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Friday, December 28, 2018

Fidget Tools for Sensory Processing and Anxiety Disorders

Excerpted from my book: From Flapping to Function: A Parent's Guide to Autism and Hand Skills

Many children and adults focus better when fidgeting with something; for example, jingling coins in one's pocket, pulling a zipper up and down, or tapping a pencil. Grasping and manipulating objects in these ways may be calming, alerting, or both. Many commercial "sensory" products are available to provide this kind of hand stimulation.
Fidget tools may be considered primarily a
 1) sensory fidget or
 2) quiet fidget tool.

The following video demonstrates both "sensory" and "quiet" fidget tools. At the bottom of this post, I share Associate Amazon links to products .....

Sensory Fidget Tools

Sensory fidget tools provide deep pressure stimulation to muscles and joints as they are pulled, squeezed, or pushed. Choosing sensory fidget tools requires individualization and some trial and error-one child may quietly pull on a stretchy toy while another might shoot it at peers.

Possible sensory fidget tools include these:
  1. Stretchy book covers, socks, coiled bracelets or key chains, rubber bands, or elastic hair bands. Children may enjoy stretching elastics around a ball or crunched-up paper to make a rubber-band ball. 
  2. Squeezing putty, modeling clay, or stress balls. You can make your own squeeze ball by pushing play dough inside a large, strong balloon (or plastic glove). Knot the balloon, then double its strength by inserting it inside a second balloon. This is easier to do if you cut the knot end off of the second balloon. (see picture below)
  3.   A kneadable eraser is enjoyable to mold and use, and may appeal to older children who do not want to look different than their peers. 
  4. Attach  a strip of Velcro or loop fastener to a table or desk. Then attach pieces of Velcro fastener to a couple of blocks or similar objects. The child can repeatedly attach and remove them while working. (see Velcro Railroad tracks photo below)
  5. Toys that make sounds, light up, or vibrate when squeezed, pulled, or pushed may be especially fun and stimulating. 

Quiet Fidget Tools

Quiet fidget toys fill the sensory needs of children who focus better while quietly moving their fingers. A quiet fidget tool might be a smooth stone, pen cap, marble, strand of beads or a paper clip. Advantages of quiet fidget tools are that they are generally not disruptive to other children and can be easily replaced when lost. A child can easily put the object down when engaged in a hand activity, or may be able to tuck it under the ring and pinky fingers while doing puzzles or even writing.

This client grasps small, smooth rocks between her fingers In each hand- all the time, including while eating, washing and inserting objects into containers. She finds it calming and becomes upset if they are removed! 

I try to create activities that meet the person's sensory needs while at the same time developing hand skills and having fun. For me that includes kneading dough to make bread or knitting. The following videos demonstrate activities that meet the sensory needs of my adult clients with   developmental disabilities.

Source: Adapting Velcro Activity for Sensory Processing Disorders by RecyclingOT

Pulling, shaking and squeezing materials at the "sensory table" help decrease hands in mouth behaviors.

Source: Sensory Table for Individuals with Developmental Disabilities by RecyclingOT

Source: Busy Bottles for Individuals with Developmental Disabilities by RecyclingOT
Source: Stretchy Ring and Ball Activity for Children with Sensory Processing Disorders by RecyclingOT


Friday, December 21, 2018

Animal Holiday Cheer

I love seeing wild life when I vacation at Myakka River Park in Florida.

I hope that these videos bring a smile to your face!!!

urce: Birds and Alligators at Myakka River Park by RecyclingOT

Source: Woody Wood Pecker at Myakka River Park by RecyclingOT

Source: Hungry Begging Bird! by RecyclingOT

Source: Oh..... Dear! by RecyclingOT

Monday, November 26, 2018

Children with Sensory Processing Disorders and Hand Preference

Excerpt from From Flapping to Function: A Parent's Guide to Autism and Hand Skills. 

Most typically developing children show a preference for one hand or the other by the time they enter kindergarten, although it is not abnormal to develop hand dominance as late as six or seven years of age.
  •     Hand dominance is the result of brain specialization so that the hand opposite the dominant brain hemisphere develops great skill. 
  Children develop coordination between the right and left sides of the body when the right and left halves of their brain- called the brain hemispheres- are communicating efficiently.  Many children with Sensory Processing Disorders (SPD), especially those with dyspraxia, have difficulty with coordinating the two sides of their body, especially to perform complex tasks such as braiding hair or knitting. Because the right and left halves of their brain may not communicate well, these children may develop hand dominance (right-or left-handedness) at an older age than is typical, or not at all.  

Let's take a brief look at the relationship between brain hemispheres and hand dominance. Each hemisphere controls the opposite side of the body-the left hemisphere controls the right side, and vice versa. One hemisphere of the brain is typically dominant and people develop greater skill on the body side opposite the dominant hemisphere. Thus, someone with a dominant right hemisphere is typically left-handed. Most people are right-handed, have greater skill on the right side of the body and have a dominant left hemisphere. 

The person reaching for pictures in the top photograph demonstrates a  right hand preference because she consistently uses it to reach across her midline and to perform skilled tasks such as fitting shapes into form boards.  She also tends to avoid using her non-dominant left hand unless she really must-another characteristic sometimes seen in people with SPD. 

  • Midline  is an imaginary line that runs down the center of the body, dividing it into left and right halves or sides.  
The term hand preference is sometimes used to mean hand dominance. However, hand dominance is the result of brain specialization. This means that certain skills- like language- develop in one hemisphere rather than the other and that one hemisphere becomes dominant with the opposite side of the body becoming more skilled. 

  • The term hand preference is sometimes used to mean hand dominance. 

The preferred or dominant hand is often stronger, as well as more skilled at performing tasks such as controlling pens, scissors, tweezers or a sewing needle. 

There are other reasons why a child may prefer one hand over the other. For example, Thomas may be left-handed but use his right hand to cut because he was given right-handed scissors or he imitated his right-handed teacher.  Some children switch hands when one hand gets tired or when they are searching for a more comfortable way to grasp a tool. Modifying tasks may help them to use their dominant hand consistently. For example a fat piece of chalk that is easier to grasp may reduce hand switching due to fatigue.  

It is important to develop hand dominance because using the same hand consistently for specific  tasks helps develop proficiency. Try writing with your non-preferred hand and you can see what I mean! 

Some children develop what is called crossed or mixed dominance. This means that they use different hands for specific skills. For example, Claude became adept at using his right hand to write and his left hand to throw a ball. This was not a problem because he practiced each skill consistently with the same hand. Thus, he became very good at throwing with the left hand and writing with the right.  

Many children with SPD  also avoid reaching across midline, or even bringing their hands together at midline.  Learn why this is an important skill to develop in my post...  The Importance of Crossing Midline for Children with Sensory Processing Disorders

Children with poor coordination between the right and left sides of the body may also have difficulty using their hands together to stabilize materials and to discriminate right from left.

The following videos demonstrate a few strategies to
  • promote right left side coordination
  • promote crossing midline
  • learn to discriminate right and left  
  • develop an awareness of which hand feels stronger, more coordinated and comfortable  
Velcro bottles are difficult to use unless stabilized with one hand, usually the non-preferred hand.  Pulling Velcro objects off backings requires force and using force provides proprioceptive sensory stimulation to muscles and joints. Encourage your child to use the same hand consistently to remove the objects and the other hand to stabilize.

Source: Velcro Bottles for Individuals with Developmental Disabilities by RecyclingOT

As this video demonstrates, children pull using force and using force provides sensory stimulation. Ask your child to think about which hand is stronger while pulling and which hand gets tired more quickly.

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

Talk to your child about the "worker hand" and the "helper hand" and refer to them as either right or left respectively. Position materials so that they cross midline to retrieve them with the hand identified as the more comfortable "worker hand".  

Don't forget to make Developing Hand Skills Fun !

Source: Recycling Occupational Therapist demonstrates Fidget Spinner by RecyclingOT

Tuesday, November 13, 2018

Screw Cover matching Activities that Develop Fine-Motor Skills

Screwing and unscrewing covers to bottles and other containers is a great way to develop manipulation skills!

There is an unlimited supply of plastic containers from detergent, dishwasher soap and juice bottles available to make these activities.

I cut around the threaded pouring spouts and saved the lids so that young children with or without disabilities or adults with developmental disabilities can match by size and then screw the pieces together.

The yellow covers shown in the photo screw onto white threaded  containers used for Thick-it. Many of my clients have their drinks thickened with this product. Sometimes the threaded pieces are the same color as the caps so that children can match both size and color at the same time.


This activity may be used as a simple single- step matching cover to threaded piece activity without inserting them into containers.

 It is generally easier to motor plan the motions to unscrew than to screw the pieces together. So you may set the activity up to separate them before teaching how to screw them together.

Create a 2 step task by requiring the child to insert the covers into container openings.  The threaded pieces may function as rings to stack on a ring stack. .

At first, choose larger materials that are easier to manipulate. As skill develops use smaller caps and threaded pieces... perhaps from juice bottles.

You may choose to have only 2 or 3 different types of  sizes to match and then increase the challenge as skill develops.

The client removing the yellow covers has limited visual perceptual skills, so I provided a container with only one opening and all of the yellow covers can fit inside.

 In the following video, there are so many different sizes that even I found it a challenge to match them! So I numbered the covers to match the threaded pieces and it turned out to be a hit!

I discovered that my clients really enjoyed having the threaded pieces organized on a long strand of fabric or cord.

Cut 2 holes in the threaded pieces to string these in sequence. Children can work on matching and sequencing skills as they develop eye-hand coordination.

You may choose to match and sequence these in alphabetical rather than numerical order. Some children or clients m ay best match simple shapes or pictures drawn or glued onto materials.

Source: Matching Numbers Screw Cap Activity to Develop Fine- Motor Skills by RecyclingOT

This activity may also be adapted to be performed while sitting, standing or moving across the room to retrieve materials. Moving from high to low and back provides not only aerobic exercise but vestibular sensory stimulation. Many children or adults with sensory processing disorders will appreciate the movement sensory stimulation that may decrease anxiety or agitation.

Reaching high up is great for developing posture and visual attention since the materials are right in front of the person's face.

The individual in the green shirt has cerebral palsy and avoids using his left hand. However, he was so motivated to work on matching and unscrewing - he stabilized the threaded pieces - and worked with a smile!

Source: Unscrewing Bottle Caps to Insert or Stack by RecyclingOT

This gentleman is blind and enjoyed working on a book stand that has the threaded pieces attached. A maintenance man at work drilled holes into the bookstand so that I could attach string to tie pieces onto.

A container with  2 different shape openings turns this into a simple shape sorter after the covers are unscrewed.....

Another option is two attach materials to the sides of a large container used for cat litter a bucket.

Source: Matching Lids Sensory Activity by RecyclingOT

I share the links to demonstrate the products that come in the containers I like. If you shop on Amazon through any of these links, I earn a few pennies.....

However, obviously, I prefer to recycle!  

Sunday, September 30, 2018


My book costs only $25.00 if you click on this pay pal button and you also get free shipping if you live in the continental United States. I can afford to do this when I don't pay the Amazon fees..... 

If you want shipping to outside the continental United States please email me for shipping costs.... These can be quite high, so I suggest purchasing the digital edition from Amazon.

This valuable resource is written for therapists and teachers, vocational instructors, parents, and all environmentalists who wish to use their ingenuity to create useful therapy products from common objects. Author Barbara Smith, M.S., OTR, reasons that when she finds alternative uses for plastics and recycles them, not only does she avoid having to purchase the material, but she also reduces the amount of waste deposited in the environment. Many a pattern can be carved from a plastic bottle. Cut a large detergent bottle to provide a surface for weaving. Snip off narrow bottle necks and use them as rings on a dowel. Cut off a hollow bottle handle, and you have something to fit a peg inside, or cut up that same bottle to make disks for stringing on a colorful length of discarded jump rope. For imaginary play, cut out space boats and weird helmets. The possibilities are endless! 

The therapy products described in this book are made mostly-if not entirely-from recycled throwaways. These materials are easily collected, free, and versatile. The products can be used over and over again, and creating them can be fun and rewarding. The products and activities are presented in three categories-fine-motor activities, gross-motor activities, and sensory activities. The activities are presented in a cookbook fashion, with a brief description of the material or activity, a list of needed materials, construction directions, and suggested uses and adaptations. The Appendixes provide six lists for guidance in planning of activities for clients. Terms used throughout the book are defined in the Glossary. Although the activities in this 155-page manual are designed for adults with developmental disabilities, many are appropriate for clients of all ages, with or without developmental delays.

Of course, you may still choose to purchase the print edition on Amazon for $35.00 and the

Kindle edition for $9.99

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