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Wednesday, March 22, 2017

Introduction to - From Flapping to Function: A Parent's Guide to Autism and Hand Skills

When I hear the word autism the image that pops into my mind is 4-year-old Gary. He is lining up cars, end to end, while children around him make their cars roll, beep, and drive over paper roads. Gary doesn’t seem to notice what they are doing, even as he crawls over another child’s leg to reach the bucket of toys.
Gary glances at a toy just long enough to reach for it before looking away. He sits with his knees bent and feet outside his hips, in a position called W- sitting because his legs form a “W” shape (see photograph 1). While picking up cars with his left hand Gary shifts his weight to his right side. His wrist is loose and floppy. He grasps the cars with his fingertips, as though they were slimy fish he was keeping from touching his palms. When another child jostles the perfectly aligned cars, Gary grunts and, without missing a beat, adjusts them. Then he stands up and flaps his hands while walking around in circles.

(photograph 1 Boy playing in W-sitting position)

You may have imagined a similar child—a child who does not play with toys the way most children do (or spends more time flapping hands than using them to play). A multidisciplinary team observing Gary would all contribute important findings. An occupational therapist (OT) would note that although his eye-hand coordination seems fairly normal, Gary does not look directly at objects, he avoids using his palms when grasping and seems unaware when his body moves into a space occupied by another child, signs of a sensory processing disorder (SPD). A physical therapist (PT) would note hypotonia (low muscle tone) and poor postural control, meaning his muscles seem weak and floppy and he leans on his hands to help hold himself up. A speech-language pathologist (SLP) would note his lack of social awareness—he doesn’t even protest when another child bumps his cars. He doesn’t use toys functionally or vocalize while playing, the way the other children are making their pretend cars drive and crash while saying “beep, beep.” Gary’s lack of eye contact with other children and the way he repetitively lines up his cars would draw a child psychologist’s attention. Gary’s preschool teacher would be concerned that he cannot name the colors of the cars or engage in pretend play, such as forming an imaginary steering wheel with his hands and pretending to drive.

As the team discusses their observations, the picture of Gary that emerges is typical of children on the autism spectrum. The way he grasps, manipulates, and uses the cars while ignoring his peers demonstrates difficulties with

·        Postural control: his body and hands seem to be floppy and weak.

·        Visual skills: he avoids looking directly at the objects in his hands.

·        Play skills: he lines up the cars rather than using them in pretend play.

·        Communication and social skills: he does not imitate other children or share the play experience with them.

·        Sensory processing: he has difficulty interpreting and responding to touch and other stimuli.

Challenges in all of these developmental areas contribute to Gary’s difficulty using his hands, which is my particular interest as an occupational therapist. This book explains how atypical development affects the way children with an autism spectrum disorder (ASD) use their hands. It also offers intervention strategies aimed at helping children to experience success and be as independent as possible in performing everyday tasks such as dressing, cutting paper, or writing their names.  In chapter I you will be introduced to how children use their vision, think, process sensory information and behave influence hand skill development and learning in general. 

The technical term for hand skills is fine-motor skills, because grasping and manipulating objects uses the small, or “fine,” muscles of the hands in delicate movements. Traditional examples of fine motor skills would be stringing small beads or stacking blocks. Effective hand use, however, requires much more than good motor control. In this book I take a comprehensive look at how children diagnosed with ASD typically use their hands, what challenges they face, and what strategies will help them reach their potential. I stress “reach their potential,” because there is currently no cure for autism or its associated challenges. There are, however, many effective and fun strategies that parents can implement.  

Who This Book Is For

I wrote this book first and foremost for parents. When I worked in early intervention and Head Start programs I saw how family education enabled caregivers to carry over OT strategies throughout the young child’s day and night, seven days a week, whether at home, in the community, or on vacation. Many of these strategies are easily integrated into everyday routines and continue to be useful as the young child grows to adulthood.
As an example, four-year-old Abdul preferred to line up objects rather than drop them into a container with a small opening. Inserting objects is an early skill that develops the eye-hand coordination to use shape sorters and push coins into a piggy bank. Abdul was motivated to insert magnets into the can shown in photograph 2 when an electric toothbrush was placed inside.
Caution: Use larger objects if there is a choking risk. Magnets are dangerous if swallowed.

photo 2 Vibrating container adaptation

The toothbrush created vibration and motor sounds that interested Abdul and made him want to hold the container. He had to use both hands together-an important skill that will be discussed later, in order to separate the magnets. Pulling magnets apart is an enticing activity by itself, but inserting them into a vibrating container is irresistible. This is one of my oh-so-simple, yet oh-so-effective strategies to help children to build hand skills. 
This activity is also suitable for older children or adults who are developmentally ready to learn insertion skills. Many of the strategies described in this book can help individuals with cognitive and/or motor delays to develop hand skills typically mastered at a younger age. However, it is important that the materials be age appropriate and the person have the prerequisite skills to learn them. For example, six-year-old Bonnie refused to touch gooey substances such as paint or glue and she had difficulty learning how to form letters. Her mother filled a sturdy zip locked bag with paint, and Bonnie imitated her mother using her index finger to  form lines and shapes by pressing. Bonnie had the prerequisite skills to use her index finger as a writing tool, visually attend and imitate the movements. Bonnie liked this activity because she didn’t have to struggle with controlling a pencil, it was fun to feel the paint move through the plastic and she felt like an artist. 
This adaptation is just one of many strategies provided that may be beneficial to children with or without an autism diagnosis. Many strategies may also help very young children who do  not yet have a diagnosis but perhaps the parents sense that they should be concerned.   Although children with ASD are typically not diagnosed until toddlerhood or older, some parents may notice developmental differences in their babies. Therefore, I include red flags and strategies relevant to babies. These may be especially important if the baby has older siblings diagnosed with ASD. If the descriptions in this book “resonate” with your child, speak to your pediatrician or local child development center to get further information specific to your child’s needs. 
Much of the current literature on autism focuses on the social, communication and behavioral aspects of the disorder. I have written From Flapping to Function: A Parent’s Guide to Autism and Hand Skills for the early childhood professionals, educators, counselors, therapists, and other professionals working in school, residential, community, or institutional settings who seek a comprehensive, one-stop resource that focuses on how developmental challenges impact building hand skills and the strategies that will enable children to reach their potential.

Tuesday, March 14, 2017

Developing Hand Skills Using Slap Bracelets

Its always exciting to find an inexpensive product that can be used when creating or adapting new activities. My clients love to try new activities and get bored doing the same old thing day after day. It is a challenges to come up with new ideas to help people who have limited fine motor skills, but the slapper bracelets have been versatile, easy to grade and a lot of fun.

They offer sensory feedback when simply bending them .  Add them to your sensory bin of manipulatives for children or adults who need to fidget and/or relax. 

The bracelets come in a variety of sizes, colors, strengths and materials. I recently bought a package of 72 for about 10.00 and use them in repetitive tasks such as the following....

1. I present them on a tray curled up so that the person has to straighten them out and insert into the slot opening. This takes quite a bit of motor planning and is quite challenging for some individuals.

2. I tied strips of fabric all over the bucket because the lid was not staying on and I didn't want my clients to dump out the contents.  Then I attached the bracelets all over the fabric so that they need to pull them off and insert. The orange lid stays on the bucket permanently. I cut a circle in the lid's center and pushed the top of a screw cap container  through it and taped in place from the bottom. I can screw a cover back onto that white screw piece you see on top to keep the contents inside. Its large enough for me to reach inside and remove the contents.

This bucket was originally used by a client who enjoys inserting the small objects on the yellow tray and he does not have the motor skills to remove the bracelets. So in this way different clients can use the same bucket in different ways according to their skills. Another individual has the skills to attach the bracelets, also a pretty high level fine motor skill.

3) You will see in the video clients removing the bracelets from a tall ring stack. I attached a pin wheel to the very top and asked them to blow after inserting the bracelet. This seemed to be calming as well as funny to them and others watching them. They certainly did really nice reaching and neck extension in the process.

4) Some individuals enjoyed attaching the bracelets to the top of the curvy ring stack. The bracelets  functioned as rings but putting them on and off involved a higher level of motor planning and they enjoyed the sensations of bending them in the process. I think that manipulating the bracelets provided the proprioceptive stimulation to the joints and muscles in the fingers helping with coordination and body awareness. 

5) The man in the blue shirt is blind and nonverbal but very good at motor planning. He also seeks sensory stimulation by ripping his clothes. We have not found a solution to the ripping behavior  (believe me, we have tried a lot of strategies) , but I like creating new sensory based activities such as the one below. I taped a cat toy to the top of a container lid. You can see the yellow lid in the photo below. The cat toy has a spring with a toy mouse on top that makes sounds when moved.  The client is able to attach the bracelets to the spring part and also has the skills to remove them, straighten them out and insert into slot openings on the sides of the container. The bracelets are retrieved by unscrewing the cap with cat toy taped onto it.
You will also see in the video a stringing activity made by attaching a heavy duty slap bracelet to the end of cord. The individual in the video has poor motor planning skills but is able to string or remove the large rings. Notice how I tied the bottom of the cord to his chair  to make the materials easier to control.

Source: Help children with autism build hand skills with slap bracelets by RecyclingOT