Occupational Therapy Toolkit

Welcome to our Occupational Therapy Toolkit, below is a variety of information, advice and tips and general resources to help with a child’s everyday life skills.

It is important to remember that every child develops at their own pace, therefore it is impossible to tell exactly when a child will learn a given skill. Please be aware that the information below gives general advice and what to expect as your child develops. If you are concerned about your child’s development, please contact your GP for further information and support.

 

Activities of Daily Living

Washing:

  • Involve the child in the activity as much as possible (e.g. hand over hand motion, rubbing soap over their body, pouring water over themselves)
  • Use unscented soap to decrease sensitivities
  • Allow your child to have the choice of a shower or bath
  • Use of a bath rail to support with balance and getting in and out
  • Use a bath visor to avoid getting as much water on the child’s face
  • Allow your child to play with the water to become more comfortable with the experience
  • Sequence the task (e.g. first wash hair, then arms, legs and feet)
  • Use pressure when drying with a towel if your child is sensitive to touch
  • Use a timer so the child knows how long they have to do the activity for

Dressing:

  • Follow a consistent sequence and technique when dressing
  • Begin with undressing
  • Encourage your child to sit down when taking off clothes to help with balance and stability
  • Start with using loose fitting clothing which will be easier for the child to remove
  • Use of a mirror to enable your child to visually see body parts and check themselves once they are ready
  • Use of visual cues or word prompt list of the different steps
  • A design on the front of clothing can help your child with orientation
  • Initially practice fastenings when the child is not wearing the item.
  • When doing buttons begin practising with larger buttons and holes and gradually reduce the size
  • Practice unbuttoning first
  • Backward chaining - teach the last step of the task before the other the steps, as the child becomes familiar gradually reduce level of assistance. Let the child take more responsibility for performing the task alone
  • Encourage your child to identify any mistakes and correct them (e.g. pull t-shirt down, trousers are the wrong way round, shoes are on the opposite feet)

Toileting:

  • Be consistent with timings and going regularly throughout the day (e.g. in the morning, before meals, before going out, before going to bed)
  • Encourage your child to let family know when they need to go to the toilet to help develop awareness
  • Use of visual stories or schedules to help with understanding the process
  • Ensure your child is sitting correctly on the toilet and has good posture (e.g. feet have a stable base of support and they feel secure and comfortable)
  • Make sure you give your child enough time and do not rush them. But do not keep them on the toilet for too long that it becomes a negative experience (10 minutes at the very most)
  • Games and activities that involve blowing, such as bubbles and whistles will naturally encourage the stomach pushes needed to go to the toilet

Eating and Drinking:

  • Give your child the opportunity to try new foods, different textures and flavours
  • Use of thicker cutlery for ease of grip (e.g. Kura Care Cutlery)
  • Ensure the plate/ bowl is firm on the table and not sliding around. A non-slip mat may be useful
  • Ensure your child is sitting comfortably with their feet resting flat on the floor or a small block or box can be placed for higher chairs and tables
  • Involve your child in the making of food
  • Practice cutlery skills in play (e.g. use of playdough or putty)
  • When learning to cut initially only expect the child to cut soft foods, gradually increase the difficulty and quantity

Sleep:

  • Ensure bedtime routine and keep it consistent
  • Switch off tv, games consoles, tablets and phones an hour before bed to help your child fall asleep easily. The blue light from the screen interrupts the production of melatonin (sleep hormone) in the body which will keep your child’s brain awake for longer
  • Avoid caffeinated drinks such as cola or coffee before bed
  • A warm bath before bedtime can help relax your child
  • Ensure the room is at the correct temperature and lighting for the child to be comfortable
  • See the recommended sleep time by the National Sleep Foundation below:
  • Age Recommended Time
    School-aged Children 6-13 Years 9 to 11 Hours
    Teenagers 14-17 Years 8 to 10 Hours
    Young Adults 18-25 Years 7 to 9 Hours

Fine Motor Skills

Grasps:

  1. Palmar Grasp - pencil positioned across palm and held with fisted hand, wrist slightly flexed, using full arm movement
  2. Digital Pronate Grasp - pencil positioned in the palm, placing fingers in a downwards position and is held by index finger and thumb, using mostly arm movement
  3. Tripod Grasp - 3 finger grasp using thumb and index finger with the pencil resting on the middle finger 
  4. Quadrupod Grasp - 4 finger grasp using thumb, index and middle finger with the pencil resting on the 4th finger
  5. Thumb Wrap - thumb wraps around fingers reducing web space

Pencil Skills:

  • Handwriting is a complex skill that requires the integration of postural stability, hand eye coordination, organisation, differentiation, sequencing, memory, perceptual skills, motor planning, language skills and cognitive functions
  • Encourage your child to complete shapes such as a vertical line, horizontal line, circle, cross, square, diagonal lines and a triangle as the basis for pre-writing skills
  • Use of wide pens for better positioning, ease of grip and comfort
  • Trialling different pencil grips that facilitates a functional grasp allowing your child to correctly form letters and develop their handwriting
  • Using lined or squared paper to help encourage correct height, size and spacing of letters and words
  • Align the paper with the forearm of the hand using to write. 
  • Use of different materials and textures (e.g. pencils, crayons, chalks, pastels, and paint; use of different paper, and surfaces e.g. forming letters on steamed up windows, writing on someone’s back, writing letters in the air and using sand paper) This will encourage the child to use multiple senses to learn letter formation, by providing feedback for pencil control and line placement
  • Doodles, fluency patterns, drawing and colouring, and pen and paper games are all good ways of helping a child to develop the skills and abilities needed for letter formation and handwriting
  • Use visual cues to guide the correct starting point, direction and finishing point
  • Encourage self-evaluation by allowing the individual to look and see how closely the letter formation matches the target letter, encourage them to circle the best formed letters based on their targets or set criteria
  • Please see the table below for general data on the average letters per minute:
    Age: 6 7 8 9 10 11 12 13
    Letters Per Minute: 18 28 36 45 52 60 67 75

Scissor Skills:

  • Stages of scissor skill development:
  1. Correctly holding scissors
  2. Holding paper whilst snipping
  3. Cutting across paper. Start with narrow strips of card then gradually introduce larger pieces of card
  4. Cutting along a straight line. Start with a thick line gradually introducing a narrower line
  5. Cutting along a curved line
  6. Cutting around simple shapes (square, circle, oval, triangle)
  7. Cutting around simple shapes with corners and curves (moon, heart, star)
  • There are different types of scissors that can be used to help develop your child’s hand strength and make the task of cutting easier. These include:
  1. Bounce back scissors
  2. Mounted/ table top scissors
  3. Easy grip scissors
  4. Long loop scissors
  5. Dual control scissors

Useful Links:

Visual Perceptual Skills

Visual perceptual skills help our brain to make sense of what we are seeing. They involve extracting and organising information the eyes see. It is not the same as to how clear we see something. Your child can have very clear vision, for instance, they could have 20/20 vision, but still not be able to make sense of the environment around them. The process of visual perception cannot be directly observed. It relies on input from other senses, previous experiences and cognitive functions. Visual perception includes many different components, these include; visual discrimination, visual closure, visual memory, visual spatial awareness and visual motor coordination.

The Beery VMI is a standardised assessment that can be a completed by an Occupational Therapist to provide further information on your child’s visual perceptual abilities.

What visual perceptual difficulties may look like:

  • Struggles to identify shapes and objects
  • Difficulty with completing puzzles, dot to dots and general copying
  • Looses track of words when reading
  • Has difficulty sequencing words and letters
  • Unable to tie shoe laces
  • Letter reversal e.g. "b" instead of a "d"

It is important to have your child’s eyes tested by a optometrist to rule out any vision problems.

What can you do to help your child? This is where the fun bit comes in for your child! There are multiple activities that can support and build their visual perceptual skills. These include:

  • Hidden pictures activities e.g. Where’s Wally
  • Dot to dot activities
  • Jigsaw puzzles
  • Construction games
  • Memory games
  • Sorting objects
  • Matching colour games

Coordination and Motor Skills

Coordination and motor skills allow us to move our body parts to do a particular action. As children grow, they reach different milestones of their motor skills. There are important building blocks to develop a child’s coordination and motor skills. Some of these building blocks include: attention and concentration, body awareness, postural support, muscular strength, bilateral integration and sensory processing. 

The Movement Assessment Battery for Children is a standardised assessment that can be completed by an Occupational Therapist to assess for motor coordination difficulties.

What coordination and motor difficulties may look like:

  • Fall over easily and have difficulties in “recovering” from being off balance
  • Lacking body fluidity – body appears stiff
  • Have difficulty with getting dressed standing up
  • Later to reach their developmental milestones
  • Tire quicker than peers
  • Less aware of personal space

What can you do to help your child?

  • Make it fun! Include physical activities your child enjoys. Think about creating a circuit
  • Start with focusing on the core area, this is your child’s stabilisation and main area to build the arms and legs
  • Walking on a pretend tightrope line
  • Practicing keeping the beanbag on your child’s head
  • Climbing frames and general climbing
  • Swimming
  • Standing on one leg
  • Throwing, catching and kicking a ball
  • Aiming a ball
  • Playing tug of war
  • Use of a swiss ball - sitting and throwing

Sensory Processing

Sensory Processing is about how our nervous system receives and organises information from all our senses which allows us to understand and give meaning to what we experience and allows us to respond and behave accordingly. We continually respond to sensory information from our bodies and our environment.

Sensory Integration is like a puzzle. When all the pieces come together, we can use our sensory information successfully to perform functional activities. For example imagine being on a swing. We experience the sensation from the position of your body sitting on the seat, feet pushing off the ground, sustaining momentum by moving your legs back and forward, and our body moving in rhythm to this; the rope in our hands and wind in our face. This activity is a whole-body experience. Our life is a multisensory experience. All sensory systems are linked and work together, allowing us to navigate daily life.

Our senses are:

  • Touch
  • Taste
  • Smell
  • Hearing
  • Vision
  • Proprioception 
  • Vestibular
  • Interoception

When information from our senses does not come together, children may have problems coordinating their movements and can be more accident-prone. They may struggle to maintain attention and following instructions at school. Functional skills such as dressing, using cutlery or eating new foods can be challenging and result in frequent meltdowns. Children who struggle to process sensory information may show signs of stress and anxiety as they try to navigate their daily life. Responses to sensory information are variable depending on our mood and environment.

Useful Links:

Postural Care

Postural care is any intervention which protects a person’s body shape. It promotes body symmetry and reduces risk of deformity or changes, and promotes access to learning, play and opportunities for development within the home and school environment. We work together with the family and wider multidisciplinary team to support your child with accessing 24 hour postural care.

There are many ways to look after posture including movement and exercise, however for some children who are unable to maintain or manage their posture independently, they may need therapeutic positioning and the use of equipment such as appropriate seating, wheelchairs and night-time positioning equipment. This is known as the 24 hour postural care approach.

The Occupational Therapy team will support your child with postural seating within the educational environment, sleep systems and orthoses (hand splints and Lycra garments).

Seating Clinic:

  • If your child requires specialist seating, they will be invited to a seating clinic held at the Child Development Centre, City Care Centre. During this clinic, there will be two equipment reps present and opportunity for your child to be assessed in different seating options to find the most suitable seating system.
  • Why not have a look at out seating leaflet here.

Useful Links:

Sleep Systems:

  • The Physiotherapist and Occupational Therapist will arrange an assessment in your home with two different companies to assess what accessories and positions are best for your child to protect their body shape. Have a look at the video below which demonstrates the benefits of 24 hour postural care (Simple Stuff Works Associates, 2017).

Upper Limb Management:

  • The Occupational Therapy team will support your child with their upper limb management including stretching and exercise programmes and orthoses such as hand splints and Lycra.
  • Take a look at our generic hand, wrist and finger exercise programme here.
  • Take a look at our generic shoulder exercise programme here.

Hand Splinting

The Occupational Therapy Team run regular hand splint clinics where your child may be invited to attend to assess their need for splinting and then create and provide splints that meet this need. This may include splints for function to increase grasp or stability, or resting splints to provide a prolonged stretch and immobilisation of joints for management. The Occupational Therapy Team will complete joint ranges and set goals with the child and family for the purpose of the splint. Your child may then be provided with an off the shelf splint or a bespoke made splint depending on the needs assessed.

  • Why not have a look at our hand splinting leaflet here.

Lycra:

  • Your child may be invited for assessment for a lycra garment. Depending on your child’s needs, this could include a sleeve, glove or full body suit. Your child will be measured by the Occupational Therapist and Physiotherapist. The purpose of a lycra garment is to increase sensory feedback as well as provide stability to joints and muscles.

 

If you are concerned about any of the areas above and they appear to be impacting your child's everyday life, then please discuss this with the school SENCo or your GP. They can use this information to complete an Occupational Therapy referral if together you feel this would be of benefit to your child at that time.

 

Useful Videos:

Please see the below videos that have been created by Peterborough City Council.

 

 

The page was last updated on 09 October 2020 by paediatricpsychologicalservices.

Cambridgeshire and Peterborough NHS Foundation Trust
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Cambridge, CB21 5EF

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