his scissors correctly from the get go. This will prevent your child from developing a habit of holding his scissors incorrectly/inefficiently, and will lead to greater accuracy and confidence in the end. The thumb should be in the smaller of the two holes and the pointer and long fingers should be inside the larger hole. The ring finger and pinky can be tucked into the palm. **Note: make sure the thumb is facing up towards the ceiling, rather than turned towards the paper.
  • Patience is a virtue with cutting activities. A child should first start by simply snipping the paper, followed by cutting across the entire sheet of paper. After these skills are perfected the child can begin to practice cutting on both straight and curved/wavy lines, and cutting out large circles and squares. Lastly your child will work towards cutting out smaller circles and squares, and more complex shapes.
  • Remind your child to turn their paper rather than turning the directionality of their scissors. Your child’s scissors should ALWAYS be facing forward, cutting away from their body.
  • If your preschooler continues to struggle, try loop scissors or self-opening (spring loaded) scissors to help increase both of your confidence!

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