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August 1 2011 2 01 /08 /August /2011 22:58


What is it? 

Children are naturally active and impulsive. They need to move around their environment freely to explore and learn about the world around them. They often become over excited, over active or display impulsive behaviour frequently. This can leave parents, other carers and the general public slightly confused and concerned about the child when he or she is not conforming to the expected behaviour within our society. Questions about the child's level of activity arise and when this high level of activity begins to interfere with daily life, professional help is often sought.


Attention Deficit Hyperactivity Disorder (ADHD) is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness. These symptoms usually show before the age of seven and are seen as a coexistence of attention problems and hyperactivity.  Attention Deficit Disorder (ADD) is a type of ADHD and is characterised primarily by inattention, easy distractibility, disorganisation, procrastination, forgetfulness and lethargy or fatigue. ADD has fewer or no symptoms of hyperactivity or impulsiveness and is more recently not referred to as a seperate diagnosis by medical professionals.


Common symptoms of ADHD include:

  •  a short attention span
  •  restlessness
  •  being easily distracted
  •  constant fidgeting

Manny people with ADHD will also have additional problems such as sleep disorders or learning difficulties. However, ADHD has no effect on intelligence. The symptoms of ADHD are especially difficult to define because it is hard to draw the line at where normal levels of inattention, hyperactivity and impulsivity end and where the clinically significant high levels that require intervention begin. However, if it is significantly affecting a child's ability to learn and their ability to complete normal daily tasks, then a diagnosis and intervention should be sought. ADHD is a chronic disorder that affects 2-4 times more boys than girls. It is thought that 30-50 percent of children diagnosed will continue to have symptoms into adulthood. Most adults by this stage have developed coping techniques, so the symptoms are not as marked as they are in childhood.




 The cause of ADHD is unknown, however it has been thought that a number of factors (including diet, genetic as well as social and physical environment) contribute to exacerbate the condition. Genetics tend to be a factor in around 75 percent of all cases whilst environmental factors are thought to be the next major influence. This involves alcohol and smoking during pregnancy, exposure to lead and pesticides, complications during pregnancy and birth (including premature births), infection during pregnancy and at birth all increase the risks.




Diet and the use of artificial food colours have a strong link to ADHD (The Lancet 2007). The study found that certain yellows and reds used in food were the main contributors. A study conducted at Southampton University found that along with food colouring, some food preservatives are also thought to contribute towards ADHD.




The social factors that are thought to contribute to the condition include dysfunctions in family life or inadequate education systems. Some researchers have found that the child's relationship with the caregiver (parent) can be a major influence, but there has been much controversy over this possible factor .



Many of the symptoms of ADHD occur from time to time in all children. However, children with ADHD display a much greater frequency of the symptoms and their lives are significantly impaired to the extent that their friendships and school work are affected. The impairment needs to occur and be observed in different settings for the symptoms to be classified as ADHD. If a child is over active in the playground, but not anywhere else, the symptoms may not be considered ADHD. If a child has the symptoms of ADHD, but continues to form and keep friendships as well as achieve in school, then it is doubtful if they would be diagnosed with ADHD (American Academy of Child Adolescent Psychiatry 27/6/2009).  


ADHD is considered a psychiatric medical disorder of which the formal diagnosis is made by a qualified professional in that field. The diagnosis is based on a set number of criteria that can be found listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). ADHD may accompany other disorders such as anxiety or depression. This makes diagnosis difficult and can complicate treatment.





The treatment and diagnosis of ADHD has caused controversy since the 1970s. Treatment usually involves a combination of medication, behaviour modification, learning coping techniques, lifestyle changes and counselling. Many children with ADHD will also have sensory processing disorders and this can contribute to their inability to pay attention, focus and concentrate. These children will either withdraw from or seek sensory stimulation like movement, touch, light and sound. They may make loud noises and constantly move, touch and fidget in order to get the appropriate stimulation that they seek. Other children with ADHD may withdraw from loud noises, busy rooms, bright light and not engage appropriately in an activity as expected. They will then be considered to be troublesome and badly behaved in school and in other social settings.


Occupational therapists are able to provide therapy programmes that will address the sensory processing difficulties and help the child to attend and learn by adapting the environment and activities. There are several programmes and activities that occupational therapists may use to provide the child with tools and coping techniques for use within school , home and other social environments.   





The Alert Program

This is also called "How Does Your Engine Run" and was created by Mary Sue Williams and Sherry Shellenberger as a means of helping children to learn self regulation. The programme works well with children who have sensory processing difficulties as it teaches the child that their brains are like "engines" that are sometimes running fast and sometimes running slow. The goal is to make the engine run just right. The child learns this by engaging in activities that bring their engine up or down according to their needs at any particular time. Fast engines can be slowed by squeezing balls, dimming lights and listening to relaxing music. Slow/sleepy engines can be perked up with fast music, tickles, dancing and bright lights.


Sensory Diets

 Occupational therapists design individual Sensory Diets to provide a child with the type of stimulation that they need to remain focused and able to learn throughout the school day. The diet may include movement activities such as jumping on a trampoline during break time, carrying heavy objects such as books, chairs and heavy school bags. Other sensory activities include squeezing putty, wearing weighted vests for short periods of time, using a scooter board or playing tug of war. These are incorporated into the school day to ensure the child remains alert and focused for learning. The therapist reviews the activities to determine which ones help the child's brain to become more organised at different times of the day.




Brain Gym 

Some occupational therapists use movements from the Brain Gym programme which was created by Paul E. Dennison. Ph.D. The aim of the programme is to improve communication between the left and the right side of the brain using whole body movements such as drawing giant sized infinity signs on a board or touching the left foot with the right hand and the right foot with the left hand whilst hopping. The basis of the Brain Gym theory is that improved communication between the two sides of the brain will decrease hyperactivity and increase focus.


Other tools such as Visual Perceptual programmes, teaching strategies and classroom adaptations are facilitated by the occupational therapist who will work closely with teachers and parents. Small tips often work, such as asking a child to repeat the sentence when giving instructions. Keeping classroom materials clearly labeled and in the same place can make a big difference to a child with ADHD when they are trying to organise their thoughts and environment. There are many other strategies that are beneficial to a child with ADHD. The occupational therapist can individually assesses and determin the most suitable ones for the individual child.






Useful links:








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June 24 2011 6 24 /06 /June /2011 21:26

tumblr lcnvcutTS81qdp3nbo1 500The word hippotherapy is derived from the Greek hippos meaning horse. Hippotherapy is therefore treatment or therapy that is aided by a horse.


Throughout history horses have been used in many ways to help improve our quality of life. They have been essential for farming, battles, transport, entertainment, sports, herding animals and police work amongst many other uses. Their versatility and ability to be easily trained have made horses an important part of many cultures throughout history. Horses have recently played an important part in therapy and have been proven useful therapeutic aids to the therapist.


Hippotherapy in its purest form is carried out by occupational therapists, physiotherapists and speech therapists. It is based on a classic German model of practice used since the 1960s. Therapists need to have had the relevant training and hold a certificate of clinical competence (SLP/CCC) if they are using the classical method as this involves the movement of the horse to influence the client.


Hippotherapy can therefore be described as the use of the movement of the horse as a treatment strategy to address impairments, functional limitations and disabilities in children with neuromotor and sensory dysfunction. Carefully graded motor and sensory input is provided to achieve treatment goals. It can then be generalised to a wide range of daily activities. Hippotherapy may also be used with adults, but it is more commonly started at an early age where the therapeutic effects and results are more immediate.  



Hippotherapy is the medical application of the horse in therapy. The use of the movement of the horse makes hippotherapy unique to other equine-assisted therapies as the movement is multi-dimensional, variable, rhythmic and repetitive. It is purely the horses movement that influences the patient who in turn passively responds to and interacts with this movement. The therapist can then analyse the patient's response and adjust the way the horse moves accordingly. The therapist therefore needs sufficient understanding of the way horses move to be able to direct the horse and alter the tempo of the gait or length of stride. 


The primary focus of classic hyppotherapy is the patient's posture and movement response. The horse provides a dynamic base of support, making it an excellent tool for increasing trunk strength and control, balance, postural control (strength and endurance), addressing weight bearing, co-ordination and motor planning.The horse's movement also helps with the development of fine motor skills, visual motor skills, bilateral co-ordination, attention and cognition. The child needs to perform subtle adjustments in the trunk to maintain a stable position whilst the horse increases it's speed, slows down or lengthens and shortens its stride. Whilst this is happening the therapist can work on specific targets that facilitate co-ordination, motor planning, timing, respiratory control and attention skills through graded activities.




Hippotherapy can be used to address sensory processing issues. It provides input to the vestibular, proprioceptive, tactile, visual and auditory systems. The occupational therapist can incorporate the movement of the horse to modulate the sensory system in preparation for a therapy or treatment goal that will lead to a functional activity. the results can be seen from the appropriate adaptive responses from the child and often influence emotional, social, behavioural and communication outcomes.


There are other equine assisted therapies that benefit mental health, learning disabilities and autism. The child may be on or off the horse during these therapy sessions as they do not rely on the movement of the horse to influence or facilitate an adaptive response in the child. Treatment with other equine assisted therapies is not focused on the child's posture and movement, but includes a number of beneficial equine activities that involve handling the horse, grooming, riding, driving and vaulting amongst other activities. These activities provide the child with opportunities to increase self awareness with programmes that work on behaviours, feelings and attitudes amongst many other intrapersonal aspects.


Occupational therapists using hippotherapy will provide one-to-one hands on intervention and  continued assessment as to how the patient is responding. Adjustments are made where necessary and results are documented. This makes it very different from many equine assisted therapies or therapeutic riding. The treatment sessions are enjoyable and the interaction with the horse motivates many children who may otherwise avoid participating in their treatment aims. Therapy on a horse is fun and seems more like play than work. The hippotherapy setting is an ideal place to achieve occupational therapy goals.



Useful links:






















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May 21 2011 7 21 /05 /May /2011 14:02

Working Memory

What is Working Memory?


Our memory is the core of our learning and ability to function successfully within our environment. We need to remember what we hear, see, feel, smell and taste in order to process, analyse and form conclusions about our experiences. In school, children need to remember facts, dates, numbers, spellings and many other key elements that form our education. 


Our working memory is a temporary system for storing and managing the information that passes by quickly, but is needed to carry out complex cognitive tasks such as learning, reasoning and comprehension. This information is not required to be remembered forever and is only needed for short term. Short term memory has a limited capacity (not much of it can be stored) and it has a rapid loss of information as it is only stored for a limited time to be used at that time.


Children with working memory difficulties are often seen as having poor concentration and attention. They are easily distracted and lose their train of thought whilst another replaces it. Working memory difficulties will make it hard for the child to follow instructions and retain information. This can result in them being poor at subjects like mental maths because once they are distracted away from the task the information that should have been held in the working memory is gone and they have to start all over again.



It has been observed that children with coordination difficulties will also tend to have working memory difficulties. This is because they are distracted by consciously thinking about coordinating their movements, so that the information that should be held in their working memory is lost. Learning will become difficult for these children and they lose motivation or they start guessing the answers and appear not to have understood the question or the process.


Children with dyspraxia are 7 times more likely to have poor visual-spatial memory than those without motor difficulties. Visual-spatial memory is used for remembering directions and locations as well as in tasks such as handwriting and maths. It is therefore essential to be able to hold such information in the working memory to function at a level expected of their age. These children could have a high IQ, but would still underachieve in school if they have working memory difficulties.







 Intervention for improving the working memory is vast and can be categorised into the component parts of the Auditory, Visual and Tactile memory. It is usually the auditory and visual memories that are concentrated on in schools and needed for classroom learning. An Occupational Therapist can assess the child for specific working memory difficulties as each sense has different aspects to it e.g. visual-spatial, visual-closure, visual-figure-ground, visual-discrimination as well as similar aspects of the auditory system including sound pitch, sound sequencing and sound intensity.


When working on the development of visual memory the role of language in labelling and fixing visual experience and visual imagery is of great importance. With visual working memory the therapist concentrates on recall of displayed material (with delayed recall). The identification and reproduction of colours, shapes, forms, symbols, letters, words and sentences as well as recent visual experiences are used. Sequential memory is also worked on as this has a great impact on reading and spelling.


Below is a game that is beneficial to developing the visual working memory. This idea would be graded and adapted by the therapist to suit the individual child. It is therefore important to have an assessment carried out by a trained therapist.



 The training of auditory working memory and auditory sequencing involves accurate repetition of known sequences or colours or numbers presented to the child for recall. This is usuall graded and increases with difficulty as the child progresses. This is essential for understanding, retaining and following instructions. There are numerous different activities that can be used for training the auditory working memory.




Individual treatment programmes that are also beneficial to the whole class are often given to teachers by the Occupational Therapist. This ensures that the required amount of treatment is easily encorporated into the school's routine and the other children benefit from the programme as well. The general recommendation for improving a child's working memory is to develop effective coping strategies with situations in which the child may experience working memory failures. This includes:


  • Encouraging the child to ask for forgotten information where necessary.
  • Training in the use of memory aids
  • Offering encouragement to continue with complex tasks rather than giving up (even if the steps are not completed due to memory failure)


Arming the child with such self-help strategies will promote their development as independent learners who are able to identify and support their own learning needs.







A useful website to visit:









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April 30 2011 7 30 /04 /April /2011 22:00


What is it?

This is a sound based programme that combines the therapeutic benefits of music with sophisticated sound technology. It produces specific effects on listening skills and listening difficulties, i.e., the ability to perceive, process and respond to sounds.


People with listening difficulties often have perceptual- motor, attention and learning difficulties. These are in turn largely due to sensory processing problems.


‘Listening’ is a function of the entire brain and training these sensory functions goes well beyond stimulating the auditory system-we tend to listen with our whole body.


The listening programme uses sound stimulation in combination with sensory integration, with a strong emphasis on vestibular and postural movement strategies. It integrates a number of electronically synthesised or altered CD’s based on ideas of various sound technicians, physicians and hearing specialists.


When used with sensory integration treatment, the listening programme has given remarkable results and greatly reduced the time it takes to meet treatment goals.


Changes are typically observed in Sensory Modulation, ‘attention’ and ‘behavioural organisation’. Changes can also be seen in balance, postural organisation and motor skills as well as improved organisation in time and space, communication and pragmatic use of language.


The listening programme can be used for clients of all ages with a wide array of clinical pictures who are experiencing difficulties with sensory processing and listening skills.







Vital Links (www.vitallinks.net ) offers Therapeutic Listening courses for therapists to enable them to provide innovative clinical tools and strategies that can be implemented in schools clinics and homes.



How does it work?

The Therapeutic Listening Programme was originally designed by Dr Alfred Tomatis who had music and sound electronically altered for the purpose of training the ear. He was a French ENT specialist who had an interest in music and most of his clients were singers or musicians. He said, “The voice can only produce what the ear can listen to.”


The programme comprises CD’s that are modified using alternating high and low pass filters that accentuates the high frequencies from the low frequencies; and the foreground from the background.


The sounds stimulate and retrain different areas of the brain. They have an exercising effect on the muscles in the middle ear. As the middle ear muscle focuses on sound in the environment it contracts and relaxes. This is not automatic in some individuals who have listening problems.


Headphones are used due to the importance of the high frequency sounds that tend to die out quickly as they travel in air. They are the sounds that children most often have difficulty capturing and attending to. Headphones became part of the adaptive equipment to capture the sound.


Listening boy



The following areas of change have been noted with a listening programme:-


  1. Arousal, attention and focus
  2. Receptive and expressive language
  3. Processing speed for movement and language
  4. Integration of movement and sound
  5. Balance and co-ordination praxis (sequencing and timing)
  6. Range of effective expression
  7. Self motivation
  8. Awareness of environment
  9. Sensory modulation including sensory awareness
  10. Organisation
  11. Self initiation of play and work behaviour
  12. Self initiation of verbal interaction.






Other therapeutic listening programmes are available which run along the same lines and stem from Dr. Tomatis’ original findings. The Integrated Listening Programmes such as the Denver Pilot Study clearly shows the results that can be achieved from therapeutic listening. www.integratedlistening.com









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March 23 2011 4 23 /03 /March /2011 22:19



What is it?

 Erb’s Palsy (also known as Brachial Plexus Paralysis) is a condition which is mainly due to birth trauma. It is a paralysis of the arm that can affect 1 or all 5 of the primary nerves that supply the movement and feeling to an arm (specifically the upper trunk C5-C6 is severed to cause the palsy, but not exclusively). These nerves form part of the brachial plexus. They come out of the spinal chord between the bones of the neck (the vertebrae), comprising the ventral rami of spinal nerves C5, C6, C7, C8 and T1. The brachial plexus are the major nerves of the arm and run from the neck, passing under the collar bone to the level of the armpit.

Each baby’s injury is individual and the paralysis can be partial or complete. The damage to each nerve can range from bruising to tearing, so prognosis depends on the extent of the damage. Some cases resolve on their own over a period of months, whilst others require specialist therapy or even surgery. In all cases, however, early intervention is crucial so that the full extent of the damage can be ascertained and treatment begun. Treatment in the first year of life can have a significant impact on recovery.


Nerves are chord like structures of tissue from a collection of nerve fibres. One nerve may contain thousands of fibres (like a telephone cable). These fibres in the arm carry electrical messages from the brain to the muscle so that the muscle can work and move the arm. When a nerve is damaged the muscle that moves the arm may be weakened as the message is not getting to the muscle. Damaged nerve fibres that are outside the spinal chord can repair themselves; however, if an entire nerve is damaged or broken it can not grow back to the muscle.


Main Cause

The most common cause of Erb’s Palsy is an abnormal of difficult childbirth or labour. It can happen if there is excessive pulling on the shoulders during a head first delivery. It can also be the result of the baby’s head and neck being pulled towards the side at the same time as the shoulders pass through the birth canal. The injury can also occur in a breech delivery where there is pressure on the raised arm. Similar injuries can occur at a later age following a traumatic fall onto the side of the head and shoulder, where the nerves and plexus are violently stretched.




The signs of Erb’s Palsy include loss of sensation in the arm as well as paralysis and atrophy of the deltoid, biceps, and brachialis muscles. This results in a characteristic position of the arm where it hangs by the side and is rotated medially; the forearm is extended and pronated. The child can not raise the arm from the side and the elbow can not be flexed (bent). The forearm can not be supinated (rotated and turned upwards with palm facing up). The classical physical position is called a “waiter’s tip” (turning backwards).

When all the nerves are affected and the entire arm and hand is limp, there may be an associated Horners syndrome. This is when the child’s eye lid droops and the pupil in the eye may be smaller. There may be an associated Torticollis too (the baby faces away from the affected arm and is unable to face forward for any length of time). If the injury occurs at birth it may stunt the growth of the arm from the shoulder to the fingertips.


There are many factors that affect how severe the injury is and this, in turn, depends on the number of nerves affected. The paralysis can be partial or complete and the most commonly involved nerves are the suprascapular nerve, musculcutaneous nerve, and the axillary nerve.  Sometimes all the nerves may be affected causing weakness or paralysis of the entire arm or hand. The injury is so individual where by one or all of the muscles can become paralysed. Treatment will, therefore, depend on the specific patient. There are, however, four classifications of Erb’s Palsy that describe the severity of the injury:

 ·         Stretch

 ·         Neuroma

 ·         Rupture

 ·         Avulsion (most severe type)

Stretch- The fibres have only been mildly stretched and the child can recover use of the muscle quite quickly. The more fibres that are stretched or pulled apart, the weaker the muscle will be and the longer it will take to start working properly again.

Neuroma- The nerve is severely damaged, but still remains connected. It may heal, but scar tissue may form at the site of the injury. The scar tissue may stop the electrical messages from the brain getting to the muscle.

Rupture- The nerve is completely pulled apart and can not repair itself. The muscles it controls will remain paralysed. It is sometimes possible to have surgery that will restore some nerve function; however, the child is likely to be left with some residual weakness in the arm.

Avulsion- In rare cases the nerve is torn away from the spinal column. Neonatal/paediatric neurosurgery is often required.



For the babies that do not fully recover on their own (usually evident within 3 to 4 months), specialist intervention is required.  Range of movement is usually recovered within a year, but individuals that have not healed after this point will rarely gain full function in their arm, but may continue to improve. They may also be prone to developing arthritis.

Occupational Therapy and Physiotherapy (combined with Hydrotherapy) are the main forms of treatment besides surgery. Once the child has had surgery they will need OT and PT to support the surgical results.

Most of the initial Occupational Therapy treatment will involve the parents. They usually have home programmes and their therapist shows them how to carry out the exercises and activities. These have to be done several times a day with at least 10 repetitions of each motion. The programme becomes part of baby’s life and daily routine.



The programme includes gentle range of movement exercises for the baby in a prone lying position. The aim is to increase joint flexibility and muscle tone as well as sensory awareness with tactile stimulation using various textured materials. The extremity of the limb needs vibration and massage to increase its sensory awareness in the overall body scheme.

Joint compression/weight bearing throughout involved extremity will increase the proprioceptive input/muscle contraction.

The active use of the arm in purposeful activities that are developmentally appropriate will encourage range of movement and increase strength and co-ordination. These movements should be graded beginning in gravity eliminated and then advancing to against gravity.

Bilateral motor planning activities should always be included.

Sometimes splinting may be necessary e.g. to hold the arm in supination and external rotation. The Occupational Therapist will advise on suitable and necessary splinting methods.

Usually the last movements to return are:

·         Full shoulder flexion/abduction using deltoid musculature

·         Supination (children do not actively and spontaneously do this until 11 months of age)

·         External rotation

·         Full elbow extension using triceps


Shoulder Strengthening


In eighty percent of these cases, a baby born with Erb’s palsy will recover without the need for surgical Erb’s palsy treatment. In other cases children can benefit from surgical Erb’s palsy treatment and other rehabilitative techniques. Research has shown that children between the ages of five and twelve months benefit most from surgical Erb’s palsy treatment. Surgical Erb’s palsy treatment is often less effective after one year of life. Younger children tend also to recover more quickly from surgery to repair Erb’s palsy.


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February 22 2011 3 22 /02 /February /2011 17:09





“The teacher is primarily responsible for handwriting instruction. The therapist’s role is to determine underlying postural, motor, sensory integrative, or perceptual deficits that might interfere with the development of legible handwriting” (Stephens and Pratt 1989).






 Many children who are referred to Occupational Therapy from main stream schools have difficulties with handwriting. It is the Occupational Therapist’s task to assess the child’s handwriting and identify the underlying cause of the difficulties. Occupational Therapy is process-oriented, whilst education is product-oriented. When the teacher and the therapist work together, combining medical and educational knowledge, the results are often very positive in achieving legible handwriting.


The child’s stages of development and “readiness” for handwriting need to be taken into consideration. All research tends to agree that children should not be taught handwriting before they are ready as this can result in creating writing difficulties that are hard to reverse. Letter formation requires the integration of visual, motor, sensory and perceptual systems and it has been concluded that most kindergarten children who are typically developing should be ready for formal handwriting instruction in the latter half of the kindergarten school year (5-6 year olds – year 1).





When a child with handwriting difficulties is presented to the Occupational Therapist, the therapist will need to assess the level of functioning in the following areas:


Visual Motor Integration (neural function transferring what is seen into motor expression)


Fine Motor Skills (hand dominance, bilateral and motor co-ordination, in-hand manipulation, functional pencil grip, muscle tone, hand, arm and shoulder strength).


Visual Perception (discrimination between numbers, letters and words that are similar; spacing between letters; placing letters on the writing line and using margins correctly; identifying which letters have been formed completely; letter and number reversal).


Cognition (memory; language comprehension; specific learning difficulties e.g. spellings; problem solving and reasoning).


Possible sensory processing difficulties (that interfere with posture, attention, tactile, visual or proprioception having an effect on handwriting).


These may all impact on handwriting so it is important to determine and diagnose the underlying cause of the handwriting problem.




Correct equipment for handwriting is an important factor contributing to positive results. The child needs correct chair and table height for good posture. The type of pen/pencil used is also influential and using a correct pencil grip may aid speed and fluidity of writing.


There are many handwriting programmes to assist with difficulties and as occupational therapists work with the underlying cause of the problem and not necessarily the actual handwriting, it is important to choose the most suitable programme for the individual child. In this way therapists can work with teachers to address the problems that are causing the poor handwriting.  The following programmes are the ones that I use and find most productive:


Handwriting Without Tears    http://www.hwtears.com/


Speed Up (Lois Addy)


Teodorescu (Write From The Start)


Callirobics (handwriting exercises to music)   http://www.callirobics.com/index.html



  Pencil gripThere are a number of activities that a child can do to help with handwriting difficulties. An Occupational Therapist will usually provide a programme of activities to be done daily along side the chosen handwriting programme that focuses mainly on letter formation and legibility. These activities tend be incorporated into the child’s daily routine in school, self care and play. 


There is evidence to suggest that mild handwriting difficulties will be helped with good teaching and the maturation of the child. The more severe problems, however, tend to persist into adolescence and could continue into adulthood if the right intervention is not given. Occupational Therapists, Physiotherapists and specialist teachers will make a noticeable difference for most children with their professional intervention. Unfortunately there are a few children who may continue to have difficulties with handwriting despite professional intervention. A keyboard is often recommended as an essential alternative for these children











 Useful Links: 





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February 3 2011 5 03 /02 /February /2011 23:25




Aquatic Therapy is used as a water based therapeutic tool for many conditions. Occupational Therapists are increasingly tuning into the benefits of treatment within the water. It is different to Hydrotherapy as Hydrotherapy uses water to maintain and restore health. Hydrotherapy is more physically based and is defined as  “ . . . the use of water to revitalize, maintain, and restore health."  Hydrotherapy treatments include saunas, steam baths, foot baths, sitz baths and the application of hot and cold water on the part of the body to be treated.


Occupational therapy is based on purposeful and meaningful activity in which the person concerned actively engages in their treatment.  Purposeful and meaningful activity for children is play. Children learn through play and play is used in paediatric treatment sessions. Water play, therefore, is becoming increasingly popular for sensory integration, developmental co-ordination disorder, attention deficits, hyper active children and many other conditions.




The swimming pool can be transformed into a sensory room with different treatment stations that have different treatment aims such as memory development, co-ordination development , proprioceptive and vestibular feedback. This is done using different props within the water. Each exercise and activity can include one or all of the senses such as visual, auditory, tactile etc as well as using memory, sequencing and other cognitive processes. Speech and language can be developed along side mathematics and the level can be graded acording to the child's ability. The water adds a new dimension to the senses, giving resistance where it is needed and helping with movement flow as required. It is a great way to incorporate strengthening exercises and promote general fitness for the children.


  Water is stimulating and exciting and most children love the difference of doing their therapy activities in the water. Activities can be adapted to suit many children in a fun and stimulating way. The water can also be used as a calming tool with relaxing music, a warmer temperature and attention to lighting.





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January 19 2011 4 19 /01 /January /2011 17:19

baby-eating-apple_thumb.jpgSensory Integration Disorder

The link between the way the brain works and a person's behaviour is sensory integration. This occurs naturally in most people. After receiving sensory information about things through your five senses as well as from pain or the position of your body, your brain captures this information and reacts to your environment correctly.

Difficulty processing information from the senses is sensory integration disorder or dysfunction. The brain puts information together incorrectly from the body's senses.

Sensory integration disorders typically appear in young children. Children with sensory integration disorder display problems in learning, development and behaviour.

Sensory Integration Therapy is a form of occupational therapy in which special exercises are used to strengthen the person’s sense of touch (tactile), sense of balance (vestibular), and sense of where the body and its parts are in space (proprioceptive). These 3 types of sensory input traditionally comprise the cornerstone of the SI approach.


Tactile is the sense of touch, and is especially regulated through the more sensitive skin areas such as the hands, feet, mouth and head. It tells us about texture, size shape and temperature and helps us distinguish between threatening and non threatening touch sensations.



Proprioception is an umbrella term for the sense of body position and is involved in body awareness in space, planning and coordinating movements. This is also connected to emotional security and confidence. Proprioceptive input is sent to the brain through receptors in the muscles, joints, tendons and ligaments.


The Vestibular system is made up of sense receptors in the inner ear, as well as the fibres of Cranial Nerve VIII (Vestibulocochlear) connected to the internal brain structures. This determines the quality of balance and movement. It provides information about gravity and space, balance and movement, and about our head and body position in relation to the surface of the earth.


The ability to modulate sensory input through these three systems has a powerful impact on the development of functional skills. They affect how we regulate our muscle tone, balance, motor control, postural stability, visual perception, visual motor control, auditory language skills and attention. Sensory Integration Therapy appears to be particularly effective for helping patients with movement disorders or severe under- or over- sensitivity to sensory input.


If we look at the vestibular system in particular we can see that people with vestibular sensory integration problems often have difficulties coping with their environment. Engaging children in simple activities for both the overactive and under active vestibular system allows them to grow up into healthy adults.


Certain conditions such as autism and attention deficit disorder respond well to sensory integration therapy and improve the life of a person with either of these conditions.
 A professional trained in this area should be consulted for the best outcome.



 The Vestibular System  

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 Our sense of balance is determined by vestibular sensations. The part of the ear that is not responsible for hearing make up the vestibular system. This system detects our orientation to gravity and our movement through space even in the dark. The vestibular system helps us maintain our equilibrium while we spin, rock, sway or bend.
Additional vestibular system functions include muscle tone, and language. Changing head positions, shifting your weight, and using both sides of your body develop a good vestibular system.



 Over Sensitive To Movement

Children with overactive vestibular systems prefer slow movement, avoid risk-taking (such as climbing frames in the playground) and avoid activities that require good balance and fast movement. They are fearful of falling, elevators, going up and down stairs and being tipped upside down. There are many activities that children can engage in to help an overactive vestibular system. Some of these include gentle swinging on a swing, moving heavy objects, ‘tumbling’ or rolling down a gentle slope, slow repetitive rhythmic movements such as Tai Chi, water aerobics or swaying in a rocking chair or rocking horse. Firm pressure on the body from hugs and compression devices also help (please seek advice from a trained professional).


 Under Sensitive To Movement

These children enjoy fast spinning and swinging. They are always jumping, running and moving. They enjoy taking part in dangerous activities and move whilst sitting.

Activities suggested for these children will help their brains organize and process information more efficiently and effectively by activating the vestibular system. This will help prevent them from falling, keep body parts properly aligned, and contribute to coordinated movement.

Outdoor and indoor swings give children of every age the vestibular activity they need. Rocking toys are calming and will help a child that becomes over active with movement and other stimuli. Bouncing on a large ball improves balance. Monitor the child during any vestibular activity. Watch for signs of over-stimulation.


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December 20 2010 2 20 /12 /December /2010 11:03



Some children are sensitive, I mean really sensitive. They won’t wear their socks because the material bothers them - it's too 'scratchy' (especially the seams at the toes). They can’t get comfortable and go to sleep because their sheets feel bumpy. They pull away from you when you try to hug them. They won't get their hands messy and feel very uncomfortable if they do. Some start to developing an unhealthy dislike of public places and crowds - won't go to the cinema or use public transport. Going to the dentist is a nightmare. On the other hand some children are really insensitive, talking and shouting too loudly, heavy handed and hitting too hard, pressing too hard when writing with a pencil so the tip breaks or goes through the page, accidentally hurting others or hurting themselves by bumping into things– not out of spite, but because they don't feel their own strength and force and they can't feel self inflicted bumps unless it hurts.


If this sounds like your child, you may have tried Sensory Integration Therapy as they may have been diagnosed with Sensory Integration Dysfunction. Sensory Integration is the ability to perceive, attend, and respond to sensory information from the environment. It is the organisation of sensation for use. Sensory Integration therefore needs effective intake and interpretation for an appropriate reaction to that particular stimuli. Sensory Integration Dysfunction is therefore considered to be a disruption in the brain’s ability to organize and respond appropriately to all the sensory input. It may manifest as hyper- or hypo-sensitivity (too sensitive or very insensitive) to touch, movement, sounds, smells or taste, or a combination of any of the five. Sensory Integration Dysfunction was first identified by Dr. Jean Ayres, an Occupational Therapist who noticed children struggling with functional tasks, but who did not fit into specific categories of disability commonly used in the 1960 - 1970's.

Sensory Integration Therapy has been proven to be effective in many ways - and for some children more than others. In my experience most children benefit from Sensory Integration Therapy and I have seen very good performance results through using this therapy method. There are, however, a very small minority of children that need more input and extensive therapy sessions. It may be useful to consider alternative therapy or educational approaches in these cases. There are some alternatives to Sensory Integration Therapy (if your child is one of the "others") that works in a completely different way. One of these approaches is the Learning Rx Brains in a Box.


Alternative - Learning Rx Brains in a Box:




The thinking behind Brains in a Box in relation to Sensory Integration has been explained by imagining a kitten, asleep in a box. If you touch the outside of the box with a feather, trying to wake the kitten he may not wake up. You then take a pen and poke the outside of the box, hoping to wake him, but he continues to sleeps. Next you try to hold a hot water bottle or an ice cube up against the box, but there is still no reaction. The final thing to do is reach inside the box and touch the kitten directly. That is when he wakes up.


The Brains in a Box suggest that children’s brains are like that kitten. Sensory Integration Therapy tries brushing all kinds of different objects against the “box” that is your child’s body, in order to wake the sleeping kitten. Many things may work and resolve, but some of the problems still remain or come back once the therapy is over.


Learning Rx claims to know how to wake the sleeping kitten with specially designed brain training procedures they say actually alter the connections in the brain that cause the dysfunction in the first place. "Once the connections are straightened out, the brain is able to interpret and respond appropriately to sensory input." Click here to learn more about LearningRx brain training.


sensory integration 

There are not many known alternatives to Sensory Integration Therapy that result in the desired sensory processing outcomes, however it is refreshing to see something that can claim to be as effective for children who take longer to respond to Sensory Integration Treatment.


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December 6 2010 2 06 /12 /December /2010 12:40

Tummy Time!



There is an abundance of information on the importance of Tummy Time for babies and the developmental benefits it brings. Due to this wealth of information and the escalated health campaigns, mothers are becoming more aware of the need to place their babies on their tummies daily. Before the Back to Sleep campaign in the early 90s (to prevent Sudden Infant Death Syndrome SIDS)


 babies were naturally placed on their tummies to sleep and therefore had ample Tummy Time.  They became accustomed to this position from birth and had the opportunity to learn to lift their head and prop on their arms while on their tummy.


Importance of Tummy Time

When you place your baby on their tummy you are enabling them to practise and achieve important developmental mile stones. Tummy time helps motor development by strengthening their back muscles and allowing them to gain head and trunk control. It also helps develop perception, body awareness and sensory motor skills as well as a whole array of Sensory Integration systems that include vision, tactile and proprioception.


The focus in most literature, however, is on the importance to the motor development and the prevention of motor delay. Motor control develops in a cephalocaudal fashion. This means that a baby will gain head control first and then shoulder control, then the abdomen, and so on down to their feet. If babies don’t get the strengthening of the back and neck muscles that they need, it can lead to or exacerbate an early motor delay.


Early motor delays are increasingly being diagnosed with and estimated one in 40 babies diagnosed and 400,000 babies a year at risk (Smith, D. 2010).  “Early motor delay” was used as a description within a wide range and variety of conditions from low muscle tone to cerebral palsy. Some of these early motor delays are present from birth, whilst others develop or worsen because the baby does not get enough tummy time. The positive thing is that most of the early motor delays are not so serious and with Occupational Therapy and Physiotherapy that involves a programme of tummy time, most children can catch up quickly.


When To Start Tummy Time.

Tummy Time can and should be started with a healthy new born baby. This will make it easier for the baby to accept and get used to being placed in this position. It is often not so practical as with a new born baby the main concerns are with feeding, sleeping, changing and bonding. Tummy time would therefore need to be centred on soothing and holding and would be for short periods of time (around a couple of minutes several times a day). After 3 weeks of age the baby will start to recognise faces and sounds and this makes Tummy time much easier as the length on her tummy can be extended with fun objects and faces to look at. The aim is to get around an hour total within a day by the end of three months.


Difficulties with Tummy Time.

Most babies will initially find being on their tummies uncomfortable or unusual, but they soon get used to it and eventually enjoy it as a natural play position. There are, however, a small minority of babies that just don’t seem to tolerate being on their tummies despite their mother following all the advice on “short bursts” and “making baby comfortable”. These tend to be babies that have colic, severe reflux, sensory processing difficulties as well as other dysfunctions. They are generally restless babies and will not sleep well or fall into a routine. Many of these babies will want to be held most of the time and have difficulty settling.


It is important to find a Tummy Time strategy that works for these babies and this will usually incorporate some form of Sensory Integration (SI) input. The input does largely depend on the difficulty or dysfunction that the baby has and this would need to be assessed by a Paediatric Occupational Therapist for an individual strategy. In more general terms, however, I have found that many Tummy Time difficulties can be overcome by using SI techniques that are calming and by giving vestibular input as well as propriocetive input. This basically means that gentle rocking/swaying and holding baby very close will calm them down a notch (this is also considering that they have been fed, changed and are not sleepy). For new born babies, carrying them extended along your arm, with your arm between their legs is an ideal way to very gently swing/rock them whilst holding them close to your body. They can also gradually be introduced to the Tummy Time position by laying them upright on your chest and then gradually inclining back a little each day until flat on the floor. Music is a very good distraction so it would be advisable to play some calming music in the background.


At the beginning of 4 months the baby should be pushing up on its forearms and lifting and holding its head up. Cause for concern is when the baby has some difficulty lifting its head, has stiff legs with little or no movement, pushes back with its head or turns its head to one side only.






There are some very good informative video clips on tummy time and its importance at the following link:  www.pathwaysawareness.org/top/pathways-video-tummy-time-english-and-espanol1/ 




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