Loving the Bumble Ball, Junior!

I have a few kiddos on my caseload right now with hemiplegia that are so good at accommodating and doing things with their less affected hand, that it is a challenge to get them to use both hands!

Blocks are not exciting enough, wind-up toys can be too difficult, but the Bumble Ball, Junior is just right! Holding the ball in one hand and pulling the string with the other provides just the right amount challenge. And they love the vibration of the ball, which motivates them to pull the string over and over again, strengthening the more affected arm!

Friday Features

After enjoying a long weekend visiting with family last week, Friday Features are back!

~I know I've mentioned before how much I enjoy the blog, Love That Max. This week Ellen asked pediatric therapists how to get the maximum benefits out of therapy. You can read the tips here. 

~To get your weekend started, check out "Slipping off the fast track to kindergarten", a lighthearted and quick read about kindergarten prep and the role of pediatric occupational therapy.

Handwriting Without Tears Letter Card Adaptation

I feel like I'm on a Handwriting Without Tears kick this week! Today I'd like to share with you how I adapted the Handwriting Without Tears letter cards to help one of my preschool students. 

Due to his limited motor control, when he tried to trace the letter L, it kept looking like this. More of a random line from the beginning to the end, rather than an L.

So I added a few Wikki Stix to the edge of the L. This created a physical boundary, as well as a high contrast visual boundary.

Now he can trace the L more successfully!

Mat Man

I absolutely love the Handwriting Without Tears curriculum! Handwriting Without Tears has so much to offer outside of basic handwriting, including Mat Man to work on body awareness. If you are not familiar with Mat Man, you can visit Mat Man World on the Handwriting Without Tears website or check out the video below. Basically, Mat Man is created using the Handwriting Without Tears mat, wooden pieces, and a few other extras. Mat Man also has a fun song to go along with building Mat Man that kids love.

Here's a picture of Mat Man that some students helped me make:

And here are a few before and after pictures. I asked my students to draw a picture of me prior to building Mat Man. After we built Mat Man, I had them draw a picture of me again.

This student was on the right track until he decided I turned into a drooling zombie (the line down the middle is my drool), with LOTS of legs!

This student still has some areas to work on, but I was happy to see that the after picture has ears and a face, and at least somewhat resembles a person.

Here's a video from Handwriting Without Tears about building Mat Man.

In my therapy bag...a safety pin

As promised yesterday, here is a simple way to promote the use of the more affected arm in a child with hemiplegia. I simply used a safety pin to hold the unaffected arm close to the body. (Caution! This should only be done under CLOSE supervision, as it WILL affect the child's ability to maintain balance! Also, this should only be done for short periods of time, as it does inhibit the use of the unaffected arm, thereby limiting the child's ability to complete tasks that require the use of both arms.)

With that said, it can be a great way to work on grasping items and playing with toys using the affected arm!

What are your favorite ways to promote the use of the affected arm in children with hemiplegia?

Pediatric Constraint Induced Movement Therapy

What is Pediatric Constraint Induced Movement Therapy?
Pediatric constraint induced movement therapy (also known as CIMT) is a form of therapy that encourages children with hemiplegia to use their affected arm by physically constraining the less affected arm. CIMT is offered by many children's hospitals across the country. These programs are intensive and follow a rigorous protocol.

How does CIMT work?
CIMT programs typically involve casting the child's unaffected arm anywhere from 2 hours per day to 24 hours per day for 4-8 weeks. During that time, the child also receives intensive occupational therapy, sometimes up to 6 hours per day!

What are the benefits?

• Improved use of the child's affected arm
• Improved fine motor skills
• Improved spontaneous use of the child's affected arm
• Improved bilateral coordination (using both arms together)

Is there research to support the use of CIMT?
In general, research on the use of CIMT is limited, but growing. The research that has been conducted generally reports positive outcomes.
A quick literature review of the American Journal of Occupational Therapy revealed the following studies, all of which report positive outcomes:

• Case-Smith, J., DeLuca., S. C., Stevenson, R., & Ramey, S. L. (2012). Multicenter randomized controlled trial of pediatric constraint-induced movement therapy: 6-month follow-up. American Journal of Occupational Therapy, 66, 15–23.
• Cope, S. M., Forst, H. C., Bibis, D., & Liu, X.-C. (2008). Modified constraint-induced movement therapy for a 12-month-old child with hemiplegia: A case report. American Journal of Occupational Therapy, 62, 430–437.
• Dickerson, A. E., & Brown, L. E. (2007). Pediatric constraint-induced movement therapy in a young child with minimal active arm movement. American Journal of Occupational Therapy, 61, 563–573.
• Martin, A., Burtner, P. A., Poole, J., & Phillips, J. (2008). Case report: ICF-level changes in a preschooler after constraint induced movement therapy. American Journal of Occupational Therapy, 62, 282–288.

In addition, The CanChild Centre for Childhood Disability Research has written An Update on Constraint Therapy in Children with Hemiplegia. The research in this article is a little outdated, as it has not been updated since 2006. However, it does give a good overview of CIMT, as well as a review of the research completed prior to 2006.

Where can I learn more?
The update written by the CanChild Centre referred to above, provides an excellent overview of CIMT, as well as a review of the research.

Parents, if you think your child could benefit from constraint induced movement therapy, ask your pediatrician, your child's physical or occupational therapist, or check with your local children's hospital to see if they offer a program.

Therapists, Cincinnati Children's Hospital has created an Evidence-Based Care Guideline for Pediatric Constraint Induced Movement Therapy. To download the guidelines, visit their website by clicking here. Scroll to the bottom of the page and click on Constraint-Induced Movement Therapy under the Occupational Therapy and Physical Therapy section.


Check back tomorrow to learn about technique that I use to promote the use of a child's affected arm.

Let your voice be heard!

The 2012 AOTA Elections are now open for voting! AOTA members, be sure to vote before it closes on February 28th!


The 2012 election includes general elections for the following positions:

• President-Elect
• Vice President
• Director to the Board of Directors
• Commission on Education (COE) Chairperson-Elect
• Ethics Committee (EC) Chairperson-Elect

There are also elections for Chairperson of four of the Special Interest Sections:

• Administration & Management
• Early Intervention & School
• Home & Community Health
• Mental Health 

AOTA student members can also vote in the Assembly of Student Delegates election for the following positions:

• Chairperson
• OT Vice-Chairperson
• OTA Vice-Chaiperson
• Secretary
• Communication and Advocacy Chairperson
• Student Representative to Commission on Education
• Student Representative to the Representative Assembly

Click here to read the candidates' biographies and position statements. You MUST be an AOTA member to vote.