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Sensational Development Occupational Therapy of Massapequa, NY provides skilled, child-centered individual and group intervention for children ages birth through 21 who may be experiencing difficulty with daily activities such as self-care, academics, play, social skills, organization, coordination, and behavior. We have teamed up with some of the most dynamic and passionate instructors and we are thrilled to now be offering Yoga! Please call for scheduling and reservations.

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Blog posts by the staff at sensational development. We post information and topics of interest for our clients.

 

Filtering by Tag: occupational therapy

   You’re on a diet? NO, I’m on a “Sensory Diet”

Sara Rutledge

When hearing the word “diet”, as a society, we immediately associate the word with eating healthier or limiting our intake of certain foods and beverages. For parents, when the term “sensory diet” is first introduced, a variety of questions of confusion and curiosity may come into play. Have no fear- this type of diet has no effect on what your child can/cannot eat but what in fact your child can do throughout his/her day to help and assist with attention, arousal, and adaptive responses. A sensory diet is a carefully planned program of specific sensory-based activities that are scheduled according to each child’s needs, consisting of specific components and “nutrition” for the central nervous system (CNS).

Children with a Sensory Processing Disorder (SPD) may have a difficult time adjusting to everyday stimuli that may not appear as a problem to a person without sensory-processing difficulties. As a child who may have a difficult time adjusting everyday stimuli it may illustrate an under-responsive behavior (low arousal) or an over-responsive behavior (high arousal) (Wilbarger & Wilbarger, 2002). With these children who have a hard time adjusting or modulating his/her behaviors, this may effect a child’s participation in everyday childhood “occupations”, or behaviors and roles that are important to the child’s growth and development. Examples of “occupations” that are important throughout childhood are play, self-care, school, and sleep.  

With all of this information the next step is asking; how is a sensory diet created? As an occupational therapist it is our role to help assist in creating the sensory diet, with the help of parents/guardians, teachers etc. that are with the child on a daily basis. The key to creating a successful sensory diet is by gathering information on the child's day, routines and schedules in addition to observations of the child and how they respond to sensory experiences.  In terms of writing down your child’s daily activities, it is important to note/comment on your child’s performance or activity level during these times or activities. The more detailed you are the more helpful your information will be in determining sensory diet activities and/or tasks that will benefit your child in his/her environment.

For parents and children with a Sensory Processing Disorder, incorporating a sensory diet into his/her daily routine may be helpful in allowing the child to perform as optimally as possible in his/her environment. With this being said, there may be trial and error process, and this is not something to get discouraged about. With the help of your child’s occupational therapist, teachers, and supporters, your child will find a variation of different activities/tasks to helpful maintain an optimal arousal level, in order to find success in each activity throughout the day. Every child with Sensory Processing Disorder is unique and this will reflect each sensory diet differently. Some activities may work for your child and some may not; it is important to stay positive and work through this process- it will be worth the wait!

 

- Marisa DiRienzo, OTS

 

There is so much more to writing than holding a pencil!

Sara Rutledge

Foundational skills are often overlooked when talking about handwriting. Neat, legible handwriting does not come overnight. There are many prerequisites that need to be acquired before a child’s handwriting performance can improve. In order to build a solid foundation for handwriting, a developmental progression of hand functioning and hand skills must be reached.

We all need adequate core muscles for everyday activity. Children need stable cores to maintain upright postures in their seats, develop shoulder stability and adequate fine motor skills. Going hand-in-hand with core muscles is trunk control. To understand the importance of a strong and stable trunk, just think about a fishing rod. Imagine a rod made of rubber. Try casting a line - it simply wouldn't work. With a floppy rod your control of the line and hook would be non-existent. A child's trunk is like the fishing rod. A strong and steady trunk provides the base of support needed for delicate fine motor tasks like writing (Handwriting Help for Kids, 2001).

Did you ever think that postural stability could have an impact on your handwriting? It is critical to have proximal stability in order for the more distal muscle groups to perform fine movements. Many muscles around the shoulder work together to hold this joint stable when performing fine motor tasks. If a child has poor shoulder stability, then he/she cannot hold this joint stable, impacting fine motor control. If this joint is loose, then fine motor control needed for writing is impossible to achieve. A strong upper body and shoulders are necessary for controlled movements of the hand and fingers. Without a stable base of support it is difficult to guide the eyes and hands to work together.

            Each hand is divided into two separate sides: the precision side and the power side. The radial (thumb) side of one’s hand is important for precision with manual dexterity such as threading a needle or buttoning a shirt.  The ulnar (little finger) side of the hand is important for power such as opening a jar.  Together these two features of the hand comprise the necessary prerequisites for fine motor control.  Writing, coloring, and scissoring require stability of the ulnar side of the hand while the small muscles of the radial side of the hand produce small precise strokes/snips for proper motor control.

            As a child’s strength and control develops, the movement of writing will move from the whole arm, to the wrist, and finally to the fingertips. Intrinsic muscle movement can be seen when the ulnar side of the hand is stabilized on the table while the fingers move a pencil to write. The intrinsic movements are best observed in activities that require the tips of the thumb, index finger, and middle finger be touching while they are performing flexion with the thumb is in extension.

Motor planning involves spontaneously sequencing and organizing movements in a coordinated manner to complete unfamiliar motor tasks. Timing and sequencing are essential to motor planning, as well as ideation (how to approach a novel task) and execution (how to follow through with a novel task).  Adequate motor planning abilities are needed for writing; some examples are: knowing how to form letters and where to start the letter, spatially planning a sentence and knowing when to move to the next line, coming up with an idea for a story or sentence, and knowing the relationship or part to whole.

There are so many different pieces and components to handwriting that go unrecognized. Every piece to this ‘puzzle’ is equally as important as the next and has its own impact on the puzzle as a whole. Until all the pieces comes together, functional and successful handwriting is much more difficult to achieve!

Rachel Durante, MS OTR/L

What is Wrong with “W” Sitting?

Sara Rutledge

A few weeks ago, an article about W sitting in children began circulating around various social media sites and began to raise more awareness about this body position.  As occupational therapists, we are acutely aware of this position and understand the concerns associated with it. However, it is our responsibility to educate parents and families about these types of concerns and introduce strategies to modify or alter them in order to encourage a proper body position during seated tasks. So, what exactly is “W” sitting, and why is it such an important topic to address?

Take a look at this great handout about W sitting by Inspired Treehouse:

What is “W” sitting?

 “W” sitting occurs when a child sits on his bottom with both knees bent and each leg positioned on either side of the body, next to each hip. If you stood above a child seated in this position, it would look like his legs form a “W” shape. This seated position provides a greater base of support for the child and allows for increased stability in the lower extremities. However, when seated in this position, the child does not have to elicit his core muscles to maintain an upright posture.

Why is this a Concern?

When a child sits in the “W” position, he does not utilize his core muscles to achieve trunk rotation or shift his weight to reach for his toys.  Without the activation of core musculature, a child may have decreased core strength and postural control which are important foundational motor skills needed for further growth and development. A child who is unable to shift his weight or rotate his trunk is likely to have difficulties with balance, crossing midline, and using both sides of his body together (bilateral coordination).  This delay in skill development may directly affect a child’s functional skills in his home and school environments.

 How Can You Help?

If you notice your child “W” sitting, you can encourage him to position his body in different sitting styles. Show your child how to sit in the criss-cross position, side sit, or sit with his legs extended in front of his body. Do avoid telling your child to "fix your legs" as there is nothing "broken". Instead you can tell the child how they can sit: "legs in front" or "one leg in front". If you "side sit" with one leg behind in hald of the "W" position and one leg bent in front of you, you will see that most of your body weight is on the hip with the leg in front, thus placing less strain on the hip that is rotated internally. Additionally, introduce core strengthening activities that will help your child develop the postural control needed to assume an upright seated posture using his core muscles, rather than his legs and bottom to maintain the seated position.

Siobhan Stellato, MS OTR/L

 

 

 

‘Tis the Season!

Sara Rutledge

The holidays are fast approaching and although this is a time for family, memories, joy and giving, it can also be a time of stress for children and their families, especially when sensory processing difficulties come into play. The lights, carols, sounds of bells, Christmas trees, smells of pine and peppermint, Santa and his Elves at the mall, as well as increased traffic and shoppers out in the community can create a state of sensory overload for many of us.  Just imagine how a child, maybe even your child, feels during this time. The house, entire neighborhood even, can look different with trees trimmed, lights on and blinking and decorations galore.  Driving up to your beautifully decorated home may cause stress for your child if it looks different than usual. Try including your children in the decorating process. Maybe even tell a story or talk about decorations, what specifically will be in or on your home and how it will make the environment look different. When decorating your home, it is important to consider and respect your child’s sensory preferences and needs. This may include choosing lights that stay lit rather than ones that flash or change color, choosing decorations that are silent rather than ones that make noise.  Holiday stories may also cause anxiety, stories about reindeer on the roof, being naughty or nice etc.

Taking shopping trips and general trips into the community during the holidays are times to consider implementing sensory diet techniques more than usual. When you are aware that your day may include activities involving a great deal of sensory information, try to schedule other times of the day to involve calming activities. It will be important to watch your child for signs of sensory overload, shutdown or fright/flight/fight behaviors.  Meltdowns may become more frequent, causing your holiday errands and shopping to become more difficult. Other signs of stress include: changes in sleep wake cycles (having a more difficult time than usual settling down or waking up), changes in overall activity level, changes in their interactions with others (more aggressive than usual).  Prepare your child for any changes in routines; use calendars and visual schedules whenever possible. Writing and drawing a list on a small paper or whiteboard to take in the car can also help. Have your child/children cross off each errand/store as it is accomplished. This should also decrease the “Are we done yet? When can we go home?” questions. You could also try giving your child a “visual shopping list” so they are part of the shopping process and this could keep them attentive, involved, prevent them from pulling everything off of the shelves as well as giving a sense of accomplishment. Baseball caps can decrease the spatial and visual components of being at the mall and oral input (gum, sucking candy etc) can also be organizing.

Please remember to be consistent. If you say you are going to one more store and then going home for dinner, it is important that you follow through with this. Children have a hard time understanding how time elapses and phrases such as “just a minute” or “we will leave soon” may cause your child to become easily frustrated.

A holiday event itself can be difficult as there are typically many more people around possibly bumping into you unexpectedly, more noise and movement and many unfamiliar or strong smells. Keep an eye on your child during the event. Watch for signs of stress and facilitate opportunities to take breaks from family members, go for a walk, and have the child “help” incorporating heavy work activities. Allow the child to stand on the outskirts of group activity (i.e., if the cousins are playing loudly). Maybe go for a walk, have the child get firewood from outside or something out of the car. Also, inform family members that it would be appreciated if they would allow the child to warm up to them prior to approaching them and invading the child’s space before they are ready.

Spending more time in the car can be difficult as well. Keep activities in the car to help with the driving around. If your child gets carsick easily, incorporate heavy work. Provide your child with chewy snacks or gum/lollipops. Wearing a baseball cap in the car can decrease the amount of spatial and visual input too. Play calming music in the car, slow rhythmic music, low frequency sounds such as drumming or classical music can be great. Avoid strong air fresheners or smells in the car as well. If in a car seat, try to provide your child with a surface to place feet flat or push against the back of the seat in front of them.

When sleep/wake cycles are interrupted this can impact the entire family. A bedtime routine is important.  Over time, a routine can help your child’s body get ready for bed before even getting to the bedroom. If bath time is part of the bedtime routine, bring PJ’s into the bathroom and put them on after a vigorous rubdown with a towel before ever opening the door and changing the temperature. A warm towel thrown into the dryer 10 min prior to bath time can also be nice. Background noise such as a humidifier, fan or heater or soft calming music may be helpful, especially if you know music/auditory input is helpful for your child. Respect your child’s preferences for sleepwear. A child who is sensitive to touch may not like footed pajamas or may prefer tighter fitting pajamas that offer deep pressure to the entire body.  Heavy blankets or large pillows may be beneficial too as well as stuffed animals to hug or cuddle with. Massage, joint compressions or pillow squishes may be a way to provide calming input prior to bedtime.  Some children need to be slowly awakened as well; including slowly introducing light into the room, massage, gentle squishing, or rocking. Always limit conversation first thing in the morning for a child who has a hard time waking up.

Be sure to catch your children being good! This includes praise for following directions or routines, displaying appropriate behavior etc. 

And most of all, have a wonderful, happy and healthy Holiday Season and New Year!

 

Happy Halloween

Sara Rutledge

Fall is a time of the year that many people seem to look forward to and enjoy. This season is filled with the anticipation of changing leaves, apple and pumpkin picking, and of course all of the events surrounding and leading up to Halloween.  Although the traditional preparation and activities involved with Halloween may be a fun and exciting for most families, a reasonable number of children may also find this time to be filled with frightening decorations, uncomfortable costumes, and unpredictable sounds and surprises.  The anticipation of encountering these holiday stressors may cause a child to experience anxiety and discomfort in the presence of Halloween events.  As individuals who celebrate Halloween by distributing candy, Trick-or-Treating, and attending costume parties, it is important to remain aware of these stressors, do our best to prepare our children for this event, modify the environment to address their concerns, and provide every child with the opportunity to participate in this exciting holiday. 

In the last few years, there has been a powerful quote shared throughout social media that has raised awareness of the challenges that many children may face during the events that surround this fright-filled holiday.  It reminds us to remain open minded about each individual child’s needs and be aware of our ability to remain patient and try to understand that the children we see celebrating this day may be facing their own obstacles in order to engage in the various Halloween activities. 

Tonight a lot of creatures will visit your door. Be open- minded. The child who is grabbing more than one piece of candy might have poor fine motor skills. The child who takes forever to pick out one piece of candy might have motor planning issues. The child who does not say “trick or treat” or “thank you” might be painfully shy, non-verbal, or selectively mute. If you cannot understand their words, they may struggle with developmental speech.  The child who looks disappointed when he sees your bowl might have an allergy. The child who isn’t wearing a costume at all might have SPD or autism. Be kind, be patient, smile, pretend you understand. It’s everyone’s Halloween.

When reading the above quote, it may seem easy to remain patient and understanding throughout the day of Halloween. However, there are additional steps we can take to help prepare children for the excitement of the day and provide them with an environment that will promote their ability to participate in the holiday activities while remaining aware of their needs and concerns. Here are some tips and strategies to ease the stress of Halloween and assist in creating a fun and interactive day. Do you have any additional tips that have been helpful for your family on Halloween? Please share in the comments below!

Prepare your child for the holiday traditions:

Discuss some of the traditions and activities that surround Halloween. Read a book, watch a video, create a social story, or role-play some of the events they may experience.  Establish and review the rules and boundaries regarding certain activities (i.e. Trick-or-Treating or approaching strangers).

Be flexible when choosing and wearing a costume:

Remember that an outfit does not need to be elaborate to be considered a costume. Be aware of the costume’s qualities including the texture, beading, stiffness, and restrictiveness. Allow your child to try out various costumes and decide which is best for him. Let your child know that he may change his costume as needed, or may participate in Halloween activities without a costume if preferred. Practice wearing the costume at home to become familiar with the fit and to become accustomed to others’ reactions to the outfit.

Map out a pre-planned Trick-or-Treat route:

In the upcoming weeks, travel around your town and be aware of houses that may be too scary or areas that may become very busy during the Trick-or-Treating hours. Prepare a route to follow that avoids large crowds, loud noises, scary decorations, and heavy traffic.  If possible, go to houses or friends or family members.  Prepare your child and remind them that they can pass by houses that may have too many children at the door, people with scary costumes, or frightening decorations.

Practice the sequence of walking to the door, saying “trick-or-treat”, putting the treat in the bag, and saying thank you. Remember that even a short Trick-or-treat session can be fun!

If your child does not want to Trick-or-Treat, choose alternative activities:

Trick-or-treating is not mandatory. Meaningful participation in Halloween activities can include making Halloween crafts, carving a pumpkin, bobbing for apples, watching Halloween themed movies, or even handing out candy at home.  Choose activities that benefit your child’s needs.

Focus on your child’s sensory diet to prepare for the Halloween activities:

Complete heavy work and proprioceptive activities at home prior to engaging in exciting Halloween events. Oral sensory input can also be calming. Provide your child with exercises or activities that will promote regulating his body in preparation for a busy day filled with many stimulating events.

Consider noise-canceling headphones during events that may have loud music, large crowds, or unexpected sounds from decorations.

Allow all children to participate in party games and activities:

Although some children may enjoy getting messy and carving a pumpkin, this activity may cause other children discomfort. Allow children to decorate pumpkins with markers or stickers. Show children that a dark or overwhelming room can be modified by turning on the lights, decreasing music volume, and covering decorations.

Be aware of the various “treats” that your child is given:

Many candies and foods may contain allergens and trigger food sensitivities. Establish rules on making sure an adult checks the “treats” before the child eats them. Be aware of “hidden” ingredients such as soy, milk products, and red-dye.

Monitor your child’s behaviors and reactions throughout these Halloween events:

Throughout these Halloween events, it is important to remain alert and aware of your child’s behaviors and arousal level to help them fully participate in the desired holiday activities.  Some things to consider include limiting the duration and number of people and activities, give your child notice and advanced sequence of the upcoming events, and practice using phrases such as “is it my turn?” and “please don’t touch my costume”.

Know when your child is giving you signs that it is time to disengage from an activity. Recognize the signs of sensory overload including fatigue, crying, easily frustrated, and increased level of arousal or excitement. Provide your child with a quiet and safe environment when activities become too overwhelming.

Preparing your children for Halloween and providing them with a safe and understanding environment will encourage them to participate in the various holiday festivities and enjoy a day filled with fun and exciting events for everyone!

-Siobhan Stellato, MS OTR/L