Pediatric activity ideas for Occupational Therapists

Archive for September, 2010

3-D 'Occupational Therapy' for Children: Virtual Muscle Machine for Kids With Disabilities

It was her love of ballet that led her to work with children who have motor disabilities. The retired dancer, now an occupational therapist, is pioneering a new “virtual” method to analyze movement patterns in children ― and more effectively treat those with debilitating motor disorders.

Dr. Dido Green of Tel Aviv University’s Department of Occupational Therapy in the School of Health Professionals is using a “virtual tabletop” called the ELEMENTS SYSTEM, developed by her partners at Australia’s Royal Melbourne Institute of Technology, to “move” kids with disabilities and provide home-based treatments using virtual reality tools. Combining new three-dimensional exercises with two-dimensional graphical movement games already programmed into the tabletop (which resembles an early video game), she reports not only success but also enthusiasm among her young patients.

“I’ve been working with children with movement disorders for the last 20 years,” says Dr. Green. “By the time I meet these children, they’re sick of us. They’ve been ‘over-therapied,’ and it’s difficult to get them to practice their exercises and prescribed treatment regimes.”

Fun for kids from three to fifteen

“The virtual tabletop appealed to children as young as three and as old as 15,” Dr. Green reports. “The movement-oriented games allowed them to ‘make music’ and reach targets in ways that are normally neither comfortable nor fun in the therapeutic setting,” she explains.

Dr. Green determined that children with partial paralysis and motor dysfunction resulting from disorders such as cerebral palsy may be helped by giving them a new interface to explore. Building upon earlier research she conducted at the Evelina Children’s Hospital in London, Dr. Green found that virtual reality applications enhance the skill sets learned by her patients.

Coupled with new technology involving 3D Movement Analysis, a technique she is now integrating into research at Tel Aviv University, Dr. Green hopes to develop this virtual tabletop-type game into new and effective therapy treatment regimes.
“Traditional approaches are labor-intensive and their results limited,” Dr. Green says. “Our research aims to create a complete system for therapist, parent and child. It could bring daily treatments into the home and provides therapists with a complete solution to track and analyze improvements or setbacks in the most accurate way to date.”

From the virtual to the real world

In children who attended sessions with her interface for three days a week over a period of about one month, Dr. Green found some impressive results. One child with a paralyzed hand was able to perform more complicated movements, culminating in a “eureka!” moment when she opened a door for the first time in her life. The girl was also able to gain control over some motor movements essential for basic life tasks, such as buttoning sweaters, opening doors, or going to the washroom. These are skills some children never develop with current therapy regimes.

In the near future, Dr. Green hopes to develop the technique for remote rehabilitation, enabling children to practice movements at home with parental supervision. Therapists located elsewhere could “log in” with a webcam and computer to coach the students or monitor their progress.

The researcher also plans to analyze brain function using trans-cranial magnetic brain stimulation. Currently, brain function relating to motor activities is analyzed with magnetic resonance imaging (MRI). But many children are too impatient to sit in an MRI machine, so clinicians need a more accurate means of analyzing movement in children with disabilities to develop individualized therapy regimes.


American Friends of Tel Aviv University (2010, April 28). 3-D ‘occupational therapy’ for children: Virtual muscle machine for kids with disabilities.

Causes and Treatment of Poor Fine Motor Control

Don’t miss our first article about “Fine Motor Control in Children
poor fine motor control treatment

The primary cause of fine motor control problems is a lack or over abundance in muscle mass. A child having high muscle tone may make mistakes based on the over activation of muscles, resulting in activities being sloppy or even clumsy in nature. A child having low muscle tone is quite common; a child with low muscle tone may struggle to maintain even the smallest control of a pencil or even scissors. Small feats like finger movement may prove to be an extreme effort for a child with low muscle tone.

It can be said that genetic and environmental factors can lead to fine motor skill problems. While pregnant, a mother exposed to alcohol and drugs can be a big factor in the development of a baby. Alcohol can directly affect the neurons in the brain. If a baby is born premature the connection of the neurons in the brain may be disturbed. The more premature a baby is the risk for this problem rises. Disturbing the connection of neurons can lead to difficulties with attention span and/or self control in fine motor skill development. Even smoking has been known to have negative effects on motor skills.

Treatment with pediatric occupational therapist can greatly improve a child’s fine motor skills with the right therapy geared to successful treatment of fine motor problems. The pediatric occupational therapist may try two approaches in the treatment of your child. The first is a relatively general approach dealing with the assessment of their sensory development. How a child moves and reacts to stimuli. Finding that underlying factor helps them form a second approach designed specifically for fine tuning the way they perform more complex tasks using fine motor skills. Teaching them how to accomplish and fine tune their skills can greatly improve motor function.

Being that no one method is successful for all patients a Pediatric Occupational Therapist may also treat a child in these areas:
– Their finger strength, hand strength, hand position and stability
– Overall pencil grip and control
– Control of the wrist and forearm
– Finger movement
– The spatial organization of space and letter formation
– Speed and dexterity
– The isolated movement required for tweezers and scissors

It is necessary for parents to take an active role in their child’s treatment for the continuation of improvement outside of the pediatric occupational therapists office. For at home improvement of fine motor skills the occupational therapist may suggest activities like drawing (sample activity), coloring and paper cutting art involving cutting out paper chains and making paper snowflakes. Drawing can improve how neatly the child can draw lines and shapes, improving the overall appearance of letters and shapes all together; paired with coloring this helps the eyes determine where to stop by staying within the lines in shapes and forms. Tracking movement is one of the key factors in fine motor skills. There are also toys and games available that are geared for the improvement of fine motor skills.

Developing and improving fine motor skills can take a lot of time but with the proper guidance from a pediatric occupational therapist you can make all the difference in the way your child learns and perceives life in general. Children with fine motor skill problems can suffer greatly in school and even social situations. Therefore it is important to identify any fine motor control issues and begin an occupation therapy program to help them develop these skills as quickly as possible.

Fine Motor Control in Children

Psychology Pedagogy; Educational Psychology; G...

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Fine motor skills are important to a child’s development. Not having these skills can interfere with school and home activities. It is important to understand the difference between fine motor skills and gross motor skills. Fine motor skills are those skills that require smaller, more delicate movement; usually using the smaller motion with an emphasis on the coordination of those movements. Gross motor skills are those skills using the larger muscles in the body, those to run, jump and move about.

Concerns with a child’s fine motor skills can be treated by a therapist with a strong focus in the area of pediatric occupational therapy. A child with fine motor problems may become easily frustrated in school when having to copy things from the blackboard or in art class because he or she may have problems either writing neatly, staying within the lines when coloring or cutting out shapes.

A child’s motor planning and speed of movement can be greatly affected in cases of fine motor control development. Motor planning involves the visual detection of motion and errors in movements. For a child’s movement to be effective things must be timed adequately and fine motor skills require a certain amount of attention and concentration as well. What is more important is the order in which certain movement is made to accomplish a task. Managing complex activity using the smaller muscle groups may be compromised when dealing with fine motor skill problems. School age children face more fine motor skill problems than most other age groups, making pediatric occupational therapy a very important step in the treatment of this problem.

Children with fine motor skill problems may present other behaviors as well. At times a child may have underlying issues that could be associated with fine motor skill problems. They may actually present problems with articulation of words and sounds due to the fact that fine motor control has to do with tongue movement as well; being the tongue is a smaller muscle. Fine motor control struggles can be due to sensory problems in the brain; the child may have an aversion to being touched and being introduced to new things. In these cases the child’s ability to behave and control their fine motor skills may be hampered by the over stimulation of the senses, causing frustration and clumsiness.

Children experiencing fine motor skill problems may present the following issues:
– Clumsy pencil grasp (pincer grasp activities)
– Poor scissor skills
– Not able to grasp and release things in a controlled manner
– Cannot hold small objects or use tools such as pencils and scissors
– Dislikes completing mazes and dot to dots due to being easily frustrated with them
– Has problems copying from the blackboard in class

Autism Survival Manual – Fine motor skills tips and tricks

Swing Invention for Autism

Check out this video on a new swing invention for autism that a grandfather invented. Looks great for a sensory clinic or playground. You can view more info at the website for the Swring at

Source: ABC News

The Dynamic Tripod Grasp

Pencil skills, and particularly handwriting, is a more complex skill than we often realize. A child’s ability to color within the lines, trace over a shape and draw simple pictures forms the building blocks for writing letters and words. Mastery of these skills enables children to focus on the content of their writing rather than the mechanics of pencil control, pencil grasp, speed and movement. However, given society’s emphasis on, and haste to commence, ‘academics’ earlier now than ever before, we sometimes overlook the vital role these seemingly basic skills play in developing writing skills. Yet we expect children to demonstrate their knowledge on paper in order to assess their academic abilities.

The video on the right was taken at a workshop that provides parents and professionals with an awareness of when a child is struggling to master pencil skills (even as early as Kindergarten), as well as some easy strategies to overcome these difficulties.

Handwriting is influenced by the development of appropriate sensorimotor, perceptual and cognitive skills. One of the most common problems occupational therapists in the school are consulted about is improper pencil grasp. While the most efficient way to hold a pencil is the dynamic tripod grasp (figure 1) many other patterns are commonly seen in children and it does not always require intervention or modification. In the dynamic tripod grasp, the pencil is held between the thumb and index finger, with the pencil resting on the middle finger.

There are variety of reasons why children hold their pencils in patterns other than the dynamic tripod. One common reason is participating in a lot of writing before their hands are developmentally ready for this activity. This is becoming more and more common as parents try to start preparing children to school with writing activities at an earlier stage.

Grasp left hand
Grasp left hand

(figure 1 – dynamic tripod grasp for right and left handed)

It is important to try to modify the pencil grasp as early as possible, since many students seem to have developed bad habits even before entering kindergarten. Adaptive pencil grips may be helpful in teaching students to modify their grasp and are used to facilitate an optimal pencil grasp (figure 2). There are many different types of grips available. For a pencil grip to be effective, the student needs to be involved in choosing the grip and to understand the importance of using it.
The most optimal position for writing includes the ankle, knee and hip at right (90 degrees) angles with the forearms resting on the desk. The top of the desk should be approximately 2 inches above the elbows when the arms are at the student’s side.

Pencil Grasp Patterns

Functional Grasp Patterns
Tripod grasp with open web space: The pencil is held with the tip of the thumb and index finger and rests against the side of the third finger. The thumb and index finger form a circle.
Quadripod grasp with open web space: The pencil is held with the tip of the thumb, index finger, and third finger and rests against the side of the fourth finger. The thumb and index finger form a circle.
Adaptive tripod or D’Nealian grasp: The pencil is held between the index and third fingers with the tips of the thumb and index finger on the pencil. The pencil rests against the side of the third finger near its end.
Immature Grasp Patterns
Fisted grasp: The pencil is held in a fisted hand with the point of the pencil on the fifth finger side on the hand. This is typical of very young children.
Pronated grasp: The pencil is held diagonally within the hand with the tips of the thumb and index finger on the pencil. This is typical of children ages 2 to 3.

Adaptive Pencil Grips

(figure 2 – adaptive pencil grips)

Inefficient Grasp Patterns
Five finger grasp: The pencil is held with the tips of all five fingers. The movement when writing is primarily on the fifth finger side of the hand.
Thumb tuck grasp: The pencil is held in a tripod or Quadripod grasp but with the thumb tucked under the index finger.
Thumb wrap grasp: The pencil is held in a tripod or Quadripod grasp but with the thumb wrapped over the index finger.
Tripod grasp with closed web space: The pencil is held with the tip of the thumb and index finger and rests against the side of the third finger. The thumb is rotated toward the pencil, closing the web space.
Finger wrap or inter digital brace grasp: The index and third fingers wrap around the pencil. The thumb web space is completely closed.
Flexed wrist or hooked wrist: The pencil can be held in a variety of grasps with the wrist flexed or bent. This is more typically seen with left-hand writers but is also present in some right-hand writers.

Activities to Improve Pre-Writing Skills
– Playing jump rope
– Volleyball-type activities where hands, paddles, or rackets are in palm-up position
Activities using a Squirt bottles
– Slinky-shift back and forth with palm up
– Bead stringing/lacing with tip of finger against thumb
– Pouring from small pitcher to specific level in clear glass. Increase size of pitcher as strength increases.
– Ich a pencil or chopstick positioned in tripod grasp toward and away from palm. The shaft should rest in open web space.
– Practice screw and unscrew lids
Pop bubble wrap
– Play dough/silly putty activities
– Use a turkey baster or nasal aspirator to blow cork or ping pong balls back and forth. These can also be used to squirt water to move floating object/toys.
– Tier pieces of construction paper into small pieces and paste the different colors of paper on simple picture from a coloring book, or make your own design.
– Floor activities – large mural painting, floor puzzles, coloring when lying on stomach on floor.
– Dot-dots, color by number, mazes. (example activity)
– Wheelbarrow walking-child’s hands are the large ones from Bed Bugs game or kitchen tongs.
– Finger plays/string games such as Cat’s Cradle.
– Use tongs/tweezers to pick up blocks/small objects. (activities using tongs or tweezers)
– Pennies into piggy back or slot cut in plastic lid. Coins can also be put into slots cut in foam.
– Working on vertical surface, especially above eye level. Activities can be mounted on a clip board or tapes to surface or chalkboard/easel. Examples: pegboards, Lite Brite, Etch-a-sketch( upside down), Magna doodle, outlining, coloring, painting, writing.
– Clothespins/pinching. Put letters on clothespins and spell words by clipping on edge of shoe box. Use a clothespin to do finger “push-ups” by using the pads of the thumb and index finger to open a clothespin and count repetitions.
– Squirrel objects into palm (pick up with index finger and thumb, move into palm without using the other hand)
– Squeeze sponges to wash off table, clean windows, shower, etc.
– Additional activity ideas are available at

Award-Winning Occupational Therapy Website Provides Easy Access to Activity Plans for Children

OTPlan logo imageIrvine, CA, September 07, 2010 –(– The Internet now offers a new solution for parents and caregivers who want to help children develop motor skill acuity. The newly designed is an innovative search engine that provides occupational therapists, parents and educators with simple and creative occupational therapy activities designed to help children master daily tasks. The site allows users to match the skills they want to practice with ordinary household materials to develop a detailed treatment plan. received a 2008 Maddak Innovative Product Award from Maddak, Inc., a New Jersey-based manufacturer of home healthcare and rehabilitation products. The award was announced on April 11, 2008 in Long Beach, Calif., at the American Occupational Therapy Association’s (AOTA) annual conference.

“ is unique because it allows the user to decide how to design a treatment plan,” said OTPlan creator Avital Shuster, MA, OTR/L. “Parents typically do not follow through with complicated home treatment programs that require them to purchase additional material. By offering a wide range of simple activities using common materials like cotton balls, kitchen tongs and clothes pins, lets users search for specific activities that strengthen particular skills, increasing the likelihood that the program will be completed.”

A licensed and registered occupational therapist with the Irvine Unified School District, Shuster created the site while she was designing home therapy programs for children as part of her graduate work at the University of Southern California.

The website also serves as an interactive portal that encourages collaboration between therapists, educators and parents. Users can rank activities according to usefulness and share their thoughts on, and experiences with, particular activities and plans. Each activity posted on the website is reviewed by registered and licensed occupational therapists.

For more information, visit

Best Way – Various Occupational Therapy Treatment Techniques for Cerebral Palsy

Occupational therapy (OT) is a treatment method for cerebral palsy (CP), a neurological disorder which hinders body movement and muscle coordination. The goal of occupational therapy is to allow people to live more fulfilling lives by being as independent as possible. Therapists work to increase a patient’s independence by employing various treatment techniques. Occupational therapy is available through a doctor’s prescription and is readily offered at places such as schools, hospitals and rehabilitation centers.

Read more: Best Way – Various Occupational Therapy Treatment Techniques for Cerebral Palsy |

ADHD: Who makes the diagnosis?

As a toddler, Ian Barrier got expelled from day care.

“They just said that he was all over the place, he couldn’t handle the structure, they didn’t have the staff or the skills to deal with it,” said his mother, Amy Barr. “They said, ‘We think he has ADD or ADHD’ and I’m like, ‘What is that?”

Ian, now 11, and his 9-year-old brother Aidan are just two examples of some 5 million children in the United States who have received the diagnosis of attention deficit hyperactivity disorder (ADHD), a condition marked by impulsive behavior and a lack of focus.

But although this is a medical condition with medical treatments available, often doctors aren’t the ones suggesting a diagnosis.

Many parents begin their struggles with treating their children’s ADHD the way that Barr did: with a suggested diagnosis from a school or day care setting. That’s a problem, doctors say, when there could be many other factors contributing to a child’s behavior.

For a teacher to suggest that a child has ADHD is “inappropriate and dangerous,” says Dr. Elizabeth Roberts, child psychiatrist in Murrieta, California. Depression, anxiety and abuse are all possibilities in a child’s life that could lead to attention problems, Roberts said. That means that many children are receiving medication for the wrong problem.

Roberts wants to say to all educators: “There are many, many diagnoses that cause these problems, including abuse and depression and anxiety. So please, withhold your judgment.”

But Barr is happy that her son’s day care center mentioned the condition to her. It explained Ian’s behaviors that she had been excusing with the adage “boys will be boys.” The center also directed her to a facility where he could get tested.

“I’m just glad that they brought it up, because I was living in it and didn’t know any better,” she said.

In Barr’s case, having gotten her kids tested for ADHD even before school, the educational system has been supportive. But the question of medication has plagued her, with years of trying different combinations of drugs — sometimes four or five at a time.

Despite medication, Ian pulled the fire alarm at his fourth day care center, dispatching the same fire department that would get him out of a tree at age 9, Barr said. And both brothers have spent time in a psychiatric ward at a children’s hospital; for the younger one, it may have been because of overmedication, Barr said.

“You go through all of that, and it’s just various different medications, and then you start to feel guilty: I’m drugging my kid,” said Barr, of Fleming Island, Florida. Her boys are now both on just one medication — Vyvanse (lisdexamfetamine) — for focusing in school.

All too often, parents come to pediatrician Dr. Claudia Gold’s office asking for a prescription for ADHD, based on a recommendation from school. When she consults with parents alone, however, she’s likely to hear stories of trauma: a death in the family, an abusive relationship, and other life experiences that the teacher knew nothing about.

“I think that sometimes folks want an immediate answer and they want to help a child as quickly as possible,” said Cheryl Rode, Director of Clinical Operations at the San Diego Center for Children in California. “Medication is quick and easy but it’s not the answer alone for working with kids who have ADHD.”

Experts agree that ADHD does exist as a real disorder, and that some children really do benefit from medication. Studies have shown a biological basis to the disorder and a genetic component, suggesting it can be passed down in families.

But it’s not the teacher’s place to make diagnoses, or to recommend medication, Gold said.

Teachers and related school personnel have an important role in identifying learning and social challenges faced by students, including those with ADHD, says Clarke Ross, CEO of CHADD (Children and Adults with Attention Deficit / Hyperactivity Disorder). But teachers should never give a diagnosis for the purpose of medication use, or advise the use of medications, he said.

Alana Morales, of Thornton, Colorado, is one of those teachers who has brought up the subject of ADHD testing with many parents. She doesn’t tell parents to medicate their kids, but brings up the subject of getting children tested because she thinks it’s important for parents to know.

“You have to be so careful because, again, we are not doctors,” she said. “But does that mean we don’t recognize it? No.”

Not every child with ADHD needs medication, doctors say, and Morales said some students benefit more from counseling, special adjustments in school, a tutor, or a different environment for doing homework. It’s helpful for parents to get informed about the condition and become advocates for their children — but some may make the situation worse by having a closed mind to interventions and denying that there’s anything wrong, she said.

“You’re really setting them up for failure, because it’s not a crime, it doesn’t mean you’re less of a parent if your child learns differently,” she said.

Rode agrees with Roberts that teachers should not recommend medication, but thinks that teachers have an excellent frame of reference for what is typical or normal development.

Also the parent of two children with ADHD, Morales has specific strategies she uses when there are kids with ADHD in her class: don’t seat them together, put them on the edges of the classroom so she can see them better, and sometimes modify assignments.

Providing an environment conducive to helping kids with conditions such as this is getting harder as budget-tightening schools cut back on teachers, Morales said.

Last year, teaching at a public school in Arizona, Morales had one classroom with 37 students, which included at least four kids with ADHD and one with Asperger’s syndrome. And teachers whose job it is to provide extra help to those kids get responsibility for more students, leaving them with less time for each one.

Roberts estimates that only about 10 to 20 percent of children who receive the diagnosis of ADHD actually need medication.

While parents like Barr have tried to inform themselves as much as possible about ADHD and treatment options, some doctors say the condition gets misapplied because it is a quick and easy catch-all diagnosis for a variety of behavior problems, with drugs available to treat it.

Parents are also culprits, and bear some responsibility for their children’s behavior, Roberts said. She thinks a lot of kids just need better structure and discipline in the home.

“Parents want to leap-frog over the parenting job and get right to the grandparenting,” she said. “Everyone wants to have fun with their kids and everyone wants to be popular with their kids like Grandma is. But the reality is: Someone has to be the bad guy or the kid never learns.”

Morales recommends that parents stay involved in their child’s school lives by helping them with homework, assisting with organizing their papers, and writing notes to teachers so that everyone is on the same page.

On behalf of her own two children with ADHD, Morales is writing letters now to their teachers explaining how her kids learn differently and what accommodations have been made in the past (they are both on medication). She is also asking the teachers to let her know about any problems this school year.

Looking back, Barr wishes that when her children first got the ADHD diagnosis and then started school, she could have had a teleconference with the school and the psychiatrist at the same time. Instead, she had to relay what the teachers said about her children’s behavior to the psychiatrist, and then the psychiatrist’s treatment decisions back to the school.