Category Archives: hand coordination

Which Improves Pencil Grasp Best: A Pencil Grip Or A Thicker Pencil?

 

kelli-tungay-324329A a pediatric occupational therapist, I am often asked to weigh in on this debate.  Not often enough, it seems.  There are a lot of kids out there using pencils with wonky grasp patterns because no one has made an effort to improve the way they hold a pencil, or they doubt that it matters.  Oops.  Although grasp isn’t often or evn usually the biggest issue with writing problems, a really poor grasp can reduce control and increase pain and fatigue.  Not every kid with poor pencil grasp is a hot mess.  Some of them just need good instruction and good materials.  For the others, it might be time to get an OT involved.

Kids that struggle with pencil grasp are often (in my opinion, too often) given a pencil grip and told to use it when they write. It may help, but it may not.  An yet, I will still hand out my favorite pencil grip if I think that it will build control and strength. The Pencil Grip That Strengthens Your Child’s Fingers As They Write.

I thought I would drill down into the ways that OTs think about the use of pencil grips, and present a few alternatives to reflexively sending kids home with a bit of plastic on the end of a pencil:

  • Change the pencil.  Triangular pencils give more sensory feedback during writing, and they offer a flat surface for finger pads.  Thick mechanical pencils still have a standard-thickness lead, but they also are easier to hold for some children.  Short pencils, including golf pencils, force more fingertip contact and can be helpful (but not if grasp is really weak or awkward).
  • Don’t jump into pencil use too early.  Until a child can manage a mature grasp, I try very hard to keep them using crayons when they are not yet in kindergarten.  I like the flip crayons from Learning Without Tears because they are so very small, but not all kids in kindergarten are ready for them.  I break a toddler crayon in two so that they get the benefits of a thick shaft but they will be unable to use a fisted grasp.
  • Like markers?  I only use them if they are the Pipsqueak markers from Crayola.  Nice thick, short shafts for little fingers.  Markers don’t give a child any resistance at all, so they don’t give enough sensory feedback or strengthening for my kids that need both.  And they make a mess most of the time.  I don’t have the time to scrub off markers.
  • Build strength and control with play.  Yes, fine motor play.  Totally outdated (just joking) but necessary.  I use the iCreate tablet stylus, bead stringing, therapy putty and lots of tiny toys like travel Connect Four games.  Even baking.     Utensil use counts too. How Using Utensils To Eat Prepares Your Child To Write    Children are spending less time with toys and more with tablets, so I insist that they use a tablet stylus with me in sessions.  They have no idea that the physical “drag” of the plastic point on the glass screen as they move objects around is creating resistance that helps their fingers get stronger.
  • Color with children, draw with children. A lot.  Coloring is less stressful to the risk-averse child who thinks he can’t write. Drawing simple shapes is directly applicable to writing letters and numbers.  Think “T” and a vertical cross, “A” and a volcano.  Watching an adult and listening to their narration, such as ” I am coloring around and around to fill in the balloon, since it is a circle shape”  is very helpful to young children who resist direct instruction.  The child that doesn’t naturally gravitate to coloring may need downloads of their fave character or stickers to add to the picture to make it exciting.  But the key is the adult interaction.

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For Kids With Sensory and Motor Issues, Add Resistance Instead of Hand-Over-Hand Assistance

 

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One of my most popular posts, Why “Hand-Over-Hand” Assistance Works Poorly With So Many Special Needs Children , explains how this common method of assisting children to hold and manipulate objects often results in rejection or even aversion.  This post tells you about my most successful strategy for kids with low muscle tone and limited sensory processing:  using graded resistance.

Why does making it harder to move work better?  Because if the child is actively trying to reach and grasp an object, you are providing more tactile, kinesthetic and proprioceptive information for their brain.  More information = better quality movement.  Your accurately graded resistance is doing what weighted/pressure vests, foot weights and SPIO suits do for the rest of their body.  Could you use a hand weight or weighted object?  Maybe, but little children have little hands with limited space to place a weight, and weights don’t distribute force evenly.  Did you take physics in school?  Then you know that gravity exerts a constant pressure in one direction.  Hands move in 3-D.  Oh, well.  So much for weighting things.

How do you know how much force to use?  Just enough to allow the child to move smoothly.  Its a dance in which you constantly monitor their effort and grade yours to allow movement to continue.

Where do you place the force?  That one is a little trickier.  It helps to have some knowledge of biomechanics, but I can tell you that it isn’t always on their hand.  Not because they won’t like it, but because it may not deliver the correct force. Often your force can be more proximal, meaning closer to the shoulder than the hand.  That would provide more information for the joints and muscles that stabilize the arm, steadying it so the hand can be guided accurately.   If a child has such a weak grasp that they cannot maintain a hold while pushing or pulling, you may be better off moving the object, not the hand,  while they hold the object, rather than holding their hand.

Still getting aversive responses from the child?  It may be because the child doesn’t want to engage in your activity, or they don’t realize that you are helping them.  They  may think that adults touch them to remove objects from their grasp or otherwise stop them from exploring.  Both can be true.  In that case, make sure that you are offering the child something that they want to do first.  Remember, we can’t force anyone to play.  The desire to engage has to come from them, or it isn’t play.  Its just adults making a kid do something that we think is good for them.

 

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One of the most amazing places I have ever seen:  Australia!

OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues

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Does your child knock over her milk on a daily basis?  Do utensils seem to fly out of your son’s hands?  I treat kids with hypermobility, coordination and praxis issues, sensory discrimination limitations, etc.; they can all benefit from this terrific line of cups, dinnerware and utensils.

Yes, OXO, the same people that sell you measuring cups and mixing bowls: they have a line of children’s products.  Their baby and toddler items are great, but no 9 year-old wants to eat out of a “baby plate”.

OXO’s items for older kids don’t look or feel infantile.   The simple lines hide the great features that make them so useful to children with challenges:

  1. The plates and bowls have non-slip bases.  Those little nudges that have other dinnerware flipping over aren’t going to tip these items over so easily.
  2. The cups have a colorful grippy band that helps little hands hold on, and the strong visual cue helps kids place their hands in the right spot for maximal control.
  3. The utensils have a larger handle to provide more tactile, proprioceptive and kinesthetic input while eating.  Don’t know what that is?  Don’t worry!  It means that your child gets more multi-sensory information about what is in her hand so that it stays in her hand.
  4. The dinnerware and the cups can handle being dropped, but they have a bit more weight (thus more sensory feedback) than a paper plate/cup or thin plastic novelty items.
  5. There is nothing about this line that screams “adaptive equipment”.  Older kids are often very sensitive to being labeled as different, but they may need the benefits of good universal design.  Here it is!
  6. All of them are dishwasher-safe.  If you have a child with special needs, you really don’t want to be hand-washing dinnerware if you don’t have to.

For more information about mealtime strategies, please take a look at Which Spoon Is Best To Teach Grown-Up Grasp? and Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child.

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Teach Utensil Grasp and Control…Without the Food!

Therapro has just published my latest guest post! There are some situations that almost require occupational therapists to separate mealtime from utensil manipulation, at least at the earliest stages.  Check out my post Teaching Utensil Use Outside of the Mealtime Experience to find out if your child or client would benefit from this approach!

If you haven’t already read this very popular post I wrote earlier, make learning to use utensils an opportunity to bond emotionally,  take the pressure of self-feeding off the table and help an avoidant child engage in food play with Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child.

Therapro has been one of my go-to sources for quality therapy equipment for years.  Take the time to review their catalog online and explore their unique bowls, plates and utensils that can help children with developmental delays achieve independence in self-feeding.

Helping Little Kids Cut With Scissors

 

 

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terrific safe scissors for little hands!

I am very proud to share my latest post on Therapro, a terrific company that I have used for years to find quality therapy equipment.  They were nice enough to allow me to be a guest blogger this month, and so I wanted my readers to have the chance to go over there and check out my scissors post.  Here it is: Helping Little Kids Cut .

Therapro sells a wide variety of scissors for use in therapy and at home, so if you are not sure what you need, ask your occupational therapist for some advice.  My best suggestion is safety first; don’t buy a scissor that will cut skin unless you know that your child will be able to respond to your safety guidelines.  After that, some kids need a scissor that opens back up for them after they close it, and some need more physical assist to close the scissor as well.  The best scissor is the one that your child will use and will assist them to be successful.

To learn any skill, it helps if a child is interested and engaged.  Getting them there can be a problem.  That is what this post is all about; the preparation and presentation that makes kids want to learn.  So take a look at  my post on Therapro’s site, and let me know what you think!!

Why Eating From a Pouch Isn’t Helping Your Child As Much As You Think

 

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Sucking food from a pouch has become a common way to funnel fruits, veggies and even protein into young children.  Few kids are eating them because they have oral motor or sensory processing problems that don’t allow them to eat solid food.  Most of the pouch kids are picky eaters or eating a pouch “on the fly” in between activities and locations.

I know very well what a food fight looks like with a picky eater.  All that whining, food flying onto the floor, and fears that your child will either starve or be nutritionally deprived.  It can get ugly.  I know.  But when pouches are more than an occasional emergency ration, they aren’t without some costs.

Here is what you risk when pouches replace solid food:

  1. Your child’s digestive system needs the physical fiber to learn how to handle it well. A colon that has very little fiber isn’t capable of dealing with regular food as well.  You risk constipation and then you have to treat that problem.  And your child feels awful when “backed up”.  Don’t let them suffer that belly pain when they are capable of eating foods with fiber.  Natural fiber.
  2. If your child is young enough to be still learning to speak (and some sounds, like “th” don’t fully emerge until 3.5-5 years old), eating, chewing and even swallowing still counts as exercise and motor learning for all the structures/movements that accomplish this amazing task.  Sucking on a nozzle doesn’t support learning anything unless you are under 6 months old.  Oops.
  3. Eating is a social activity, done over time and with other humans.  Not with tablets, not with screens.  With people that model language, social and feeding skills.  Sucking down a pouch is a one-and-done experience that sends a child off their chair and back to playing too fast to absorb much of anything.
  4. Eating is a fine motor activity, from finger feeding to spoon use with soup.  Miss out on all that work, and you might find that your child is the slowest writer or even hates to write and draw.  They haven’t spent the first 3 years of life refining finger movements in the most rewarding way possible.  Food in: successful hand use.  Food on the bib/table/floor?  Recalculate and refine finger use.

What do those pouches really provide?  An easy way to feed a child nutritious food ingredients without an argument.  The problem is that all that work for kids and parents when they eat real food with their fingers or utensils is actually an investment in current and future skills that too many children need today.

Looking for more information on building self-feeding skills?  Read Teaching Children To Use Utensils to Eat: Use Good Tools, Good Food, and Good Timing for some hints on how to make things easier, and Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child for the most fun and easy way to practice holding a spoon.

Taping The Paper To The Table For Your Child? Stop!

Many young children between 2 and 5, especially children with low muscle tone or postural instability, will struggle with bilateral control.  In preschool, one way to notice this is to see the paper sliding around the table while a child colors.  The common response of teachers (and parents) is to tape the paper down.  Oops!  This  eliminates any demand for both hands to work together.  Bilateral control only develops if it is needed and practiced.

The better approach, the one that makes the brain work and builds a child’s skills, is to make it even more slippery while making the activity more fun.

Why?  This child,’s brain, as described, needs more information about what is going wrong with the activity.  You can use heavier paper, stickers in a book that need accurate placement, or fun glittery markers.  Really, anything that makes a child care more about placing marks accurately.   I select the smoothest table surface available.  Glass coffee tables are a fave at home.  The alternate choice is a bumpy surface, something that will be slightly uneven and make the paper move more with each stroke.

I have some older kids that really struggle but can use a visual cue.  I make a mark on their paper and tell them to put their “helper hand” – the one not coloring- on this mark.  This is sometimes helpful, but it is limiting the extent that this hand is providing optimal postural support.

Yup, support.  The hand that holds the paper is also performing another function.  It is stabilizing the child’s body so that the dominant hand can execute a skilled movement.

So….no more tape on that paper, OK?