Tag

fine motor skills

What’s the Big Deal about a Pencil Grip?

By | NESCA Notes 2021

By: Jessica Hanna MS, OTR/L
Occupational Therapist, NESCA

With kids back in school, drawings, coloring pages, and written work will make their way from the classroom to backpacks and eventually to the fridge for everyone to admire.

From infancy to adulthood, we all hit many milestones in life. Some milestones stand out more than others, but the little ones are no less important. The ability to hold a writing tool is a milestone that moves through various stages from infancy through adulthood. If you get the chance to view and capture each stage along a child’s development, it’s genuinely fascinating!

So, what’s the big deal about the stages involved in holding a writing tool, such as a crayon, marker, or pencil? These stages are the foundation for developing the tiny muscles and arches of the human hand, creating strength and endurance during a writing/drawing activity, and developing stability to manipulate the writing tool to use it the intended way. As humans, we all move through these stages at one point. The progression through each stage is not uniform or standard. The ultimate goal is to reach the ability to hold a writing tool with a functional grasp pattern that promotes adequate speed, accuracy, and legibility without it being the cause of pain or fatigue.

For many kids, achieving fine motor precision and the skill for written output is challenging. However, as NESCA Occupational Therapist Sophie Bellenis, OTD, OTR/L, reminds us in her recent post, “Handwriting vs. Typing: Where do we draw the line?,” handwriting is still a valuable life tool.

So, what does the progression of pencil grasp development actually look like?

Primitive Stages – Observed between 12 and 36 months. The art of drawing and coloring is often the first exposure and gateway to children learning how to hold a writing tool. There is all the freedom, no pressure of writing, and no right and wrong to their drawing.

  • Radial Cross Palmer Grasp (Fig a.) – Full arm and shoulder movement is used to move the writing tool. The writing tool is positioned across the palm of the hand, held with a fisted hand, and the forearm is fully pronated with elbow winged high out to the side.
  • Palmer Supinate Grasp (Fig b.) – Full arm and shoulder movement is used to move the writing tool. The writing tool is positioned across the palm of the hand, held with a fisted hand, with slight flexion of the wrist, and the elbow slightly lowered out to the side.
  • Digital Pronate Grasp (Fig c.) – Full arm and shoulder movement used to move the writing tool. Arm and wrist are floating in the air, and only the index finger extends along the writing tool toward the tip.

Schneck, CM, and Henderson (1990)

Children will begin to shift between the various pencil grips as their shoulder and arm muscles become stronger and steadier.

Immature grasp or transitional grip phase – This grip has been observed as young as 2.7 years of age through 6.6 years of age as stated through research (Schneck, CM, and Henderson (1990)).

  • Static Tripod grasp (Fig g.) – The child will use their forearm and wrist movements only keeping fingers stationery and wrists slightly bent. Movement of the hand can be observed as not graceful. The thumb, index and middle finger will work together as the shaft of the pencil is stabilized by the 4th finger.

Ann-Sofie Selin (2003)

Mature grips – There is so much talk about what looks right and what looks wrong. Traditional pencil grips have evolved through time. There have been four pencil grips now classified as a mature grasp pattern. All mature grips use precise finger movement to manipulate a writing tool while keeping the forearm stabilized.

  • Dynamic Tripod Grip (Fig 1) – Previously known as the golden standard of all grips, where the thumb, index, and middle finger function together, while the pencil shaft rests on the middle finger.
  • Dynamic Quadrupod Grip (Fig 2) –The thumb, index, middle, and ring fingers function together while the pencil shaft rests on the ring finger.
  • Lateral Tripod Grip (Fig 3) – The pencil shaft is stabilized by the inner (lateral) side of the thumb and index finger while resting on the middle finger.
  • Lateral Quadrupod Grip (Fig 4) – The pencil shaft is stabilized by the inner (lateral) side of the thumb, index, and middle finger while resting on the ring finger.

Koziatek SM, Powell NJ (2003)

Pencil grips are generally believed to affect handwriting, and awkward pencil grips become the most commonly assumed cause as to why that is (Ann-Sofie Selin, 2003). However, the production of untidy or illegible handwriting does not always correlate to an unusual pencil grip. The most efficient pencil grip for a child is the one that will help them write with speed and legibility, without pain for an extended period of time.

When should a parent, caregiver or educator be concerned?

  • There is pain and excessive pressure on the writing tool by holding on too tight
  • Illegible handwriting
  • Writing speed is compromised
  • Complaint of hand fatigue during writing and coloring activities
  • Holding the pencil with a primitive grasp (e.g., full fist) after 4 years of age
  • White knuckles or hyperextended joints in fingers holding a writing tool
  • Visible flexed wrist and forearm lifted off the writing surface
  • Inability to choose a clear hand preference between ages 4 and 6 years of age
  • Complete avoidance of all drawing or writing activities

If you are concerned about your child’s pencil grip and/or handwriting, an Occupational Therapist can work with you to identify challenging areas and determine next steps. Let us know if we can help support your child.

References

Koziatek SM, Powell NJ. Pencil grips, legibility, and speed of fourth-graders’ writing in cursive. Am J Occup Ther. 2003 May-Jun;57(3):284-8.

Schneck, CM, and Henderson (1990) Descriptive analysis of the developmental progression of grip position for pencil and crayon control in nondysfunctional children. American Journal of Occupational Therapy, 44, (10) 893 – 900

Ann-Sofie Selin (2003). Pencil Grip: A Descriptive Model and Four Empirical Studies. Åbo Akademi University Press.

 

About the Author

Jessica Hanna has over 10 years of pediatric OT experience in conducting assessments and providing treatment of children and adolescents with a broad range of challenges and disabilities, including autism spectrum disorders, sensory processing disorders, visual impairments, cerebral palsy, executive function deficits and developmental disorders of motor function. Prior to joining NESCA, Jessica trained and worked in a variety of settings, including inpatient and outpatient hospital settings, private practice, schools and homes. She has served on interdisciplinary treatment teams and worked closely with schools, medical staff and other service providers in coordinating care. In addition, Jessica provided occupational therapy services at Perkins School for the Blind and Spaulding Rehabilitation Hospital pediatric inpatient unit, where she conducted comprehensive evaluations and interventions for children with a broad range of presentations.

 

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Handwriting vs. Typing: Where do we draw the line?

By | NESCA Notes 2021

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Real-life Skills Program Manager and Coach, NESCA

For many of our students with dysgraphia, or those who struggle with the fine motor precision and the skills necessary for written output, digital tools and accommodations that promote the use of tech and keyboarding in the academic setting are immensely helpful. These tools allow our students to show their knowledge, demonstrate their written abilities, and fully access their curriculum.  When implemented correctly, these accommodations can have a huge impact on a student’s academic career. While all of this is true, it is worth discussing whether fully taking away the need to produce and practice handwritten work is leaving some of our students at a disadvantage.

When working with adolescents and young adults to help figure out future career or education plans, I am consistently reminded of the fact that despite our continuing transition toward a more and more digitally-based world, the need for handwriting has not disappeared. While we absolutely do not need to be handwriting essays, papers, or long letters sent via snail mail, there are aspects of almost every profession and daily life that require the skill. Here are a few common issues that I am seeing pop up that speak to the need for some continued practice –

  1. Job or rental applications. While some of this has moved over to an online format, many of these still need to be filled out appropriately and legibly by an applicant.
  2. Jotting down notes. The importance of this skill should not be diminished. Whether taking a phone message, making a grocery list, or writing down a phone number, most young adults are expected to be able to read their own handwriting at a later date, or leave a message for someone else who will need to be able to read it.
  3. Vocational responsibilities. Many of our students with disabilities choose to forgo the traditional college path and find a more suitable career field to pursue. Many of my clients have become successful carpenters, mechanics, or other tradespeople. These fields all require vast skill and talent, and often require employees to mark down measurements or make quick notations.
  4. Signing documents. Many banks, institutions, and legal documents require a handwritten signature and initials on any paperwork.

While I am not advocating that we take away accommodations from our students who do not have the foundational skills to write long paragraphs or essays, I am advocating that we stop fully eliminating the demand. By expecting some quick, consistent practice of handwriting, we are building a skill that will be needed multiple times throughout life. I would suggest that students who are being given a keyboarding fine motor/visual motor accommodation, also continue to receive instruction or opportunities to practice writing activities that are less fatiguing in order to continue to build the motor planning and skill necessary. It is unfair to equate the inability to use handwriting as a tool for academic output, with an inability to learn handwriting as a useful functional tool for life.

 

About the Author
Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

 

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Don’t Let Summertime Chores Deflate Your Vibe

By | NESCA Notes 2021

By: Jessica Hanna MS, OTR/L
Occupational Therapist, NESCA

It’s summertime, and let’s face it, nobody wants to do chores. However, through learning about the benefits of chores in a previous NESCA blog post, we realized all that it can bring to the table to improve child development skills.

Nevertheless, let’s step back. No one ever said chores must be painful or that it is all business and no play. Even when it comes to chores, you can keep it fun! The beauty about chores is that in addition to learning personal responsibility, improved self-care skills, and teamwork, chores help children to incorporate and work on an array of skill sets, such as:

  • Visual perceptional skills
  • Executive functioning skills
  • Bilateral coordination skills
  • Fine motor skills
  • Upper body strength
  • Sensory regulation

Let’s take a closer look at exactly what that can look like:

 Water play chores

Stop what you’re thinking…yes, it can seem messy, but remember the goal: participation, have fun, work on important skills (bilateral coordination, sequencing, crossing midline, integrating sensory input).

  • Cleaning off sandy beach items Works on a 2-step or 3-step sequence and bilateral coordination skills.
    • 2-step sequence (rinse and dry using a water bucket or water hose)
    • 3-step sequence (rinse/dry/store back in beach bag)
  • Watering plants/flowers outside – Provides heavy work and promotes bilateral coordination to hold a water-hose and use upper body strength to maintain arms lifted above gravity.
  • Rinse dishes in the sink – Works on sequencing steps, crossing midline, upper body strength, and bilateral coordination.
  • Wipe down indoor/outdoor tables – Incorporates motor planning, crossing midline, and promotes upper body strength.
  • Clean reachable outdoor/indoor windows – Remember it is not about the streaks left behind. The task promotes and builds on upper body strength, hand strength, motor planning skills, and bilateral coordination skills.

Chores that work on visual perceptual skills

  • Sorting clean laundry – Play assembly line with clean clothes or turn it into a mini obstacle course. Sorting and putting away laundry can be a group effort for everyone in the family!   
    • Matching socks
    • Color coding clothing
    • Sorting by category (pants/shirts/undergarments)
  • Putting away groceries…what is more fun than playing store? – Have your child follow a pre-made visual or written checklist to make sure and check off all items purchased (e.g., create your shopping list on Prime Now or Peapod where visuals are supplied, and you print a copy for your child to follow and mark up).
  • Loading the dishwasher – When it comes to loading the dishwasher, we all know it can be a game of Tetris, even for adults! When helping your child load the dishwasher safely, make sure you place one item first in a designated area and see if they can sort items accordingly.
  • Cleaning up toys on a floor – When asking your child to pick up toys, reduce visual clutter, and be specific.
    • Place a perimeter (e.g., use a hoola hoop/painter’s tape) around toys that need to be picked up.
    • Use a visual checklist to identify toys to be picked up (e.g., books, Legos, crayons).
    • You can turn it into a scavenger hunt game (e.g., find 10 crayons on the floor).

Chores that promote regulation

Heavy work chores/activities help with sensory regulation through the act of pushing, pulling, and lifting heavy items.

  • Laundry – If you have a front-loading reachable washer and dryer, have your child pull wet clothes out of the washer, or dry clothes from the dryer. Or have your child (depending on size and strength) help carry a basket of clean or dirty clothes to and from the washer and dryer. (To add a fun twist, have them walk over items, around items, spin, bend, etc., with a basket of clothes).
  • Vacuuming/Swiffering – Make sure the size is appropriate. Little ones love handheld vacuum cleaners and dust pans if they cannot manipulate larger sized appliances. Handheld vacuums are fun for kids to use in helping to clean out the car! Turn it into a game to vacuum the treasures your car “ate” during those summer outings can be an adventure for them and a bonus for you!
  • Bed making – Have your child sit in the bed and help pull up those sheets and blankets from the sitting position. It’s fun when it fluffs up and gets tricky when you must sneak or crawl out without pulling the sheets down!

Always keep in mind what you want the goal of a chore to be and remember that they do not have to be done perfectly. When chores are broken down into steps, are provided and paired with a verbal and visual demonstration, and are concrete, your child will be successful in participating in your chore of choice. You must remember to create the just-right challenge regarding your child’s age and pair it with fun!

 

About the Author

Jessica Hanna has over 10 years of pediatric OT experience in conducting assessments and providing treatment of children and adolescents with a broad range of challenges and disabilities, including autism spectrum disorders, sensory processing disorders, visual impairments, cerebral palsy, executive function deficits and developmental disorders of motor function. Prior to joining NESCA, Jessica trained and worked in a variety of settings, including inpatient and outpatient hospital settings, private practice, schools and homes. She has served on interdisciplinary treatment teams and worked closely with schools, medical staff and other service providers in coordinating care. In addition, Jessica provided occupational therapy services at Perkins School for the Blind and Spaulding Rehabilitation Hospital pediatric inpatient unit, where she conducted comprehensive evaluations and interventions for children with a broad range of presentations.

 

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

OTs’ Remote Learning Equipment Tips!

By | NESCA Notes 2020

Co-authored by: Sophie Bellenis OTD, OTR/L and Jessica Hanna MSOT, OTR/L

With the momentous shift in education this year, many families are looking for support with the remote learning or hybrid learning process. Children are facing new barriers to education, such as inability to focus within the home setting, inappropriate work space and lack of independence with attention, initiation and motivation. Fortunately, many fabulous educators are stepping up to the plate, acknowledging these struggles and advocating on behalf of their students. Many families are working to help in their efforts by finding new products, tricks, tools or strategies to help promote learning and access to curriculums. Some of these products are gimmicky tools promising a “quick fix.” Some of these new tricks and tools may be beneficial, but today we are going to advocate for getting back to the basics and truly analyzing how best to use, set up and care for the foundational tools that children currently employ for learning. If using these tips feels difficult or is not helping your child to achieve the level of focus and commitment to learning that they need, we recommend reaching out to your school-based occupational therapist or getting an occupational therapy evaluation.

Things to Consider:

Laptops/Tablets

  • Basic Functionality – Your child is never too young to be part of the process. Teaching your child basic functionalities of their computer and tablet, as well as specific platform features is hugely important. Your child may find a visual checklist helpful to recall what basic features do, where to find them and when it is ok to use them.
  • Keep Screens Clean – As expected, kids often touch everything and anything, including computer and tablet screens. Make sure to check and wipe down screens to limit glare and distortion caused by sticky little fingers. Encourage your child to respect and handle their device with care.
  • Screen Height – According to the American Optometric Association, most people find looking at screens more comfortable when their gaze is pointed slightly down. Ideally, try to set up a computer screen with the center of the screen about 15-20 degrees below eye level (AOA, n.d.). This may be especially tricky with little learners, who tend to crane their necks up to look at a monitor or laptop screen, or students who tend to set their laptop way down on their lap.
  • Screen Distance – To decrease eye strain, try to position a screen about 20-28 inches away from the eyes (AOA, n.d.). Recent evidence shows that there is a significant increase in visual symptoms, such red eyes, blurriness and visual fatigue in individuals who look at screens from a distance of 10 inches or less (Chiemeke, Akhahowa, & Ajayi, 2007). While it is easy to set a computer a certain distance away, make sure that children are not holding an iPad or phone right up to their face during the school day.
  • Simplify Access to School Webpages and Links – Make sure that when your child opens up the computer, they can quickly and easily access all of their school websites and links for Zoom, Google Classroom, etc. One easy way to do this is by creating shortcuts on the desktop or having a visual guide printed next to them for exactly how to access their work.
  • Limit Access to Distracting Apps or Webpages – Is there a way to disable your child’s access to games and apps during school hours? While our students are working hard to attend to remote learning, the pull of distracting digital fun may be too enticing to pass up. Consider looking into some of parental control options on your device.
  • Learn the Limitations of Chromebooks – Due to the digital demands of remote learning, many school districts and community organizations are providing Chromebooks for students to use at home. While this is excellent and allows students access to the curriculum, some of these devices have limitations, such as not allowing communication to certain website or software platforms. Consider reaching out to your district if you need your child’s device to allow communication with an outside therapist or service provider.
  • Back Up Your Personal Work – Many families are sharing one computer or device between multiple family members. It is important to make sure that any important documents, folders or programs are fully backed up before giving a computer to your student. Accidents happen, and children can quickly delete files without meaning to! Creating a separate user login for each family member allows different privileges for each user and helps keep work separate and organized.
  • Say No to Open Drinks! – Water bottles with a lid will help to prevent any hardware damage from spills.

 Extra Equipment

  • Invest in a Mouse – Using a touchpad often requires substantially more fine motor precision and finger isolation than using a mouse. Most devices can connect with a mouse either through a USB port or a Bluetooth connection.
  • Headphones – Different children may benefit from different types of headphones. Some of our learners need earbuds or overhead headphones during Zoom meetings to help them attend to the class going on virtually. Some of our students may prefer being in a quiet space and listening to their teacher and classmates out loud. Additionally, some students may benefit from wearing noise cancelling headphones during independent work to limit the distraction from noises in their environment.
  • External Camera – Using an external camera that is not embedded in a computer or laptop may be helpful for our students who need movement or want to look at a screen while a teacher or therapist observes their work. An external camera pointed down at a student’s hand during an activity can help a therapist to evaluate a child’s fine and gross motor movements, while the student still sees a friendly face up on the screen.
  • Chargers – Help your children remember to keep their devices fully charged and to transport their charger between school and home if necessary. Many students benefit from a visual checklist when packing their bag for the next day. Chargers are hugely important for students who need to access their curriculum and may be especially difficult for students learning in a hybrid model.

 

References

American Optometric Association. (n.d.). Computer vision syndrome. Retrieved from https://www.aoa.org/patients-and-public/ caring-for-your-vision/protecting-your-vision/ computer-vision-syndrome?sso=y

Chiemeke S.C., Akhahowa A.E., Ajayi O.B. (2007) Evaluation of vision-related problems amongst computer users: a case study of university of Benin, Nigeria. Proceedings of the World Congress on Engineering. London: International Association of Engineers.

 

About the Co-authors:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Dr. Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

 

Jessica Hanna has over 10 years of pediatric OT experience in conducting assessments and providing treatment of children and adolescents with a broad range of challenges and disabilities, including autism spectrum disorders, sensory processing disorders, visual impairments, cerebral palsy, executive function deficits and developmental disorders of motor function. Prior to joining NESCA, Jessica trained and worked in a variety of settings, including inpatient and outpatient hospital settings, private practice, schools and homes. She has served on interdisciplinary treatment teams and worked closely with schools, medical staff and other service providers in coordinating care. In addition, Jessica provided occupational therapy services at Perkins School for the Blind and Spaulding Rehabilitation Hospital pediatric inpatient unit, where she conducted comprehensive evaluations and interventions for children with a broad range of presentations.

 

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

The Ideal Remote Learning Workspace

By | NESCA Notes 2020

Co-authored by: Sophie Bellenis OTD, OTR/L and Jessica Hanna MSOT, OTR/L

Designated Space for Schoolwork – Make sure to set up a workspace with intention. While it may be easy to have children hop on the couch or sit at the kitchen table, having a space that is specifically used for academics will help them to compartmentalize and associate the space with focus and learning. There should be a concrete difference between a place to work and a place of rest. Ensure that this space is distraction-free and set away from the hustle and bustle of the home. Give your child some autonomy by allowing them to decorate their space and take ownership. A small desk, a card table in a quiet corner or a small bedside table set up in a private space are all options for workstations that children can make their own.

Remove Distractions – Take a moment to sit down at your child’s workstation and note any potential distractions. Some will jump right out, such as a TV or box of enticing toys within their line of sight, but some may be less obvious. Are they near a window facing a busy street or a dog park? Is there a substantial amount of visual clutter around their desk, such as busy posters or a family photo collage? Is their desk covered in mail, knickknacks, or arts and crafts supplies? If removing items is not an option, consider creating a physical barrier between your child and any environmental distractions by using a desktop study carrel/shield. Taking these distractions away will help a student to focus their energy on attending to school, as opposed to ignoring it and resisting distractions.

Organize Materials – Depending on your child’s age, they may need help organizing their workspace to be prepared for the day. For our young students, consider using toolboxes or tabletop organizers to hold their materials. A toolbox may have crayons, markers, scissors, pencils, erasers and glue sticks. If your child benefits from sensory supports, consider a toolbox with manipulatives, as appropriate per occupational therapy (OT) recommendations. Children are often very visual learners and may benefit from color-coded or designated folders for each subject or class they are taking. If a workspace is shared, keep your child’s personal materials all in one location, such as a personalized storage container that is easily portable, accessible and organized. Finally, remember to consider digital organization. Students are often told how to label and save documents by teachers at school. With the move to remote learning, children may need assistance organizing documents, folders and classwork on their computer so that they can easily find everything in the moment.

Adequate Lighting – Assess the lighting in your student’s workspace by checking to see whether there is any glare from the sun on the screen, whether they could benefit from a desk lamp to better illuminate their paper and determine whether there is a specific location with good natural light. If natural light is preferred, it’s best practice to position your electronic at a right angle to the light so the light is neither in front nor behind the screen. Avoid fluorescent light bulbs whenever possible. One more thing to consider is the fact since this past March, students and professionals alike have noticed an increase in headaches and visual fatigue due to spending substantial portions of the day in front of a screen. Technology is visually straining. Consider investing in a pair of blue light-reducing glasses, a newly popular solution to this problem that has shown promise for improving adolescent sleep, mood and activity levels (Algorta et al., 2018).

The Rule of 90 Degrees – When sitting at a table, children’s hips, knees and elbows should all be positioned at 90 degrees. Feet must be firmly planted on the floor. This helps to create a solid foundation. When children have a strong foundation and postural stability, they are set up to freely and accurately use their fine motor skills. Being grounded allows for easier writing, typing, cutting and manipulation of all the tools necessary for learning.

Appropriate Furniture – To meet the Rule of 90, it is important to consider the furniture that your student is using. Furniture needs to be the correct size or be modified to help children fit comfortably. If a desk/table is positioned too high, it will cause extra strain and fatigue. If your child’s feet do not reach the floor, consider using a step stool or fortified box for their feet. With regard to the chair itself, avoid options that spin and slide around as they are often distracting and make it difficult for children to pay attention.

 

 

 

References

Perez Algorta, G., Van Meter, A., Dubicka, B. et al. Blue blocking glasses worn at night in first year higher education students with sleep complaints: a feasibility study. Pilot Feasibility Stud 4, 166 (2018). https://doi.org/10.1186/s40814-018-0360-y

 

About the Co-authors:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Dr. Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

 

Jessica Hanna has over 10 years of pediatric OT experience in conducting assessments and providing treatment of children and adolescents with a broad range of challenges and disabilities, including autism spectrum disorders, sensory processing disorders, visual impairments, cerebral palsy, executive function deficits and developmental disorders of motor function. Prior to joining NESCA, Jessica trained and worked in a variety of settings, including inpatient and outpatient hospital settings, private practice, schools and homes. She has served on interdisciplinary treatment teams and worked closely with schools, medical staff and other service providers in coordinating care. In addition, Jessica provided occupational therapy services at Perkins School for the Blind and Spaulding Rehabilitation Hospital pediatric inpatient unit, where she conducted comprehensive evaluations and interventions for children with a broad range of presentations.

 

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Sensory and Motor Strategies to Support Online Learning

By | NESCA Notes 2020

By: Julie Robinson, OT

Director of Clinical Services; Occupational Therapist, NESCA

For many families, this spring’s experience of remote learning and receiving integrated services was challenging, to say the least. As parents begin to think about their children returning to school this fall questions and concerns arise, not only about regression, but also how they will keep their children engaged in online learning.

For children with sensory processing difficulties and/or motor delays, there may be additional challenges in participating in Zoom classes and remote group learning. Some may have difficulty sustaining their attention, settling their body down to sit in front of a screen, managing the visual challenges of a screen, engaging socially or transitioning from a desired task to an academic one. Below are some suggested strategies, from an OT perspective, that may help your child participate in academics with less stress.

Regulation Strategies

The term “regulation” refers to someone’s ability to match their level of alertness (or arousal) to the environment and an activity. Throughout the day, our brain and our bodies are working to either increase or decrease our arousal levels for us to feel regulated and feel “just right” for the situation.

Sometimes children may have trouble with regulating themselves, causing them to experience dysregulation. Dysregulation can look very different depending on the child and can present as low levels of arousal or high level of arousal. This state may make it challenging for the child to be engaged and participate in certain activities, such as online learning. Sensory strategies are ways to help a child either increase arousal or lower arousal to match the needs of the task of online learning.

If a child is experiencing a low level of arousal, or their engine is running low, they should use a sensory strategy to help feel more alert. These include activities that have fast movement and increase heart rate. Taking movement breaks throughout the day is key! This could mean:

  • Jumping Jacks
  • Frog jumps or jumping on a trampoline
  • Playing at an outdoor playground
  • Creating an obstacle course
  • Doing something as simple as taking a walk around the house
  • Using a sit and spin or bouncing on a therapy ball
  • Hanging from a chin-up bar

If a child is experiencing a high level of arousal and their engine is running high, a sensory strategy to help them feel calm is beneficial. Calming strategies tend to be slower and more rhythmic. Ways to help slow down a child’s engine include:

  • “Heavy work,” such as wall push-ups, carrying books, laundry or groceries, wheelbarrow walk or crab walk can do the trick.
  • Yoga poses. Cosmic Kids Yoga on YouTube has some good videos with stories to encourage young children.
  • Creating a “sensory space” that is quiet and free from distractions. This could be a beanbag chair in the corner, a pop-up tent or a space behind a piece of furniture.
  • Using a weighted/heavy blanket or doing work on the ground with pillows underneath while spending time online may help your child to settle his or her body down. Explore the use of a therapy ball, T-stool, Move and Sit cushion or bike pedals that go under a chair to help kids who have difficulty sitting still.
  • Tactile play can be very calming for some children. Make a bucket of beans and hide small objects in it. Working with Playdough, shaving cream or water play can also help.
  • Encourage deep breathing to promote relaxation. Blow soap bubbles with a straw, pretend to blow out candles or blow a pinwheel.
  • An icy drink or popsicle can prove calming for many children. Or allow them to chew gum while learning to facilitate attention.

Strategies for Transition into Online Learning

As the new school year approaches, the change of routine into online learning may be a challenge for some kids. Here are some strategies to help your child adjust:

  • Create a clear schedule for your child that they can follow throughout the day (and make sure to schedule in plenty of breaks!). It may be helpful to use visuals or pictures, similar to a preschool schedule to help structure the time.
  • Make time for movement breaks around the house or outside. It may help to engage in a movement activity for 10-15 minutes before settling into an online class.
  • Use timers when needed (apps that have a visual timer, such as “Time Timer,” can be beneficial).
  • Create a designated space for the child to do their learning and make it their own.
  • Factor in a reward for good participation at the end of a virtual learning session, particularly for a child who seems resistant to remote learning.
  • Practice some brief online learning opportunities before school begins and slowly increase the time incrementally. Conduct Zoom calls with grandparents or other relatives where they read to the child to help maintain their attention. Search on YouTube together for some craft activities to follow along with. Khan Academy and Outschool have all kinds of online lessons for kids of all ages.

 Preventing Visual Fatigue in Online Learning

Along with the many challenges that come with online learning, the constant staring at electronics can cause strain or fatigue on the eyes. Eye strain can present as headaches, blurry vision, tired eyes and neck aches. In this world of virtual learning, it is more important than ever to help kids with strategies to prevent digital eye strain. Here are some strategies:

  • Turn down the screen brightness and turn up the contrast on screen settings.
  • Every 15-20 minutes, make sure to take a break from looking at the screen; set timers if needed. Sometimes placing your hands over your eyes and staring into them with open eyes can help. No matter what the day’s schedule is, always encourage a break from looking at the screen when needed.
  • Zoom in when text is too small.
  • Set limits for recreational use of electronics and avoid electronics before bed.
  • Sit in an ergonomically proper position when using the computer. This means keeping feet flat on the floor, lower back supported and shoulders related, and arms at a right angle.
  • Position the screen to avoid glare and use natural lighting as much as possible.
  • For a child who may have difficulty looking back and forth from a screen to paper, it may help to place the paper on a contrasting background of red or yellow.

 

About the Author

Julie Robinson is an occupational therapist with over 25 years of experience as a clinician. The work Julie does is integral to human development, wellness and a solid family unit. She particularly enjoys supporting families through the process of adoption and in working with children who are victims of trauma. Julie has extensive experience working with children diagnosed with an Autism Spectrum Disorder (ASD), or who have learning or emotional disabilities. She provides services that address Sensory Processing Disorder (SPD) and self-regulation challenges, as well as development of motor and executive functioning skills.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Sitting Down to Work – Tips for Proper Set-up and Posture

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L

Occupational Therapist; Real-life Skills Program Manager and Coach

When working from home, it’s easy to ignore the important things that most people know about maintaining proper posture. The draw of a bed covered in pillows or a cozy nook on the couch can outweigh the rational knowledge that sitting with good posture will help us to stay focused, decrease back or joint pain, and help build a strong core. When it comes to children, they are often unaware of the ways that posture can affect their bodies and their work. They need cues, reminders and examples of the best way to sit to stay focused and be productive. In our last OT Tuesday blog, we discussed the importance of a child’s physical foundation, the core. When it comes to learning, a strong core helps with postural stability. As the start of a new school year draws near, let’s review some important things to consider about the environment and physical set-up for learning and the best positions for our students’ bodies.

Creating a space for learning helps to differentiate between school and home activities that, for many students, are currently happening in the same building. Here are some tips for setting up this space:

  • Find appropriately sized furniture. Children should have their feet on the ground when sitting at their desk! Tables should be at an appropriate height. Tables that are too tall tend to prompt children to hunch their shoulders or sit on their feet, while tables that are too small cause children to slouch and lean their heads on their hands.
  • Help them organize. Classrooms are built to help students grow their executive function skills, as teachers constantly help set up organizational systems and use tricks to keep students on track. Your child may benefit from color coded folders for each subject, a hard copy of their daily schedule (with pictures for younger kids!) or a visual timer.

There are also a few important things to remember to help with proper seated posture.

  • Use visual reminders. Your child may benefit from a picture of someone using proper seated position posted near their workspace. While they may still need a reminder every so often, having an image gives children a model to mimic.
  • The Rule of 90 Degrees. When sitting at a table, children’s hips, knees and ankles should all be positioned at 90 degrees. This helps to create a solid foundation. When children have a strong foundation and postural stability, they are set up to freely and accurately use their fine motor skills. Being grounded allows for easier writing, typing, cutting and manipulation of all the tools necessary for learning. Ideally, children’s elbows will also create a 90 degree angle.
  • Consider a slant board. Placing a computer or a paper on a slanted board can help students realize that they need to sit up straight, promote proper wrist placement and angle, and draw their eye gaze up from the desk. Writing on a vertical or slanted surface in general can help with the development of handwriting skills.
  • Stabilize that paper. Reminding students to use their non-dominant hand to hold their paper helps with precision and accuracy.
  • Allow them to switch it up! Some tasks really require a child to be sitting up straight, grounded and engaged. For example, a student who is hand-writing a final copy of their paragraph or using scissors for an art class will want to be cognizant of their bodies and how they are seated. In contrast, some activities provide opportunities to move around and change positions. If a student is reading a book for English Language Arts, they may want to lie on their belly or sit in a beanbag chair.
  • Take breaks. No matter how perfect a child’s seated posture is, they will benefit from movement and stretching breaks. Little bodies are built to move, bounce and wiggle!

Prioritizing posture as a child helps to build good habits, evenly distribute stress on the body’s muscle ligaments and joints, and create a strong, grounded foundation.

 

About the Author

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Dr. Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Core Strength and Stability: The Physical Foundation

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L

Occupational Therapist; Real-life Skills Program Manager and Coach

As our country heads into a period of unique learning, whether through a remote learning experience, a hybrid model or an in-person option with heightened rules and regulations, I find myself focusing on foundation. Foundation, simply defined, means, “the basis upon which something stands or is supported.” Currently, we are looking at a huge shift in how programs will run, how teachers will teach and how schools will support our children, but these principles are rooted in strong foundations. Our educators have knowledge, proven methods and an evidence base that allows for creativity, flexibility and evolution.

With regard to our students, foundational skills are the basics that help them feel secure and grounded enough to tackle the more individualized and creative aspects of learning. It is, in part, due to these foundational skills that many of our surprisingly resilient children have handled the COVID-19 pandemic with more flexibility and grace than the adults in their lives.

Today, let’s highlight the physical foundation that supports a child throughout their day, the core. Anatomically, the core refers to the transverse abdominis, internal and external oblique muscles, rectus abdominis, and the multifidus and erector spinae. This group of muscles holds a child upright when they are sitting at their seat, standing in line and running around on the playground. It is one of the foundational elements that promotes healthy motor development. Having a strong and active core makes it easier for a child to use their fine motor muscles with intent, stay alert for the duration of a class or a Zoom session, and develop healthy postural habits. Occupational therapists are trained to determine whether these activities are being affected by a weak core and if there is a need for intervention. Teachers and parents who spend substantial time with our children may want to be aware of and look out for the clues and signals of core instability, which include:

  • Compensatory strategies for stability – These are the subconscious ways that children compensate for core weakness. Essentially, they are bad habits that initially help to keep kids from getting too fatigued to participate in activities, but can have negative long-term effects. Some common examples include “W-sitting” and holding a breath during activities that require strength.
  • Leaning on anything and everything – Some children sit and lean their head on their hands or the desk when they write, lean against adults when standing up or sitting on a couch, and lean on furniture or tables when they are standing at home. These same students often slouch down in their seats and hunch their shoulders forward when they stand. This could signify a weak core.
  • Difficulty with balance – The inability to stay balanced and upright may be due to core instability. Many children are still developing the ability to run, jump, walk across a balance beam and stand on one foot, but if they seem to be falling over or losing control of their body more frequently than their peers, a weak core may be the culprit. These balance issues may also be apparent when a child is doing daily activities, such as getting dressed, putting on shoes or getting in and out of a car.
  • Difficulty with fine motor tasks – Sometimes children have a strong core and still have weak fine motor skills; however, often a weak core is exacerbating fine motor deficits. There is a little phrase that goes, “proximal stability for distal mobility” that is used by therapists, yogis and personal trainers alike. This means that it is important to have strength and stability at the core to easily move and control the muscles in our arms and legs.

Notably, helping a child to build their core is not always as simple as doing a few targeted exercises. While pure muscle strength may be the root cause of instability, it is not the only possibility. Other causes include poor alignment of the ribcage and pelvis, the need for some neuromuscular reeducation to help children engage the right muscles, and breathing habits that interfere with proper muscle use. If you feel like core weakness may be interfering with your child’s success, it may be worth seeking an occupational therapy assessment or speaking to your school’s occupational therapist about how to help them feel secure, sturdy and grounded. We can all benefit from a strong foundation.

 

About the Author

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Dr. Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Skill Highlight: Touch Typing!

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Real-life Skills Program Manager and Coach

As you are sitting at home with your child and working to find a reasonable balance of academics, physical movement, chores, social time and relaxation, one specific skill to consider targeting is touch typing or keyboarding. As we move further and further into the digital age and, more recently, an unprecedented era of remote learning, the ability to successfully type and get ideas onto the screen is paramount. We often joke that our children are more technologically adept that we are, as they easily navigate between iPad apps and turn on anything with a screen. While this is, in many ways, true, two things I constantly observe in students are the propensity to type with just their pointer fingers (hunt and peck method) and that they initially learn about a keyboard for games rather than academics.

As their fingers fly around the keyboard, I am often asked, “Why does it matter if they can use all ten fingers? Who cares if they are typing with two fingers if they are getting the information out of their head?” These are all great questions, and I hope to answer and provide clarity around the ones I hear most frequently.

Why does ten-finger, touch-typing matter?

Massachusetts State Guidelines recommend that a student should be typing at a speed of 5 times their grade level with 80-95% accuracy. For example, a third grader should be typing at 15 words per minute (3 x 5), and a seventh grader should be typing at about 35 words per minute (7 x 5). Following this formula, by graduation, a senior in high school should type with a speed of at least 60 words per minute, a functional speed for an adult in most professions.

While it is likely that some third grade students can use two fingers and type at a rate of 15 words per minute, as these students get older and the demand increases, it is unlikely they will be able to keep up with these guidelines if they have not been taught a functional typing approach.

That may be true for some students, but I promise my child is able to type quickly! Can I just let her teach herself?

While children may be able to type quickly using their own typing method, ten-finger typing uses almost of all of the intrinsic hand muscles to complete the task. This means that children are much less likely to feel fine motor fatigue than if they were using two or three fingers. While this may not matter for a young student typing a paragraph, it will absolutely affect a high school student who is working on a 10- or 15-page paper. Teaching the correct approach will set young students up for future success.

Is it okay to start later in elementary school? My student is still working on handwriting.

There are some mixed opinions on the best time to start teaching keyboarding. I personally recommend first or second grade as an appropriate starting point. At this level, most students can identify their letters and are used to using computers to some extent. As with most motor tasks, practice makes perfect, and the more time our children spend using all ten fingers to type, the better at it they will be. It is perfectly fine to learn handwriting and keyboarding simultaneously.

How much time do you recommend my child spends practicing?

I recommend students practice for about 20-30 minutes at a time. This allows time for direct practice, as well as time for playing games that promote correct finger placement. If a student can do this practice two to three times a week, they will absolutely start to develop the motor patterns necessary and commit them to muscle memory.

What are your thoughts on speech-to-text software?

Speech-to-text software programs are excellent tools when they are used with the right student. They increase accessibility, help students get information on the page and can increase the speed at which a student completes their work. I am hesitant to introduce these tools too early or with the wrong student.  The need to type will not go away and not all programs can support a speech-to-text option. Additionally, in an academic setting, using a speech-to-text option requires a student to have extra testing accommodations, such as a separate room for testing and 1:1 test administration. For some of our students, this is exactly what they need for success, but for others these accommodations are not reasonable or necessary.

Can I leave my child to practice on their own?

Children quickly slip back into old habits. I recommend keeping a watchful eye to ensure that a ten-finger approach is truly being practiced.

Is there anything else I should consider?

Yes! Make sure to consider your child’s posture as they sit at the computer. Ideally, ankles, knees, hips and elbows should all be at 90 degrees, while wrists should be “neutral” or flat.

Where can I go to find lessons or tutorials for my child?

Great Question! Fortunately, there are many excellent online options to help teach children how to type. Some free online sites that directly teach and help to practice ten-finger typing include www.typingclub.com and www.typing.com. Other reasonably priced options include Typing Instructor for Kids Platinum, Mavis Beacon Keyboarding Kidz and Mickey’s Typing Adventure. For more entertaining, game-based practice, take a look at www.abcya.com and www.typinggames.zone.

 

About the Author

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Dr. Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

An OT’s Guide to Home Learning: Board Games and Puzzles

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Real-life Skills Program Manager and Coach

As social distancing recommendations, stay-at-home orders and shelter-in-place mandates continue to keep families confined to the home, parents are quickly being asked to take on the roles of teacher, therapist, warden, work-from-home professional, best friend and more. For parents of children with special needs and learning differences, this can feel extra daunting. There are countless online resources providing specific in-home activities, recommendations, and suggestions for working on targeted skills (e.g., literacy, fine motor, sensory integration, gross motor, etc.) in the home. It’s easy to get quickly overwhelmed by the onslaught of information.

While I believe there are many useful and creative free resources available online (I’ve written some of them!), our “new normal” includes many barriers to easy implementation including time, expertise, resources and confidence. Today, I want to share how some fun activities involving board games that you may already have in your home could make the task of keeping children engaged, interested and learning a little bit easier. Our game makers are getting increasingly creative and aware of their role in helping children build their skills, and the games listed below are just a few of the many options available.

5 Board Games for Development of Visual Perception

  • Connect 4 – Playing Connect 4 with the traditional rules requires kids to track horizontally, vertically and diagonally with their eyes. They need to visualize where their checker will land and place it in the correct spot at the top. Additionally, children need to monitor two colors at a time to ensure that they do not need to block their opponent on their next turn. For younger children, consider using the board to practice patterns or make shapes out of one color.
  • Quirkle – Quirkle combines colors, shapes and a grid pattern to create an interactive game for children to play with their parents. It promotes form perception, visual discrimination, tracking and matching.
  • Dominoes – There are many different games that can be played with Dominoes, making it easy to scaffold the activity for all different ages. Dominoes works on many of the same skills as Quirkle, but really allows children to practice visual figure ground. Figure ground is the ability to distinguish relevant information from a busy or overwhelming background. Dominoes have lots of different colored little dots in different patterns and alignments allowing children to practice this skill. Notably, Dominoes often have a tactile aspect allowing children to both see and feel the dots.
  • Spot it! / Spot it Jr! – Spot it! has quickly become a favorite game of occupational therapists, speech language pathologists and school psychologists alike. It practices a multitude of important skills. In terms of visual perception, Spot it! focuses on visual discrimination, hand-eye coordination, attention to detail, figure ground and more. Due to its popularity, Spot it! has provided us with an excellent variety of specific versions, such as Alphabet, NFL, Gone Camping, Animals, as well as substantial Spot it Jr.! options.
  • Memory – Unsurprisingly, the game Memory works on increasing visual memory! Children have to remember which cards they have picked, where they are on a grid and where the matches are. There are lots of options to order online, but this can absolutely be played used playing cards or DIY pictures drawn on pieces of paper. Children are also able to practice pronation/supination by flipping over the cards and placing them back down on the table.

 5 Board Games for Development of Fine Motor Skills

  • Trouble – Trouble allows children to work on building hand strength as they push down the pop-o-matic die roller. Try to ensure that children are using the muscles in their hands and fingers to push down, and limit the amount of body weight they use to help them push down. Additionally, children practice a pincer grasp as they pinch their pegs to move them around the board.
  • Hi-Ho! Cherry-O! – This game includes little plastic fruit that need to be placed in a basket to promote a pincer grasp and a spinner board that helps teach kids to flick or push a spinner.
  • BedBugs – Tongs and tweezers are part of an OT’s go-to toolbox as they promote fine motor precision, keeping an open webspace, and hand strength and coordination. This game is for children age 4 and up and provides each player with their own tongs to try and catch little bouncy bugs on a bed. Add a layer of complexity by having kids each try to catch one color!
  • Avalanche Fruit Stand – Another game that incorporates tweezers, Avalanche Fruit Stand promotes grip strength, pincer grasp and problem-solving as children need to balance different fruits on a stand. There is also a spinner to add in another element.
  • Hungry Hungry Hippos – Use this game to practice finger isolation and increase finger/hand strength. Encourage your children to use one finger at a time to depress the lever and make their hippo eat the marbles. Try switching fingers for each round.

*Bonus!* While many of these games work on more than one skill at a time, one age-old recreational activity that targets visual perception, visual motor integration and fine motor skill is simply completing a puzzle. Focus on teaching strategy and problem-solving by having your children start with the edge pieces, organize by color or choose one figure or character in the puzzle to build independently.

About the Author

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Dr. Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.