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Tuesday, May 22, 2018

Activities for Individuals with Grasping Challenges

 Children and adults with grasping challenges can engage in meaningful activities, especially sensory stimulation activities. Examples are:
  •  placing their hands on top of textures to press or rub
  • Providing a basin or tray filled with sensory materials such as water, dried beans, marbles or whip cream or 
  •  activating a switch with a tap, press or roll

Of course, what the individual enjoys and can do depends on the person's cognitive level and interests. Switches such as the one shown here are popular, especially if the student loves, music or vibration.  Other people may be more interested in accessing a computer or Ipad. 

The young man shown in the picture enjoys pressing the switch attached to his chest. It activates a voice that says "good morning everybody".  

Its easier for people with limited grasping skills to have all of their objects easily accessible and enclosed. I tied bags of sand, socks and other fun to feel objects, along with a motorized toothbrush inside a cat bed so that my client can move them around without the contents falling out. The cat bed is plush and fun to feel and some clients like the added heavy pressure by  sewing a bag of sand to the bottom.

Other fun materials to press the hand on top of include: 

  •  a bag filled with gel, shaving cream or other gooey objects to press down on. 
  •  a latex glove filled with water
  • a whoopee cushion. The one shown in the photo is on top of a vibrating cushion.

Materials to swat may be suspended from the ceiling or a tall pole that can be moved around the room. I have used IV poles before..... 

Another option is to attach a swimming noodle over a spanking new toilet plunger handle and then tie some dangly objects to swat  or entwine the fingers inside of. The suction of the plunger will stick to many surfaces, but I suggest that you buy a decent plunger, not one from the dollar store. 

Now, lets take a look at the bowling video that requires nothing more than a push to make the ball roll down the "ramp". Bowling pins are optional..... 

Source: Bowling for Children Who are Unable to Grasp by
Source: Busy Bottles for Individuals with Developmental Disabilities by RecyclingOT

The cat toy consisting of a spring on a stand can be used for swatting.

Source: Spring Toy Ring Stacks for Sensory Stimulation by RecyclingOT

These bottles are fun to pull, slide, jiggle and push.....

Source: Busy Bottles for Individuals with Developmental Disabilities by RecyclingOT

Sunday, April 22, 2018

The Importance of Crossing Midline for Children with Sensory Processing Disorders

Adapted from: From Flapping to Function: A Parent's guide to Autism and Hand Skills

Typically developing children naturally cross midline during play and functional activities. This is not a skill that parents usually teach, which is why you've probably never heard the term before. Children with dyspraxia other types of Sensory Processing disorders (SPD) may avoid crossing midline.

MIDLINE: is an imaginary vertical line running from the top of the head to the toes, that divides the body into left and right sides. 
Seven-year-old Pedro reached for markers using whichever hand was closest to them, and then used that hand to color. He didn't attempt to stabilize the paper with his opposite hand. Observing this, the teacher, consulted with the school occupational therapist, Leila. Leila recommended that he practice forming large circles on a whiteboard. She offered him a marker positioned directly in front of him at, midline. He grasped it with his left hand, suggesting this hand might be dominant. Leila gently held his right arm at his side while he drew large circles on the board. Next, Leila placed her hand on top of his to guide his movements. With this help Pedro was able to trace over large diagonal crosses and horizontal figure-eights without switching hands.
Leila also recommended activities to help Pedro strengthen his hands, especially his fingers, so that he didn't switch the marker from hand to hand due to fatigue. His teacher tried the 1-2-3 PULL activity shown in the video below and realized that Pedro's left hand had better control than his right when pulling the rings. This observation reinforced the idea that he was left-hand  dominant. 

Source: Sensory Pull Bottle Helps Children with Autism or sensory Processing Disorders by RecyclingOT

Here are a few more activities that promote crossing midline: 
1) Find two containers of different colors (such as red and blue) and bean bags to match. Place the red beanbags on the child's left and the red container on the child's right and vice-versa for the blue. Instruct the child to insert the red bean bags into the red container with the right hand, and the blue beanbags into the blue container with the left hand. 

The girl in the photo has a basket on the other side of the horse so that she can sort the objects while working on crossing midline.

2) Ask the child to touch her right knee with her left hand. Repeat with various body parts. Reverse by showing her how to use the right hand to touch named body parts on the left side of her body.

Sometimes we can encourage crossing midline while children use both hands to move a larger object. The girl in the photo is grasping a vibrating cushion with body hands to touch it to her right leg. She is crossing midline with her left arm.
Suspend a ball so that the child can bat at it with a long tube. Initially have the child hold the tube with both hands. He will at times cross midline as the ball jumps around. 

Position your hand while giving high fives, so that the child crosses midline. I did this repeatedly when performing hippotherapy. 

This simple strategy can be used anywhere, anytime - whether sitting standing or moving.  

The person inserting checkers into the Connect Four Board must stabilize it with one hand because it he doesn't it will fall over. When he began working from his left t
o right, he did not cross midline, but eventually he did as he worked his way across the board.

Another awesome game that will surely promote crossing midline is Twister.

Its also very easy to position materials so that the person reaches across midline with the dominant hand. The person in the video enjoys repetitive picture matching in the form board.
Source: Form Board Picture Activity for Individuals with Developmental Disabilities by RecyclingOT

Finally, the last video demonstrates an activity that uses either Scrabble tiles or alphabet blocks. This works on many visual and fine motor skills as I alternate hands to place the letters alphabetically.

Source: Crossing Midline Alphabet Sequencing for Children with Sensory Processing Disorders by RecyclingOT

Sunday, April 15, 2018

Using Sensory Reinforcement to Build Motor Skills

A basic principle in shaping behaviors is that people want to repeat an action that leads to a desirable outcome. This is commonly referred to as a positive  consequence. For example, a child might finish putting away laundry because she is eager to jump on her trampoline afterward. In this situation, jumping  functions as a positive consequence. Since jumping provides wonderful sensory stimulation- it  functions as a sensory reinforcer.

A reinforcer is a reward or an event that increases the likelihood that a behavior will reoccur 

This principle is used during Applied Behavior Analysis (ABA) therapy.Research has shown ABA therapy to be effective in teaching useful behaviors such as washing hands and reducing maladaptive behaviors such as screaming. Commonly used reinforcers include food, videos or time with a favorite person.  We all enjoy or provide positive reinforcement at times such as when we give praise, a pat on the back or a pay bonus.

Sensory Reinforcement provides desired sensory stimulation

Occupational therapists often use sensory modalities to impact the nervous system with the goal of helping clients achieve an optimal state of alertness- neither lethargic nor hyperactive, but rather focused and ready to learn. Children or adults with Sensory Processing Disorders (SPD) seek to find this optimal state of alertness by engaging in behaviors that meet their sensory needs. They may
  • spin, flap, jump or rock-more than seems typical
  • crash into people, walls or objects
  • seek objects to push, pull or squeeze 
  • put nonedible objects such as toys or clothing in their mouths for oral stimulation 
I have found that use of sensory reinforcement, especially movement  can help children have their sensory needs met while at the same time motivate them to engage in functional activities such as opening a lunch box (food provides an instant reward!).  This is important when working with  children and adults with developmental disabilities including autism spectrum disorders.  

Movement is a powerful sensory reinforcer

My clients becomes very aware when movement begins, stops or changes in intensity. If children are enjoying the sensory stimulation of a swing and it suddenly stops, they will be eager to make it start again. This is a great time to teach how to point, sign or say " go” . If a child has been tuning you out, he may be motivated to look at you and follow your directions to indicate "go" because he wants the movement to resume ASAP.  As soon as the child attends and follows the directions he can be reinforced with movement.  I have incorporated this technique when working with children on horseback, as well as movement equipment such as 
·        swings

·        rocking chairs or gliders

·        therapy balls or scooters

·        trampolines

The desire to move is a powerful tool that can be used to promote hand skills. I have used it in the following scenarios:

·        ·  A girl with Retts syndrome sitting in a rocking chair needs to grasp the hoola hoop before the chair rocks. Rocking stops when she releases her grasp. The movement motivates her to engage in the functional hand skill of grasping

·        A child sits on a platform swing with a lacing board. After inserting the lace through each hole, the swing is briefly pushed. After the entire lacing board is completed he is rewarded with more intense praise and swinging input.

·        A child is prone over a scooter and able to move around to retrieve gears for her toy. After she finishes her mom holds her hands for some fast scooting movement across the room.  
Other types of sensory reinforcement include music, watching bubbles and  smelling scents.  However, activities that stimulate the vestibular(i.e. movement)  and proprioceptive (i.e. deep pressure) sensory system are especially effective.  

Proprioceptive sensory receptors are in muscles and joints. They are stimulated by using materials that are "resistive", weighted materials and/or vibrate.

Resistive Materials

Materials that require force to use are described as resistive. They often require squeezing, pulling or pushing, lifting or carrying heavy objects such as water bottles or bags of sand or activities such as shoveling sand or snow. Many of the activities that I adapt incorporate these principles and I share some video demonstrations below.  

The person in the photo finds it calming to push socks through a small lid opening. The socks are filled with sand, marbles or dried beans so that they feel good  and require a lot of squeezing and pushing to insert. When the activity is completed the child may be rewarded with a big pile of   cushions to throw around and crash into. 

Adapting Activities with vibration

Vibration provides proprioceptive sensory stimulation to muscles and joints. It is easy to incorporate vibration into insertion activities by placing the motor from an electric toothbrush or a motorized pen (with the point removed) into containers. I have used both commercial shape sorters and home-made single shape sorters (see photo) made by cutting an opening in the lid. Some of my clients have refused to engage in insertion type tasks until I adapted them to vibrate. The sound of the motor also helps them to focus on the activity. 

The client in this photo is blind. The pink cushion is vibrating. He receives sensory stimulation when pulling the shapes off the Velcro and pushing them into the small openings in the green container. When the task is completed he can enjoy the vibration by holding the cushion against his body. 

My favorite reinforcers involve movement and deep pressure because my clients LOVE it and unlike food there is no risk of choking, allergies or eating too much. It is always possible to bring movement into an activity or use it as a reward for completing a task. If you don't have movement equipment (such as swings) available you can always try using movement activities such as these as sensory reinforcers: 
  • alternate touching toes and sky
  • jumping, hopping, galloping and skipping
  • doing jumping jacks
  • rolling up inside a blanket or rolling down a hill
  • turning in circles
  • dancing

In my book From Flapping to Function: A Parent's Guide to Autism and Hand Skills  I describe the following  activities designed to promote focus and learning by using sensory based activities and reinforcers. 
1. Wendy lies prone on a large ball and gently bounces while reaching to match spelling words cards placed on the floor. When finished she enjoys lots of fast bouncing.
2. Wendy scoots across the room while sitting on a scooter board to retrieve clothespins she will use to hang up doll clothes
3. Wendy squeezes snap cubes together to spell words.

 After the activities are completed, additional sensory reinforcement may be offered such as  feeding the Hungry Harry Ball.

Hungry Harry is made by inserting a slit in a tennis ball. This child is feeding him pennies that he removes from the putty.

Choosing the reinforcement totally depends on trial and error and what your child likes. One thing is for sure- when you provide the sensory stimulation children seek and need they are motivated to engage and learn.


Source: Velcro Bottles for Individuals with Developmental Disabilities by RecyclingOT


Source: Sensory Frisbee Ring Stack by RecyclingOT

Source: Creating Push and Squeeze Activities for students with Sensory Processing Disorders by RecyclingOT


Source: How Vibration Helps Children with Autism or Sensory Processing Disorders by RecyclingOT

Source: Sensory-Motor Activities for Individuals with Autism by RecyclingOT

Tuesday, April 10, 2018

Insertions Ring Stack for Children or Adults with Disabilities

The "Insertions Ring Stack" is very versatile and develops many skills. Children or adults with developmental disabilities may find repetitive tasks soothing.

This activity involves either  pushing rings down the tubing or inserting small objects inside. Your child or client will need to think about which of these steps to perform. They will learn to develop flexibility as they switch back and forth...
This activity promotes:

·        eye-hand coordination

·        using hands together

·        visual and auditory stimulation

·        proprioceptive stimulation by pushing the objects down

·        following directions

·        sequencing skills

·        problem solving

I cut the rings and small objects out of plastic bottles, but you can use other types of rings or small objects in the same way. Be sure to supervise closely or avoid if your child or client puts small objects in his or her mouth.

This activity can be adapted by

·        using larger rings to make success easier

·        smaller rings that require force to push and thus, provide greater sensory feedback.

·        try placing a motorized toothbrush inside the container and see how your child or client reacts!

The client in this photo benefits from reaching since she typically sits with rounded shoulders. She avoids using her hands together but is about to realize that she cannot do this task with only one hand!

She is on the autism spectrum and loves to be busy, yet this task requires a bit of problem-solving. It meets her cognitive and sensory needs. 

Learn more about activity adaptations at

Source: Eye-Hand Coordination Insertions Ring Stack for Individuals with Autism by RecyclingOT

Saturday, April 7, 2018

April 2018 Book Sale: The Recycling Occupational Therapist

April Book Sale
with free shipping in continental United States...... 

The Recycling Occupational Therapist

 Now until the end of April sale!    

$25.00 with free shipping in continental United States !!!!! 

Happy Occupational Therapy Month!!!!!!
Happy Earth Day month !!!!
Learn strategies to help your child or clients be as independent as possible....

Source: Jig for Unscrewing a Bottle Cap by RecyclingOT

Learn strategies to help your child or clients meet their sensory needs......

Source: Sensory-Motor Activities for Individuals with Autism by RecyclingOT
Make toys or activities out of everyday recycled materials to use with your child or clients....

Source: Help children with autism build hand skills with slap bracelets by RecyclingOT

Friday, March 30, 2018

Types of Sensory Processing Disorders

The following information is excerpted and condensed from my book From Flapping to Function: A Parent's Guide to Autism and Hand Skills.

Types of Sensory Processing Disorders 

It has been my experience that most if not all children who have an autism spectrum disorder (ASD) also show one or more symptoms of  a Sensory Process Disorder (SPD). However, many children who have  SPD do not demonstrate the social  and communication challenges associated with autism.
Understanding SPD is complex because there are three primary diagnostic groups, and children may have more than one type. These three primary types are:
1) sensory modulation disorders (see 3 subtypes below)
2) sensory-based motor disorders and; (see 2 subtypes below)
3) sensory discrimination disorders 

In addition, there are the following subtypes, resulting in a total of six recognized sub-types of SPD. 

 1) Sensory Modulation Disorders 
  • Sensory over-responding: These children are extra-sensitive to sensations, often picky eaters, and easily over-stimulated by sensations. They are sometimes called hyper-reactive or avoiders.
  • Sensory under-responding: These children need a lot of stimulation to respond; for example, they can spin intensely without getting dizzy. They are sometimes called hypo-responsive, under-reactive, or seekers

  • Sensory craving: These children never seem to get enough stimulation, touching and chewing on everything. They may also be called seekers.
2) Sensory-Based Motor Disorders
  • Postural disorders: These children show poor body awareness and low muscle tone; for example, they might slip out of a chair or lean their head on an arm while writing.
  • Dyspraxia: These children have difficulty with motor control needed to perform tasks accurately (such as folding paper on a line).
3) Sensory Discrimination disorders: These children have difficulty interpreting sensations; for example, a child may keep stuffing more popcorn in her mouth, even though it is already full. 

 The Impact of Sensory Modulation Disorders on Individuals with Autism

Let’s look more closely at the first type of SPD called sensory modulation disorders and how it impacts individuals with autism. 
Many children with autism have challenges with sensory modulation. These children may be  described as having difficulty with self-regulation. Self-regulation is the ability to control one’s behavior, emotions, or thoughts and adapt to the demands of a situation. Children with a sensory modulation disorder may be impulsive, overly and easily stressed, difficult to soothe, or highly distractible. On the other extreme, they may seem lethargic, apathetic, or day-dreamy. Some children have behaviors associated with both seekers and avoiders! Most children with ASD have signs of sensory modulation disorders. Let’s take a closer look at the three subtypes of sensory modulation disorders.
  • Sensory over-responding, or super-sensitive: Four-year-old George is easily overwhelmed by sounds, smells, movements, and things he sees, to the point where he frequently “shuts down” and cries. He hates to touch food, bubble bath, or fur, and often strips naked at home. George’s favorite “toys” are rocks and blocks of wood, which he lines up in the basement. Repetitive body movements—such as rocking, flapping his arms, or flicking objects—seem to calm him. George will give familiar people a “high five”—but it had better be a firm one. His mom calls him “the Naked Curious Avoider.” 
  • Sensory under-responding: Ten-year-old Dorothy frequently daydreams and slumps in her chair at school. She finds it easier to do her homework while bouncing on a ball seat, listening to  music, and chewing gum. Even with all this sensory stimulation, Dorothy’s hand gets tired after writing a couple of sentences and she struggles to organize her sentences into a paragraph. 
  • Sensory craving: Twelve-year-old twins, James and Errol, are home-schooled. They both love to make funny sounds, stand on their heads, and have pillow fights. Their parents converted the basement into a small gym with a suspended swing, trampoline, and crash pad made out of pillows on a mattress. James and Errol follow a schedule that includes weight lifting, jogging, cooking—the spicier the better, according to the boys—making bread, and creating pottery between their academic lessons and weekly visits to volunteer at a farm. These boys never seem to get enough stimulation.
Researchers have documented that sensory modulation disorders interfere with developing functional skills. Some of these children may have difficulty developing hand skills because they just don’t sit still long enough to learn and then practice them. For other children it takes extra effort just to sit upright and still long enough to connect two pop-it beads or insert a straw into a juice box. Both sensory “seekers” and “avoiders” frequently have fine motor delays because they lack experience and practice in common childhood activities, such as building with construction toys or cutting out paper dolls. 
Researchers disagree on which of the three types of sensory modulation disorders are most associated with autism. In fact, many children appear to fluctuate between hypersensitivity and hyposensitivity. 
Occupational therapists often use sensory-based strategies with children on the autism spectrum with the goal of  promoting engagement and self-regulation and decreasing what is called sensory defensiveness.  Sensory defensiveness describes strong sensitivities to touch, movement, or other sensations. Children who have sensory defensiveness are often described as “avoiders” because they try to escape from sensations that seem neutral or pleasant to most people, such as a kiss on the cheek. To them, the sensation seems unpleasant, perhaps even painful!

Strategies for Sensory Modulation Disorders
Occupational therapists often create sensory diets that may explore:

1)      Seating and positioning options 

2)      Use of weighted, vests, collars, lap bags or wrist weights

3)      Use of fidget tools

4)      Activities that provide deep pressure and movement sensory stimulation

Source: How Vibration Helps Children with Autism or Sensory Processing Disorders by RecyclingOT

The Impact of Sensory-Based Motor Disorders
Many children with autism have  one or both of the following type of SPD called a sensory-based motor disorder. 
1) Postural disorder
2) Dyspraxia 
These children often have low muscle tone so that it takes a lot of work to control their posture and movement. They  may  have decreased body awareness and appear clumsy. A child with poor body awareness might sit on top of, instead of next to, another child, have difficulty fitting his arm into a sleeve, or use so much force on a spoon that he splatters food on his clothing when scooping. Children with dyspraxia often do not stabilize (hold steady) materials when working (such as steadying the paper while writing). They may have delays in developing a hand preference or not develop one at all.  Also, they often avoid reaching from one side of the body to the other. 

 Strategies for Sensory-Based Motor Disorders 
Toy manufacturers know that children love multisensory games and products that engage all their senses. That is why some ring stackers and puzzles play music, baby toys may vibrate, markers may be scented, and some balls make giggly sounds when thrown. Multisensory like these appeal to more than one sense, and may help children better understand where objects are in relation to their bodies and how objects such as shapes relate to other objects such as shape sorters.  Many children find that multisensory and resistive activities help them to tolerate touch better so that they can engage in hand activities. Children with dyspraxia may also benefit from using

1)      Resistive activities that involve squeezing, pushing or pulling. This provides deep pressure sensory stimulation. Examples are- pushing Lego bricks together,  using a hole puncher or stapler, coloring over sandpaper squeezing a Hungry Harry ball.    

2)      Activities adapted to vibrate

3)      Activities with extra large, easy to manipulate parts such as stringing rings instead of beads.

4)      Simplified materials such as a shape sorter with only one or two shapes

5)       Repetitive activities that promote practice

      6)       “success only” activities

Source: Sensory-Motor Activities for Individuals with Autism by RecyclingOT

Sensory Discrimination Disorder
Sensory discrimination is the last of the SPD subtypes I describe in my book. It refers to abilities to differentiate various sensory stimuli such as temperatures, textures, and colors. 
Sensory discrimination disorders

·         Visual: Sense of sight

·         Auditory: Sense of hearing

·         Gustatory: Sense of taste

·         Olfactory: Sense of smell

·         Tactile: Sense of touch

·         Proprioception: Sense of position in space

·         Vestibular: Sense of balance

·         Interoception: sense of internal regulation

Children with sensory discrimination disorders often overreact to sensations they see, hear, taste, or feel. You have learned that this is called sensory defensiveness. Sensory defensiveness can impact any of the senses. However, it is the tactile sense that is most important for learning to grasp and manipulate objects. Children with tactile defensiveness (an overreaction to touch sensations) who have avoided early touch experiences, such as grasping a rattle, may be slow to learn about how objects differ in texture, size, weight, shape, or other attributes. These children may manipulate objects in an awkward and inefficient manner. 
Many of the same strategies that help children with sensory modulation challenges and/or sensory-based motor disorders also help children who are sensitive to touch and movement. These strategies include tummy positioning early in infancy, deep pressure and resistive activities, alternative seating, positioning, alternatives to messy play, and use of multisensory activities.