What is Sensory Processing Disorder?

To describe what Sensory Processing Disorder (SPD) is, we need to first look at what the terms Sensory Integration and Sensory Processing mean.

What is Sensory Integration?

Sensory Integration (SI) is a normal, neurological, developmental process which begins in the womb and continues throughout ones’ life. It is the process by which the brain receives information from the direct five senses (vision, hearing, movement, touch, taste), and interprets it so we can respond in an appropriate, effective, and meaningful way.

What is Sensory Processing?

Sensory Processing (SP) is the process by which our brain takes in sensory input, organizes it and interprets this information for use.

What is Sensory Integration Dysfunction?

Sensory Integration Dysfunction is difficulty with sensory integration. SID was first studied in-depth by Anna Jean Ayers who described SI as the ability to organize sensory information for use by the brain.

The more current diagnostic study uses the Sensory Processing Disorder (SPD) term. SPD is a condition where sensory integration is not adequately processed in order to provide appropriate responses to the demands of the environment.

Sensory processing is something most of us don’t think about as it happens naturally, unconsciously, and spontaneously throughout our day.

However, some children’s central nervous system has difficulty accurately perceiving or integrating the information it receives. If this neurological process becomes disrupted somewhere in the loop of intake, organization or output, then normal development and adaptive responses will not be achieved. As a result, learning, physical and emotional development, as well as the behavior may be impacted.

It is this disruption which yields a neurological dysfunction called Sensory Integration Dysfunction/Sensory Processing Disorder.

What Does SPD Look Like?

A child with sensory processing disorder would have an inability to organize sensory information that comes through the senses.

It can affect a child in only one-sense or in multiple senses. A child with SPD might overreact to sensation and find light, sound, contact, or food to be unbearable. It could also cause an individual to not react to stimulation (e.g. not reacting to extreme cold).

Posture and motor skills can be affected in children with impaired sensory processing messages from the muscles and joints. These are the “floppy babies” who worry new parents and the kids who get called “klutz” on the playground. Still, other children exhibit an appetite for sensation that is in perpetual overdrive. These kids often are misdiagnosed – and inappropriately medicated – for ADHD.

Do all children on the Autism spectrum have Sensory Processing Disorder?

It is believed that 95% of children on the Autism spectrum have sensory integration difficulties.

Children on the spectrum typically have a different way of perceiving the environment. This different sensory perception can interfere with the child’s ability to attend, learn, interact with the environment, handle unpredictable situations and develop appropriate peer relationships.

Occupational Therapy utilizes Sensory Integration therapy to help these children manage and master their environment as best as possible.

Can SPD be cured?

SPD can’t be fully cured. However, with OT and related interventions, the symptoms can be lessened.

Research has shown that the nervous system and neural pathways are constantly changing and can be reprogrammed. This coupled with learned behavior and effective strategies help children lead normal and productive lives.

I Think My Child Has SPD. What Should I Do?

If you suspect your child might have SPD, do the following:

  • Try to identify triggers that set off these behaviors with your child
  • Start writing in log behaviors that seem unusual
  • Try to identify what helps soothe your child
  • Try using Red Flags of Sensory Processing Disorder checklist to help organize your thoughts.
  • Schedule an appointment with your pediatrician and discuss your child’s behaviors
  • Ask for a referral to an Occupational Therapist. If you’re in Orange County California, consider contacting our pediatric occupational therapy clinic.
  • Provide sensory input at home using our Sensory Processing activities.

A Week of Sensory and Motor Development Activity Ideas

Sometimes it’s not easy to come up with fresh new fun ideas for sensory and motor development activities. We don’t want to use the same activities over and over because it eventually gets boring for us and the kids.

The following list shows a week of therapeutic activity ideas with common materials that you can do at home.

Click the link for each activity for detailed steps and additional images.

Sensory Salad

Sensory Salad
Sensory Salad

The Sensory Salad activity promotes bilateral hand use, cutting, finger strength, pincer grasp, sensory processing, tactile perception, and also social interaction.

You’ll need a bowl, construction paper, paper plate, pom-poms, scissors, straws, and tongs to complete the activity.

Sunflower Handprint

Hand Flower
Sunflower Handprint

The Sunflower Handprint activity promotes bilateral hand use , cutting, eye-hand coordination, fine motor control, sensory processing, tactile perception, and also visual motor.

You’ll need brown construction paper, green construction paper, glue, markers, scissors, and tempera paint to complete the handprint activity.

Cut the Line

Cut The Line activity
Cut The Line

The Cut the Line activity promotes bilateral hand use and cutting.

You’ll need construction paper or index cards, markers, ruler, scissors, and stickers.

Hand Strengthening Artwork

Hand strength artwork
Hand Strengthening Artwork

The Hand Strengthening Artwork activity promotes crossing midline, eye-hand coordination, finger strength, hand arches/separation, and also visual motor skill.

For this messy activity, you will need paper, paper cup, paper plate, and tempera paint.

The end result is a visually satisfying creation and all ages can participate in this fun activity.

Balance on the Web

Balance on the Web
Balance on the Web

The Balance on the Web activity was designed to promote balance and body awareness. It also enhances core strength, eye-hand coordination, motor planning, and visual perception.

In this activity, the child will promote motor planning skills, as he plans his route on the spider web. In addition, he will strengthen his balance skills and his core, while walking on the web lines and squatting down to pick up objects.

Bean Mosaic

Bean Mosaic
Bean Mosaic

The Bean Mosaic activity promotes distal finger control, eye-hand coordination, fine motor control, finger strength, grasp, finger translation, and many other skills.

When we use small pellets such as beans or small buttons we strengthen finger muscles and promote pincer grasp pattern.

Hang Up a Pattern

Hang Up a Pattern
Hang Up a Pattern

The Hang Up a Pattern activity promotes bilateral hand use, eye-hand coordination, grasp, visual perception, pincer control, and also promoting crossing midline.

It is a simple activity that uses clothespins, hanger, some index cards, and stickers.

Through the use of clothespins and a visual pattern, the child promotes visual perception skills, develops pincer grasp, and practices crossing mid-line by matching patterns on a hanger or writing words using clothespins with character stickers attached.

What else can you do?

If you’re looking for additional OT activity ideas in addition to the “Week of Occupational Therapy Activity Ideas” above, you can search OTPlan by the specific skill to promote or based on the materials you have handy.

Pyramid of Learning

“Where do I begin?”

This question often comes about when thinking of ways to support our children. Many of us benefit from having structure or general guidelines; the “Pyramid of Learning” is a source for that. The Pyramid of Learning is an illustration that depicts a general idea of our children’s foundational skills, and what other skills build upon those. This information is useful, as it helps breakdown skill sets into underlying characteristics and helps prioritize what to address.

The Pyramid of Learning

The Pyramid of Learning was developed by occupational therapist Kathleen Taylor and special educator Maryann Trott. They utilized the Sensory Integration theorist, Jean Ayres’, concepts to display the foundational skills that support academic learning.

The Pyramid of Learning
The Pyramid of Learning

This illustration outlines the foundational skills at the bottom of the pyramid, and the skills that are supported by the foundational skills on the tiers above. Once the bottom tiers of the pyramid are adequate, the tiers above can be more efficiently developed. Addressing the skills in this order is known as utilizing the bottom-up approach.

The Pyramid of Learning Tiers

The very bottom box in the illustration is the central nervous system, which most closely supports the second tier.

The second tier identifies our children’s sensory systems:

  • Olfactory (smell)
  • Visual (vision)
  • Auditory (hearing)
  • Gustatory (taste)
  • Tactile (touch)
  • Vestibular (balance)
  • Proprioception (knowing where their bodies are in space)

The third tier depicts their sensory-motor development:

  • Body scheme (body awareness through movement)
  • Reflex maturity (having developed reflexes, for safety purposes)
  • Ability to screen input (knowing what sensory experiences are important to pay more attention to)
  • Postural security (confidence in maintaining certain postures to prevent falling)
  • Awareness of two sides of the body (bilateral integration)
  • Motor planning (ability to plan their movement)

The fourth tier depicts perceptual motor development:

  • Auditory language skills (hearing and speaking appropriately)
  • Visual-spatial perception (identifying what is seen in space)
  • Attention center functions (maintaining attention to tasks)
  • Eye-hand coordination (when they use what they see to guide the movement of their hands)
  • Ocular motor control (locating and fixating on something in their environment)
  • Postural adjustment (adjusting their posture to maintain balance)

The fifth/top tier depicts cognition intellect:

  • Academic learning
  • Daily living activities (such as eating, toileting, bathing)
  • Behavior
  • This means that the quality of our children’s sensory systems (the second tier) is closely linked to adequate functioning of their central nervous system (the first tier).

Our children’s ability to plan their own movements, use both the left and right sides of their body efficiently, along with other sensory motor development characteristics (the third tier), depend on the quality of their vision, touch, proprioception, and other sensory systems (the second tier).

Their ability to use their eyes and hands in a coordinated manner, their ability to adjust their posture for balance, and other perceptual motor development characteristics (the fourth tier), depend on their ability to plan their own movements, and other sensory motor development characteristics (the third tier).

Their ability to attend to formal, academic learning, eat, bathe, toilet, and perform other cognition intellect characteristics (the fifth tier), depend on their abilities to adjust their posture for balance, and coordinate their eyes and hands together, and other perceptual motor development characteristics (the fourth tier).

Classroom Sensory Strategies for Proprioception Input

What is Proprioception?

Kids playing wheelbarrow
Proprioception Input

Refers to compression (weight-bearing or pushing, etc.) and traction which stimulates proprioceptive nerves in the joints where muscles attach. This gives the body very important sensory feedback and the internal awareness of our body parts to allow us to perform tasks with coordination.

What are the benefits?

To stimulate proprioceptive sensors, do heavy work tasks. A benefit of doing heavy jobs is that you are using groups of larger muscles, which helps your brain work better so you can focus on fine motor tasks like writing, reading, and drawing. The movement provided during heavy work activities often helps increase a child’s level of alertness. Heavy work activities contribute to a child’s body awareness, motor planning ability, and the development of stability for coordination.

How can I offer heavy work activities to the student?

You can try having them do some heavy work as a break between work time, before engaging in a quiet/fine motor/cognitive tasks, or anytime to promote coordination. See below for examples of heavy work.

How can I offer heavy work activities to the student?

Classroom Sensory Strategies

You can try having them do some heavy work as a break between work time, before engaging in a quiet/fine motor/cognitive tasks, or anytime to promote coordination. See below for examples of heavy work.

Being a Classroom Helper:

  • Place chairs on desks at end of the day or take down at beginning of the day.
  • Erase or wash the chalkboard.
  • Help rearrange desks in the classroom.
  • Help out the janitor with emptying wastebaskets, mop the floor, etc.
  • Sharpen pencils with a manual sharpener.
  • Cut out items for display with heavy weight paper like tag board.
  • Have students carry heavy notebooks to the office or from class to class (or if he/she is bringing attendance up to the office, have the student wear a weighted vest or backpack with a heavy book inside).
  • Carry books with both hands hugging the book to yourself.
  • Have child pass out papers/objects to the class members.
  • Push the lunch cart or carry lunch bin to the cafeteria.
  • Staple paper onto bulletin boards.
  • Open doors for people.
      •  

Playground or in Class:

  • Help the P.E. teacher move mats, etc.
  • Climbing activities (such as playground equipment)
  • Run around the track at school
  • Push against a wall (do “push-ups” for a count of 10 against a wall)
  • Sports activities involving running and jumping
  • Animal walks (crab walk, bear walk, army crawl)
  • Jumping jacks
  • Sitting and bouncing on a therapy ball counting down from 100.
  • Slowly roll a ball over child a few times like steamroller with sight pressure as she lays on her back or tummy
  • Mini trampoline, jumping 30 times
  • Push another child on a swing
  • Playing tug of war with a big exercise rubberband or rope

Other Exercises and Tips:

  • Teachers have successfully used beanbag chairs in their classroom, allowing kids to use them during a silent reading time or to lay over or under them during independent work tasks to get a chair in position and the benefit of consistent pressure input. More of a passive mechanism, but definitely helpful for many students.
  • Give child firm pressure on shoulders
  • Have the child color a rainbow with large paper on the floor in quadruped position.
  • Chair push-ups (seated in a chair, try to push your body up for 10 counts; works better with a chair with arms)
  • Quiet squeeze toys such as a squishy cow. Kids can be taught to squeeze the cow or the likes of him on their laps under their desks so as not to disturb the class.
  • Prior to seat work, have child pinch, roll, pull theraputty or squeeze balloons filled with flour.
  • Finder fidget activities for fine motor: do these before a fine-motor academic task for 1-3 minutes
    • pinches
    • spider push-ups
    • rubber band stretches
    • fidget balls
    • theraputty
    • hole punching

Search OTPlan for activity ideas for proprioception.

The idea is to do these regularly and frequently to give the child the sensory input the body may need to regulate itself.

These same strategies may be used during times to help calm the child if the child is frustrated or overly aroused.

Occupational Therapy Requirements per State

Regulations are used to protect consumers in a state or jurisdiction. These regulations protect from unqualified, unscrupulous, or unethical OT practitioners.

Regulations are developed by regulators, who are appointed public officials of various departments in state government.

In the USA, Occupational Therapy is regulated in all 50 states, the District of Columbia, Puerto Rico and Guam.

Different states have various types of regulations. The strongest form of regulation is licensure.

Most states, the District of Columbia, and Puerto Rico require occupational therapists and occupational therapy assistants to be licensed. A few states have certification or registration by a state agency.

States have similar, but not identical requirements and procedures for obtaining an OT license.

For an up to date, state-specific, licensure requirement, consult the state occupational therapy regulatory agency at your state.

StateNBCOT Exam RequiredWebsite
AlabamaYeshttp://www.ot.alabama.gov
AlaskaYeshttp://commerce.alaska.gov/dnn/cbpl/ProfessionalLicensing/

PhysicalTherapy

OccupationalTherapy.aspx

ArizonaYeshttps://ot.az.gov/
ArkansasYeshttp://www.armedicalboard.org/Professionals/pro.aspx?type=4
CaliforniaYeshttp://www.bot.ca.gov/
ColoradoYeshttp://cdn.colorado.gov/cs/Satellite?c=Page&childpagename=DORA-Reg%2FDORALayout&cid=1251632299230&pagename=CBONWrapper
ConnecticutYeshttp://www.ct.gov/dph/cwp/view.asp?a=3121&q=389442
DelawareYeshttp://dpr.delaware.gov/boards/occupationaltherapy/index.shtml
District of ColumbiaYeshttp://doh.dc.gov/node/157592
FloridaYeshttp://floridasoccupationaltherapy.gov/
GeorgiaYeshttp://sos.ga.gov/index.php/licensing/plb/36
HawaiiYeshttp://www.hawaii.gov/dcca/areas/pvl/programs/occupational/
IdahoYeshttp://www.ibol.idaho.gov/IBOL/BoardPage.aspx?Bureau=OCT
IllinoisYeshttp://www.idfpr.com/profs/info/OccTherapy.asp
IndianaYeshttp://www.in.gov/pla/ot.htm
IowaYeshttp://www.idph.state.ia.us/licensure/

PhysicalandOccupationalTherapy.aspx

KansasYeshttp://www.ksbha.org/main.html
KentuckyYeshttp://bot.ky.gov/
LouisianaYeshttp://www.lsbme.la.gov/licensure/

occupational-therapistsassistants

MaineYeshttp://www.maine.gov/pfr/professionallicensing/

professions/occupational/index.htm

MarylandYeshttp://dhmh.maryland.gov/botp/SitePages/Home_revision.aspx
MassachusettsYeshttp://www.mass.gov/ocabr/government/oca-agencies/dpl-lp/
MichiganYeshttp://www.michigan.gov/mdch/0,1607,7-132-27417

_27529_27545—,00.html

MinnesotaYeshttp://www.health.state.mn.us/divs/hpsc/hop/otp/index.html
MississippiYeshttp://www.msdh.state.ms.us/msdhsite/_static/30,0,82.html
MissouriYeshttp://pr.mo.gov/octherapy.asp
MontanaYeshttp://bsd.dli.mt.gov/license/bsd_boards/otp_board/board_page.asp
NebraskaYeshttp://dhhs.ne.gov/publichealth/Pages/crl_rcs_ot_ot.aspx
NevadaYeshttp://www.nvot.org/
New HampshireYeshttp://www.nh.gov/alliedhealth/boards/occupationaltherapy/

index.htm

New JerseyYeshttp://www.njconsumeraffairs.gov/occup/
New MexicoYeshttp://www.rld.state.nm.us/boards/Occupational_Therapy.aspx
New YorkYeshttp://www.op.nysed.gov/prof/ot/
North CarolinaYeshttp://www.ncbot.org/
North DakotaYeshttp://www.ndotboard.com/
OhioYeshttp://www.otptat.ohio.gov/
OklahomaYeshttp://www.okmedicalboard.org/occupational_therapists
OregonYeshttp://www.oregon.gov/OTLB/pages/index.aspx
PennsylvaniaYeshttp://www.portal.state.pa.us/portal/server.pt/

community/state_board_of_

occupational_therapy/12518

Rhode IslandYeshttp://health.ri.gov/licensing/
South CarolinaYeshttp://www.llr.state.sc.us/POL/OccupationalTherapy
South DakotaYeshttp://www.sdbmoe.gov/content/occupational-therapist-ot
TennesseeYeshttp://health.state.tn.us/Boards/OT/index.htm
TexasYeshttp://www.ptot.texas.gov/page/home
UtahYeshttp://www.dopl.utah.gov/licensing/occupational_therapy.html
VermontYeshttp://vtprofessionals.org/opr1/o_therapists/
VirginiaYeshttp://www.dhp.virginia.gov/medicine/
WashingtonYeshttp://www.doh.wa.gov/LicensesPermitsandCertificates/

ProfessionsNewRenewor

Update/OccupationalTherapist.aspx

West VirginiaYeshttp://www.wvbot.org/
WisconsinYeshttp://dsps.wi.gov/Default.aspx?Page=f9cebe65-aead-44e8-a876-35ce5f920eb1
WyomingYeshttp://ot.state.wy.us/

Occupational Therapy and Work Settings

The basic definition for an occupational therapist (OT) is one who assists a multitude of different people in finding independence or “normalcy” in their everyday lives. Many of these patients have some sort of illness or disorder that inhibits normal living. These people can range from children who were born with a disability to the elderly who are going through a difficult time with the loss of agility or mobility. Occupational therapists help people regain skills or learn new ones that will make their everyday lives easier.

The types of services occupational therapists offer include evaluations with the client and family to determine what goals would like to be met, creating intervention and plan for helping the patient reach these goals, and ensure the goals are being worked towards and met long term. Occupational therapists not only assist their patients firsthand but also monitor them long-term to ensure that success is being met.

Types of Occupational Therapy

During and after your education and schooling in the field of occupational therapy you will probably find that there are many settings in which you can work. The area you will work is dependent upon what type of patient you would like to work with and what unique skills they will require with therapy.

Once you have obtained your degree in occupational therapy you will be able to pursue whichever specialization you wish. These specializations may include pediatric, hand therapy, adult rehabilitation, vision rehabilitation, assisted living care and much more.

New opportunities in work settings are opening up for occupational therapy every day.

Locations for Occupational Therapy

The location and area in which you practice occupational therapy really depends on what types of patients you are working with. Some therapists may work in one individual area or a number of them. These locations include schools, detention centers, clinics (public and independent), communities (city and rural), corporate areas and health centers. Some therapists may work entirely with other medical professionals at their locations.

Occupational Therapy for Children

Working as a pediatric occupational therapist is a rewarding job. There is an abundance of children who require the assistance of an occupational therapist to reach their true potential and independence in life. A child with a congenital disease, injury or illness that has caused life-altering effects may benefit from occupational therapy services. Other children who require occupational therapy might have been diagnosed with ADD or ADHD, PDD, Autism, Cerebral palsy, or anxiety disorders.

Occupational therapists help children acquire and maintain the skills required to engage in everyday life. Finding creative and meaningful activities is an essential key in assisting those children to participate in self-care, school, and social settings. Pediatric occupational therapists work closely with the child’s family, caregivers, and the educational team, in order to come up with the best therapy program and intervention strategies.

Occupational Therapy for Adult

The general population that is commonly seen by occupational therapists is adult of various ages. Adults who require occupational therapy may include those with disorders (developmental and psychological), illness or injuries, and finally, those who are going through a major life change or crisis.

Occupational therapists working with adults often help their clients become more independent and improve the way they function. Sometimes this requires the use of certain technology, assistive devices, or adjustments to the client’s environment. In some settings, such as rehab or hospitals, the occupational therapist role is to assist their client to relearn the basic skills that might have been lost due to illness or injury.

These skills may include, but are not limited to, eating, dressing, walking and mobility, communication, and the use of assisting devices. In other settings, such as mental health, occupational therapists may help their clients find strategies that will promote engagement in meaningful activities, which in turn improve the quality of their life.

The help that adults require is highly dependent on the individual person. There will be occasions in which “normalcy” won’t be possible for certain adults. In the event of this situation, it is important that occupational therapists help their client get to the highest level possible through the use of strategies that can be used within their limitations.

Occupational Therapy for the Elderly

Occupational therapy for elderly people is growing due to the baby boomer generation aging as well as technological advances allowing for longer lives. Many of the occupational therapists who specialize with the elderly are working with those who have age-related diseases and ailments or may have suffered from heart attacks and strokes.

Those who have suffered from a recent stroke or heart attack may have a difficult time adjusting to their now limited abilities and independence. In extreme cases, these people may have to essentially relearn daily life tasks from scratch. Other elderly people may be suffering from debilitating disorders and diseases such as arthritis. Learning to use assistive devices due to loss of agility and balance is another area that the elderly may need help with.

Fine Motor Control in Children

Fine motor skills are important to a child’s development. Not having these skills can interfere with school and home activities. It is important to understand the difference between fine motor skills and gross motor skills.

Fine motor skills are those skills that require smaller, more delicate movement; usually using the smaller motion with an emphasis on the coordination of those movements. Gross motor skills are those skills using the larger muscles in the body, those to run, jump and move about.

Concerns with a child’s fine motor skills can be treated by a therapist with a strong focus in the area of pediatric occupational therapy. A child with fine motor problems may become easily frustrated in school when having to copy things from the blackboard or in art class because he or she may have problems either writing neatly, staying within the lines when coloring or cutting out shapes.

A child’s motor planning and speed of movement can be greatly affected in cases of fine motor control development. Motor planning involves the visual detection of motion and errors in movements. For a child’s movement to be effective things must be timed adequately and fine motor skills require a certain amount of attention and concentration as well.

What is more important is the order in which certain movement is made to accomplish a task. Managing complex activity using smaller muscle groups may be compromised when dealing with fine motor skill problems. School-age children face more fine motor skill problems than most other age groups, making pediatric occupational therapy a very important step in the treatment of this problem.

Children with fine motor skill problems may present other behaviors as well. At times a child may have underlying issues that could be associated with fine motor skill problems. They may actually present problems with an articulation of words and sounds due to the fact that fine motor control has to do with tongue movement as well; being the tongue is a smaller muscle.

Fine motor control struggles can be due to sensory problems in the brain; the child may have an aversion to being touched and being introduced to new things. In these cases the child’s ability to behave and control their fine motor skills may be hampered by the overstimulation of the senses, causing frustration and clumsiness.

Children experiencing fine motor skill problems may present the following issues:

  • Clumsy pencil grasp (pincer grasp activities)
  • – Poor scissor skills (activities with scissors)
  • – Not able to grasp and release things in a controlled manner
  • – Cannot hold small objects or use tools such as pencils and scissors
  • – Dislikes completing mazes and dot to dots due to being easily frustrated with them
  • – Has problems copying from the blackboard in class

Ideas for Developing Fine Motor Skills

Below are a few activities you might find helpful to promote functional grasp patterns:

  • Squirt bottles can be used to promote the pincer grasp. Activity ideas can be found here
  • Bead stringing/lacing with the tip of the finger against thumb
  • Practice screw and unscrew lids
  • Activity ideas using bubble wrap to promote pincer grasp
  • Play dough can be used to promote the pincer grasp.
  • Tear pieces of construction paper into small pieces and paste the different colors of paper on a simple picture from a coloring book, or make your own design.
  • Use tongs/tweezers to pick up blocks/small objects.
  • Pennies into a piggy bank or slot cut in a plastic lid. Coins can also be put into slots cut in foam.
  • Working on a vertical surface, especially above eye level. Activities can be mounted on a clipboard or tapes to surface or chalkboard/easel. Examples: pegboards, Lite Brite, Etch-a-sketch( upside down), Magna Doodle, outlining, coloring, painting, writing.
  • Clothespins/pinching. Put letters on clothespins and spell words by clipping on edge of a shoe box. Use a clothespin to do finger “push-ups” by using the pads of the thumb and index finger to open a clothespin and count repetitions.

Pencil Grasp Patterns

The Dynamic Tripod Grasp

Pencil skills, and particularly handwriting, is a more complex skill than we often realize. A child’s ability to color within the lines, trace over a shape and draw simple pictures forms the building blocks for writing letters and words.

Mastery of these pencil skills focuses on the content of their writing rather than the mechanics of pencil, speed, and movement. However, given society’s emphasis on, and haste to commence, ‘academics’ earlier, we sometimes overlook the vital role these seemingly basic skills play in developing writing skills. Yet we expect children to demonstrate their knowledge on paper in order to assess their pace.

Handwriting is influenced by the development of appropriate sensorimotor, perceptual and cognitive skills.

One of the most common problems occupational therapists in the school are consulted about is improper pencil grasp.

While the most efficient way to hold a pencil is the dynamic tripod grasp many other patterns are commonly seen in children and it does not always require intervention or modification. In the dynamic tripod grasp, the pencil is held between the thumb and index finger, with the pencil resting on the middle finger.

There are a variety of reasons why children hold their pencils in patterns other than the dynamic tripod. One common reason is participating in a lot of writing before their hands are developmentally ready for this activity. This is becoming more and more common as parents try to start preparing children to school with writing activities at an earlier stage.

dynamic tripod grasp pencil hold for left hand figure
(dynamic tripod grasp for left-handed)
dynamic tripod grasp pencil hold for right hand figure
(dynamic tripod grasp for right-handed)

It is important to try to modify the pencil grasp as early as possible since many students seem to have developed bad habits even before entering kindergarten.

Adaptive Pencil Grips

Adaptive pencil grips may be helpful in teaching students to modify their grasp and are used to facilitate an optimal pencil grasp.

There are many different types of grips available. For a pencil grip to be effective, the student needs to be involved in choosing the grip and to understand the importance of using it.

Adaptive pencil grips in 2 different sizes

The most optimal position for writing includes the ankle, knee, and hip at right (90 degrees) angles with the forearms resting on the desk. The top of the desk should be approximately 2 inches above the elbows when the arms are at the student’s side.

Pencil Grasp Patterns

Functional Grasp Patterns

Tripod grasp with open web space: The pencil is held with the tip of the thumb and index finger and rests against the side of the third finger. The thumb and index finger form a circle.

Quadripod grasp with open web space: The pencil is held with the tip of the thumb, index finger, and third finger and rests against the side of the fourth finger. The thumb and index finger form a circle.

Adaptive tripod or D’Nealian grasp: The pencil is held between the index and third fingers with the tips of the thumb and index finger on the pencil. The pencil rests against the side of the third finger near its end.

Immature Grasp Patterns

Fisted grasp: The pencil is held in a fisted hand with the point of the pencil on the fifth finger side on the hand. This is typical of very young children.

Pronated grasp: The pencil is held diagonally within the hand with the tips of the thumb and index finger on the pencil. This is typical of children ages 2 to 3.

What is an efficient pencil grip?

“A pencil hold that provides speed, legibility is comfortable and will not cause harm to the joints of the hand over time. If a hold satisfies these criteria there is no need to change it” (Benrow 2002, cited: Foundation of Paediatric Practice for the Occupational Therapy Assistant, 2005)

Inefficient Grasp Patterns

Five finger grasp: The pencil is held with the tips of all five fingers. The movement when writing is primarily on the fifth finger side of the hand.

Thumb tuck grasp: The pencil is held in a tripod or Quadripod grasp but with the thumb tucked under the index finger.

Thumb wrap grasp: The pencil is held in a tripod or Quadripod grasp but with the thumb wrapped over the index finger.

Tripod grasp with closed web space: The pencil is held with the tip of the thumb and index finger and rests against the side of the third finger. The thumb is rotated toward the pencil, closing the web space.

Finger wrap or interdigital brace grasp: The index and third fingers wrap around the pencil. The thumb web space is completely closed.

Flexed wrist or hooked wrist: The pencil can be held in a variety of grasps with the wrist flexed or bent. This is more typically seen with left-hand writers but is also present in some right-hand writers.

Activities to Improve Pre-Writing Skills

The following list of activities can be used to improve pre-writing skills. Additional ideas can be found here.

  • Playing jump rope
  • Volleyball-type activities where hands, paddles, or rackets are in a palm-up position
  • Squirt bottles (activities using squirt bottles)
  • Slinky-shift back and forth with palm up
  • Bead stringing/lacing with the tip of the finger against thumb
  • Pouring from small pitcher to a specific level in the clear glass. Increase the size of the pitcher as strength increases.
  • Ich a pencil or chopstick positioned in tripod grasp toward and away from the palm. The shaft should rest in open web space.
  • Practice screw and unscrew lids
  • Pop bubble wrap
  • Play dough/silly putty activities
  • Use a turkey baster or nasal aspirator to blow cork or ping pong balls back and forth. These can also be used to squirt water to move floating object/toys.
  • Tier pieces of construction paper into small pieces and paste the different colors of paper on a simple picture from a coloring book, or make your own design.
  • Floor activities – large mural painting, floor puzzles, coloring when lying on the stomach on the floor.
  • Dot-dots, color by number, mazes.
  • Wheelbarrow walking-child’s hands are the large ones from Bed Bugs game or kitchen tongs.
  • Fingerplays/string games such as Cat’s Cradle.
  • Use tongs/tweezers to pick up blocks/small objects.
  • Pennies into piggyback or slot cut in the plastic lid. Coins can also be put into slots cut in foam.
  • Working on a vertical surface, especially above eye level. Activities can be mounted on a clipboard or tapes to surface or chalkboard/easel. Examples: pegboards, Lite Brite, Etch-a-sketch( upside down), Magna Doodle, outlining, coloring, painting, writing.
  • Clothespins/pinching. Put letters on clothespins and spell words by clipping on edge of a shoe box. Use a clothespin to do finger “push-ups” by using the pads of the thumb and index finger to open a clothespin and count repetitions.
  • Squirrel objects into the palm (pick up with index finger and thumb, move into palm without using the other hand)
  • Squeeze sponges to wash off the table, clean windows, shower, etc.

Causes and Treatment of Poor Fine Motor Control

The primary cause of fine motor control problems is a lack of or overabundance in muscle mass. A child having high muscle tone may make mistakes based on the over-activation of muscles, resulting in activities being sloppy or even clumsy in nature. A child having low muscle tone is quite common; a child with low muscle tone may struggle to maintain even the smallest control of a pencil or even scissors. Small feats like finger movement may prove to be an extreme effort for a child with low muscle tone.

It can be said that genetic and environmental factors can lead to fine motor skill problems. While pregnant, a mother exposed to alcohol and drugs can be a big factor in the development of a baby. Alcohol can directly affect the neurons in the brain. If a baby is born prematurely the connection of the neurons in the brain may be disturbed. The more premature a baby is the risk for this problem rises. Disturbing the connection of neurons can lead to difficulties with attention span and/or self-control in fine motor skill development. Even smoking has been known to have negative effects on motor skills.

Treatment with a pediatric occupational therapist can greatly improve a child’s fine motor skills with the right therapy geared to successful treatment of fine motor problems. The pediatric occupational therapist may try two approaches to the treatment of your child. The first is a relatively general approach dealing with the assessment of their sensory development. How a child moves and reacts to stimuli. Finding that underlying factor helps them form a second approach designed specifically for fine-tuning the way they perform more complex tasks using fine motor skills. Teaching them how to accomplish and fine-tune their skills can greatly improve motor function.

Being that no one method is successful for all patients a Pediatric Occupational Therapist may also treat a child in these areas:

  • Their finger strength, hand strength, hand position and stability
  • Overall pencil grip and control
  • Control of the wrist and forearm
  • Finger movement
  • The spatial organization of space and letter formation
  • Speed and dexterity
  • The isolated movement required for tweezers and scissors

It is necessary for parents to take an active role in their child’s treatment for the continuation of improvement outside of the pediatric occupational therapists’ office.

For at home improvement of fine motor skills the occupational therapist may suggest activities like drawing (sample activity), coloring and paper cutting art involving cutting out paper chains and making paper snowflakes. Drawing can improve how neatly the child can draw lines and shapes, improving the overall appearance of letters and shapes altogether; paired with coloring this helps the eyes determine where to stop by staying within the lines in shapes and forms. Tracking movement is one of the key factors in fine motor skills. There are also toys and games available that are geared for the improvement of fine motor skills.

Developing and improving fine motor skills can take a lot of time but with the proper guidance from a pediatric occupational therapist, you can make all the difference in the way your child learns and perceives life in general. Children with fine motor skill problems can suffer greatly in school and even social situations. Therefore it is important to identify any fine motor control issues and begin an occupation therapy program to help them develop these skills as quickly as possible.