Thursday, February 17, 2011

The Sky is the Limit!

Children love to learn and have fun while they are learning, and as therapists, parents, and teachers it is our job to make it fun.  I was working on vertical lines with a child just this week, and I kept showing the child the stroke over and over again, and saying “line down,” but the child continued to scribble on the board.  I then began to make it a game, and said “zip down!” And, just like that, the child repeated after me, and said “zip down!” and drew a vertical line.  This little moment, reminded me how important it is to make learning fun and engaging for children.  With just a little more effort, we all have fun and learning takes place.  Not only does the child more quickly acquire the skill, but it will stick too! So, the next time you are frustrated with homework, teaching your child a new skill, or the day to day routine, just stop and ask yourself, “How can I make this more fun for both us?”
It may be…
·         Writing spelling words in shaving cream, finger paint or pudding
·         Singing a song while cleaning up the toys
·         Involving the whole family in the activity
·         Allowing the child to be the teacher (to younger siblings or his/her stuffed animals)
·         Acting out stories
·         Using whole body movements when learning math problems (hop forward for addition  or backwards for subtraction)
·         Going on nature walks to talk about science
The sky is the limit, and so is the learning!                 

Amy Bumgarner, MS, OTR/L

Monday, February 14, 2011

Eye Opener

Boy, being on crutches has really opened my eyes to the world of the children and the families I work with.  I was on crutches for 3 months in high school, but I was so much younger and carefree then, it didn’t matter if I fell on my crutches and I certainly didn’t have two children to take care of.  Simple things can be so difficult, and they take so much more time! It’s just amazing how difficult it is to walk through those big heavy doors and the revolving ones are really tricky!  My Mom has been a huge help within the walls of my house, but as I’m feeling better and getting out some, it has been a huge eye opener, both good and bad!

On one hand, I have those individuals who make a point to open the door for me or help me carry something.  In Trader Joe’s I picked up a box of pretzels, stabilized it between my crutch and made my way to the check out line.  The friendly cashier said, “You need something to dip them in.  Have you tried the mustard?”  After I told her I had seen it, but couldn’t carry it, she immediately went to the shelf and picked up a jar for me. 

I’ve also encountered some not so helpful people. But, the most appalling experience for me was when I went back to the doctor to get my stitches out.  I was two weeks post-op, so by this point I was feeling comfortable and quite good on my crutches. I drove myself to the appointment (it’s my left knee and for those of you who know me I like my independence), pulled into the very full parking garage and parked on the opposite side of the deck.  Since the elevator was on the opposite end, it was closer to use the stairs.  I hobbled down the stairs, pulled open the big heavy door and hurried through it so it wouldn’t hit me on my back side, swung my leg over a chain and proceeded into the office.  Pondering this situation, I looked around the waiting room to find most everyone either in a wheelchair or on crutches.  How did they all manage, I thought?  Perhaps they have a handicap sticker (which would have only helped part of the problem) or they were dropped off at the front door as many of them did have someone by their side. 

Being an OT, I shared my concerns with all of the other patients in mind.  Evidently, this premier Orthopedic office of the Carolinas (can I get any more specific?) is aware of this problem as they are currently sharing the parking garage with a nearby hospital.  The strange thing is that they don’t have a solution.  Why not offer valet for those individuals who can’t participate in the Crutches Olympics?!

As Ellen says, “Be Kind to One Another!” and open that door for someone today! (Yes, I've watched a lot of T.V.)

Michelle Yoder, OTR/L
Occupational Therapist
S/P Knee Surgery and now on the other side of therapeutic intervention

Friday, February 11, 2011

Making Mountains out of Mole Hills with Picky Eaters

Having a child who is picky eater often means daily frustrations for moms and dads as they become overwhelmed with being a short-order cook, having their day revolve around what their child will eat and when, or struggling to have their child tolerate and eat “normal” foods.  It’s also hard to know whether your child’s pickiness is part of typical development, as toddlers often do display some finicky eating, or if there are some underlying sensory integration difficulties. For a child with sensory integration difficulties, there may also be other areas of sensitivity and aversions and it may be best to follow-up with your occupational therapist for additional insights and treatment ideas.
Below are some ideas of strategies to try at mealtime to assist your picky eater in increasing his interest and independence with feeding:
·        Allow your picky eater to explore with and play with his food.  Eating is a whole-body experience in which we need to first become comfortable with the sight, smell, and feel of foods.  By engaging in food play (painting with applesauce, washing plastic cars with pudding, having a tea party and feeding small farm animals), you are providing an experience that is “safer” to explore textures and providing the opportunity to taste new foods without the pressure that can arise at mealtime.  Getting messy is okay!
·        Encourage your child to get more involved with food preparation.  A child is more likely to try things he has helped make.
·        Introduce new and different foods with foods of interest and in a sequential non-threatening way! Using divided plates can be your friend and encourage your child to initially just tolerate the new food on his plate. After a few days, work on touching the food.  Once he is comfortable to touch it, I would ask him to bring it to his lips and pretend to kiss it. Once he is successful with that, you may work towards licking the food and eventually taking a small bite.  Keep in mind that research shows that children can take up to 15 times of trying a food before they swallow it and or truly determine if they like it or not.  Don’t give up the first few times!
·        Once you find a particularly successful food, try introducing similar foods. Some things to be aware of are the texture, color, temperature, and taste of foods.  Try slightly changing one of these items (i.e. moving from Goldfish crackers to cheddar bunnies; moving from chocolate pudding to chocolate and vanilla mixed pudding; trying  level II baby food to level II baby food with mashed cheerios).
·        Learn to love condiments! Dipping foods is a wonderful way to work on expanding on tastes as you can try such condiments as ketchup, salad dressing, mustard, barbecue sauce, gravy, spaghetti sauce,  whip cream, chocolate, cottage cheese, yogurt, creamy soups.  You can then work on introducing a variety of things to dip including crackers, fruits, vegetables, chicken nuggets, and fries.
·        Count on inconsistency. For young children, what they will eat and how much they are willing to eat may (and probably will!) vary daily.
·        Engage your child in oral motor play.  Whistles, bubbles, vibrating toothbrush, blow toys, chewy tubes, sucking through a straw…all of these provide opportunities for your child to engage in mouth play in order to build up his muscles (for chewing and swallowing) and to decrease the sensitivities he may have around his mouth.
·        Provide consistent praise and positive reinforcement.  If he played with it, smelled it, licked it, tasted it, chewed it and/or actually swallowed it…praise him for what he did!  Don’t punish what he didn’t do.
Finally, don’t forget the importance of setting a good example yourself!  Eat together as a family, eat in front of your child, and provide opportunities for him to try something on your plate if he would like.  Keep in mind that it may take your child a long time to feel comfortable with trying new or different foods and I say make mountains out of mole-hills when it comes to feeding!  Small successes are huge and both you and your child deserve to celebrate small break-throughs.  Continue to consult with your occupational therapist for additional mealtime strategies and/or a nutritionist if necessary.

Keira Gathers, MOT
Occupational Therapist

Friday, February 4, 2011

Up and Down and Round and Round

Rocking my 2 month old baby girl to sleep each night reminds me of how important our vestibular system is to the well-being of ourselves and our children.  Clara specifically enjoys her swing, being bounced by daddy, and rocking and swaying with mom.  While the vestibular system can be our greatest tool as parents for calming our children, daily activation is also vital for the promotion of its healthy development. 
As a child, I struggled with various activities related to vestibular functioning, including car sickness, inability to tolerate roller-coasters and enjoy amusement parks with my friends, and aversions to various playground equipment.  Use of regular, structured vestibular activation can prevent and reduce these types of difficulties that can be so limiting to a child’s scope of play.  Fun vestibular activities include:
-          Sit n’ Spins
-          Games such as “Ring around the Rosie,” “Duck, Duck, Goose,” or “Pin the Tail on the Donkey”
-          Rolling down a hill or an incline
-          Performing forward and backward rolls and other gymnastic activities
-          Various swings
-          Rocking and Jumping
-          Scooterboards
-          Teeter Totters
-           Playing “Simon Says” and having your child move their head into different positions, such as touching their toes with their head down or shaking their head from side to side or up and down. 
These activities are especially valuable because they provide the child with control, which helps to decrease overstimulation.  Providing the child with proprioceptive input through heavy work before and after these activities will also prevent the child from becoming overstimulated.  Heavy work activities involve moving one’s body against resistance and include activities such as pushing, pulling, lifting, carrying, and weight-bearing.  A few heavy work options include:  pushing the laundry basket or a wagon, wheelbarrow walking, animal walks, climbing, hanging, tug-of-war, crawling, and jumping.   Oral motor heavy work is also beneficial, including sucking, blowing, and chewing.  All of these heavy work activities can be helpful prior to activities, such as riding in a car, that you know may be difficult for your child to tolerate or after any dizziness or motion sickness has occurred. 
Children love to move and they love having that special time to play with mom or dad.  These activities can also be fun for siblings to play together or during play dates .  So, have fun with it and find a game everyone can enjoy!  

Dana Elliot, MS, OTR/L

Tuesday, February 1, 2011

Smile for Me!

February is National Children’s Dental Health Month!  While we all know that our children should brush their teeth two times per day, for some of our kids, getting a toothbrush even near their pearly whites is impossible!

Try some of these strategies to beat the tooth brushing battles!

·        Make it part of his daily routine.  Always do it in the same place at the same time with the same expectations.
·        Do some heavy work before going into the bathroom.  Maybe wheelbarrow walk or crab walk to the bathroom.
·        Massage the outside of his mouth and his cheeks with firm pressure prior to brushing.
·        Provide deep pressure with textured finger puppets or washcloths around his mouth and cheeks.
·        Try some heavy work with his mouth by biting on foam bath letters, refrigerator tubing, chew tubes, NUK brushes or other safe mouth toys. (Always offer these with supervision to prevent choking.)
·        Don’t feel like he has to stand at the sink.  Allow him to sit in a chair, lie on his stomach, or even do it in the bath if that is a fun time for him!
·        Have him wear a weighted vest or a compression vest while brushing. If you don’t have one of those, fill a long sock with rice or beans, tie the end up and drape it around his shoulders while he brushes.
·        As always, give him a sense of control by choosing which tooth brush or which tooth paste he would like to use that day.
·        Try a vibrating tooth brush.  He’ll either love it or want nothing to do with it.
·        Consider trying different bristles- soft, medium or firm.
·        If a toothbrush is impossible try a thin, wet washcloth, NUK brush, or infant gum massager, then work towards the toothbrush.
·        Characters do count!  Distract him with fun characters on the toothbrush or toothpaste. 
·        Give a time frame expectation:  the length of a song or until the timer rings.  Sand timers work well for those children with auditory hypersensitivity.
·        To ensure thoroughness, have him brush for a count of 10, then you brush his teeth for a count of 10. 
·        Sometimes the brushing sound of the toothbrush may be bothersome.  Try music or other noise to distract him.
·        Reward him with a sticker chart or other motivating tools.

 Hopefully you'll both have something to smile about!

Michelle Yoder, OTR/L