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SELF CARE

Self care is something we all do everyday. It includes activities which contribute to our basic needs, such as dressing, showering, going to the bathroom, brushing our teeth, sleeping and eating. 

As occupational therapists, we often refer to self-care skills as activities of daily living (ADLs) and it is an important milestone for children to develop. At Explore and Soar, our goal is to practice and strengthen skill development (at an age appropriate level) to enable independence in self care for all of our clients and therefore reducing stress on our parents and families. For many of us, these skills come naturally. However for many children, many of these tasks are complex and require high cognitive, sensory and physical capacity. This can cause challenges in getting ready in the morning, attending to hygiene or getting ready for bed at the end of the day.

Foundationally, self-care involves multiple complex skills including bilateral integration (the ability to coordinate both sides of our body), motor planning, balance, postural control and core strength. 

Additionally, higher executive functions are also important, such as sequencing, organisation and planning. It further involves our biological rhythms, being able to register when we need to toilet, hungry or full, and our sleep/wake cycle. Children with sensory processing challenges can have increased difficulty understanding where their body is in space, or be overly sensitive to textures on their skin or in their mouth. This can make tasks such as dressing, brushing hair and feeding particularly challenging and children can become avoidant.

We provide sensory diet strategies or sensory snacks to support our families in promoting self-care independence for our children. 

These can include auditory interventions through specialised music to help motivate, regulate, activate muscle tone and shift our brains into an optimal state to complete tasks. We also use strategies such as therapressure brushing and deep pressure to support regulation and internal grounding. Additionally, we think about what helps them to get moving in the morning, which may include heavy work activities or just jumping on the trampoline for 10 minutes to activate their body and sensory systems. Explore and Soar value multidisciplinary involvement and we often refer to chiropractic intervention to support biological rhythms.

Many of our referrals at Explore and Soar involve challenges in following routines and getting out the door of a morning. 

The morning routine involves multiple self care tasks. Planning outfits, dressing, brushing hair, preparing and eating breakfast, brushing teeth and packing school bags are common tasks necessary for children to complete before leaving the house. 

So often, children can find it difficult to remember and follow the routine in a timely manner, which can in turn cause stress on parents and family members. Occupational therapists can intervene by implementing the use of visual schedules and visual timers. Visuals are a great way for kids to see what step comes next and therefore support their independence and responsibility in self-care. The use of a visual timer can support their capacity to understand and stick to the expectations and can also incorporate a fun challenge for them to complete a task within a certain timeframe. Consideration of how our children learn and understanding their needs is important, whether using pictures, a list, or breaking each task down into smaller steps.

To help understand the complexity of self-care tasks, let’s break down the skill acquisition of dressing. This includes:

  • Higher executive functions: Before they even begin the task, organising and planning appropriate clothes is needed. Further, sequencing is required to move through each step of dressing in a timely manner.
  • Bilateral coordination: The use of both sides of the body working together to put on clothes, complete zippers, buttons and shoelaces.
  • Spatial and body awareness: understanding where our body is in space is important when putting arms through sleeves, legs through pants and pulling a shirt over our head.
  • Fine motor skills: utilised to complete zippers, buttons, shoelaces and putting on shoes and socks.
  • Trunk rotation: Being able to twist the body to put arms through sleeves of a jacket or shirt.
  • Hand eye coordination: controlling our arms and legs in relation to what our visual system is telling us.
  • Motor planning: Dressing requires coordination of both sides and our upper and lower body together, as well as executing motor movements. It also involves activating core strength, muscle tone and postural integrity to control our body. We have recently written about motor planning and the aspects involved.
  • Balance and core strength: Required when lifting one leg at a time to dress lower body.

If a child lacks competence in one or more of these areas, the dressing process will be more difficult, time consuming, and their capacity to achieve independence will be reduced. At Explore and Soar, when we assess clients, we make observations of these skills and then utilise play to develop and build on them in our sessions and home programs.

If you think your child may need some assistance with developing self care skills, please don’t hesitate to reach out and get in contact with us. Whether you’re a new or existing client, we can help!

Until next time,
Hannah

ORIGINALLY PUBLISHED AUGUST 4, 2021

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The Developmental Stage of Handwriting Skills

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THE DEVELOPMENTAL STAGE OF HANDWRITING SKILLS

The year is flying by! I cannot believe that we are already in July! 

Our winter school holidays are in full swing and we are now taking the time out to rest, recharge and perhaps even go on a small trip with our family! June brings about the halfway mark of the year and from here on we start thinking about what the remaining six months of the year will look like. We reflect on what has been achieved in the first six months of the year and set new goals for the months ahead. 

It’s also a time where we start to think about the transition to Kindergarten.

It’s about doing the preparation needed for a successful and stress-free leap into the next stage of life for both parents and children. It’s all about ensuring our children have the skills needed to make the transition. Reading back through our blogs over the years, we have detailed many of these including emotional regulation, sensory processing and gross motor skills.

A big question that is often asked by parents is how to prepare their child’s handwriting skills. How can we actually determine how well our child is prepared to learn how to write and are they ready for the transition to school?

To commence developing pre-handwriting skills, we spend time focusing on and developing our fine motor skills. You can see more information on fine motor skill development in a blog that we previously wrote here in July of 2020! 

The development of fine motor skills in relation to pre-handwriting skills begins with a focus on shoulder stability and control of whole arm movements including strength of the shoulder, upper arm and forearm, transitions to whole hand movements, positioning, grasping, whole hand coordination, finger isolation and finally finger movements.  

Once the development of fine motor skills has emerged and is strengthening, we then focus on the pencil grasp itself. 

Picking up a pencil: It may sound funny, but there isn’t just one way to learn how to hold a pencil. We first teach children a whole hand grasp, then onto a digital grasp, modified grasp and finally we transition to a tripod grasp. Through the early developmental years, forming these grasps is ideal in working towards a tripod grasp when engaging in academics. Each individual holds their pencil their own way, however, our aim is to ensure that they can each reach functional capacity and ease when completing all writing tasks. 

From the moment they pick up a writing utensil, our children draw, scribble, paint, colour and explore within the world of art. This can be in all mediums and is the beginning of pre-academic handwriting skills. This happens from a very young age and continues to develop over time. It plays such an important part in their development and not just with handwriting skills, but with their language, visual information, grapheme knowledge, word knowledge and developing symbolic representations of letters. 

Learning to write is a long term process and something that needs to be based on each child’s individual goals and skills. During our intervention and support, we scaffold and grade activities based on different developmental stages with pre-handwriting and fine motor activities. This allows for foundational skills to be set, whilst we support each of our clients emerging skills and ultimately preparing them to enter schooling

Learning to write can happen at different times for each child but as a guide and general rule of thumb, this is what most children are exploring / have the ability to do at particular ages:

At 15 months to 2 ½ months:

Random scribbling occurs, picking up their pencils and scribbling on anything they can get their hands on. Let’s face it, how many of our toddlers have picked up a writing utensil and scribbled all over our walls or doors without us realising! As frustrating as this may be, it’s a good indication that they are honing their fine motor skills. At this point in time it is about spontaneous circular shapes or scribbles with reduced clear direction. 

At 2- 3 years:

Controlled Scribbling over time with more practice and their hand muscles strengthening, scribbling drawing has increased in control, smaller drawings and creativity is becoming a part of their ability. They are starting to naturally move towards more controlled circular movements, vertical and horizontal lines, including multiple loops and spirals and shapes that resemble the letters ‘t’ and ‘v’.

Basic Shapes  (2 ½ years – 3 ½ years)

The development and understanding of being able to draw horizontal and vertical lines. Other shapes include circles and squares and shapes that may resemble the letters ‘t’, ‘v’, and ‘h’. 

This can then expand into curves, lines, scribbles that resemble writing and creating their own letters and words which is also helping their imagination, building upon letter recognition and developing drawings and ideas that have meaning, which they are excited to share. 

Pictures of objects or People (3 to 5 years)

This is when the development of distinguished drawing, such as drawing a person begins to emerge. From 3 to 4 years of age it is usually people with their arms and legs attached to their head, with expansion and development of head, body and limbs in appropriate places towards the end of 4 to 5 years of age. In addition, increasing details around the face, including eyes, mouth, nose, ears and hair. At this point your child will be able to tell you all about their drawings and what they represent but they may not always clearly represent the idea at hand. Children at this age will have an increased awareness of being able to draw two objects together, as well as beginning to expand on their subject matter, including trees, houses, vehicles etc. 

Letter and Word Practice (3 to 5 years)

In addition to the expansion of picture drawing, the child’s ability to draw and expand on pre-handwriting shapes also increases. This sets them up for increased letter representation and awareness, shapes expand from squares and circles to a cross (X), attempting triangles, diamonds and an interest in attempting letter development. 

All of these stages are fundamental in developing the pre-handwriting skills required prior to entering Kindergarten. Having these foundational skills allows for the awareness, skill and ability to make the shapes and lines required prior to knowing and beginning the correct letter formation. 

This significant part of development and fine motor skills can be lots of fun and can be completed in so many different ways through craft, play and art!  Being able to get creative, with finger painting, shaving cream, water play, colouring in and drawing are all ways that allow children to experience these skills in a playful way. It’s important to remember that play is the most effective way to learn all pre-academic and handwriting skills. Allowing the child to lead the play and explore their ideas with them will inadvertently assist you in naturally supporting and providing these opportunities to develop the skills needed. 

There is no one size fits all when it comes to developing handwriting skills! Remember that each child is different! 

What’s important for us as Occupational Therapists is coming up with creative and supportive ways to facilitate these learnings.

Berk, L. E. (2013). Child Development (9th Edition). Upper Saddle River, New Jersey: Pearson Education

Huffman, J. M., & Fortenberry, C. (2011). Helping preschoolers prepare for writing: Developing fine motor skills, Young Children, 66(5), 100-103.

Until next time,
Jess

ORIGINALLY PUBLISHED JULY 7, 2021

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Understanding Motor Planning and Coordination

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UNDERSTANDING MOTOR PLANNING AND COORDINATION

This month we are going to talk about motor planning and coordination.

Each child develops at a different rate and at Explore and Soar it’s our job to identify and offer intervention solutions to help that process. 

Developmental Coordination Disorder is what postural and motor sensory based disorders are diagnosed under, in the DSM-V. We use sensory based motor disorder definitions, information and research to help us identify behaviours consistent with this, as occupational therapists.

One of the most common reasons we find that children are referred to Explore and Soar is difficulty with gross motor skills. This could be concerns regarding poor coordination, appearing clumsy and falling over a lot, difficulty with crawling or an inability to jump with two feet at a time, to skip or to ride a bike. 

As part of our initial assessment process and during our intervention sessions, we pay close attention to how your child moves their body in various scenarios. This provides us with vital information regarding how your child is processing the varied types of sensory inputs around them.

Last year we wrote about Sensory Processing Disorders on our blog, how to correctly identify the warning signs and how to best assist your child. One of the types of sensory processing disorders that we only spoke briefly of was sensory-based motor disorders (SBMD) also commonly known as a developmental coordination disorder, as recently outlined in the DSM-V under the category of neurodevelopmental disorders.

In SBMD, we see children who have difficulties with “stabilising one’s body or thinking of/planning/sequencing or executing a series of movements based on sensory information outside and inside the body” (Miller, L.J., 2014, pg.14). SBMD can be categorised into two groups; Postural Disorder and Dyspraxia.

Postural disorder is seen in a child who has difficulty in maintaining the control of their body, to meet the demands of an activity. It involves our muscle tone, core strength and stability. It is the action part of all motor movements. 

Children who have difficulty with ideation (forming an idea in the brain), planning and sequencing (identifying what steps are involved) and execution of motor movements fall into the dyspraxia category. This can occur across all motor movements including gross motor, fine motor, visual motor and oral motor. This is known as the planning part of all motor movements.

Motor planning is an automatic subconscious process that occurs every time we seek to move our body. We tend to take this process for granted. It occurs with many common daily activities such as opening a door, putting a jacket on, writing our signature, or chewing our meals. Once acquired it becomes like riding a bike – once you know how to do it, it begins to happen without too much conscious thought. Everything we do can be broken down into steps that our brain automatically executes via motor movements for successful completion of the desired activity. Children who are experiencing difficulties with motor planning find such tasks difficult, awkward and exhausting because of the level of conscious energy they have to put into completing each and every task! 

One common result of motor planning difficulties is an impact upon the ability to form social connections and self-worth. This is often due to difficulties with oral motor (eg. speech), visual motor (eg. difficulties copying work from the board at school), fine motor (eg. difficulty with buttons, shoelaces) and gross motor skills (eg. difficulty keeping up with their peers at recess). 

So how do we address motor planning difficulties in OT sessions?

We practice all the steps involved – ideation, planning and sequencing, and execution – so that it eventually becomes an easy and automatic process for the child. We provide opportunities for the child to create their own ideas for an activity, we break skills down into smaller steps to achieve success and we provide high repetition rates to allow feed forward and feedback loops to develop around the sensory information the child receives from the world around them. This is where we apply our knowledge and skills of activity analysis as OT’s to coach and teach your child skills that allow them to increase their independence. 

This is not a quick process. It takes time to rewrite neural pathways in the brain for autonomic responses to sensory input. By addressing motor planning goals within intervention sessions, we are not only looking to increase a child’s skill level but also their self-esteem and confidence to complete activities that are meaningful to them, ultimately leading to a happier successful life!

If you have any questions around motor planning, please reach out to one of our therapists who will be able to provide more information to you.

Reference:
Miller, L.J. (2014) Sensational Kids: hope and help for children with sensory processing disorder (SPD). New York:Penguin Group.

Until next time,
Lori

ORIGINALLY PUBLISHED JUNE 2, 2021

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Health Promotion for our Families

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HEALTH PROMOTION FOR OUR FAMILIES

As occupational therapists we are trained to provide support to all our clients and their families, in order to increase their independence, grow their confidence and to live a happy and healthy life. 

More often than not, this is first done or activated when someone is starting to experience discomfort or challenges in certain areas of their life. For our children, self-care, play, schooling and their social interactions with their peers are where areas of concern often arise. As we’ve spoken about previously, when these challenges occur, they manifest in behaviours. For our children, the way in which they behave is in fact their method of asking for help. They are in turn telling us as adults, that something internally doesn’t feel right and they require extra help. It is then our role to determine what is going on and how we can provide effective support. 

But what if we could actually reduce these areas of concern and the amount of worry that comes along with them but being proactive rather than reactive? 

This is an area that as occupational therapists we are so very passionate about. Through health promotion we can bring awareness, education and support to all families and communities about child development, patterns to look out for and access to support services when you have questions. This should be readily accessible to every person in each of their communities. By having access to services that offer advice and support, promoting health and wellness for both the parent/carer and their child, inadvertently increases well being and reduces the risk of mental health. 

From an OT perspective; the definition of health promotion from the World Health Organisation is “the process of enabling people to increase control over and to improve their health. To reach a state of complete physical, mental, and social well-being, an individual or group must be able to identify and realise aspirations, to satisfy needs, to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond health lifestyles to well-being.” (1986, para.2). 

Something that we do as a company outside of providing intervention strategies and support to our clients and their families, is also providing them with a range of essential health promotion strategies to positively influence, empower and educate in order to further reduce the inequalities in our health industry. Therefore, significantly supporting positive interactions and emotional connections in our client’s support networks. 

Each of our OT’s provide strategies and supports to our clients, such as:

  • Teaching positive ways for your child to move their body that feels good for them, to increase control and awareness.
  • Teaching them to feel safe and comfortable sharing their emotions and sitting within their feelings.
  • Providing as many possible positive social interactions with other peers who are presented with similar challenges in group program settings.
  • Conducting skill based training for self-care so that children can be successful on school camps or overnight trips.
  • Teaching your child how to plan, organise and sequence activities or thoughts together, to help with positive inclusion in school – this makes them feel clever, smart, successful and allows them realise their worth. 
  • Providing strategies and support to be successful and confident in navigating their local communities.

Additionally, each of our OT’s provide strategies and supports to our clients parents/caregiver’s such as:

  • Providing connections and relationships within the Explore and soar family; other families, clients or health professionals.
  • Taking into account every parent’s well-being when working with their children, giving them emotional support, and interventions that are based both on the child and the parent, so as not to overwhelm and contribute to more stress.
  • Running parent groups, where like minded parents are present to talk about their own situations, so that they feel heard and they are able to build connections around them without feeling isolated, increasing their support network outside of health professionals.
  • Utilising parent coaching strategies to teach them how to do the interventions; positively reshaping their confidence in order to be able to manage all aspects of their lives with their children. 

Within Explore and Soar, we support and provide strategies to our local communities for health promotion such as:

  • Education nights at preschools for the parents and their educators. This is a regular offering as a part of our service to build awareness and health promotion for development – it’s one of the most consistent things we do. 
  • Work within our local schools; teacher professional development courses that support them in the classroom and the playground. This differs from early education nights, as rather than identifying areas of concern at a younger age, it’s more about working with difficulties that have already been identified and enveloping the right strategies.
  • Remaining very community orientated by sponsoring and supporting sporting events or team members. We do so, so that the community knows there is a point of access, that if information or support is needed, there is a place to ask questions. We always seeking to create a presence in the community to bridge the gap and get people openly talking about behaviour, emotion or social skills.
  • Promoting safe access within the community, so as to eliminate anxiety and stress.

This brings us to an exciting event happening at the end of this month in support of the Hunter Region! We are participating in the Hunter Disability Expo this May! We participate in local expos in the community to bridge the gap and bring awareness to the support that is offered.

The Hunter Disability Expo is open to anyone that would like to attend and it is on Friday 21st and Saturday 22nd May at the Newcastle Entertainment Centre. 

Participants get to see all the different supports and companies within the Hunter that offer assistance to our kids, all the way through to adulthood, from allied health professionals to general support services. 

On a personal note, growing up, this level of awareness, education and events to support our local communities and families simply weren’t available. This is often still the case in our regional communities. So participating in events like this to share with others within a safe space, is and will always continue to be a passion of mine. 

So, if you have time and want to see us and many other local health professionals, join us at the Hunter Disability Expo and don’t be afraid to say Hi! We would love to see you there. 

Until next time,
Jess

ORIGINALLY PUBLISHED MAY 5, 2021

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The Impact of Relationships on Social Development

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THE IMPACT OF RELATIONSHIPS ON SOCIAL DEVELOPMENT

Over the last few months, I have seen a consistent theme emerge with clients and families within our communities, centered around personal health, well-being and relationships. 

As we are focusing on the importance of mental health this year, I thought it would be good to talk about the impact of relationships on social development – especially in that of our children in their early stages of life. 

Modern life seems to be filled with more stresses as humanity progresses. From a social emotional perspective, as a society, many of us are struggling. Our emotions are high, and we are feeling anxiety and uncertainty more than ever before. Once felt, this stream of thought and instability transfers to all aspects of life. But what if I told you that there is an intervention model designed by a psychologist, Stanley Greenspan that acknowledges our emotional social development and how it stems from relationships developed soon after birth? As health professionals we can use this model to support our families, both parents and children in developing the skills to maintain healthy relationships from the first 3 months of life! At Explore and Soar, we reference this model and use it as a guide in our intervention sessions. It is called the DIRFlootime Model; a Developmental, Individual Differences and Relationship based model that acknowledges each child’s unique differences and uses relationships and connections to establish a strong emotional social connection to further enhance development. This model is integrated into our sessions by following the child’s lead and adapting their ideas to enhance these skills through play. 

So why DIRFloortime? 

Well for us it aligns perfectly with our core values and supports our ability to develop connections and relationships with all our clients. But most importantly, it is an intervention model that acknowledges the emotional social development from birth into our adult years. It allows us as clinicians to work through developmental milestones from an early age. It is also a model firmly based on parent coaching; supporting our client’s parents/carers to further develop the skills needed to support healthy relationships. 

So how can we support our communities and families in developing these skills from birth to increase emotional development, resilience and social engagement, in order to avoid seeking intervention at an older age? This is done through awareness, education and acknowledging that the first months up to two years of life are of great importance when developing healthy relationship skills. 

In the first 3 months of life the foundational skills of regulation begin. This is the beginning of co-regulation between the parent and child and fosters shared attention; where the baby can seek the mother’s attention and they respond or vice versa. This then becomes the child’s foundation to a secure attachment. Attachment between the caregiver and the baby. The start of co-regulation is around the caregivers/mother’s ability to understand the baby’s wants, needs and desires. It’s the ability to answer cues and answer questions like are they hungry, uncomfortable, do they require a nappy change or are they in fact tired? The connection and relationship is based on love and learning to soothe the baby, creating a positive experience and strong connection. This ability comes from the baby having their own unique cries or cues to indicate to the mother or caregiver what they need. This is where the baby and caregiver become entrained with one another forming a bond; the foundations to co-regulation.

In an ideal world this seems simple, easy and realistic. However, every baby enters this world differently, every mother has a different experience and every baby has different sensory processing capacities that then impact their own biological rhythms. There simply is no one size fits all when it comes to taking care of an infant. 

As a new baby comes into the world, parents are presented with an array of challenges. Difficulty sleeping, reflux and feeding concerns, high stress births, babies being unable to settle or babies that simply do not enjoy being touched or soothed. These difficulties that arise for every parent, have a flow on effect with little to no sleep, stress, anxiety, self-blame and hormonal changes being merely a few of the impacts on our parents. This too then has an affect on the relationships that surround mum and dad, including their relationship with one another.  

This is all normal. But why don’t we talk about it more? Why do we gloss over the early stages of parenthood and try to make it look as easy as possible to the outside world? I remind my clients and friends that as parents, you simply are NOT a failure for not being able to soothe your baby. The only way you will ever fail is when you stop trying to understand your child. It is about asking questions and seeking medical advice when required, but also not being afraid to ask for help from your family and friends. 

It takes a village to raise a child. 

As OT’s we provide an extra level of support to parents, children and families. We understand and work with children in motor movement patterns at a young age to support their discomfort and the development of their sensory systems, including their sleep-wake cycles. We have the skills and ability to discuss with you your routines and support in identifying cries and ability to connect with your babies. We also acknowledge where other health professionals’ unique strengths can provide positive impacts for you and your child. But most importantly for us, our skills lie in the development of connection. We look to support our parents/caregivers by building the skills to interact, laugh, smile and play together with your child from a young age. We work with you to build upon the ability to co-regulate emotions, to keep you calm in challenging circumstances and to be present in order to assist in the soothing and engagement of your child. 

If you have any questions around the foundational skills of co-regulation and shared attention please don’t hesitate to reach out. The first three months with your baby’s life is the starting point to all engagement, self-regulation and social skill development for life. My hope is that in having these conversations, we will increase our ability to ask for help when needed. We will foster strong, resilient children who have confident, calm parents who are a little kinder to themselves in challenging circumstances. If we make an effort to start from birth, we can positively impact the mental health of our children as they get older. I know I’d love to see our children’s quality of life, self-esteem and love for themselves be greater in future generations. 

In our socials this month we will go through some examples of challenges and strategies that can help to support you. Take a look at our instagram or facebook to see more. Please don’t hesitate to reach out if you need a helping hand or would like further information on how we could help you!

Until next time,
Jess

ORIGINALLY PUBLISHED APRIL 7, 2021

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