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Post Archive

Ask an OT: Eating

Question: My 10 month old daughter does not eat enough, any suggestions?

Answer:

If she tends to gag, maybe she has swollen glands or ear infections. If she does not like to be held upside down, she may have gravitational insecurity. Consider an elimination diet or see an allergist to find out if certain foods are causing swelling around the throat. The sensations need to be quite distinct at the back of the throat to trigger a swallow. Get an occupational therapy assessment to determine if swallow rhythm or tongue mobility might be an issue.

Set up the eating environment to make sure the cues are clear when she should eat. Specific times of the day, in a certain chair, etc. Model eating and drinking. Play imitation games.

If she eats less when she is constipated save your new food trials for times after she has had a bowel movement when she may have less of a full feeling.

Enjoy food. It's catchy.

Ask An O.T. about touch sense activities.

 

 

Question: On neuro exam, our daughter had difficulty identifying objects in her hand when her eyes were closed, or by touch. I was wondering if there are specific exercises, games etc that may help us in trying to help our daughter develop these skills that she struggles with.

Answer: Some simple touch activities:

 
1) Get a soft bag about 6x8 inches and put a few things in it. Each item should be very different in texture and size. I made one recently for a 9 year old boy. It had a large block, a large car, a small slimy toy reptile, a marker, a wheel, and a toy soldier. Other things could be a feather, a large bead, a rope, a small box, a beany bear, and wind up toy. Write the names of the objects on a card. List each object for the child to find, one at a time. Help prevent looking by gently closing the bag over the wrist. Cue "no looking", "use your fingers to find it".
 
Alternate: start with a clear plastic bag.
Alternate: start with two bags, give the clear one to the client initially to teach the task of finding a match. Then, model not looking to find the named object. Then, a week or two later, keep the clear one and just point to the object. 
Alternate: place the objects in a ball pit or a bowl of rice (dry beans feel nicer).  
 
2) Another easy activity is to get a number of objects of various textures. Say, "find the one that is soft, hard, prickly, rough, moveable, slimy, or smooth". Then, hide the objects in a bag or under a pillow to find one at a time. Ask if she likes the feel of each one.
You may also want to look up stereognosis.

Where the comfort of routine becomes the rigidity of routine.

Question: My daughter is unable to accept change. She wants the same ski's from 4 years ago, she  will only wear the same snow pants from 2 years ago  that are almost up to her knees, ... Any ideas?

 

1) Use a progression technique - similar to the SOS technique for feeding. Start with tiny steps. The first goal is usually "tolerates presence of the item". For instance, leave pictures of snowsuits from catalogues in her presence while she is busy on a familiar, engaging, activity. She may toss it away. Gently bring it back in. Then baby step number two is comment on the picture, and so on. Limit language and set no expectations.

 

2) Whenever using the structure of routine, build in a time to be flexible to the middle of the routine. In a visual schedule, you can title these moments of flexibility: "learn something new" or "try something new". Begin and end each routine with a familiar activity while having a challenge in between.

 

3) Preparation. Say "next winter, you will need a new snowsuit". Repeat weekly. If resistance is expressed, acknowledge the concern, and move on to something else. Many people respond with an approach-avoidance style. They want to be brave, but the fear interferes. If the subject is brought up again, ask "are you ready to look at catalogues?". Or offer a choice: "would you like to look at catalogues or online pictures of snowsuits". If the person is non-verbal, imagine what questions they might ask. Take short dabs at the conversation, then intervene with some other experience or sensation. Do something relaxing or physical before discussing the topic again.

 

4) Sensory exploration. Acknowledge how the familiar object feels. For instance, "your old snowsuit has a soft liner, do other snowsuits have soft liners?". Go from there.

 

5) Alert first. Only present challenging activities during windows of alertness, no matter how short the window. Help her get physically and mentally ready; get a "just right" level of alertness. If necessary, use the Extended Matrix model of the ALERT program. Use a quiet break, then a together break, then an exercise break to get ready for brain power learning time. End learning time before alertness turns to agitation or an overwhelmed state. See Alert Manual page 3-4. 

 

Hope this helps.

 

Charlene Wright

 

Ask an OT: What do you do?

 
 
Question:
 
While I was career searching, I saw the comments some  people made about an occupational therapist and was seriously intrigued and interested in the profession. What  do you do on a day to day basis?
 
Reply:
 
This morning I was out to a home nearby to see a family of three children who are homeschooled. We talked about the angle of lines they took some shots on my net. The oldest was doing geometry and needed to think big picture so I had a string and we talked about how much easier it is to get a goal on the net from in front where there is more degrees of angles to choose from. The middle child was learning about printing letters with the diagonal that slopes from the top left to the bottom right. The youngest was learning about tying a lace by doing the last step, pulling the two loops straight away from each other.
 
I just got a phone call from the parent of a 15 year old autistic male whose psychiatrist has recommended OT to treat sensory issues that were interfering with his ability to perform daily living skills. I will help the parents come up with goals and submit a service plan to Family Supports for Children with Disabilities for behavioral aide support.
 
This evening, I will visit a 9 year old autistic boy I have seen off and on for about 3 years. I may discuss the integrated listening system with the parents and will consider purchasing the start up kit for $1145.00 to let the parents trial it with him before they purchase their own. It may help his dyslexia, auditory processing, and attention to task likely because the multi-sensory rhythmic sequencing is organizing, firing the whole brain at once. I will assess his oral motor function and may trial a lip protrusion and/or jaw strenghtening exercise. I may try to help the aide and family use the Wii for developmental skills.
 
If any other OT's would like to comment, please hit the comment button above.
 

Grips and reversals

1. Pencil grasp 

An appropriate referral for "grasp", like every OT referral is anyone whose occupational performance is interfered by a health care issue. If the grasp is not interfering now or likely to in the future, it is functional. Specifically, the quad grasp is functional (as is the dynamic tripod, of course). The Benbow program is an excellent source for information. The ETCH assessment is also very good and comes with a book of handouts called the TRICS.  I find it helps to ask where is the movement is coming from. Often it is coming from the shoulder which is going to be tiring and ironically requires strengthening at the shoulder (stability promotes mobility).
An occupational therapy can join a class during printing time and walk around offering TRICS and grips to the whole class. Screening for bigger problems like low tone, undeveloped dominance, and visual motor issues.
Taking grips:
- The Start Rite(blocks the thumb from wrapping - and is usually combined with finger strengthening activities like "ok wrestling").
- The Grip (bulbous end to open the web space and three sides to promote the tripod position)
- The long blue one (expensive but great results, especially with sensory defensive people).
- The smooth one (for kids who do not like the sensation of the edge of the pencil - rounded pencils work, too)
It is also good to have an HB4 pencil (darker lines for kids who print too lightly), a clicker pencil (for those who spend too much or too little time at the sharpener), and sandpaper for those who print heavy (looking for sensory feedback). I have been getting incredible results with a vibrating pen, especially for kids who otherwise are adverse to picking up any utensil.
 
What have I missed, ... anyone wish to comment?
 
2. I use a cognitive behavioral approach for reversals.
a) Hook:  "when you are drawing a dog, the direction does not matter, it is still a dog facing one way or another". [Draw demo].
b) Authority: "For printing there are rules. You must follow the rules."
c) Practice: do one letter, paired with the sound it makes in words and songs, over and over, correctly. Never pair the opposites in a practice session (e.g. b and d - what fires together wires together).
d) Attention: stop and think before you write.
e) Self-monitoring: A reminder on the desk (a stop sign and the letters in question).
 
If that does not work, there are several bigger programs that seem to be having positive effects on decreasing reversals. Vision therapy, Integrated Listening Therapy, and the Move to Learn program, for instance.
 
CW

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