Pediatric Occupational Therapy, Teaneck, Bergen County, Englewood

The Wonder of Weight

carol — Thu, 19 Apr 2012 19:06:42 +0000

What is the benefit of using weighted materials?

Many children with sensory processing disorders crave constant proprioception and deep touch pressure to enhance their sense of body position in space. They may generate this type of input by inadvertently bumping into other children or crashing into walls or objects. One way to proactively provide proprioception and deep touch pressure is through the use of weighted materials.

Constant deep, even pressure is calming and organizing, which can help to decrease fidgeting and in-seat movement. Consequently, children often show improved attention to the task at hand as their sensory needs are met in a systemic fashion.

Weighted Basics:

• In conjunction with your child’s occupational therapist, create an individualized schedule for wearing weighted materials.
• Children will benefit most from wearing something weighted during their most challenging times of day, such as starting the day, circle time, and homework and sleep.
• Weighted materials should be used with the guidance of your child’s occupational therapist.
• Weighted vests can be purchased with varying amounts of weight to best suit the needs of the individual child.
• Use the least amount of weight necessary to achieve the desired results.
• Children often wear a weighted vest for 30-60 minutes during an activity, with at least one hour off in between wearing.
• Weighted pencils provide the proprioceptive input to enhance a child’s sense of their fingers to enhance writing ability.

Aviva Goldwasser, MS, OTR & Chaye Lamm Warburg, DPS, OTR, Director of POTS

Chaye will be presenting at the AOTA conference on the digital metronome

carol — Thu, 19 Apr 2012 19:00:40 +0000

I am delighted to announce that I will be presenting a poster at the American Occupational Therapy Association’s annual conference, entitled The Effectiveness of a Digital Metronome Program on Visual and Gross Motor Performance in a Single Case Design. The study was done in collaboration with Aviva Goldwasser and served as the basis for my doctoral work at NYU.

The subject for the study was a 9 year old boy with ADHD, sensory hypersensitivity, poor handwriting and limited organizational skills. Over the course of the 24 week study he received sensory integration based occupational therapy once a week. There were two experimental time periods during which, for 5-10 minutes during his occupational therapy session, he also learned simple exercises to a beat generated by a digital metronome. These exercises were carried out at home 3-4 times per week for 5-10 minutes. Timing and rhythmicity were tracked using the Interactive Metronome each session.

The results of the study indicated that timing, visual motor integration and motor coordination improved with the use of the digital metronome, especially during the first 12 weeks. The gains remained stable during the last 6 weeks of the study, in which the digital metronome program was not administered. Most important for the family, child’s mother reported that he had become independent in starting and completing homework without constant reminders, his handwriting improved and he was more attentive. The advantage of using the digital metronome was that impressive improvements occurred using an inexpensive, portable device without the child did not have to be tethered to a computer; as he would be for Interactive Metronome. While these results cannot be generalized to all children, I am encouraged by the results and hope to expand the study to incorporate more clients ages 7-10 into the study.

For further information, please contact me at chaye@potsot.com.

Dr. Chaye Lamm Warburg, DPS, OTR/L

A guide to the perplexed: 6 tips on how to be a great therapy parent.

carol — Fri, 02 Mar 2012 20:50:10 +0000

Many parents are unsure of how to maneuver through the world of therapy. Since there is no rule-book for parents (as far as we know), listed below are some guidelines that we feel would be helpful for you to maximize the benefits of occupational therapy.

Keep your therapist in the loop. P.O.T.S. therapists want to collaborate with parents to ensure the best outcome for all children. In order to do so most effectively, therapists benefit from knowing what is happening outside of therapy, in the real world. Information about how your child is coping with expectations at home, school, play dates, after-school activities, birthday parties and homework helps us target underlying skills for intervention, judge the efficacy of our treatment and provide suggestions for home. We also love how to hear about your child’s successes and accomplishments, and how therapy has impacted on his/her life.

Ask questions. Parents need a solid understanding of what is challenging for their child and how therapy can help. If you received an explanation, but the concept remains elusive, we will happily explain it again, and again.

Choose your spot. Because the waiting room is a difficult place to conduct a conversation, and it is often counter-productive to have discussion with the child present, feel free to contact the therapist by phone or email ahead of time if there is something the therapist should know before the session starts. Similarly, feel free to ask questions by phone or email after the session. The therapist will get back to you as soon as possible.

Sitting in on sessions. Often parents are uncertain whether or not to sit in during their child’s treatment sessions. Take your cue from your child. If your child is able to function as if you are not there, it can be very productive for you to observe, take notes, and implement the strategies you learn at home. However, if your child distracted by your presence or changes his/her behavior, it may best if step out of the session. If you are out of the room, you always have the option of observing through the one-way mirror in the door. Do come in for the last 10 minutes of the session so that the therapist can update you on your child’s progress and upgrade your home program.

Home programs. When your child’s therapist provides you with a home exercise program or sensory diet, please give him/her feedback about what is most easily implemented, and what strategies have been the most effective. Do let him/her know if she is over-loading you, not providing enough suggestions or not targeting key points in your day. Remember, 5-7 minutes of “work” with your child a day is equivalent to one additional therapy session per week. Home programs have to be updated frequently as your child makes progress and priorities change.

The team approach. Encourage and facilitate communication between the professionals in your child’s life to capitalize on their collective expertise. When professionals meet in person each has the opportunity to gain perspective on the total child, and understand his/her unique place in helping you and the rest of the team and achieve the goals you have identified as priorities for your child. Parents, teachers and therapists will gain a deeper understanding of the child and have the opportunity to incorporate techniques and benefit from the suggestions that each party has to offer. Maintain the channels of communication by allowing professionals to contact one another, if it is appropriate in your situation. Successful venues for meeting have included school, a therapy office and the child’s home. At P.O.T.S, teachers, ABA coordinators, speech therapists, physical therapists, aides and others have joined us for sessions, and those events are often turning points for all of those involved.

3 Ways to Survive Homework Time

carol — Fri, 03 Feb 2012 19:17:17 +0000

Homework is a dreaded time of day in most homes. By the time homework rolls around, you and your child have already had a long, tiring day. For a child with sensory challenges, coming home after an exhausting day and facing homework is especially difficult. Whether your child is overly active or completely wiped after the school day, using sensory strategies to your advantage will make the afternoon and evening hours go much more smoothly in your home.

Some children are so worn out by the effort of sitting in class and keeping their behavior in check all day that they are bouncing off the walls when they come off the bus. If your child fits that description, incorporate resistive activities (“heavy work”) that are calming and organizing into your after-school routine. Spend 15-20 minutes engaged in these activities to ease the transition to homework. Assign specific chores to your child as great way to integrate these activities into the day seamlessly. An added benefit is that having your child perform these chores will lessen your work load!

Raking leaves
Shoveling the snow
Pushing a loaded shopping cart around the supermarket
Unloading groceries at home

Many children are exhausted when they come home from school. They need up-regulating activities in order to shake off their sluggishness. Strong movement (vestibular) activities will help your child stay alert and focused for homework.

Trampoline
Jumping jacks
Jumping rope
Hula-hoop

Once you have employed one of the above-mentioned sensory strategies to help your child achieve a calm, alert state for homework, use rhythm to keep him/her on task for longer. A heavy rhythm is very grounding and organizing, making it a highly effective tool for homework time. A few simple ways of incorporating rhythm into the day are listed below:

Having your child chew a large piece of (sugar free) gum before beginning his/her school work.
Listen to music that has a strong beat. Consider playing the music over headphones if the workspace is shared and could be a distraction to other family members.
Keep a sports-top water bottle at your child’s work station and encourage him/her to take sips regularly.

Blog by Dr. Chaye Lamm Warburg, DPS, OTR 1/30/12

3 Steps to making your child’s morning easier

carol — Wed, 04 Jan 2012 15:45:39 +0000

Mornings are a particularly challenging time of day for children with sensory processing disorder. Children need to get up, dressed, backpacks and lunches must be packed . . . and all before the bus comes! That is stressful under the best of circumstances, but if you are dealing with a child’s sensory sensitivities in addition, the challenge can seem daunting. It may appear that the slightest thing can send your child into a tailspin. Your best line of defense is to be proactive, stick to your routine, and be an advocate for your child’s sensory needs.

1. Be proactive:

• Avoid anything that is difficult for your child to part from (e.g., TV), to ease the transition.

• If your child is hyper-sensitive to touch and dislikes hair and tooth brushing, here are some suggestions to make it more palatable:

o Use a vibrating toothbrush

o Allow your child to choose the flavor of the toothpaste, or try Tom’s of Maine unflavored

o Always brush in the same pattern (e.g., top teeth first) to establish some predictability

o Desensitize the scalp before brushing by massaging the head

o Use a soft bristled brush

o Heavily condition the hair when bathing and use a detangling spray before brushing

• Use your (limited) time wisely:

o If your child is sluggish and slow to get-going, use sensory activities that are alerting, such as jumping jacks, stride jumps, hopping, or skipping to get around the house.

o If your child is overly excited in the morning, use calming sensory activities while waiting for the bus, such as blowing bubbles, jumping rope, pedaling a car or tricycle, or playing catch with a weighted ball.

• For useful tips on helping your tactile defensive child get dressed, check out our previous blog, “The Morning Rush: How to get your hyper-sensitive child dressed in the morning” from October 2010.

• For additional suggestions on how to use music to get going and how to keep your child on track, check out our blog from September 2009, “Keeping it simple: Establishing morning routines for the sensory challenged”.

2. Routine is reassuring:

• Create a pictorial step-by-step Velcro schedule to help your child manage his/her morning routine independently. Take pictures of your child performing each step of the morning routine, such making the bed, getting dressed, brushing teeth, eating breakfast, etc. and put a Velcro dot on the back of each. Place a long strip of Velcro, or Velcro dots on a piece of cardboard or poster board. Arrange the pictures in sequence together with your child. Having your child organize the pictures will give him/her practice with the morning routine (or any other schedule), and serve as a pictorial guide each day. Allowing her to change the sequence with you on days that will be different, such as the weekend or a vacation, will give him/her a measure of predictability and control and smooth over potentially rocky transitions

• Make a “Things to Bring to School Checklist” for your child that includes general materials, such as pens, pencils, and highlighters, as well as notebooks or textbooks for individual subjects, and display it in an obvious location where he/she packs his/her backpack.

• Discuss changes in plans or after-school activities before they happen. Rehearse them out loud.

3. Advocate for your child’s sensory needs:

• If your child is sensitive to loud noises or is tactile defensive:

o Request a permanent seat on the front of the bus

o Make sure that he/she is not starting the school day in a noisy, crowded multi-purpose room that will ignite your child’s “fight or flight” reaction

• If your child’s occupational therapist has designed a sensory diet for school, check in regularly with the teacher so that it can tweaked to best suit your child’s needs in the classroom

• Power breaks are beneficial for most students. For children who have difficulty with sensory processing, “keeping it together” for the whole day can be exceedingly difficult. Intermittent power breaks that involve movement and stretching will allow your child’s “batteries” to re-charge.

“Popcorn Maker”: Sit in a chair with your feet flat on the floor. Put your hands on the chair at your sides. Slowly begin to bounce up and down like a piece of popcorn in the microwave. Use your hands and feet to help push you up and down. Go faster and faster as the popcorn begins to pop. When it is almost all popped, start to slow down and then stop.
Jump, hop, or skip while transitioning from one activity to the next or lining up.
“Wall push-ups”: Place open hands, shoulder width apart, against a wall with elbows straight. Push as hard as possible against the wall to “make the room bigger”.

Aviva Goldwasser, MS, OTR/L

Dr. Chaye Lamm Warburg, DPS, OTR/L

What scissors work well for children who are learning to cut?

carol — Fri, 23 Dec 2011 14:19:14 +0000

For children who have difficulty diving right in to children’s Fiskars scissors there are several options.

We highly recommend the Benbow scissors, invented by occupational therapist, Mary Benbow. They are uniquely designed with small finger loops, making them easier for small hands to control. The loops are coated in vinyl to prevent them from slipping off the fingers. Right-handed and left-handed scissors are both available.

A cutting kit can be purchased along with the scissors to gradually build up your child’s skills in a developmentally sound sequence.

Mini Loop Scissors, also known as “squizzors” are a good choice for children who seem unsure about where to place their fingers and have difficulty maintaining a mature scissors grasp. The whole hand surrounds the handles, thumbs-up to squeeze as a unit, compared to traditional scissors that require more refined control of the small muscles of the hand. The scissors automatically re-opens upon release of the handle, and require less pressure than traditional scissors. Use squizzors to practice smoothly opening and closing the scissors and develop the eye-hand coordination necessary to cut on the line, without demanding refined control of individual fingers.

The double loop on the Dual Controlled Training Scissors makes them ideal for a beginner who needs to get the idea of the cutting motion. They are designed to have an adult and child hold them together. The first set of loops is for the adult’s fingers and the back set are for the child. From the front, the adult generates the strength, coordination and control necessary to cut. From the back, the child senses the cutting motion, and can begin to develop the motor plan for cutting, without placing demands on grasp and fine motor control.

All 3 scissors and a variety of scissors activity kits are available for purchase at www.therapro.com

Blog by:

Aviva Goldwasser, MA, OTR/L

Dr. Chaye Lamm Warburg, DPS, OTR/L

Cutting to perfection

carol — Fri, 16 Dec 2011 19:57:12 +0000

What is a proper scissors grasp?

There are several key elements to achieving a proper scissors grasp. First, the hand must be placed in a thumb-up position. The thumb goes in the “top loop” and the middle finger goes in the “bottom loop” and the scissors should rest on the index finger. The fourth and fifth fingers should be tucked into the palm to provide stability for the hand as it opens and closes.

What activities can be done to help a child maintain that frequently elusive thumbs-up position?

Dropping and catching: With the elbow bent at a 90° angle palm-down, drop a small object, such as a ball or bean bag into the lower hand, which is cupped palm up. Alternate hands. Gradually increase the weight of the object once the skill has been mastered with a light object
Scoop flour, sugar, beans, rice, etc.
Melon baller
Carry a ping pong ball or marble at arm’s length on a long-handled spoon. A first hold the handle close to the bowl of the spoon. Work your way to the end as skill increases.
Carry a tray from the bottom to play house or restaurant. Position hands palms up, upper arms in contact with trunk, and elbows at a 90° angle
Board games that require turning pieces over, e.g. Lucky Ducks, Squiggly Worms and Lotto
Slinky: Shift the slinky back and forth between hands, palms up, elbows bent
Bounce a ball on a racket (face up or face down)
Throw a ball underhand
Lock and key toys

How do you begin to teach children to cut with scissors?

Learning to grasp a pair of scissors correctly requires practice and a good pair of scissors. Children’s Fiskars are great starting scissors. Difficulty maintaining a thumbs-up position is an indication of poor elbow control. Here are some activities to help strengthen elbow control:

First practice cutting on card stock, or plastic coffee stirrers because they are stiff, easier to cut, and require only one snip.
Save all of those annoying subscription cards that fall out of magazines, and pre-cut them into ½” strips. Have your beginning scissors-user cut them into pieces. This is an easy and almost always gratifying activity. If you have an incomplete collection of paying cards, those work equally well.
You can use the straw and card stock snippets to create a collage. Next, have your child cut fringes at the bottom of a piece of card stock. This should require only one snip per fringe.
When the hands are working well together, draw some shorter and longer lines on the card stock with a thick black Sharpie or a highlighter and have your child practice stopping at the end of the line. This will begin to place demands on sequential opening and closing, and facilitate awareness of the line, and introduce control. Finally, ask him/her to cut longer strips lengthwise on cardstock progressing to widthwise on construction paper to practice opening and closing the scissors 4 or 5 times in a row.

See our next blog to learn about different kinds of scissors to boost your child’s cutting skills.

Aviva Goldwasser, OTR/L

Dr. Chaye Lamm Warburg, DPS, OTR/L

12/16/11

Toy review: Feed the animals game

carol — Tue, 13 Dec 2011 15:34:39 +0000

These games are a great choice if you are in search of a game to boost the fine motor skills of your 3-5 year old child. You can purchase all 3 together, or choose the animal that is most appealing to your child. Each game comes with a pair of large tongs that will be used to “feed” treats to the animal. The pretend food treats are an appropriate size, making it challenging, but not exceedingly difficult to pick up. The larger mouths of the animals are conveniently designed to make it a “just right challenge” for young children to get the treats inside.

After having played the game, I have listed below a couple of pointers and adaptations to maximize the fine motor benefits accrued while playing:

Place a piece of colored tape around the tongs exactly where your child should hold them (approximately two-thirds of the way down the tongs) so that he/she automatically knows where to place his/her fingers.

Each game comes with 30 treats. By taking turns with your child, you will keep the small muscles of the hand from fatiguing quickly.

Quality counts! If you notice that your child is struggling to hold the tongs, or is beginning to use the entire hand to grasp them, discontinue the game or alter the game play to pick up the treats using fingers only.

Aviva Goldwasser, OTR/L

Dr. Chaye Lamm Warburg, OTR/L

Toy review: Spot-it!

carol — Wed, 07 Dec 2011 20:06:50 +0000

TOY REVIEW: SPOT-IT!

Holiday season has arrived! As you shop for the ideal gifts, keep in mind that games are a great vehicle for developing your child’s skills. Use this gift giving opportunity to buy a game that will challenge your child’s perceptual skills in a fun, creative, and interactive way.

How do you play?

Each Spot-It! card contains 8 symbols out of a bank of 50 universal symbols. Two cards are drawn at the same time, and placed face up. The object of the game is to find one matching symbol between the two cards. Be the first player to call out the name of the matching symbol.

Therapeutically, this game challenges visual perception skills. It requires accurate visual scanning of the symbols on each card and solid figure-ground discrimination to pick out the relevant symbol from the whole array. It also demands good matching, visual memory, and visual discrimination skills in order to locate the one match between the cards. Players must be able to recognize and identify the matching symbol, even though the symbol may be a different size or in different orientation, tapping into visual form constancy.

For detailed explanations of all of the visual perception terms, click on the “Glossary” tab on the left column of our potsot.com website.

Who can play?

The game is intended for 2-8 players, ages 7+. Because the symbols are universally recognized, such as hearts, ladybugs, snowflakes, and simple words such as Stop, Art, and Ok, accurate reading skills are not critical to play the game, and we have used it successfully with 6 year olds.

What’s included?

Spot-It! includes 55 cards neatly packed in a tin container. Its small size makes it easy to store and ideal for travel. The game is relatively inexpensive and in addition to the regular game, there are 5 mini-games, each with its own set of rules and objectives, making the game more versatile and interesting.

Aviva Goldwasser, OTR/L

Dr. Chaye Lamm Warburg, DPS, OTR/L

Updated Recommendations About Limiting TV for Children

carol — Wed, 26 Oct 2011 18:19:16 +0000

Do not be fooled by advertisements claiming that TV programs or video games are “educational”. About two years behind the French, the American Academy of Pediatrics has just released new warnings about allowing young children to watch TV. “Screen time”, time spent in front of TVs, computers, and video games, offers no educational value to children under the age of 2. On the contrary, it detracts from the children’s ability to engage in age appropriate play and explore the environment.

The Numbers:

On October 18, 2011, the New York Times reported that a recent survey found that 90% of parents reportedly allow their children under the age of 2 to watch some form of media.

The Risk:

A recent publication in the journal Pediatrics estimated that for every 1 hour a child is exposed to media, 50 minutes less is spent playing with a parent, and 10% less time engaged in play.

Note that children under the age of 2 are in the midst of a critical period of language development. Children pick up and understand language best when it comes from another person, face-to-face. They do not learn language from videos and TV.

The Recommendation:

While the American Academy of Pediatrics acknowledged that media is ubiquitous nowadays and many parents rely on screen time for a much-needed break throughout the day, it is incumbent upon parents to limit the amount of screen time children will be permitted.

Furthermore, parents are cautioned against leaving the TV on in the background, since it has been found that it is overly distracting to both children and parents.