visual motor

The Benefits of Working on a Vertical Surface

By | NESCA Notes 2021

By: Madelyn (Maddie) Girardi, OTD, OTR/L
Occupational Therapist, NESCA

What do you mean by a vertical surface?

If you think about it, most of the activities children do day to day are completed on a horizontal surface, where toys and tools remain static, in one position. Picture a vertical surface, whether it be a wall, window, or an easel. Working in this anti-gravity position activates new muscles and makes activities more challenging for kids. Think “tummy time,” but for our elementary-aged kids.

What are the benefits of working on a vertical surface?

  • Shoulder, wrist, and elbow stability – These activities require a child to practice bigger arm movements that may not be utilized on a traditional, flat surface. These movements promote both strength and flexibility in the joints and muscles of the upper extremities.
  • Core strength & postural control – If a child is completing vertical work in standing, he or she must reach outside of their base of support, activating those core muscles. Further increase the demands of the task by having the child complete the task in kneeling or while sitting on a therapy ball. This promotes balance and use of the stomach and leg muscles. Building this solid ‘core’ foundation is extremely important so that a child can develop more controlled movements in the upper extremities.
  • Hand strength – Working against gravity requires a child to exert increased effort while building hand strength and endurance with a utensil.
  • Visual spatial awareness & crossing midline – Working on a large vertical surface means more space to cover. This requires a child to visually scan a greater distance left to right, reaching across the imaginary “midline” of our body. Crossing midline is essential for developing bilateral coordination skills.
  • Wrist extension for pencil grasp – This is a big one! Writing on a vertical surface naturally puts the wrist in extension, the ideal position for handwriting. In contrast, a flexed wrist limits finger mobility and control.
  • Proprioception & force modulation – When performing a task on a vertical surface – think stickers or drawing – the child is required to practice grading movements so that he or she can apply the right amount of pressure for success (Boitano, 2020; Drobnjak, 2015).

What pediatric population benefits from this?

All kids would benefit from participating in these kinds of activities! Working on a vertical surface work can particularly help children to further develop the essential fine, visual, and gross motor skills. Sensory integration can also be targeted, as these kinds of activities allow a child to explore and develop proprioceptive, tactile, and visual processing skills.

Activities that can be done on a vertical or slanted surface (Boitano, 2020; Drobnjak, 2015)

  • Writing
  • Drawing/coloring
  • Tracing (stencil) activities
  • Stickers
  • Painting (finger painting or with brush)
  • Magnets
  • Spray bottle activities
  • Squigz or suction cup games
  • Felt or Velcro boards
  • Chalkboard, easel, or whiteboard activities
  • Shaving cream
  • LEGO wall
  • Window or wall washing using sponge



Boitano, C. (2020, April 20). The benefits of writing and working on a vertical surface! OT Outside. Retrieved October 6, 2021 from https://www.otoutside.com/news/2020/4/19/the-benefits-of-writing-and-working-on-a-vertical-surface.

Drobnjak, L. (2015, June 27). Why Kids Should Work on a Vertical Surface. The Inspired Treehouse. Retrieved October 6, 2021 from https://theinspiredtreehouse.com/motor-skills-and-more-working-on-a-vertical-surface/


About the Author
Madelyn (Maddie) Girardi is a Licensed Occupational Therapist in Massachusetts with experience in both school-based and outpatient pediatric settings. Maddie received her undergraduate degree in Exercise Science/Kinesiology at The College of Charleston in South Carolina and  earned her Doctorate degree in Occupational Therapy from The MGH Institute of Health Professions in Boston.

Maddie is a passionate therapist with professional interest in working with young children with neurodevelopmental disorders, fine and gross motor delays and Autism Spectrum Disorder (ASD).

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.