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

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

Insertions Ring Stack for Children or Adults with Disabilities

The "Insertions Ring Stack" is very versatile and develops many skills. Children or adults with developmental disabilities may find repetitive tasks soothing.

This activity involves either  pushing rings down the tubing or inserting small objects inside. Your child or client will need to think about which of these steps to perform. They will learn to develop flexibility as they switch back and forth...

This activity promotes:

·        eye-hand coordination

·        using hands together

·        visual and auditory stimulation

·        proprioceptive stimulation by pushing the objects down

·        following directions

·        sequencing skills

·        problem solving

I cut the rings and small objects out of plastic bottles, but you can use other types of rings or small objects in the same way. Be sure to supervise closely or avoid if your child or client puts small objects in his or her mouth.

This activity can be adapted by

·        using larger rings to make success easier

·        smaller rings that require force to push and thus, provide greater sensory feedback.

·        try placing a motorized toothbrush inside the container and see how your child or client reacts!

The client in this photo benefits from reaching since she typically sits with rounded shoulders. She avoids using her hands together but is about to realize that she cannot do this task with only one hand!

She is on the autism spectrum and loves to be busy, yet this task requires a bit of problem-solving. It meets her cognitive and sensory needs. 

Learn more about activity adaptations at RecyclingOT.com

Source: Eye-Hand Coordination Insertions Ring Stack for Individuals with Autism by RecyclingOT

April 2018 Book Sale: The Recycling Occupational Therapist

April Book Sale

with free shipping in continental United States...... 

The Recycling Occupational Therapist

 Now until the end of April sale!    

$25.00 with free shipping in continental United States !!!!! 

Happy Occupational Therapy Month!!!!!!
Happy Earth Day month !!!!
Learn strategies to help your child or clients be as independent as possible....

Source: Jig for Unscrewing a Bottle Cap by RecyclingOT

Learn strategies to help your child or clients meet their sensory needs......

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

Make toys or activities out of everyday recycled materials to use with your child or clients....

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