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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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How Household Materials Can Be Used For Occupational Therapy Goals

In occupational therapy sessions, we often use common materials and games to make our sessions therapeutic and fun.

Here are some ways that you can use materials and equipment that you may have lying around at home to help your children reach their occupational therapy goals:

Children play household games

  1. Board Games Board games are a great way to help your children develop their social skills and fine motor skills. Board games can be a way to improve eye contact, turn taking, and sharing. Many board games, such as Battleship, Trouble, and Perfection, involve small pieces that need to be placed into the game board. By having your child use his fingers to manipulate these pieces, it can help him understand how to hold small objects which can facilitate learning how to properly hold writing utensils. In addition to helping to hold small pieces, it can also assist your child to develop other fine motor skills, such as manual dexterity and in hand manipulation skills. For example, you can have your child hold onto several of the pieces with one hand and put them into the game board one by one. Using board games that also have cards, such as Sorry, can also help improve manual dexterity by means of shuffling, dealing, and manipulating the cards without dropping them or revealing them to the other players.
  2. Play-Doh Play-Doh is a wonderful tool to improve fine motor skills in children. Play-Doh can be used as a medium to practice writing, drawing, and cutting. You can trace different geometric forms (circle, square, and triangle) into the Play-Doh with a pencil and have you child copy the shapes in another piece of flattened Play-Doh and cut them out with scissors. Using Play-Doh to practice drawing and cutting is often a good precursor to writing with a pencil and paper as the texture of Play-Doh is more resistive which makes cutting and tracing easier. Play-Doh can also be used to help strengthen the small muscles in their hands by rolling it into a snake, ball, and flattening it into a pancake.
  3. Puzzles Puzzles can be used to help your children improve their visual-perceptual skills which is important for many school tasks, such as copying things from the board and finding items in their desk. The complexity of puzzles can very greatly, from simple large peg puzzles in a wooden form to 100 piece jigsaw puzzles. If you have an older child, using a complex jigsaw puzzle can be a great way to work on planning, sequencing, organizing, and problem-solving skills.
  4. Playground equipment Using the playground or the jungle gym in the backyard is the perfect way to help your children increase their core strength, upper body strength, and bilateral coordination. This will help build up the strength in your children’s larger muscles so that when they have to work at their desk or a table, their core and upper body will have the stability and endurance to sit and complete fine motor activities.
  5. Balls Playing catch, kicking, dribbling, and volleyball are just a few of the many ways balls can be therapeutic. All of these activities involve using eye-hand coordination, balance, and core strength which are great skills to have for a variety of gross motor and fine motor activities. These activities can also help with ocular motor skills as your child needs to track the object through space.

There are many types of equipment and materials used during therapy that can be adapted to meet the needs of your child. You can find these materials and many more around your house in order to improve your child’s skills so he or she can be successful in school and play activities!

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Creative Ways to Help your Child Work on Handwriting

Working on handwriting at home can feel like a lose-lose battle for parents and children alike.  It can be a challenging and/or least preferred activity for children, which makes it hard for parents to want to implement and follow through with.  While handwriting is certainly an activity which your child’s occupational therapist or academic specialist can help with, it is extremely important to expose your child to handwriting consistently at home on a daily or weekly basis.

Boy writing

Below are different creative writing ideas to get your child practicing his handwriting with less hesitation!

  • Write the family grocery list
  • Copy a recipe onto a recipe card
  • Create a bucket list of activities or places to go
  • Make a birthday list (e.g. places to have next birthday party; themes for party)
  • Write upcoming events onto the family calendar
  • Write out personal goals for the upcoming school year (e.g. to be part of a school play; to join a new sports team; to get straight A’s)
  • Keep track of what you ate each day or plan meals for the next day
  • Help create a to-do list (e.g. chores; long-term homework assignments)
  • Keep track of a topic of interest (e.g. bird watching)
  • Write a book report on your favorite book
  • Make a comic book with drawings and short phrases
  • Copy jokes into a booklet format (e.g. from laffy taffy wrappers or popsicle sticks)
  • Create a list of potential outfits to wear to school or to pack for an upcoming vacation
  • Write out cards to send to family/friends
  • Paraphrase the rules to a favorite board game or card game

The suggestions above can help your child find a handwriting activity that he does not mind doing.  If it is still a struggle, offer him two options for the day (e.g. you can either write my grocery list for me or write out a card for Grandma’s birthday).  You can also try setting a timer and let your child know that he needs to write for 10 minutes or come up with at least 3 sentences (or whatever is age appropriate compared to his peers at school).  Lastly, for the first few trials, don’t feel like you have to edit or critique your child’s work, rather, just have him try to do his best work and praise him for being creative or trying something new.  There will be plenty of opportunities to work on sizing, spacing and spelling after handwriting becomes more of a routine at home.

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What do Occupational Therapists Look for During your Child’s Handwriting Sample?

Handwriting is a lifelong skill. It begins as young as 3 years of age, when children start identifying shapes, letters, and numbers.  Handwriting and letter recognition are important for communicating (e.g. sending cards and emails) and for completing age-appropriate tasks (e.g. homework assignments; writing grocery lists).child pencil grasp

Below are many of the components your child’s occupational therapist looks for during a handwriting sample in order to work towards a clear and legible final product:

  • Sizing: Are the letters all relatively the same size (e.g. all upper case the same size and all lower case the same size)?
  • Spacing: Are the letters and/or words too close together?  Or is there at least a finger or pencil width between each word?
  • Mixing of upper case and lower case:  Is there inconsistency between the use of upper case and lower case letters?  Are upper case letters used correctly (e.g. start of a sentence or for a name/title)?  Mixing of upper case and lower case letters is appropriate until 6 years of age.
  • Capitalization: Are names, titles, and beginning letters of a sentence appropriately capitalized?
  • Formation of letters Does the child form each letter in the right direction?  (e.g. ‘b’, ‘d’)  Does the child use the correct number of lines and curves? (e.g. ‘m’, ‘n’)  Letter reversals are appropriate until 7 years of age.
  • Complete sentences Are there clear and complete thoughts?  Is the correct punctuation used at the end of the sentence?
  • Floating letters: Do all of the letters sit clearly on the line?
  • Pencil grasp:  Does the child hold the pencil or marker age appropriately?  The static tripod grasp is expected around 3 ½ – 4 years of age.  This is when the pencil is held between the thumb and index finger, with the pencil resting on the middle finger and the child uses and moves his wrist/arm to make movements with the pencil.  The dynamic tripod grasp is expected around 4 ½ – 6 years of age.  This is when the pencil is held between the thumb and index finger with the pencil resting on the middle finger, and the child uses and moves his fingers to make movements with the pencil.
  • Posture in chair:  Is the child slouching or falling out of the chair?  Is the child propped or leaning?  Are his feet flat on the floor?  Is the table the appropriate size?
  • Pressure used:  Is the child’s writing legible?  Or does he press down too hard or too lightly with the pencil, causing the writing to be hard to read or his hands to fatigue more easily?

This list of handwriting aspects may give you ideas of what to look for in your child’s handwriting during activities/assignments at home.   If you notice that your child is having trouble in any of these areas, encourage him to focus on one of those aspects each time he practices writing (to break down the task).  Your child will work on these aspects of handwriting during his occupational therapy sessions, but it is also very important to provide your child with similar learning opportunities and feedback at home.

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Top 5 Reasons Why Your Child Should Practice Mazes at Home

Mazes are a huge hit with therapists and children alike!  While mazes are lots of fun and provide a sufficient challenge for children, they also help therapists to address a variety of skills within your child’s therapy session.  Mazes can be taped to a wall at your child’s eye-level so that he can work on a vertical surface.  This mimics a chalkboard or an easel board and promotes wrist extension and copying from a board (like in a classroom).

Mouse and cheese maze

Below are several reasons to practice mazes with your child at home:

  • Problem solving:  Mazes help your child to work on his executive functioning skills, such as planning and brainstorming various strategies (e.g. starting from the beginning of the maze or working backwards from the end of maze).
  • Fine motor control:  Mazes require your child to control his pencil through the maze without hitting the black lines. This means that he must take his time rather than rushing, in order to have greater success.  Progress can be observed as your child bumps into the black lines less and less as he gains greater control of his writing utensil.  Children use fine motor control in order to produce correct letter formation and legible handwriting.
  • Visual motor:  Mazes require your child to use his eyes to scan the worksheet in order to find possible solutions.  Scanning is a great skill used for reading and writing, as it is important to scan from the left side of the paper to the right side.
  • Grading of an activity:  Mazes can be broken down into different steps.  For instance, first have your child start by moving his finger, next a pencil, then a marker through the maze.  This helps your child to solve the same maze three times consecutively, which allows the skill to sink-in better.
  • Confidence:  Mazes are perfect fine motor activities to help boost your child’s confidence.  Have your child begin with a simple maze to provide immediate success, and then have him work towards completing mazes of increased difficulty.

Fine motor and visual motor skills can be practiced in a wide variety of ways, including mazes.  Mazes are a great way to work on handwriting without just writing letters and words. There are many websites that offer free printable maze worksheets for a variety of age levels and themes.  An internet search such as, “simple mazes for 4-year-olds,” will produce a variety of mazes and printable activities that are perfect for practicing these important skills at home!

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How to Promote In-Hand Manipulation in Everyday Activities with Kids

In-hand manipulation skills are important for many everyday tasks, such as eating, writing, dressing, playing, and drawing. With all the busy schedules these days, it is often hard to find time to practice such skills enough.Mother practices hand manipulation with daughter

Here are ten ways to encourage development of in-hand manipulation through tasks and activities that you and your children already do!

  1. When putting change into a piggy bank, have your child pick up several coins with her fingers, one at a time, and transfer them onto her palm. With all of the coins securely held in her palm, she should then transfer one coin at a time into the bank.
  2. Play board games or any game involving small pieces (for example, connect-4). Have your child hold all the pieces in her hand, transferring pieces from her palm to her fingers, one at a time, as needed for the game.
  3. While eating snacks, have your child hold multiple small pieces in her hand, letting go of one at a time. Also, while eating a larger snack like a chip, have your child rotate it in-hand (turn it in a circle) before eating it.
  4. Use tongs or tweezers to pick up game pieces. You can also use them for crafts!
  5. Encourage your kid to do buttons, skips, and snaps independently or help you with yours.
  6. Ask your child for help with various baking and cooking tasks such as rolling bread or shaping cookies. She can also use tubes of frosting to help decorate cakes and cupcakes.
  7. If you are about to enjoy a pop, ask your child to help you open it. Do the same for opening and closing bottles or jars of various sizes.
  8. While drawingplace the crayon inverted (upside down) on the table so that your child has to turn it around with one hand before drawing.
  9. Complete a puzzle together. While figuring out where the pieces go, encourage your child to use one hand to rotate a piece until it fits in a spot.
  10. When writing with a pencil, practice rotating it around to erase with one hand or have races to see who can “shift” their hand down the pencil the fastest.

Do not let a learning opportunity pass you by! Keep an eye out for these everyday opportunities that can promote continued development of in-hand manipulation skills for your children. Without any planning, you can still easily help your children blossom and reach their full potential!

For more information on in-hand manipulation, see my previous blog.

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