Wednesday, March 22, 2017

Introduction to - From Flapping to Function: A Parent's Guide to Autism and Hand Skills


When I hear the word autism the image that pops into my mind is 4-year-old Gary. He is lining up cars, end to end, while children around him make their cars roll, beep, and drive over paper roads. Gary doesn’t seem to notice what they are doing, even as he crawls over another child’s leg to reach the bucket of toys.
Gary glances at a toy just long enough to reach for it before looking away. He sits with his knees bent and feet outside his hips, in a position called W- sitting because his legs form a “W” shape (see photograph 1). While picking up cars with his left hand Gary shifts his weight to his right side. His wrist is loose and floppy. He grasps the cars with his fingertips, as though they were slimy fish he was keeping from touching his palms. When another child jostles the perfectly aligned cars, Gary grunts and, without missing a beat, adjusts them. Then he stands up and flaps his hands while walking around in circles.
 



(photograph 1 Boy playing in W-sitting position)

You may have imagined a similar child—a child who does not play with toys the way most children do (or spends more time flapping hands than using them to play). A multidisciplinary team observing Gary would all contribute important findings. An occupational therapist (OT) would note that although his eye-hand coordination seems fairly normal, Gary does not look directly at objects, he avoids using his palms when grasping and seems unaware when his body moves into a space occupied by another child, signs of a sensory processing disorder (SPD). A physical therapist (PT) would note hypotonia (low muscle tone) and poor postural control, meaning his muscles seem weak and floppy and he leans on his hands to help hold himself up. A speech-language pathologist (SLP) would note his lack of social awareness—he doesn’t even protest when another child bumps his cars. He doesn’t use toys functionally or vocalize while playing, the way the other children are making their pretend cars drive and crash while saying “beep, beep.” Gary’s lack of eye contact with other children and the way he repetitively lines up his cars would draw a child psychologist’s attention. Gary’s preschool teacher would be concerned that he cannot name the colors of the cars or engage in pretend play, such as forming an imaginary steering wheel with his hands and pretending to drive.

As the team discusses their observations, the picture of Gary that emerges is typical of children on the autism spectrum. The way he grasps, manipulates, and uses the cars while ignoring his peers demonstrates difficulties with

·        Postural control: his body and hands seem to be floppy and weak.

·        Visual skills: he avoids looking directly at the objects in his hands.

·        Play skills: he lines up the cars rather than using them in pretend play.

·        Communication and social skills: he does not imitate other children or share the play experience with them.

·        Sensory processing: he has difficulty interpreting and responding to touch and other stimuli.

Challenges in all of these developmental areas contribute to Gary’s difficulty using his hands, which is my particular interest as an occupational therapist. This book explains how atypical development affects the way children with an autism spectrum disorder (ASD) use their hands. It also offers intervention strategies aimed at helping children to experience success and be as independent as possible in performing everyday tasks such as dressing, cutting paper, or writing their names.  In chapter I you will be introduced to how children use their vision, think, process sensory information and behave influence hand skill development and learning in general. 

The technical term for hand skills is fine-motor skills, because grasping and manipulating objects uses the small, or “fine,” muscles of the hands in delicate movements. Traditional examples of fine motor skills would be stringing small beads or stacking blocks. Effective hand use, however, requires much more than good motor control. In this book I take a comprehensive look at how children diagnosed with ASD typically use their hands, what challenges they face, and what strategies will help them reach their potential. I stress “reach their potential,” because there is currently no cure for autism or its associated challenges. There are, however, many effective and fun strategies that parents can implement.  

Who This Book Is For

I wrote this book first and foremost for parents. When I worked in early intervention and Head Start programs I saw how family education enabled caregivers to carry over OT strategies throughout the young child’s day and night, seven days a week, whether at home, in the community, or on vacation. Many of these strategies are easily integrated into everyday routines and continue to be useful as the young child grows to adulthood.
As an example, four-year-old Abdul preferred to line up objects rather than drop them into a container with a small opening. Inserting objects is an early skill that develops the eye-hand coordination to use shape sorters and push coins into a piggy bank. Abdul was motivated to insert magnets into the can shown in photograph 2 when an electric toothbrush was placed inside.
Caution: Use larger objects if there is a choking risk. Magnets are dangerous if swallowed.

photo 2 Vibrating container adaptation

The toothbrush created vibration and motor sounds that interested Abdul and made him want to hold the container. He had to use both hands together-an important skill that will be discussed later, in order to separate the magnets. Pulling magnets apart is an enticing activity by itself, but inserting them into a vibrating container is irresistible. This is one of my oh-so-simple, yet oh-so-effective strategies to help children to build hand skills. 
This activity is also suitable for older children or adults who are developmentally ready to learn insertion skills. Many of the strategies described in this book can help individuals with cognitive and/or motor delays to develop hand skills typically mastered at a younger age. However, it is important that the materials be age appropriate and the person have the prerequisite skills to learn them. For example, six-year-old Bonnie refused to touch gooey substances such as paint or glue and she had difficulty learning how to form letters. Her mother filled a sturdy zip locked bag with paint, and Bonnie imitated her mother using her index finger to  form lines and shapes by pressing. Bonnie had the prerequisite skills to use her index finger as a writing tool, visually attend and imitate the movements. Bonnie liked this activity because she didn’t have to struggle with controlling a pencil, it was fun to feel the paint move through the plastic and she felt like an artist. 
This adaptation is just one of many strategies provided that may be beneficial to children with or without an autism diagnosis. Many strategies may also help very young children who do  not yet have a diagnosis but perhaps the parents sense that they should be concerned.   Although children with ASD are typically not diagnosed until toddlerhood or older, some parents may notice developmental differences in their babies. Therefore, I include red flags and strategies relevant to babies. These may be especially important if the baby has older siblings diagnosed with ASD. If the descriptions in this book “resonate” with your child, speak to your pediatrician or local child development center to get further information specific to your child’s needs. 
Much of the current literature on autism focuses on the social, communication and behavioral aspects of the disorder. I have written From Flapping to Function: A Parent’s Guide to Autism and Hand Skills for the early childhood professionals, educators, counselors, therapists, and other professionals working in school, residential, community, or institutional settings who seek a comprehensive, one-stop resource that focuses on how developmental challenges impact building hand skills and the strategies that will enable children to reach their potential.

Tuesday, March 14, 2017

Developing Hand Skills Using Slap Bracelets


 
Its always exciting to find an inexpensive product that can be used when creating or adapting new activities. My clients love to try new activities and get bored doing the same old thing day after day. It is a challenges to come up with new ideas to help people who have limited fine motor skills, but the slapper bracelets have been versatile, easy to grade and a lot of fun.

They offer sensory feedback when simply bending them .  Add them to your sensory bin of manipulatives for children or adults who need to fidget and/or relax. 


The bracelets come in a variety of sizes, colors, strengths and materials. I recently bought a package of 72 for about 10.00 and use them in repetitive tasks such as the following....

1. I present them on a tray curled up so that the person has to straighten them out and insert into the slot opening. This takes quite a bit of motor planning and is quite challenging for some individuals.

2. I tied strips of fabric all over the bucket because the lid was not staying on and I didn't want my clients to dump out the contents.  Then I attached the bracelets all over the fabric so that they need to pull them off and insert. The orange lid stays on the bucket permanently. I cut a circle in the lid's center and pushed the top of a screw cap container  through it and taped in place from the bottom. I can screw a cover back onto that white screw piece you see on top to keep the contents inside. Its large enough for me to reach inside and remove the contents.

This bucket was originally used by a client who enjoys inserting the small objects on the yellow tray and he does not have the motor skills to remove the bracelets. So in this way different clients can use the same bucket in different ways according to their skills. Another individual has the skills to attach the bracelets, also a pretty high level fine motor skill.

3) You will see in the video clients removing the bracelets from a tall ring stack. I attached a pin wheel to the very top and asked them to blow after inserting the bracelet. This seemed to be calming as well as funny to them and others watching them. They certainly did really nice reaching and neck extension in the process.


4) Some individuals enjoyed attaching the bracelets to the top of the curvy ring stack. The bracelets  functioned as rings but putting them on and off involved a higher level of motor planning and they enjoyed the sensations of bending them in the process. I think that manipulating the bracelets provided the proprioceptive stimulation to the joints and muscles in the fingers helping with coordination and body awareness. 

5) The man in the blue shirt is blind and nonverbal but very good at motor planning. He also seeks sensory stimulation by ripping his clothes. We have not found a solution to the ripping behavior  (believe me, we have tried a lot of strategies) , but I like creating new sensory based activities such as the one below. I taped a cat toy to the top of a container lid. You can see the yellow lid in the photo below. The cat toy has a spring with a toy mouse on top that makes sounds when moved.  The client is able to attach the bracelets to the spring part and also has the skills to remove them, straighten them out and insert into slot openings on the sides of the container. The bracelets are retrieved by unscrewing the cap with cat toy taped onto it.
You will also see in the video a stringing activity made by attaching a heavy duty slap bracelet to the end of cord. The individual in the video has poor motor planning skills but is able to string or remove the large rings. Notice how I tied the bottom of the cord to his chair  to make the materials easier to control.








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Tuesday, February 28, 2017

Creating a Partner Activity

Someone had put a broken toddler  toy on my desk at work. The child is supposed to put a ball in the top, it rolls down a short distance and activates music as it lands. I assumed it was broken and came up with the following way to turn a one person task into a partner activity.

Several of my clients enjoy using force to push golf balls into the small container opening. I spread the pile of golf balls on a tray on top of a towel to cut down on noise. The young man on the left in the video is blind and loves deep pressure and resistive materials. He quickly learned how to place the golf balls into the top of the toy so that it rolls down, making a bit of clatter.

The other individual enjoyed watching this process as he took the delivered ball and pushed it into the container opening. When finished they reversed roles so that the blind client on the left had a turn retrieving the balls and pushing them into the container. It was a lot of fun watching them work together but, I do wish the music worked!!!

video
 
 
 
I can't find this exact toy on amazon but these look similar....
 
 
  

Thursday, February 9, 2017

20 Simple Ways to Resist!!!



 HOW TO RESIST WITH PULLING, PUSHING AND SQUEEZING

Many children and adults with autism and other developmental disabilities  have poor body awareness and decreased motivation to engage in hand activities. They may not stabilize materials with the non-dominant hand and have decreased strength and/or muscle tone. 

They don't quite know how to move their bodies effectively. They may walk on their toes with the head leading and look like they are about to topple over. Some people move fast when given the opportunity because it takes more motor control to move slowly and deliberately. In addition, moving fast gives them the sensory stimulation they crave (i.e. vestibular stimulation).

Children may tire quickly, slide down their seats and their palms may look  flat because they don't spend a lot of time using their muscles to squeeze, pull  or push objects. These individuals often love weighted blankets, vests, collars and objects because muscles and joints are getting heavy pressure sensory stimulation (proprioception).

Resistive hand activities also provide proprioceptive sensory stimulation.  "Resistance" means that the activities require FORCE to perform them. Many children find resistive activities and materials calming, as well as strengthening and they become more motivated to use their hands.
1) Popping bubble wrap strengthens the fingers as children PUSH or SQUEEZE IT. Provide lots of squirt bottles to squeeze during bath time, too.

2) Velcro- lots of toys are made with parts attached with Velcro that are ripped off and then re-attached. Many children love that sound.

The photo shows some Velcro backed shapes  that are ripped off the ball  and then attached to a Velcro board on book stand.
You can also use Velcro to  attach toys to a detergent bottle so that children can rip them off before inserting. This is developmentally perfect for the typically developing  18 month old toddler and older children and adults with delays often love it, too. (Be sure to use larger toys and closely supervise to avoid ingesting objects) I also like to attach toys from the commercial shape sorter with Velcro so that they need to rip before inserting shapes.

Placing and ripping off the red and yellow strips that form railroad tracks teaches children how vertical lines can fit between horizontal lines.

This helps prepare children for handwriting!!





3) Writing- using crayons or chalk requires much more force than markers. (that is GOOD) .

Working on a vertical surface also strengthens shoulders and puts the wrist in the best anatomical  position to grasp a writing tool. Coloring on top of sand paper or fabric also requires using a lot of force.


Many children love to press into a gel pad to form shapes. Drawing in thick pudding or wet corn meal is more resistive than finger paint, although they are all great sensory activities.







 4) Toys that involve pushing strengthen fingers. I like the foam puzzles and mushroom shaped pegs that are pushed into foam boards.











5) Children can push Lotto cards or pieces of plastic into slot openings in bottles. You can also use folded cardboard cut out of boxes or plastic from containers. Folding them first strengthens fingers and teaches the motions used to fold paper.







6)Everybody enjoys pushing a whoopee cushion!






7) Squeezing the Hungry Harry tennis ball to open his mouth is very resistive. This person is feeding him pennies. Mix the "food" items inside putty so that they have to remove it before feeding Harry. VERY RESISTIVE AND VERY FUN!
(Make Hungry Harry by drawing a face on the tennis ball and cutting the slit for the mouth.)


8) Opening up  slap bracelets to wrap around a tube or inserting them into a container slot provides a special and weird sensation to fingers as they push and pull them.



9) I cut these apples and worms out of detergent and juice bottles. It take a lot of resistive pushing and pulling to insert or remove them!



10) Ordinary ring stacks become resistive when the rings or donut shapes must be pushed downward with force. The one shown on the left happens to be made by  inserting a vibrating pen into a swimming noodle wedged inside a bottle.


11) One young lady I work with  avoids using her left hand but she will do so in order to pull the lids off of the fabric while grasping the red handle







12) Opening knots in thick cord or pulling cord out of the horseshoe lacing board is very resistive



13) There are lots of sensory toys sold that feel great to pull. The photo shows me pulling some stretchy fabric that I tied onto bottle handles.



14)  I tell my clients to smack the golf balls into the bucket opening. They really enjoy it and it helps them to be calmer.

15) Stretching elastics or rubber bands over objects is resistive. The photo shows bands stretched over a ball with fun texture, but of course use any object that your child enjoys.   Elastics can be stretched over lots of things including the backs of chairs and your 2 feet....


16) Here is an example of a toy horse that has limbs to pull. When you pull one through the holes, another is shortened.....






17) Cutting: Using thick paper provides more resistance and makes it easier to control. Ripping paper or fabric is also very resistive. I recommend doing this during an arts and crafts group.

 Some of my clients love to  rip paper or crush it into balls and then push it into bottle openings.






 18) There's lots of fun balls that can be purchased. These can be pushed into container openings or try filling socks with sand, marbles, foam or other items.


















 19) The lady in the pink shirt is stringing large rings. but  first she has to push them over the squeeze ball  (filled with putty)that I attached to the end of the string.

Sometimes, I attach a vibrating toothbrush to the end of the cord. If you use very thick cord or just tie a bunch of knots in it, the person will need to use a lot of force to make the rings go down.







 







 20) I tied a heavy bag of sand to the bottom of this green watering hose. My client stands on it to keep it stable. Then he pulls the coil upward to make rings go down. 





Tuesday, February 7, 2017

Sensory Adaptations

The sleeves of my sweatshirt are filled with bags of sand. Many children enjoy feeling the weight of the sleeves slung over their shoulders. You can also put a cushion inside the body of the sweater so that the person sits on it and can drape the sleeves over her or his lap. The young man in the video has a lot of anxiety and is always moving. He is calmer having the cushion to bounce his back against with the weighted sleeves over his legs. I tied the back of the sweater to his chair.
 
 
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Many of my clients engage better when I adapt activities to provide sensory stimulation. I found this wooden circle at work. It was part of some type of game and had holes along the perimeter. I tied stretchy cord to the holes and the other end to plastic shapes that I cut out of detergent bottles.  I attached the end of an electric toothbrush to a hole in the center of the board and covered the board with some fur that I found in a clothing bin at work.

Some individuals who typically don't use their hands at all were able to lift the rings off the center peg. The vibration helped alert some of the more lethargic clients and for others  it helped them to focus and be calmer.

The higher functioning individuals were able to press the on/off button on the toothbrush. They thought that was cool....


 
 
 
 
 
 
 


Saturday, January 7, 2017

From Flapping to Function: Scissors Tips


There are many strategies described in my book FROM FLAPPING TO FUNCTION:  A PARENT'S GUIDE TO AUTISM AND HAND SKILLS that help children engage, focus and successful in performing fine-motor tasks such as cutting on a line.

Explore use of sensory strategies that your child enjoys and save them for special times when working on a relatively challenging skill such as cutting. Your child may develop a positive association with using scissors if he or she  likes to:
  • chew gum, each crunchy foods or suck from a water bottle
  • wear a weighted vest, lap bag, collar or wrist weights
  • listens to favorite music either in the room or using headphones
  • smells pleasant scents such as vanilla or peppermint provided by a spray, cotton balls soaked in extract, candles or aroma therapy diffuser.
  • sits on a dynamic surface such as ball chair or cushion
Explore use of a visual or auditory timer so that the child knows the session will be brief and when it will be over and then offer a reward or reinforcer. My favorite ones involve movement such as time on a swing, rocking chair, scooter board or bungee chair.

Positioning the child to sit on a chair facing backwards (as I am doing in the photo) enables the child to stabilize arms on the back of the chair. I am also getting some deep pressure sensory stimulation by wrapping my legs around the chair legs. Children with autism often have low muscle tone and this can help them maintain their posture while manipulating materials. 

Explore use of different types of scissors to see which works best. Preschool age children with little hands should learn using small scissors  such as the "learning Scissors" designed by occupational therapist Mary Benbow. Some children will find it easier to begin learning the squeeze release motions by using adapted loop scissors (see links below).

Sturdy paper such as index cards or a manila folder are easier to control than flimsy paper. Children should begin by learning to snip on thin strips of paper before learning how to cut across longer pieces and then on lines.

Cutting uphill as shown in the picture puts the child's wrist in the best anatomical position for controlling scissors with the thumb facing upward. simply tape the paper to the wall.

Some children find it difficult to move the helper hand grasping the paper while the worker hand is cutting. I have found it helpful if they can learn to follow verbal or point cues to move the thumb to cover named stickers. For example, the child in the photo below is told to cover the bird sticker and as she cuts she is told to move her helper hand to cover the elephant sticker. She will be able to best control the paper if she is grasping it close to where she is cutting. 

Occupational therapists love activities such as using tongs and scoopers because they help children learn the open and close motions used when using scissors.  Many more "pre-cutting" strategies are described in my book FROM RATTLES TO WRITING: A PARENT'S GUIDE TO HAND SKILLS.

These are just a few of the strategies that may help children with or without autism to develop hand skills, specifically cutting skills.

I include Amazon links to a few related products. Shopping through my associates account helps to support my blogging.

















Friday, December 23, 2016

Developing skills to Screw and Unscrew covers as part of Ring Stack Activity


My clients love using the curvy "snake" ring stack that is made from a bird mister. I came across one at a yard sale and have bought several on Amazon (see Affiliate link below) because it requires reaching, using both hands, an upright posture, promotes visual attention and is visually stimulating to watch as the rings twirl down. I use rings that have small openings and  therefore, require force to push on with individuals who have good motor control and seek deep pressure sensory stimulation.  I use very large rings such as the ones shown when the person has decreased eye hand coordination and it needs to be easy to use.

In this situation I turned the activity into a 2 step process so that they have to unscrew the covers and learn that only the open rings go on the stack and the yellow covers go into the bag.  This activity meets the needs of people with different skills. Some individuals are great at screwing them together tightly and some are better at unscrewing the covers. 

The covers and screwing pieces are made from the abundant thick- It containers I find at work ....

Notice that the ring stack is positioned  according to the person's needs (in the video) and you see it on the table, on a chair and on the person's lap.
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