Happy Holidays!

I'll be taking a little break from blogging. Hope you all have a wonderful holiday season! See you after the new year!
~Abby

In my therapy bag...bubble wrap

Holiday gift giving brings lots of packages with a variety of interesting packaging. I'm always looking for ways to re-use the packaging, such as bubble wrap. I often use standard bubble wrap to work on jumping (kids love to hear that pop!) and fine motor/pinching skills. The other day I received a package in the mail with a different kind of bubble wrap:

This Sealed Air bubble wrap does not pop as easily as standard bubble wrap (you can see in the first picture that an entire row is deflated, but that happened after doing the activity described below). All of the bubbles are connected, so when you squeeze one bubble, the air simply moves into the neighboring bubble.


I decided to incorporate this bubble wrap into an activity with a two year old who frequently walks on his toes. I simply had him stand on the bubble wrap while we played catch with a ball. I also had him squat to pick up toys while keeping his feet flat. The movement of air from one bubble to another slightly challenged his balance and provided additional sensory input to encourage him to keep his feet flat. This was a fun adaptation to an activity that we've done before and the new twist maintained his attention for a longer period of time!


Here's the bubble wrap in action:

For more information on toe walking, The Mayo Clinic provides a basic overview of toe walking here. For a physical therapist's point of view on toe walking, click here for information on toe walking from Dr. Joni Redlich, DPT.

Fine Motor Christmas Tree

I was inspired by one of the amazing teachers I work with to try this Christmas tree craft. I love how many skills can be addressed with this craft: hand strengthening, scissor skills, motor planning, visual motor skills, tactile exploration, etc.


All you need is some construction paper, scissors, glue, a hole punch and red yarn. 

• Make segments of a tree by cutting a large green triangle into three or four pieces. You can vary this step by drawing wavy or zig zag lines for the child to cut depending on the child's skill level.
• Glue the segments on a paper. Younger children may benefit from having a completed Christmas tree to use as a visual model.
• Use a hole punch to make colored dots. Decorate the tree by gluing the dots on your tree.
• Squeeze glue between the tree segments. Some children may benefit from having a line to trace with the glue.
• Glue a piece of yarn between the tree segments. (I didn't have any yarn on hand, so I used a pipe cleaner in the picture above. I would not recommend using a pipe cleaner, as it doesn't stick very well!)

I did this with a preschool age child, and as you can probably tell from the photo, she lost interest a little early. She loved the cutting and gluing part at the beginning, but using the hole punch and manipulating the tiny dots to decorate the tree turned out to be a little too challenging for this particular child. I recommend this for kindergarten age or up. Might be a fun activity for preschoolers with good fine motor skills (but I generally don't see those kiddos :)

Fine Motor Christmas Craft

Remember those foam shapes I found at Target about a month ago? Well, I've finally put them to use this week with some of my kiddos. We've been decorating them with glitter glue to work on hand strengthening and visual motor skills. Check out the finished products below!

This student wrote his name at the top and then squeezed dots of glitter glue on top of black dots that I drew.

This student decorated the tree by squeezing glitter glue on dots that I drew.

Squeezing and tracing.

Finished product!

Why do we use weighted pencils in therapy?

My post last week about how to make a weighted pencil received an incredible number of views and comments. Thank you all for the support and feedback! In case you missed it, click here to check it out.

Now I would like to pose this question to all of the occupational therapists out there, why DO we use weighted pencils (or crayons or markers)? And if we believe this strategy is effective (which we must, or we wouldn't be doing it), then why aren't we challenging our beliefs by creating a hypothesis, collecting data, and documenting our results?

Thank you to 101 OT Ideas for asking about research relating to the use of weighted pencils. I first did a web search using Google scholar and all I located was an article describing a Handwriting Club that mentioned the use of a weighted pencil holder. I'm not sure what a weighted pencil holder is, and the article didn't look at the outcome of specific sensory strategies. However, it is an interesting read if you're considering starting a handwriting club or handwriting camp. Click here to check it out.

I then did a ProQuest search and didn't find anything related to weighted pencils, although I did find some articles about the use of multisensory strategies for handwriting. This included strategies such as writing on a chalkboard, writing letters in sand, using whole arm movements for "sky writing", and tracing letters on various textures. The studies did not include the use of weighted pencils. I found one article from 2000 that looked at the use of weights in therapy:

Feder, K., Majnemer, A., & Synnes, A. (2000). Handwriting: Current trends in occupational therapy practice. The Canadian Journal of Occupational Therapy, 67, 197-204.

• In this study, pediatric occupational therapists were interviewed regarding the treatment approaches used for children with handwriting difficulties. In addition, the OTs interviewed were asked about their use of weights in therapy. Sixty-eight percent reported that they use weights, for reasons such as poor sensory awareness. This article went on to say that there is little research to support the use of weights, yet many therapists are doing so. It's almost 12 years later, and there is still little to no research to support the use of weights, yet many therapists, myself included, are doing so.

[Side note: ProQuest is a full-text online database provided as a benefit for members of the Occupational Therapy Association of California. If you don't live in California, you should lobby for your state association to offer a similar benefit!]

I also did a search on AJOT (American Journal of Occupational Therapy). Again, I didn't find anything specific to weighted pencils, but I did find the following articles of interest.

American Occupational Therapy Association (2009). Providing occupational therapy using sensory integration theory and methods in school-based practice. American Journal of Occupational Therapy, 63, 823-842.

• This document by AOTA discusses the use of sensory integration theory in school-based practice. While weighted pencils are not specifically addressed or researched, the use of a weighted pencil is listed as an intervention in a case study presented in this document. If the use of a weighted pencil is listed in a document by AOTA, then this is clearly an intervention that is used frequently and its effectiveness should be further studied.

Woodward, S. & Swinth, W. (2002). Multisensory approach to handwriting remediation: Perceptions of school-based occupational therapists. American Journal of Occupational Therapy, 56, 305-312

•  This study used a questionnaire to identify the types of multisensory strategies that occupational therapists are using for handwriting remediation. No research was completed on the effectiveness of any of the strategies. The use of wrist weights was identified as a strategy used for proprioceptive input.

It seems clear to me that the use of weighted pencils is an intervention that occupational therapists frequently use, but with little research to support the intervention. I'm not exactly sure how to go about collecting data on something like the use of a weighted pencil. I'm currently only using this strategy with one student, and I'm not using the weighted pencil in isolation of other interventions. If this student improves, is it because of the weighted pencil, the visual motor activities, the daily handwriting practice in his classroom (which research has found to be a very effective intervention), or some other factor?

I am highly interested in diving into this topic further and collecting data on the use of weighted writing utensils. If anyone has any thoughts about how to do this, please leave a comment below, or contact me at AbbyPediatricOT [AT] gmail [dot] com.

How to make a weighted pencil

Weighted pencils can be beneficial for students who do not press hard enough when writing or for students who have poor body awareness and need additional proprioceptive input to increase awareness of their hand.

If you've ever taken a look at a therapy catalog, then you are aware of how expensive simple items like a weighted pencil can be. Here's an easy and inexpensive way to make a weighted pencil or crayon on your own.


What you need:

• a pencil (or crayon)
• two rubber bands
• some hex nuts

 Just wrap the rubber band around the pencil to prevent the hex nuts from falling off. Then place the hex nuts on the pencil to create the desired weight. Wrap another rubber band around the pencil at the end of the hex nuts. To find the correct size of hex nut, I recommend just taking a pencil to a home improvement store and to see which size fits best.



Now you have a weighted pencil!

You can also use this method to create weighted crayons or markers

Gifts for Therapists

I was inspired by Ellen, over at Love that Max, to write this post. Today she blogged about gift ideas for therapists and teachers. Visit her blog here to read the post and to share your own ideas for gifts for teachers and therapists for a chance to win a $50 TJ Maxx/Marshall's gift card!


I'd like to give a therapist's perspective on this topic. First and foremost, gifts are never required or expected. To all of you amazing parents out there who work with your child day in and day out, you have enough to focus on; you don't need to worry about getting a present for your child's therapists and teachers.

If you'd like to show your appreciation, I think I speak for all therapists when I say a heartfelt note expressing your sentiments is the best gift you can give. If you don't believe me, notice the date on this card below (and I still have this card today!).

Handmade cards are also appreciated, such as this Valentine's Day card.

Here is an example of another homemade gift, which was accompanied by a pot of flowers.

Another unique gift that a colleague of mine once received was the book, Ten Things Every Child with Autism Wishes You Knew by Ellen Notbohm. The therapist could then share the book with colleagues and other families, so it was a gift that just kept giving!

As far as candy and baked goods go, my opinion is that you can't go wrong! However, there seems to be mixed feelings about this in the discussion over at Love That Max. I feel it is an inexpensive gift for parents to show their appreciation, and it is something that we can share with our families or colleagues if it is more than one person should be eating!

4/9/12 Update: Check out this bag that I received as a gift. Probably the most useful gift I have received!


Therapists, teachers and parents, what are your thoughts on holiday gifts?

Caring for Military Kids with Autism Act

One in 88 active duty dependent military children has autism. These families face tremendous difficulty in accessing appropriate therapy services for their children. Many states have passed laws which require private insurers to cover autism related therapies. However, these laws do not extend to TRICARE (military insurance). The Caring for Military Kids with Autism Act would ensure that these children would continue to receive therapy (primarily behavioral therapy) even after their parent is no longer active duty. This Act continues to sit in congress with limited support. Contact you congress member today and ask them to co-sponsor the Caring for Military Kids with Autism Act!

For more information on the Caring for Military Kids with Autism, click here.
For more information from Autism Votes, click here.

Crayola Dry Erase Crayons

About a month ago, my dry erase markers dried out (like they always do!), and when searching for a replacement, I came across Crayola's Dry Erase Crayons. I was skeptical about how they would work, but they work surprisingly well!

What I love:

• Requires the child to press hard, providing more feedback than a marker
• Doesn't dry out!
• No odor! 

What I like:

• Looks like a crayon
• Doesn't make marks on skin as easily as markers (but they do make marks on skin if you're really trying)
• Can also write on paper, including black paper

What I don't love:

• Requires the child to press hard, making it difficult to use for children with a weak grasp (yes, you can love and not love the same aspect of an item!)
• Difficult to erase. It comes with a mitt to use as an eraser, which most children are excited to use, but I haven't come across a child yet that has been able to push hard enough to actually erase (It does fully erase, and I am able to easily exert enough pressure to erase the marks completely.)
• Since it doesn't erase easily, I'm not able to have the child practice extra letter formation by erasing the letter on Handwriting Without Tears letter cards in the correct formation. 
• Sometimes entire chunks break off of the crayon if pressing too hard.

The box says that it washes clean from hands and clothes. I can attest to it washing off of hands easily, but I haven't yet had to wash it out of clothing, although it does seem as though it would wash out easily. As you can see from the pictures below, they are a little larger than a regular crayon, but still small enough for little hands to hold comfortably.

Here are a few pictures of the dry erase crayons in action!

Look at that beautiful grasp!

All in all, I think the Crayola Dry Erase Crayons are a good product. I will definitely keep using these crayons and I love that they don't dry out, so I don't have to keep replacing them!


To buy Crayola Dry Erase Crayons, click here.
For more information about Handwriting Without Tears, click here.
For Handwriting Without Tears Capital Letter Cards, click here.

Checklist for Toy Shopping from AOTA

As part of their Tips For Living Life to It's Fullest series, AOTA has created a checklist for shopping for developmentally appropriate toys. This is a free resource available to download and share. I wasn't able to listen to the Virtual Chat today, but I'm guessing this checklist was discussed in depth during the chat. Click here to view the checklist.


To listen to any of the past Pediatric Virtual Chats, click here.

The little things DO matter

At the Autism West AOTA Specialty Conference, there was a wonderful panel of parents and individuals with autism spectrum disorders who shared their experiences, including their experiences with occupational therapy. Included in this panel was a mother and her 19 year old daughter who has Asperger's. This mother shared that her daughter was having difficulty washing her hair, because she didn't fully understand where to rub the shampoo without being able to see her head. Her daughter's occupational therapist recently suggested that she use a shower mirror to provide a visual while washing her hair. Her mother immediately ordered a shower mirror and her daughter can now shower independently! It's amazing how a seemingly simple adaptation can be life changing to the families that we work with. This mother was incredibly grateful for the suggestion.


This story reminded me of the time I was working with a very bright child (6 or 7 years old) who was sensory seeking and struggled with sitting to attend to his schoolwork. At the end of one session, I gave his mother a piece of Theraband to take home to tie around the legs of her son's chair during homework time. I mentioned that she could try it for mealtime as well. She came back the following week, thrilled with the results. She informed me that she and her family are now able to eat meals together as a family, because with the added sensory input that the Theraband provided, her son could now sit through an entire meal. Another life changing adaptation!


As occupational therapists, we are skilled at adapting and modifying the environment to allow for full participation in meaningful daily activities (occupations!). To all of my fellow OTs out there, keep up the good work!

Free Pediatric Virtual Chat Tomorrow on Toy Selection

Pediatric Virtual Chats are a great resource available on the AOTA website. Tomorrow, December 6, they are holding a virtual chat on Toy Selection at 11:00 EST. Click here for more information.

Not available tomorrow, or reading this after December 6th? You can listen to a recorded version of the chat here. Be sure to check out all of the past virtual chats as well! These are a number of timely topics for pediatric occupational therapists.

Fine Motor Gift Wrap

With holiday season fast approaching, why not make the gift wrap part of the fun?  All you need is a small gift and a variety of items to wrap it in, such as yarn, foil, Wikki Stix, colored tape, or pipe cleaners.


Here's how you do it:

Gather your supplies. I was wrapping some Silly Putty, and I used aluminum foil, Wikki Stix, pipe cleaners and twine as the 'gift wrap'.

First, I wrapped a Wikki Stick around the Silly Putty. 

Then I added a pipe cleaner.

Then I wrapped the whole thing in foil.

Followed by some twine.

And then some more pipe cleaners to add some color.

This will really get those little fingers working to get to the surprise inside! 

For school therapists, this could be a fun addition to your treasure chest, or a neat birthday surprise for your students. This is also a good party favor for birthday parties or a fun way to wrap stocking stuffers.

This idea was inspired by the layered ball scavenger hunt over at www.ahappywanderer.com. Be sure to go check it out for a great fine motor activity!

Autism West Recap

I had a great time at the Autism West AOTA Specialty Conference in Long Beach this weekend! It was two days filled with amazing speakers and a great opportunity to meet and network with OTs from around the country. Once I have time to process all of the information from the conference, my blog will probably be filled with autism related posts for quite some time!

More great holiday gift guides for kids with special needs

First of all, if you don't follow the blog, Love That Max, you need to! It is a wonderfully written, open and honest blog about raising a child with special needs. So go check it out! While you're visiting, check out the 2011 holiday gift guide for kids with special needs. This guide is full of toys that are kid-tested and parent approved! There is definitely something for everyone in this list of toys broken down into categories of fine motor skills, sensory issues, cause and effect, gross motor skills, and learning and speech. Ellen, at Love that Max, has another great gift guide: "Handmade gifts by special needs moms that pay for their kids' therapies." This blog post contains a list of gifts for kids, moms, teachers and everyone else. What's great about this list is that all of the items in the list are made by moms of children with special needs. Most of these moms use the money made to help pay for therapies for their children. Buying from these sellers is a win-win situation!

Another great blog is written by Tana Jimenez, a pediatric physical therapist. I think her physical therapy blog is the perfect complement to my little occupational therapy blog :)  She has a written a series of holiday gift guides with a focus on promoting gross motor development for various age groups. Click here to check them out! 

Advance for Occupational Therapy Practitioners is a free publication for occupational therapists. The November 7th publication had a cover story on choosing toys for children with special needs. You can click here to check out the online version of the article. In addition, Advance has also created a patient handout, Toys for Children with Special Needs, written by Michelle Lange, an OT and assistive technology specialist, for therapists to share with families to assist in finding the right toys and adaptations for their child with special needs.

Glenda Hampton Anderson, over at Glenda's Assistive Technology Information and More, is an assistive technology consultant. She has created an informative gift guide for children with special needs. This gift guide has a great list of "Top Ten Things to Consider When Buying Toys for Children with Disabilities", as well as information about devices and switch activated toys for children with disabilities. Click here to check it out!

Each year Toys "R" Us puts out a Differently-Abled Toy Guide. This guide features specially selected toys that encourage play for children with physical, cognitive or developmental disabilities. Symbols are assigned to each toy to make it easier for parents to find toys that promote specific skills, such as language, tactile, fine motor, gross motor, creativity. Click here to check it out!  

Babble.com, which is a wonderful parenting website, has a blog called The Toddler Times. This blog has two gift guides, while not specifically written for children with special needs, with great ideas for children of all levels of ability. The first is called 15 Holiday Gifts to Make for Your Toddler. These ideas are great for crafty parents or those on a budget. The ideas range from sensory (Homemade Finger Paints) to fine motor (Activity Board) to pretend play (Felt Potato Head Dolls) to learning (Counting Bean Bags) and more! Click here to check out the complete list.

The second gift list on Toddler Times is 10 Unique Toddler Toys for under $25. This list contains items from Etsy, an online handmade marketplace. Despite all of my links to amazon, I am a strong believer in supporting small businesses (my mom is a small business owner). And these gifts are handmade, which makes them much more unique than what you'll find at all the big box stores. This list contains a magnetic fishing game (great for eye-hand coordination), an activity bag for toddlers on the go (great for working on fine motor skills and self-help skills), and felt play food (great for pretend play), among other great toys! Click here to check out the complete list!

12/3 Update:
I just came across a comprehensive gift list created by Jen Dermody, a pediatric OT. Be sure to go check it out! Click here to visit Jen's OT for Kids.




I know there are tons of great gift guides and lists out there. If you know of any other helpful toy guides for children with special needs, please share in the comments section below!

Holiday Gift Guide for Elementary School Age Children

The last installment of my holiday gift guides focuses on elementary school aged children. Children at this age are developing their motor and cognitive abilities into more complex skills, such as skills needed to participate in team sports and to complete school assignments with multiple steps. This age is a great time for games that challenge motor skills and further develop problem solving skills.

Magna Tiles
These magnetic tiles stick together on all sides and are great for building and creating anything you can imagine. Works on fine motor and visual perceptual skills.




ThinkFun Games
I love the brand ThinkFun! Their products include a number of mind bending games that challenge kids to think strategically. Many of these games will continue to challenge kids (and their parents) for years! Below are a couple of my favorites:

ThinkFun Rush Hour
This game has four levels, ranging from beginner to expert. Cars and trucks are set up on a grid, and then you have to figure out how to get the red car out of the gridlock. Great for visual spatial skills! Also, if you have an iPad, be sure to check out the ThinkFun Rush Hour app!

 


ThinkFun Shape by Shape
This tangram style game also encourages use of visual spatial skills and problem solving.



Ravensburger Make N Break Challenge Family Game
I love any game that includes the use of tongs (always looking to challenge fine motor skills). This building game not only challenges fine motor skills and dexterity, it also challenges your visual perceptual skills as you reproduce the designs on the cards.
 




I hope you find this list helpful!

What are your favorite gifts for elementary school aged children?