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Tuesday, September 25, 2018

Make Your Own Clothespins to Develop Fine-Motor Skills




My clients with developmental disabilities enjoy tasks that involve simple attaching, removing and inserting objects. I discovered that they are more successful when I cut up plastic containers to make "clothes pins" that are individualized according to their needs. I simply cut the shape shown in the photos and videos but some are longer so that they don't fall off easily and some are shorter to make them easier to remove from a cord or "clothes line". Some detergent and coffee containers are made of stiffer plastic that require more hand strength and the dish washer soap and juice bottle plastic tends to be more flexible and easier to manipulate.


Real clothespins or my DIY ones can be hung onto any structure that has thin wire, tubing or fabric etc.  The one shown in the picture is meant to hold DVDs. Explore different types of file organizers and place on top of a box if you want to increase reaching height.  The client shown above is easily agitated and benefits from movement. So the staff scattered the clothespins on the floor to require high/low movements. Some client may enjoy color sorting.

The client shown above is blind and safer working while seated. So I strung a clothes lines between to heavy objects on the table. He enjoys both attaching and removing the pins to insert into a slotted lid.

Attaching and removing any clothes pins typically requires using hands together to stabilize the line while manipulating the pin. This activity is great for toddlers who are just developing bilateral hand skills as well as older children or adults who need to develop these skills. Explore different types of clothesline materials such as cut fabric, leather, macramé cord or twine to see what works best or promotes the skills you are working on. I happen to have lots of fabric available at work and I love that the fabric can be tossed into a washing machine and plastic thrown into a mesh bag and dish washer.

As you can see, I attach the clothes line to whatever is available that won't destroy any walls or ceilings! I attached them to clothing hooks, backs of chairs (to perform while seated) and around the width of a table.   This last adaptation worked really well because it enabled 2 buddies to work together. The young man in the SHORE shirt is blind and has not yet learned to reach out of his immediate space to feel for materials. His friend in the BOSTON shirt enjoys pushing the clothes pins within reach and providing touch prompts  to find them.



Source: Teamwork to Perform "Clothespin" Insertion Activity by RecyclingOT



Source: Teamwork to Perform "Clothespin" Insertion Activity by RecyclingOT



Source: High-Low- Reaching Activity for Individuals with Autism by RecyclingOT



Source: DIY: Clothespins Activity to Build Fine-Motor Skills by RecyclingOT


If you don't have time to cut up plastic containers, there are always the commercially available push or squeeze pins. However, I observe that this population often uses too much force and they often break.....

Regardless of what materials you choose to use, its lots of fun to explore the options...…

Learn more about activity adaptations in my book The Recycling Occupational Therapist. It is available on Amazon for $35.00.
Customers in the continental United States may use the paypal link at the top of this blog  to purchase my book for only $25.00 with free shipping.

Tuesday, July 31, 2018

Why Use a Hand-Over-Hand Teaching Approach


I consult at an adult program where many individuals have difficulty grasping or using their hands in other functional ways.  Most of them have developmental disabilities but a few have had brain injuries or strokes.  I am frequently explaining why whenever possible, it is better to provide Hand-Over Hand assistance to grasp a spoon  rather than staff feed the person.

The exception would be if providing HOH causes agitation or any other emotional/physical response that impedes safe eating. Consuming nutrition is of course the most important concern but many staff wonder why even bother using the HOH technique in the first place when it is faster and easier to feed the person? In fact, some of these clients are fed by family or staff in their residential settings and perhaps this inconsistency confuses them?

Adult Day programs requires that we work on developing skills, goals and strategies that support learning and independence. If the client's physical/and or cognitive status is at a level where they don't yet grasp a spoon, then this seems like a good functional skill to work on. Most people  are motivated to eat!

A 50ish year-old woman I will call Michelle had a brain injury decades ago and she wants to feed HERSELF. Great, the staff assumed that they would feed her because she has such limited hand use.  But instead they provide a pre-loaded spoon or fork with built up handle. Staff place their hand on top of hers in order to bring the spoon toward and enter her mouth. Michelle is very happy to be feeding herself even though she is fed at her residence. but that is not within my control.  
Michelle has much spasticity so I showed the staff how to gently move and relax her first before placing the spoon inside her tightly flexed hand. The spoon functions as a splint since it is opening up her hand and the movement from bowl to mouth provide range-of-motion. Another benefit is that the HOH process takes longer than if staff feed her. That is a good thing since many of the clients need extra time to manipulate and swallow food.

The young man, Jose shown in the photo above has Down Syndrome. He throws objects and prefers to eat by grabbing fistfuls of food with his hand.  His mom feeds him at home.  I extended the spoon handle with tubing rather than placing my hand on top of his because he does not want to be touched. after he grasps the spoon handle, I place my left hand on Jose's shoulder and push it backward and at the same time I push his elbow inward toward his body. This prevents him from bringing his head into the plate to eat. Its challenging, but he has gotten used to this technique and knows what to expect. Staff need to quickly catch the spoon after Jose fills his mouth so that he does not throw it. Staff feeding him is surely easier. But this is a young man who has almost no other hand skills and he LOVES to eat. His food smells of fantastic home made foods from Central America.


An individual, named Barry has an objective to increase the amount of time grasping an object. Its obviously a pretty early developmental skill and babies are typically good at this at around 6 months of age. It is unlikely that an older man will learn to grasp if he hasn't by now.

However, providing HOH to grasp and move this object ( a green groan stick attached to a vibrating toothbrush) provides sensory and social stimulation. Barry enjoys the touch, smells, vibration and attention. Perhaps he will learn to grasp with less assistance as we explore other objects he might enjoy.


Eric in the photo below is also working on grasping objects. I place the groan stick inside his palms and he maintains his grasp as I lift it upward.  I also gently push the stick toward Eric's body so that he is less likely to release.  Eric appears to enjoy the social aspect and deep pressure sensory stimulation from the pushing.


The last photo is of an extremely social and smiley woman I will  call Jill. She is very spastic and has minimal motor control.  I placed a tube of hand lotion inside a rolled up cushion so that when her hands are pushed downward, lotion squirts out. Staff place her arms on the cushion and provide HOH assistance to push. Different individuals enjoy coming over to her wheelchair to receive lotion. Everybody enjoys this and benefits from the social and sensory aspects of receiving lotion from their friend.

Naturally, parents and teachers may use the HOH training technique to initially teach very simple skills such as brushing hair to complex skills such as closing a zipper.  As they learn, most children require less and less physical assistance, point and/or verbal cues until they are independent. Then practice makes perfect and on to learning a new skill!.
Adults with disabilities often continue to benefit from  Hand-Over-Hand support even though they likely will not be independent. However, as you can see there are many other benefits to HOH supports.

The video below demonstrates the different levels of assistance provided to perform tasks...ranging from independent to HOH and/or dependent. As an occupational therapist my goal is to help people not only be as independent as possible, but enjoy their quality of life. This often involves adapting meaningful activities and incorporating sensory stimulation when possible. This is what makes occupational therapy so rewarding and fun.



Source: Types of Cues/Prompts to Support Learning by RecyclingOT


Wednesday, July 11, 2018

Make-Your-Own: Loop Craft to Develop Motor Planning Skills



Looping is a great motor planning skill that helps to develop the dexterity to form knots and tie shoes. You can use the colorful loops sold in craft's stores used to make pot holders. These are pretty but thin and therefore, more challenging to manipulate. Experiment by cutting up old clothing:
1) sleeves from shirts
2) pant legs from fleece pants
3) socks

Just slice away to create the loops. The thicker the loops, the easier it will be to unknot them. Longer loops from sleeves are easier to loop together than the smaller ones cut from socks.

Stretchy fabric like fleece is a lot of fun to manipulate and as you will see in the video you can make a long stretchy cord to use in sensory motor activities.


Students or clients can work on these while sitting or standing. The client sitting in the photo has hemiplegia. His right hand is weak but he is able to link his index finger inside a loop in order to unknot it using his left hand. He is unable to connect the loops....or rather I should say we haven't figured out an adaptation  that will enable him to do so, yet. He loves repetitive fine-motor tasks and I love seeing him use his right hand!


This activity requires quite a bit of eye-hand coordination and sequencing skills as they
1)hold onto the tip of the chain
2)retrieve a loop from a container
3) insert it through the previous loop
4) insert one loop end through the other
5) and pull

Attaching the loops to create a long chain enables students or clients to be rough with the fabric....pulling and picking at it without it ripping. Its great sensory fun! In the second video, I demonstrate how to make the loop chains out of plastic bags. Then I make yarn and knit out of them. This is quite a high level skill. However, some students may be able to perform some of the steps. They will need to think about how much force they are using so that the chain does not rip. However, if it does rip, its easy to make a knot and continue and best of all there is an abundance of free plastic.... At least for now until it is banned everywhere....


Below is a photo of my client enjoying making a very long chain. Of course, one must use discretion to avoid choking and tripping on them. I attached a loop on a high ceiling hook, shown in the video that will not get in anyone's way when the activity is not being used.

Another option is for the individual to work while seated facing the back of the chair.  I taught this client how to wrap the chain around the back of the chair to keep it short. The long chain can easily be removed to be used in an activity or for a client to unknot and put away.


 As you can see, these recycled materials are easy to find and this activity is quite versatile. One of my clients enjoys opening the loops and placing them over a ring stack. He enjoys the sensory experience of pulling the fabric loops open to fit over the top of the ring stack which has a ball attached. He really has to use force to open and fit them over the ball before pushing down the stack.

Have fun and please share any new loop ideas.....



Source: Make-Your-Own: Knot Craft for Fine-Motor Skills by RecyclingOT



Source: Make-Your-Own Yarn for Plastic Bag Knitting by RecyclingOT


Source: Looping Craft: Team Work by RecyclingOT

Tuesday, June 12, 2018

Sensory Diets Made Easy

"Sensory Diets" can be very confusing! If you are reading this, you probably already know that these diets have nothing to do with food or losing weight. They are simply a list or schedule of activities and adaptations designed to help an individual child or adult to
  • engage, focus and learn to the best of their ability
  •     bring their alertness level to "just right"  (see chart) so that they are not over-stimulated/agitated/running high nor under-stimulated/lethargic/running low. 
  • The terms "seekers" and "avoiders" describe how people seek out the types of sensory stimulation that make them feel good and meet their sensory needs OR avoid the types of sensory stimulation that make them upset. Many people are BOTH! 
Sensory diets are frequently designed and updated by occupational therapists. They are individualized for the person and should be monitored and updated because a person's sensory needs  change as he or she develops and other life factors such as changes in health, school,  stressors such as birth of a sibling.... etc. 

As an occupational therapist I use a lot of trial and error, based on my professional training and 40 plus years of experience (including with my own son who is on the spectrum).  However, there are some basic sensory diet principles that can help parents and other caregivers to create sensory diets at home.   

Sensory Basics 

1) "Sensory Processing" is how a person receives, interprets and responds to sensations such as what one sees, hears, feels, smells, tastes and movement.
2) Children or adults may have a "Sensory Processing Disorder" SPD. This is rather complex. There are several subtypes of SPD, so please check out this  detailed  description: Types of Sensory Processing disorders  
3) Many children have SPD and do NOT have an Autism Spectrum Disorder (ASD). However, many if not most people with ASD have SPD challenges such as sensitivities to stimuli and challenges to  engage and learn.  

1) Proprioception, 2) Tactile and 3) Vestibular Sensory  Systems 

These are the 3 sensory systems that are probably least familiar to you and the most important when creating sensory diets. You can think about stimulating the other senses with music, lights,  taste, smell etc. However, it is these 3 senses that create the basis of a sensory diet: 
1) Proprioception: stimulation to muscles and joints has a big impact on body awareness and coordination
2) Tactile: stimulation to skin with a focus on heavy or deep pressure
3) vestibular: our balance system impacted by movement and how we respond to the pull of gravity  

Precautions

1) Let the child decide how much stimulation they want and need.
2) Its best if they can control the stimulation such as stopping a swing or removing a weighted vest.
3)Frequently stop and ask if he or she wants more. Perhaps they will communicate with a smile, pointing, signing more or touching a picture.
4) Weighted vests should not be more than 5-10% of the person's body weight. Work with an occupational therapist to determine the best weight or use a different type of weight such as a lap bag.
5) The body acclimates or gets used to weight so the impact wears off after about 30 minutes. Therefore, consider removing wrist, ankle, vest, lap or shoulder pad weights to wear again later.
6) Do not use weighted blankets with babies or others who are unable to remove them.
7) Stop if the sensory activity is causing increased agitation, disorientation, dizziness, nausea, changes in breathing, has pale, clammy skin- especially if a child is spinning.
8) Many people with SPD do not like light touch, especially tickles. It may cause agitation. They may use their fingertips to avoid touch to their palms.

Sensory Diet Schedules ?




Some children prefer a visual schedule because they need predictability- to know where, when and  how long activities last.  This helps them to control their environment in a confusing sensory world. But not everybody needs a visual schedule. 

Some caregivers or teachers find it easier to implement scheduled routines. If this is helpful, please go for it. However, try to add sensory experiences throughout the day based on your child's preferences, what you learn here and trial and error.  


Heavy Work: stimulates muscles and joints. Provide activities that use force: pushing, pulling, rubbing or squeezing objects. 







  • Carry heavy objects
  • Pass or toss heavy bags of sand
  • Wash the car, wash your pets!
  • Wipe tables and white boards clean
  • push a wagon or wheel barrow 
  • dig and transport sand, water or soil
  • push or pull a friend sitting on a scooter board or a sheet   
  • Roll up inside a heavy blanket
  • Arm wrestle
  • Squeeze bottles- chocolate into milk, shampoo at bath time
  • Play tug-of-war
  • build a snowman  
  • Feed a tennis ball money or other small objects (see photo)   

Source: Playing Catch with Bags of Sand is Great for Sensory Processing Disorders by RecyclingOT

Add Vibration


Vibration stimulates muscles and joints. The sound may help children to focus on a task.  Offer vibrating toys or put a motor inside an existing toy or activity. Many children LOVE vibration! Check out the video for more ideas....



Add Weight to objects and activities throughout the day



Pushing heavy bags of sand into small container opening
Wearing heavy weighted bag on lap
Roll heavy Medicine balls
Go bowling.....
Push a heavy supermarket cart




 
Source: How to Make Sensory Shoulder or Lap Pads for Children with Autism by RecyclingOT

Movement

Slow movement can be calming for overstimulated people
Fast movement can alert those with lethargy but can also be calming
  • Playground: Swings, seesaws, slides, merry go rounds
  • scooter boards 
  • rocking chair, glider chair (slow movement can help calm)
  • Trampolines 
  • Moving heavy objects from high to low, low to high 
  • Cycling, skiing, backpacking and other sports

Source: Sensory-Motor Activities for Individuals with Autism by RecyclingOT


Play Zoom Ball

Zoom ball can be purchased or home made. It can be played indoors or outdoors and helps burn off excess energy while developing coordination .....


Source: Make Zoom Ball for Individuals with Autism by RecyclingOT

Oral Motor Sensory Strategies











  • Sucking through skinny straws requires force
  • Thicken drinks with yoghurt, smoothies, purees so that it takes force to drink through the straw
  • Blow whistles, kazoos and other toy instruments
  • Blow pinwheels, cotton balls off the table
  • Chew gum
  • Eat crunchy foods
  • commercial chewable tools

Learn more about sensory diets, sensory processing disorders and autism in my book: From Flapping to Function: A Guide to Autism and Hand Skills
http://www.fromflappingtofunction.com





Tuesday, May 22, 2018

Activities for Individuals with Grasping Challenges

 Children and adults with grasping challenges can engage in meaningful activities, especially sensory stimulation activities. Examples are:
  •  placing their hands on top of textures to press or rub
  • Providing a basin or tray filled with sensory materials such as water, dried beans, marbles or whip cream or 
  •  activating a switch with a tap, press or roll



Of course, what the individual enjoys and can do depends on the person's cognitive level and interests. Switches such as the one shown here are popular, especially if the student loves, music or vibration.  Other people may be more interested in accessing a computer or Ipad. 

The young man shown in the picture enjoys pressing the switch attached to his chest. It activates a voice that says "good morning everybody".  




Its easier for people with limited grasping skills to have all of their objects easily accessible and enclosed. I tied bags of sand, socks and other fun to feel objects, along with a motorized toothbrush inside a cat bed so that my client can move them around without the contents falling out. The cat bed is plush and fun to feel and some clients like the added heavy pressure by  sewing a bag of sand to the bottom.

Other fun materials to press the hand on top of include: 






  •  a bag filled with gel, shaving cream or other gooey objects to press down on. 
  •  a latex glove filled with water
  • a whoopee cushion. The one shown in the photo is on top of a vibrating cushion.

Materials to swat may be suspended from the ceiling or a tall pole that can be moved around the room. I have used IV poles before..... 

Another option is to attach a swimming noodle over a spanking new toilet plunger handle and then tie some dangly objects to swat  or entwine the fingers inside of. The suction of the plunger will stick to many surfaces, but I suggest that you buy a decent plunger, not one from the dollar store. 





Now, lets take a look at the bowling video that requires nothing more than a push to make the ball roll down the "ramp". Bowling pins are optional..... 




Source: Bowling for Children Who are Unable to Grasp by
Source: Busy Bottles for Individuals with Developmental Disabilities by RecyclingOT

The cat toy consisting of a spring on a stand can be used for swatting.

Source: Spring Toy Ring Stacks for Sensory Stimulation by RecyclingOT

These bottles are fun to pull, slide, jiggle and push.....

Source: Busy Bottles for Individuals with Developmental Disabilities by RecyclingOT

Sunday, April 22, 2018

The Importance of Crossing Midline for Children with Sensory Processing Disorders













Adapted from: From Flapping to Function: A Parent's guide to Autism and Hand Skills



http://www.fromflappingtofunction.com

Typically developing children naturally cross midline during play and functional activities. This is not a skill that parents usually teach, which is why you've probably never heard the term before. Children with dyspraxia other types of Sensory Processing disorders (SPD) may avoid crossing midline.

MIDLINE: is an imaginary vertical line running from the top of the head to the toes, that divides the body into left and right sides. 
Seven-year-old Pedro reached for markers using whichever hand was closest to them, and then used that hand to color. He didn't attempt to stabilize the paper with his opposite hand. Observing this, the teacher, consulted with the school occupational therapist, Leila. Leila recommended that he practice forming large circles on a whiteboard. She offered him a marker positioned directly in front of him at, midline. He grasped it with his left hand, suggesting this hand might be dominant. Leila gently held his right arm at his side while he drew large circles on the board. Next, Leila placed her hand on top of his to guide his movements. With this help Pedro was able to trace over large diagonal crosses and horizontal figure-eights without switching hands.
Leila also recommended activities to help Pedro strengthen his hands, especially his fingers, so that he didn't switch the marker from hand to hand due to fatigue. His teacher tried the 1-2-3 PULL activity shown in the video below and realized that Pedro's left hand had better control than his right when pulling the rings. This observation reinforced the idea that he was left-hand  dominant. 

Source: Sensory Pull Bottle Helps Children with Autism or sensory Processing Disorders by RecyclingOT

Here are a few more activities that promote crossing midline: 
1) Find two containers of different colors (such as red and blue) and bean bags to match. Place the red beanbags on the child's left and the red container on the child's right and vice-versa for the blue. Instruct the child to insert the red bean bags into the red container with the right hand, and the blue beanbags into the blue container with the left hand. 

The girl in the photo has a basket on the other side of the horse so that she can sort the objects while working on crossing midline.

2) Ask the child to touch her right knee with her left hand. Repeat with various body parts. Reverse by showing her how to use the right hand to touch named body parts on the left side of her body.

Sometimes we can encourage crossing midline while children use both hands to move a larger object. The girl in the photo is grasping a vibrating cushion with body hands to touch it to her right leg. She is crossing midline with her left arm.
Suspend a ball so that the child can bat at it with a long tube. Initially have the child hold the tube with both hands. He will at times cross midline as the ball jumps around. 




Position your hand while giving high fives, so that the child crosses midline. I did this repeatedly when performing hippotherapy. 

This simple strategy can be used anywhere, anytime - whether sitting standing or moving.  


The person inserting checkers into the Connect Four Board must stabilize it with one hand because it he doesn't it will fall over. When he began working from his left t
o right, he did not cross midline, but eventually he did as he worked his way across the board.

Another awesome game that will surely promote crossing midline is Twister.

Its also very easy to position materials so that the person reaches across midline with the dominant hand. The person in the video enjoys repetitive picture matching in the form board.
Source: Form Board Picture Activity for Individuals with Developmental Disabilities by RecyclingOT


Finally, the last video demonstrates an activity that uses either Scrabble tiles or alphabet blocks. This works on many visual and fine motor skills as I alternate hands to place the letters alphabetically.

Source: Crossing Midline Alphabet Sequencing for Children with Sensory Processing Disorders by RecyclingOT













Sunday, April 15, 2018

Using Sensory Reinforcement to Build Motor Skills


A basic principle in shaping behaviors is that people want to repeat an action that leads to a desirable outcome. This is commonly referred to as a positive  consequence. For example, a child might finish putting away laundry because she is eager to jump on her trampoline afterward. In this situation, jumping  functions as a positive consequence. Since jumping provides wonderful sensory stimulation- it  functions as a sensory reinforcer.

A reinforcer is a reward or an event that increases the likelihood that a behavior will reoccur 

This principle is used during Applied Behavior Analysis (ABA) therapy.Research has shown ABA therapy to be effective in teaching useful behaviors such as washing hands and reducing maladaptive behaviors such as screaming. Commonly used reinforcers include food, videos or time with a favorite person.  We all enjoy or provide positive reinforcement at times such as when we give praise, a pat on the back or a pay bonus.

Sensory Reinforcement provides desired sensory stimulation

Occupational therapists often use sensory modalities to impact the nervous system with the goal of helping clients achieve an optimal state of alertness- neither lethargic nor hyperactive, but rather focused and ready to learn. Children or adults with Sensory Processing Disorders (SPD) seek to find this optimal state of alertness by engaging in behaviors that meet their sensory needs. They may
  • spin, flap, jump or rock-more than seems typical
  • crash into people, walls or objects
  • seek objects to push, pull or squeeze 
  • put nonedible objects such as toys or clothing in their mouths for oral stimulation 
I have found that use of sensory reinforcement, especially movement  can help children have their sensory needs met while at the same time motivate them to engage in functional activities such as opening a lunch box (food provides an instant reward!).  This is important when working with  children and adults with developmental disabilities including autism spectrum disorders.  

Movement is a powerful sensory reinforcer

My clients becomes very aware when movement begins, stops or changes in intensity. If children are enjoying the sensory stimulation of a swing and it suddenly stops, they will be eager to make it start again. This is a great time to teach how to point, sign or say " go” . If a child has been tuning you out, he may be motivated to look at you and follow your directions to indicate "go" because he wants the movement to resume ASAP.  As soon as the child attends and follows the directions he can be reinforced with movement.  I have incorporated this technique when working with children on horseback, as well as movement equipment such as 
·        swings

·        rocking chairs or gliders

·        therapy balls or scooters

·        trampolines

The desire to move is a powerful tool that can be used to promote hand skills. I have used it in the following scenarios:

·        ·  A girl with Retts syndrome sitting in a rocking chair needs to grasp the hoola hoop before the chair rocks. Rocking stops when she releases her grasp. The movement motivates her to engage in the functional hand skill of grasping

·        A child sits on a platform swing with a lacing board. After inserting the lace through each hole, the swing is briefly pushed. After the entire lacing board is completed he is rewarded with more intense praise and swinging input.

·        A child is prone over a scooter and able to move around to retrieve gears for her toy. After she finishes her mom holds her hands for some fast scooting movement across the room.  
Other types of sensory reinforcement include music, watching bubbles and  smelling scents.  However, activities that stimulate the vestibular(i.e. movement)  and proprioceptive (i.e. deep pressure) sensory system are especially effective.  

Proprioceptive sensory receptors are in muscles and joints. They are stimulated by using materials that are "resistive", weighted materials and/or vibrate.

Resistive Materials

Materials that require force to use are described as resistive. They often require squeezing, pulling or pushing, lifting or carrying heavy objects such as water bottles or bags of sand or activities such as shoveling sand or snow. Many of the activities that I adapt incorporate these principles and I share some video demonstrations below.  

The person in the photo finds it calming to push socks through a small lid opening. The socks are filled with sand, marbles or dried beans so that they feel good  and require a lot of squeezing and pushing to insert. When the activity is completed the child may be rewarded with a big pile of   cushions to throw around and crash into. 

Adapting Activities with vibration


Vibration provides proprioceptive sensory stimulation to muscles and joints. It is easy to incorporate vibration into insertion activities by placing the motor from an electric toothbrush or a motorized pen (with the point removed) into containers. I have used both commercial shape sorters and home-made single shape sorters (see photo) made by cutting an opening in the lid. Some of my clients have refused to engage in insertion type tasks until I adapted them to vibrate. The sound of the motor also helps them to focus on the activity. 



The client in this photo is blind. The pink cushion is vibrating. He receives sensory stimulation when pulling the shapes off the Velcro and pushing them into the small openings in the green container. When the task is completed he can enjoy the vibration by holding the cushion against his body. 


My favorite reinforcers involve movement and deep pressure because my clients LOVE it and unlike food there is no risk of choking, allergies or eating too much. It is always possible to bring movement into an activity or use it as a reward for completing a task. If you don't have movement equipment (such as swings) available you can always try using movement activities such as these as sensory reinforcers: 
  • alternate touching toes and sky
  • jumping, hopping, galloping and skipping
  • doing jumping jacks
  • rolling up inside a blanket or rolling down a hill
  • turning in circles
  • dancing

In my book From Flapping to Function: A Parent's Guide to Autism and Hand Skills  I describe the following  activities designed to promote focus and learning by using sensory based activities and reinforcers. 
1. Wendy lies prone on a large ball and gently bounces while reaching to match spelling words cards placed on the floor. When finished she enjoys lots of fast bouncing.
2. Wendy scoots across the room while sitting on a scooter board to retrieve clothespins she will use to hang up doll clothes
3. Wendy squeezes snap cubes together to spell words.

 After the activities are completed, additional sensory reinforcement may be offered such as  feeding the Hungry Harry Ball.

Hungry Harry is made by inserting a slit in a tennis ball. This child is feeding him pennies that he removes from the putty.

Choosing the reinforcement totally depends on trial and error and what your child likes. One thing is for sure- when you provide the sensory stimulation children seek and need they are motivated to engage and learn.



PULLING

Source: Velcro Bottles for Individuals with Developmental Disabilities by RecyclingOT

PUSHING

Source: Sensory Frisbee Ring Stack by RecyclingOT
SQUEEZING

Source: Creating Push and Squeeze Activities for students with Sensory Processing Disorders by RecyclingOT



VIBRATION

Source: How Vibration Helps Children with Autism or Sensory Processing Disorders by RecyclingOT
WEIGHTED MATERIALS

Source: Sensory-Motor Activities for Individuals with Autism by RecyclingOT