Sydney Martin - Parent Lecture -Activities of Daily Living, Fine Motor Skills and Sensory Stradegies...
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Transcript of Sydney Martin - Parent Lecture -Activities of Daily Living, Fine Motor Skills and Sensory Stradegies...
Activities of daily living, fine motor skills and sensory strategies for children with Down Syndrome
Sydney Martin, MS OTR Children’s Hospital Colorado
Outline
• Fine motor skills • Recommendations for activities of daily living for
Children & Adults • Visual Supports for Daily Living/Children & Adults • Sensory processing and modulation & behavior • School & Home Recommendations • Questions and Answers
Fine motor skills • Postural Control • Trunk and shoulder stability • Reach, grasp and release • Play • Dexterity skills for school, daily living skills • Assistive technology • Writing • Vocational skills
3
Developmental Considerations Postural skills
Trunk Control Shoulder stability (fine motor/dexterity)
Play
Language Self-Care
Social interaction
Engagement in purposeful activities
Postural Skills • Trunk Control • Stability • Stability with gross motor tasks • Rotation • Facilitation of reach and grasp • Shoulder Stability
§ Strengthening activities • Shoulder • Placing weight on arms and hands in play • Promoting arch development • Fine motor skills • Motivation during play • Fun Activities
5
Reach, Grasp & Release • Reach
§ Requires shoulder stability § Motivation to reach & play
• Grasp § Pinch § Thumb control-opposition § Wrist movement § Finger control & coordination § Types of grasp
• Palmar • Pronated • Tripod • Pincer (Pinch)
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Dexterity Skills • Finger Coordination
§ Moving fingers individually § Poking, pointing § Holding pencil § Scissors
• Wrist § Turning hand over § Sensory play § Self help skills § Dressing & Fasteners § Opening lids
7
Bilateral Coordination • Scissor Skills • Pre-Scissor skills
§ Tearing paper § Squeeze or loop scissors § snipping
• Scissor Skills § Double loop scissors allow adult’s help § Self-opening scissors § Cutting Straight line § Move to curved lines § Shapes § Hand Strength- spray bottle, squeeze activities
8
Pencil Grasp • Pre-Printing
§ Markers & Crayons § Sensory play-sand, clay,
shave cream § Use Stickers to target and
connect the lines § Printing § Vertical surface/wall or
Chalkboard § Vertical & horizontal
Orientation § Left to Right § Sensory play with writing § Shoulder stability § Start & Stop
§ www.HWTears.com
§ www.TVTeacher.com
Development
Developmental Skills Visual Motor
activities
Dexterity Skills with
manipulation
Puzzles, Duplo Blocks, Action songs/signs
Sensory play
SELF CARE: Brushing teeth,
Dressing/buttons
Printing
Vertical Surface
Letter recognition
Assistive Technology
Spatial Organization
Drawing
Imitation, Tracing & copying
Postural skills
Assistive Technology • Touch screen programs • Trackballs- offer better control • Joy Sticks • Track pads • Key guards • Alternative keyboards
Developmental Considerations Praxis
Initiation, Planning, & Sequencing
Imitation (motor and oral-motor)
Play
Language Self-Care
Social interaction
Engagement in purposeful activities
Teaching Strategies for Activities of Daily Living
• Intensive Toilet Training • Chaining • Picture Activity Schedules • Video Modeling • Practice and repetition • Daily Living Social Stories
Independence in Self Care and Adaptive Skills
• Wiping at the toilet • Brushing Teeth • Brushing Hair • Showering • Dressing
• Making a snack • Doing the laundry • Washing dishes • Setting the table • Getting bag ready
for school
Chaining • Chaining is a very useful basic teaching procedure that
you can use for these kinds of skills • Chain
§ Multi-step actions where all steps have to occur in the correct sequence to finish the task correctly
Chaining Interventions
Backward Chaining
Forward Chaining
TASK ANALYSIS
Chaining
Importance of a chain
• Each completed step serves as a cue for the next relevant action § If the chain is interrupted you may lose some steps
in the sequence
• Examples of Chains § Tying shoes, making a sandwich, starting a car
• Before a chain is taught you have to identify every step using a TASK ANALYSIS
Teaching a step in the chain
§ Present initial instruction (e.g., “Put on your shirt.”) • Present the steps instruction (e.g.,“Place
shirt over your head.”) • Use prompts if needed • Use reinforcement for correct responses as
needed • Fade prompts • When behavior occurs without prompts,
move to the next step
Linking Steps Together: Backward Chaining
• All steps are completed for the client, except for the last, then second to last, etc. § 1-2-3-4-5 (therapist) 6 (client) … mastery § Example: the shirt and one arm is placed into
the shirt– Child has to put other arm in. § Reduce prompts as you go for mastery
• Use when there is a natural reinforcer at the end of the chain– I’m Dressed!
• Use when task termination is a reinforcer
Forward Chaining
• Teach the steps in a forward manner, 1 at a time § 1 (reinforcer)… mastery § 1-2 (reinforcer)… mastery § 1-2-3 (reinforcer)… mastery, etc.
• Use when the client can perform each of the steps
• Use when the initial steps are easiest
Nail Trimming • Always after or during bath time when the nails are soft • Don’t use the word “cut” use the word “trim” • Provide heavy work activity before • Video the family trimming their nails & have child watch • Introduce nail trimmers to cut onto paper first in play • Slowly introduce nail trimming to your child when they
are calm • Break the activity into steps • Take breaks and offer a pleasurable activity during nail
trimming.
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Haircuts • Take Child to watch the hairdresser • Complete heavy work activities before • Use a towel and clip instead of cape • Take along an extra shirt to change into • Visual distraction- computer or IPAD • Sit on parents lap • Reward with positive reinforcement • Consider having a hair dresser come to your home if
necessary
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Schedules
Visual Schedule
Picture
Written
Tech Based
Why use activity & Visual schedules? • To increase behavior that has been learned but is not
occurring independently § Pre-teach a skill § Improve Independence
• To reduce problem behavior during transitions
• To teach new sequences of behavior and learn new skills
Prerequisite Skills
• Ability to discriminate pictures from backgrounds
• Identity matching with 3D objects
• Identity matching with picture to object
• Tolerance of manual guidance
• Ability to manipulate materials
Visual organizers • Visual Schedules • Graphic Organizers
Routine-based Strategies Work systems
The individual work system answers four questions 1. What work? 2. How much work? 3. How do I know when I am
finished? 4. What happens next?
http://www.teacch.com/
Picture Exchange Communication System-PECS
First this – Then that…
Visual Schedule First - then
Ready/Not Ready • Teach child to indicate if they are “ready” or “not
ready” • Associate “not ready” with a means to get “ready”
§ then move them into getting ready § finally, engage in task at hand because they are “ready”!
Sensory Integration
Pyramid of Learning
A Model for Understanding Sensory Modulation
Sensation seeking
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POOR REGISTRATION
Sensory avoiding
Lane, C. 2011
How We Treat Sensory Issues • Careful analysis of the problem • Sensory Diet & Sensory Based Activities • Classroom, Home and Community based Program instructions & suggestions
Sensory Systems
• Vestibular (movement) • Tactile • Proprioception (heavy work) • Auditory • Olfactory • Visual
Movement
Information to muscles and joints
Alertness Strategies
Classical SI – Bottom UP • The use of sensation through the adaptive response produces sensory integration, the basis of praxis & motor planning
• Qualities of sensation include focused work on foundation of disorder § Vestibular § Tactile § Proprioception
Adaptive Response
The Sensory Diet Concept • Originated by Patricia Wilbarger, M.A., OTR
Sensory Diet Components
• Routines for transitions and key issue management • Family lifestyle and preferences assessed and
modified • Interaction style modified for best comfort • Task/activity modification • Environmental modifications
Sensory Based Strategies Movement: Modalities
§ What sensory receptors are stimulated?
§ What areas of the brain are activated?
§ How does it effect arousal & alertness?
§ How does it support function?
• Intensity • Frequency • Duration • Rhythmicity
The Key is Building a Daily Schedule Event/Time
Sensory Diet Activity
Transition Other Support
Wake -Up
AM Lunch Early PM
Dinner Bed-time
The Relationship of Arousal to Attention, Learning and
Performance GOOD
ADAPTIVE RESPONSE --------------------------------------------------------------------------- (Attention, Learning, Performance) POOR __________________________________________________________
LOW ⇑ OPTIMAL RANGE ⇑ HIGH OF AROUSAL
After Hebb, 1949
Arousal-Relaxation Cycle Builds Self-Regulation
Child
experiences a “need”
Child feels upset
Adult satisfies need
Child Feels Content/organized
behavior
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Sensory Strategies
• Sensory Play • Tactile • Heavy Work • Movement (Vestibular) • Auditory (music) • Oral Proprioceptive • Visual
• Cozy corner • Headphones • Therapy ball • Movement Activities
Education and Advocacy • Education
§ School & community personnel § Explaining learning strategies § Explaining behavioral differences
• Advocacy § Educating about Down Syndrome conditions § Teaching strategies for success § Promoting success across all environments
Resources • “Fine Motor Skills for Children with Down Syndrome” by
Maryanne Bruni, BScOT • The Sensory-Sensitive Child: by Smith & Gouze • “How Does Your Engine Run” www.thealertprogram.com • www.Therapyfunzone.com • www.sensorycomfort.com • www.softclothing.net
Thank you for your Attention! Contact Information: Syd Martin MS, OTR Children’s Colorado Hospital Email: [email protected]