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Occupational Therapy IWK & AVH

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1 Occupational Therapy IWK & AVH
Trends in Fine Motor Occupational Therapy IWK & AVH Refer to foundation skills and best Practice

2 Deskwork - Proper Positioning
A strong and steady trunk provides the base of support needed for successful fine motor tasks Important to focus on the activity, not focus on staying upright - So when child is doing a fine motor task such as coloring, printing, cutting and are not positioned properly, more energy into sitting and keeping balance not in activity

3 Positioning - The Perfect Fit
Proper Chair Size feet flat on floor ankles, knees and hips at 90 degrees make sure chair is not too deep back should be supported two fingers’ space between back of knee and seat

4 Positioning - The Perfect Fit
Proper Chair Position should be able to sit back comfortably and bend slightly forward at the waist the arm should be at least at a 30 degree angle from the trunk Proper Desk Size height of the top of the desk or table should be about 2” above the height of the elbow

5 The Perfect Fit -back supported -seat depth appropriate
-feet supported

6 Sitting at the Desk: Tips and Tricks…
It is often a challenge to provide optimal desk position for each student in the classroom If feet don’t reach the ground use stool, container, phone book, block of wood, Jettstep If chair is too deep/ too wide add phone book/ cushion/ foam to back of chair, smaller chair add foam/ cushion to sides if too wide If child slides in seat Anti-slip material - Well we always don’t have a perfect chair to work with so……. -suggestions to assist with positioning -look for another chair that is smaller or narrower - Perhaps the wood working class at middle/high school would consider a project and make a step for your student- it helps both sets of students

7 Seating Trend ..... Many students will need to adjust their positioning or have the ability to move during the school day Allow students to stand at their desks Dynamic seating options: Hokki stool, Move N’ Sit cushion, disco disc etc. - Suggestions form audience

8 Handwriting “Writing refers to the expression of ideas and information for the purposes of communicating. Handwriting on the other hand, refers to the fine-motor skill of writing letters in order to communicate those ideas and information.” Not being able to form letters easily constrains writing Students need to work on handwriting as a foundation before they can be expected to concentrate on the message they are writing. When student is not struggling with letter formation, he/she is freer to write fluently Department of Education, English Language Arts Primary-3, April 2013

9 Best Pratice for Handwriting
Practice 20 minutes, three to five times week is recommended. Printing practice should be done as a separate activity. Focusing only on learning to print. Structured teaching will help prevent or correct bad habits. Printing Like a Pro, Sunny Hill Centre for Children Therapy Department, 2013

10 “ However ten minutes several days of week devoted to teaching handwriting is justifiable and necessary, especially in the lower grades.” Department of Education: Handwriting P-3 ELA document April 2013 Discussion……. -Discussion- Best practices vs department of Education vs Halifax RSB- feels very strongly about embedding handwriting teaching in with other activities vs. a separate activity vs valley school board -



13 Grasp The development of grasping skills starts at birth
Grasping skills are important building blocks for more refined manipulation Experiencing grasping activities helps to develop these skills Grasping is necessary for functional skills such as crayon use, feeding self and playing with toys

14 Why are grasp patterns difficult for some children?
Poor muscle development Poor attention Limited exposure to fine motor activities Lack of interest in coloring activities Not teaching early hand development skills….lack of awareness of their importance

15 Pencil Grip…. Being able to hold a crayon correctly is a readiness skill for handwriting Teach pencil grasp to your students. When children are young, it is worthwhile encouraging an efficient type of grasp. Pencil Grip Song Handout refer audience

16 Pencil Grasp….. Adapting it when needed i.e. provide a pencil grip (eg. Cross Over, CLAW, Grotto)

17 Pencil Grip….. Research has shown that having a good pencil grasp does not ensure legible handwriting; nor does having a poor pencil grasp doom one to illegible handwriting. There are other factors that may contribute to a student having difficulty with handwriting other than pencil grasp… Pencil grip is just “one piece of the puzzle” Look at quality of print as well as complaints of fatigue or discomfort to see if a concern

18 Developmental progression of skills….
A child would learn to: Trace Imitate Copy Draw

19 Prewriting Lines and Shapes
Horizontal Line (2 years) ― Vertical Line (2 years) l Circle (3 years) o Cross (4 years) + Right diagonal (4-5 yrs) / Square (4.6 yrs) Left diagonal (4-5 yrs) \ Triangle (5.3 years) ∆ Please keep these milestones in mind when you are teaching primary students how to print. Expectations need to match their development. Give the example that the letter X will be difficult for a child who can not make a diagonal line, it doesn’t mean that student can’t learn how to make an X but it may take more practice and more self correction

20 Readiness for Formal Writing Instruction
Hand dominance Knowledge of simple size and shape concepts (big line/little line, big curve/little curve) Ability to hold a crayon with fingers place correctly (for their age) Satisfactory level of attention, cognitive skills and cooperation Imitation of a vertical line, horizontal line, circle and cross Olsen, Jan Z. & Knapton, Emily. Handwriting Without Tears Pre-K Teachers’s Guide (2008) Cabin John MD, Handwriting Without Tears

21 Progression of Handwriting
Line development Print letters easily and automatically Work on simple words At first do not worry about staying on the lines As you see improvements, focus on proper positioning on the lines and consistent letter sizing Progress to having student to print entire sentences Encourage student to focus on spacing between letters and within words Proper use of punctuation Comment on not to use dots when teaching printing

22 Tips and Tricks Follow the developmental sequence of tracing, imitation and copying Don’t forget to practice lines and shapes (drawing/art/multi-sensory) in addition to handwriting Be sure to supervise your student to ensure they follow the correct steps and not just end up with a good end product e.g. start your letter a the top , proper letter formation

23 Tips and Tricks … Continue to teach letter formation to your primary classroom but be aware that your 4 year old students may need extra attention to handwriting later in the year Use a multi-sensory handwriting approach Practice handwriting or cutting with an object held in palm by ring and baby finger (stabilization of the hand)

24 Teaching Strategies for Handwriting
Step One: Modeling: Show the student a few times how to form each letter using a chalkboard or white board. Include numbered arrows that show correct letter formation as this provides a good visual cue. Having a letter strip with arrows showing letter formation on the student’s desk is also suggested for classroom work times. This is missing now. Kids are just copying Kids need to be able to problem solve and figure out why things don’t look right Printing like a pro is a cognitive approach – this is the trend- kids learn better using a cognitive approach- self talk, evaluate and practice

25 Step Two Self-Talk: Encourage repetitive talking out loud of directions of proper letter formation, i.e., self-talk of direction of movement (e.g., “i= down , lift, dot”). Verbally model the self-talk and prompt the student to talk out loud, repeating the same set of directions each time. Using the same self-talk phrase each time is important for best learning. Use can HWT as an example here, “big line down, frog jump, little line, little line”

26 Step Three Self Evaluation: It is important for the student to look at their work to see how closely their letter formation matches the target letter. Self-evaluation can also be in the form of circling their best-formed letters. Discuss with the student why they chose those letters. Use “Check Your Work” cards to remind students of self evaluation Check your work card can be based on expectations of the class or what is reasonable for that child to expect. – if for class, did I use capitals, on the line, spaces between words, sky grass dirt etc

27 Step Four Practice: Use a wide variety of writing tools. In addition to using a pencil for practicing, have the child write with chalk on a chalkboard or with felt markers on a white board. multisensory

28 Handwriting Expectations in Each Grade Level
(© N. Pollock, J. Lockhart, B. Blowes, K. Semple, M. Webster, L. Farhat, J. Jacobson, J. Bradley & S. Brunetti, 2009}) Primary 􀂉Correct letter formation 􀂉 minimal eraser marks or smudging 􀂉Smooth lines 􀂉Consistent pressure i.e. markings are not too light or too dark Grade 1 􀂉 Consistent spacing between letters and words 􀂉Consistent size of letters These should be considered guidelines, always consider the individual student and their individual learning or motor difficulties

29 Grades 2/3 􀂉 Correct letter placement e.g. hanging letters, such as “g” do hang below baseline 􀂉Appropriate orientation to baseline 􀂉Appropriate use of margins 􀂉Good organization on page Grades 4/5/6 􀂉 Text clear and easy to read 􀂉 Precise letter formation e.g. good closure and finish of strokes 􀂉Regular spacing between letters and words 􀂉No crowding (© N. Pollock, J. Lockhart, B. Blowes, K. Semple, M. Webster, L. Farhat, J. Jacobson, J. Bradley & S. Brunetti, 2009})

30 Tips and Tricks… Do not use upper case letters when teaching children to recognize or write their name Emphasize starting all letters at the top to discourage bad habits that are difficult to change later If a child has not chosen a hand dominance, always be careful to place the crayon/marker at midline Use broken crayons to promote pincer grasp Avoid dot-to-dot when working on letters, use yellow marker instead

31 Technology Despite the dramatic rise in available technology for students to produce written work, printing remains an essential functional skill to express thoughts, ideas and knowledge in the classroom and beyond. Never completely give up on handwriting because it is a life skills. There are many times in your life that you need to handwrite (writing your signature, filling out a job application, or completing a questionnaire). However, technology certainly plays an important role for the success of many students.

32 Why Keyboard ? When students have mechanical and organizational writing difficulties, keyboarding may be their primary means of written communication expression Keyboarding is becoming a life skill, research indicates it should be taught in 3rd or 4th grade

33 Advantages of Keyboarding
Less distal finger control improved legibility improved accuracy improved efficiency easier to correct typing and spelling errors improves word finding abilities less hesitant to reevaluate and edit written work improved quality and productivity

34 Disadvantages of Keyboarding
More difficult in certain environments Computers not always available in classroom child may not be familiar with keyboard arrangement, therefore keyboarding may decrease speed children may become frustrated and composition may become affected

35 Consider technology when…
Legibility is poor at a grade 3 to 4 level- can sometimes start earlier A student’s handwriting begins to hold them back A student is resistant to handwriting Poor organization within writing

36 Tips and tricks… Ensure students that need technology have opportunities to become familiar with the keyboard and its functions Engagement in meaningful keyboarding activities is the best way to learn keyboarding; young people learn to keyboard through doing activities such as writing stories, playing computer games, doing schoolwork and writing letters or s. (Niles-Campbell, Tam, Mays &Skidmore) What grade do you start…… Grade 2 most have digit isolation otherwise not developed Some research says grade 3-4 Some encourage computer skills in primary

37 Ergonomic Considerations
Proper positioning Eye gaze should be at top third of monitor Wrist should be in a neutral position Consider finger isolation Desk, mouse, keyboard, chair and monitor considerations

38 Scissor Cutting The tips of the thumb and middle finger are in the holes of the handles of the scissors. The index finger is on the outside of the handle to stabilize the scissors, and the ring and little finger are curled into the palm. The wrist of the cutting hand should be bent up (Benbow, 1991). Thumbs up!!

39 What Problems Do You See?
Poor scissor grasp Switches hands or uses two hands Scissors in palm instead of in fingers Scissors on joint Jagged cutting Tears paper instead of cuts Poor control of opening and closing scissors Paper and scissors rest on desk throughout the cutting task Child has difficulty controlling paper and scissors at the same time Child doesn’t know where to start first cut Child cuts without ever turning paper

40 Tips & Tricks to Support Thumbs Up
Do you see this? thumb down Tips & Tricks to Support Thumbs Up Playing card games, especially being the dealer Hole punch Squirt bottle for watering plants Snapping fingers Games with small pieces to manipulate (Tricky Fingers or Tiddlywinks) Turning a key in a lock or on a wind-up toy Put a sticker on student’s thumb, they always need to see the sticker when cutting

41 Tips & Tricks that Support Finger Control For Holding Scissors
Do you see this? on joint Tips & Tricks that Support Finger Control For Holding Scissors Eye droppers Tongs Clothes pins Pennies in bank Pegs Unifix cubes Opening bottles, jars Tweezer games Two hands

42 Tips & Tricks for Stabilization of the Hand
Do you see this? fingers splayed Tips & Tricks for Stabilization of the Hand Ring and Little Finger Anchors: Curl the ring and little finger into the palm by holding a small object against the palm (e.g. pom-pom, play-doh ball, marble…) while cutting Play other games or pick up objects with thumb, index and middle finger with the ring and little finger against their palm. For example, place coins in slots or play connect four, cube twirl etc. This activity can be practiced at other times during the school day such as snack time.

43 Or this? Tips & Tricks Child uses table for support. Child’s thumbs are down for the holding hand. Thumbs up for both Encourage tucking elbows hands against body Pull chair away from table during cutting activity -use a marker line

44 Or This? Tips & Tricks Keeps scissors pointed forward and rotates paper with helping hand when turning corners or curves Takes smaller snips (i.e, when turning corners) Right-handed: cut in a counter-clockwise direction around shape. Left-handed: cut in a clockwise direction around shape. Child cuts without ever letting go of the paper. Notice that both hands are at the right of midline. -use a marker line

45 Or this? Tips & Tricks This may indicate poor motor planning
Child cannot figure out how to get scissors to the shape. Tips & Tricks This may indicate poor motor planning Provide specific instruction on how to approach and execute cutting task Provide increased opportunities with specific instruction If the child is unable to figure out how to get to the shape with the scissors, the child can draw a line to the shape from the edge of the paper -use a marker line

46 Progression for developing control of scissors Part 1
Child demonstrates interest in scissors Child experiments with opening and closing scissors, not necessarily cutting paper(hand position may vary) Child orients scissor blades to paper to begin snipping (hands do not rest on table)

47 Progression for developing control of scissors Part 2
Child gains more finger control with the scissors positioned toward fingertips Child begins to cut in a forward motion across a 4-inch strip of paper without adjusting holding hand

48 Progression for developing control of scissors Part 3
Child uses one hand to adjust paper while the other hand controls the scissors, cutting across an 8-inch wide piece of paper Move holding hand forward as the scissors pass

49 Progression for developing control of scissors Part 4
Child cuts forward on a line Child cuts turning corner(s) Cutting past the shape/line to the edge of the paper before rotating object (Note: We don’t teach this, they just do it… however, we will sometimes structure a project this way to teach those that can’t break down the steps for organizing the sequence on their own.) Rotate object (the paper, not the scissors) to cut around the corner

50 Progression for developing control of scissors Part 5
Child cuts out straight-line shapes (square, triangle) Child cuts out curved-line shapes (circle, oval) Child cuts out simple shapes (heart, moon) Child cuts out complex shapes (star, hand) Notice that the two hands must shift between the tasks of moving and holding. For example, one hand holds while the other opens and closes the scissors blades, then the scissors hand must hold while the holding hand shifts position on the paper.

51 Cutting References and Resources
Klein, Marsha, Pre-Scissor Skills, Therapy Skill Builders, 1987 Knight and Gilpin Decker, Hands at Work and Play, Therapy Skill Builders, 1994 (activities only) Web pages Scissor Skills.pdf

52 Questions?

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