Interactive Metronome is a computer-based technology that enables children and adults to directly exercise and improve the processes of motor planning and sequencing. IM is an exciting technology backed by numerous clinical research studies that confirm measurable performance increases. Performance areas include: motor control, attention, language processing, math and reading skills. Studies show IM may produce significant gains in athletic performance as well.

IM is endorsed by Stanley I. Greenspan, Chairman of the Scientific Advisory Board of Interactive Metronome, Clinical Professor of Psychiatry, Behavioral Sciences and Pediatrics, at George Washington University Medical School, a renowned author, a practicing child psychiatrist, and former director of the National Institute of Mental Health’s Clinical Infant Development Program and Mental Health Study Center. Stanley Greenspan considers IM an important piece of an effective, comprehensive therapy program for children with development delays, learning disabilities and motor problems.

For more information regarding Interactive Metronome Therapy, visit their web site at www.interactivemetronome.com. For specific information about interactive metronome therapy through our clinic or to schedule an appointment, call Jill at (858) 565-6910.

The Pencil Club utilizes the Handwriting Without Tears Program and sensory integrative concepts to improve the foundations of successful handwriting. This group focuses on letter identification, formation, sizing, alignment, and spacing though fine motor tasks, craft activities, and the Handwriting Without Tears approach.

This 6 week group is offered one time per week (1 hour sessions)
to children ages 5 – 6 and a separate group for ages 6 – 7.

For more information, please call: 858-565-6910.

Therapeutic Listening is a complete program that involves more than the ears and just listening.  It is a special program targeting the concept of auditory integration on the neurological level of brain function.  Thus impacting and affecting behavior and learning.  The concept of whole brain “listening” involved in this approach is critical

Therapeutic Listening is an approach used at O.T. Etc and is based upon carefully developed theory and the use of clinical reasoning adapted for the individual.  It is sound based intervention and used with children with sensory processing disorders as part of the treatment program to increase attention, self-registration, postural control, praxis, auditory discrimination, visual-motor discrimination- to name a few things.

For evidence based research in this area, please visit the Vital Links website: https://vitallinks.com/

Rhythmic Movement Training (RMT) is a program designed to integrate retained or underdeveloped reflexes that act as the foundation our nervous system and our ability to move. Integrating these reflexes is necessary for brain development, and by simulating the natural movements of infants, RMT can build the foundations to help promote learning, and overcome sensory, emotional, and behavioral challenges. When used regularly, this program can help improve attention, coordination, emotional imbalances, and sensory processing deficits.

Resources for additional information, please visit: http://rhythmicmovement.org

This is a specific training program that involves kinesthetic, tactile, motor, and general fun based activities in learning how to form and write letters. It starts with the manipulation of lines and curves (with actual wooden pieces) to form shapes and letter, on up to activities involving sponges, water, chalk boards and other manipulatives.

 

Occupational Therapy may include activities of daily living into the treatment sessions.  These tasks are related to getting undressed, dressed, putting socks, and shoes on/taking off.  It involves mastering the skills in manipulating fasteners (zippers, buttons, and snaps).  We can include activities such as hair brushing and teeth brushing, as well.  For older children activities involving doing laundry, washing dishes, meal preparation are also part of ADL training.

Feeding evaluations and treatment sessions by our trained Occupational Therapists can include:

• Implementation of research based approach (s) can be used including SOS, AEIOU, “Get Permission Approach”, and any combination.
• Oral motor techniques involving Beckman exercises, Z-vibes, nuk brushes, tic tongs
• Goal and objectives are a part of the therapeutic intervention between parent, child and therapist.
• Practice in the clinic, with follow/up suggestions for at home is essential
• Parents bring food from home, sometimes even bringing own cups and plates to ensure success.
• Many tools may be used, including special spoons, forks, plates, and straws.
• Messy play is also encouraged for children who avoid touch and/or have texture issues.

There are also several resources often referred to, including:

www.ellynsatterinstitute.org/
www.feedingmatters.org

Fine Motor refers to the development of small muscle movements in the hands. When thinking of fine motor skills, we think of activities such as writing, pointing, stringing beads, holding onto a fork or spoon, shoe tying- to name a few things. Fine motor development does not stand alone, as our hands are part of our body. There are a lot of factors that make up fine motor skill development. These other factors may include (but not be limited to): muscle strength and tone, arm and hand stability and mobility, eye-hand coordination, perceptual skills (involving kinesthetic awareness, visual perceptual skills), and behavioral state.

If you have a concern regarding the developmental level of your child- please, please contact us at: 858-565-6910.

Fine Motor Developmental Checklist

0-4 months
Hands are mostly held fisted (closed fingers) (0-3mos)
Displays the grasp reflex (normal reflex: grasps involuntarily with object placed in hand) (0-3 mos)
Begins to move hands and swipes toward and at objects
Can begin purposeful reach towards a visually regarded object
Can maintain small object in hand

3 ½-8 months
Clasps hands together, often
Puts toys in mouth
Can pick up a one inch cube and other medium sized objects, easily (purposeful grasp)
Improves accuracy of reach (forward and to the side)
Can hold own bottle (5/6 mos.)
Is able to transfer objects from one hand to the other
Is beginning to “rake” (motion with all fingers) small objects to pick up

8 months-12 months
Purposefully picking up and dropping objects (as a game)
Is able to use thumb to fingers- usually on the side of the fingers to pick up small objects
Points with index finger

12-18 months
Holds crayon in palm with whole hand (palmar grasp), and displays a spontaneous scribbling pattern
Can stack 3-4 one-inch cubes
Can insert 3 blocks after demonstration (circle, triangle and square)
Turns pages of a book (2-3 at a time)
Insert small round peg

2 years
Tower cubes 6-8 in a vertical stack
Able to place shapes into simple formboard
Beginning to lace
Able to insert small and large square peg
Holds crayon in a fisted grasp, or with thumb and all fingers (thumb turned downwards)
Able to hold a utensil and feed self
Can draw and copy a vertical line

3 years
Able to draw a horizontal line, and imitating a circular stroke, to drawing a circle
Eye-hand coordination is improving
Able to begin cutting (snipping) with scissors
Able to build a tower of 9-10 blocks
Able to draw a 3 part person (circle, 2 legs)
Can hold crayon in fingers
Able to name own drawing
Can complete simple puzzles
Can feed self with little spilling and drink/hold a cup with one hand

4 years
Should have a “tripod grasp” on the pencil, but still moves forearm and wrist to draw
Able to draw a person with at least 5 parts.
Able to identify some letters and numbers
Can insert a key in a lock and open it
Can place small pellet in a bottle in 23 seconds

5 years
Has a “tripod grasp” on the pencil and is using finger only to write, draw, and color
Able to copy shapes, including a triangle and diamond
Inserts 10 pellets into a bottle in 18 seconds
Drawing of person is more refined with at least 7 parts, eyes equal
Is able to use a knife to spread food (i.e.: jelly, peanut/other butter)
Fine motor skill development depends upon so many factors, and there is a lot of variability. Other areas to consider with fine motor skill development includes: perceptual skills, eye-hand coordination, bilateral motor integration, stability and strength, as well as mobility, visual motor skills, sensation, attention span and cooperation.
PLEASE remember that the above list is only a guideline. A child may need to practice some skills more, or may need some professional assistance from an Occupational Therapist, if falling behind in fine motor development.

Primitive Reflexes, definitions, and signs of retention.  If infant reflexes do not integrate successfully it can lead to developmental delay.  Primitive reflexes are the first part of brain development and should remain active for the first few months of life.  In typical development these reflexes naturally integrate in sequential order during the first year.  As development progresses, postural reflexes emerge.  These reflexes are more mature patterns, and influence balance, coordination and sensory motor development.

It is believed that if primitive reflexes are retained, then it can lead to developmental delays and are related to disorders like ADHD, sensory processing disorder, autism, and learning disabilities and can contribute to problems with coordination, balance, sensory perceptions, fine motor skills, energy levels, health, sleep, concentration, emotional and intellectual development.

 

Primitive reflexes:

1. Moro Reflex: often labeled “fight/flight” reflex.  It is typically replaced by the adult startle reflex by 4 months of age.
2. Rooting Reflex: Stroke baby’s cheek and the baby will turn and open mouth towards the spot stroked.
3. Palmer Reflex: automatic grasping of fingers around an object.
4. ATNR: Asymmetrical tonic neck reflex.  With head turned to one side, arm and leg extends away from head, while the opposite side bends.
5. Spinal Galant Reflex: when back along side of the spine is stroked, the baby’s body flexes towards the side that was stroked.
6. TLR (the tonic labyrinthine reflex). Tilt baby’s head backwards, legs become stiff, straighten and toes point.  Hands also become fisted and elbows bend.  Tilt baby’s head forward, legs flex, hands and arms extend.
7. Landau: When baby lifts head up and causes the entire trunk to flex and typically emerges at 3 months of age and integrates by one year.
8. STNR: (the symmetrical tonic neck reflex)- as head is brought towards chest, the arms bend and legs extend.

In Occupational Therapy, we often hear the children complain of hand fatigue, may cry, or sob when challenged with holding a pencil, or crayon.

This fatigue may often be due to inefficient muscle use or use of the wrong muscles and/or general weakness.

We have some ideas for you to try out; in the form of activities, games and exercises, we are hoping that you can find something that will help your child improve their hand development.

Please click here to download 20 Tips to Enhancing Hand Development.

Hypersensitivity to Touch (Tactile Defensiveness)

If your child exhibits any of these behaviors:

• Avoids/dislikes/aversive to “messy play”, i.e., sand, mud, water, glue, glitter, playdoh, slime, shaving cream/funny foam, etc.
• May become distressed by dirty hands, and has to wash or wipe them frequently
• May not be able to enjoy the texture of sand or cannot walk on different textures with their bare feet and integrate the water on their feet, or enjoy seeing their shadows (as in the above picture)
• May be distressed by certain clothing; or may want to wear shorts all year, or may only want to wear long sleeved shirts all year
• May be excessively ticklish or excessively demanding with hugs (receiving and giving)
• Distressed with simple diaper changing.
• As an infant, may not like to be held or cuddled; may arch back, cry, pull away
• Overreact to a scrape or scratch
• May be distressed by seams in socks and refuse to wear them.

Please consider inquiring for some help & more information at: 858-565-6910.

We would be happy to help you by offering some guidance.

Hyposensitivity to Touch
(Under-Responsive)

If your child exhibits any of the following behaviors:

• May crave touch, needs to touch everything and everyone
• Does always seem aware of being touched or bumped, or by an injury
• May not know that hands are messy
• May put things into the mouth, excessively
• May hurt other children or pets frequently
• May repeatedly touch/stroke objects or surfaces that are comforting
• Thoroughly enjoys or seeks out messy play
• Seems to crave vibration
• Seems to have strong preferences in foods for excessive spiciness, sweetness, sour or salty tastes.

Please consider inquiring for some help & more information at: 858-565-6910. We would be happy to help you by offering some guidance.

Poor Tactile Perception and Discrimination

• May have difficulty identifying which part of their body was touched with eyes closed
• May have difficulty with fastening buttons, and snaps, as well as zippers
• May have difficulty manipulating other things such as crayons, scissors, utensils, etc.
• May be afraid of the dark
• May be a messy dresser, with pants twisted, or shirt untucked, shoes untied, one sleeve pushed up, or rolled up
• May be continuing to put objects into the mouth to explore (after age 2)
• Has difficulty matching or identifying objects by feel (eyes closed).  For example- may be reaching into backpack to retrieve something, and cannot find it by feeling for it.
• May have difficulty identifying the physical characteristics of objects- such as the shape, size, weight, texture, temperature, etc.
• May not want to be touched, and shy away from contact

Please consider inquiring for some help & more information at: 858-565-6910.

We would be happy to help you by offering some guidance.

• startles, fearful, anxious with light or unexpected touch
• infant does not like to be held, may arch back, cry or pull away
• complains with hair brushing
• avoids groups/group situations
• avoids messy play
• dislikes diaper changes
• distressed wit hair, face washing
• distressed with haircuts, toe nail or fingernail cutting
• may crave touch, touches everyone, and everything
• not aware or bothered by injuries
• self abusive, pinches;bites self; bangs head
• frequently hurts others while playing
• craves excessively spicy, sweet, sour or salty foods
• easily overwhelmed
• avoids playground equipment (swings, ladders, swings, slides)
• fearful, terrified of falling or being upside down
• loses balance easily, is clumsy
• has difficulty making traditions
• is easily overwhelmed
• sensitive to fabrics and tag
• poor fine motor skills, difficulty using “tools” such as pencils, silverware, combs, or scissors
• seems unaware how to move around (like stepping over something)
• seeks out jumping/bumping/crashing activities excessively

10 or more items may indicate a need for a formal evaluation