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Writing S.M.A.R.T. IEP Goals
My first months working in school based therapy as a new OT left me feeling ill equipped and insecure in my skills as a therapist. Nothing humbles you quite like being a new graduate working in the schools does (any of your currently going through this stick with it. IT WILL GET BETTER I PROMISE!). Back when I was a new graduate and had just taken a contract position in Hawaii, I remember feeling WAY in over my head. I was to have a mentor help me become better acquainted with the ins and outs of providing occupational therapy in the school setting. However, due to heavy caseloads and distance between schools, I rarely got to meet her in person or talk to her on the phone. I was left to figure it out for myself. One of the many challenges I faced was collaborating to write, or working to write, GOOD IEP goals. I often came across goals such as the following: Jacob (pseudonym) will demonstrate improved fine motor skills in order to copy simple pre-writing shapes such as a circle, a square, a triangle, a cross and an X with 80% accuracy utilizing a tripod grasp in 4 out of 5 opportunities observed. I also have been guilty of writing cringe worthy IEP goals myself. Just taking a look back at some IEP goals I wrote three years ago, although well meaning, measurable, they were not. How I learned: Following a due process case, during which the settlement process I rewrote my OT related goal three separate times, I decided I had to do better. I had to make sure I was not absent minded and coming up with goals on the fly. I started thinking of it in these terms: Assessment --> Determines areas of concern --> goals --> services. Therefore, I needed to make sure that if I was recommending services for a student, the services needed to align with the students projected progress toward the goal. That lead to to discover SMART goals. A S.M.A.R.T. IEP goal Stands for S- Specific M- Measurable A- use of Action words R- is Realistic and Relevant T- Time limited Listen to our Podcast on SMART goals where we add an E to create SMART-E goals. Check it out on Here or on iTunes Let’s break these down from an occupational therapy perspective. S- Specific Often times, it seems simple enough to create a specific goal; however, without being specific about the academic or functional progress you would like to see, you are unable to also make this goal MEASURABLE (which is the next part). When I look at how specific the goal is, I’m looking at a functional occupational performance area that is relevant to the child’s academic success. If the child is unable to grasp a pencil appropriately, how does that impact their performance? If a child is unable to regulate themselves within the classroom, how is this impacting his or her performance within the classroom? BE SPECIFIC!
If the child is fatiguing when writing due to the poor grasp, is the grasp impacting writing legibility? If the grasp appears odd, yet it is not impacting the child’s occupational performance, does it need to be changed? Get specific about how the child’s pencil grasp is impacting his or her occupational performance. M-Measurable Goals need to be measurable in order to monitor progress. If you are seeing a student for occupational therapy services once a week and write a goal that the child will perform the task in 4 out of 5 opportunities observed, how are you going to ensure you can measure this? Could the teacher measure this? (I have been guilty of not considering these factors in the past…. Which is why I learned to adjust and be more aware of my goal writing) Let’s assume that we’ve collaborated with the classroom teacher on Jacob’s goal. I plan to work with Jacob by pushing in and collaborating with the classroom teacher 2x month x 30 minutes to provide collaboration for Jacob to work on developing a more functional grasp as his current fisted grasp is limiting his control for writing letters with more refined movement and legibility. Proposed goal: By his next annual IEP Jacob will independently sustain a functional digital grasp (i.e. a tripod grasp) with writing and coloring instruments when performing classroom writing tasks in 3 out of 4 opportunities observed over a 2 month period. Being that I’m in the classroom 2 x month for 30 minutes, unless the teacher would be measuring this goal consistently, writing “4 out of 5 opportunities in a one week period" would not be measurable. furthermore, "4 out of 5 opportunities" observed could be measurable, but over what length of time? So be sure to get more clear on how you will measure your goal. You will find it helps to determine you service level and service type (consult, collab, individual-direct) as well. A- Action The action word in the above goal is "independently sustain". This indicates that the child is not being directed by the adults within the classroom. The goal is that he be able to pick up and position writing and coloring instruments with a digital grasp without adult intervention. I have a personal preference for writing goals in which the child is able to complete the gaol at a level of independence or with no more than one prompt or redirection. I do this because as an OT I’m focused on developing the “Just Right Challenge” for students in order for them to be successful and advance their abilities. This leads to the next part of S.M.A.R.T. goal criteria. R- Relevant and Realistic The Goal needs to be child centered, therefore it should inherently be relevant. The goal should be relevant to the child’s educational setting and address the identified areas of concern. Realistic is developing the “Just Right Challenge”. We want to develop a goal that is challenging enough to advance the child’s skills to the next level; however we do not want the goal so difficult the child is unable to meet the goal within the given time frame. Developing a realistic goal relies on establishing a baseline for the child or looking at his or her present levels. When I write a goal for a student to be independent in a skill, it is because I see prompting as a means of teaching the skill or getting the child to learn the task. If the child would be unable to perform the skill without “hand over hand” or even “moderate assistance” it may be that the goal is not at a “Just right challenge” and we may need to take a step back and look at the child’s present levels of performance. By keeping the “Just right challenge” in mind, we can make sure that the goal is relevant as well as realistic. How do you make sure your goals are relevant? Download our School-based Occupational Profile form and you will be on your way to knowing exactly where to start when developing SMART goals for your students. Just hit the subscribe button to get the Occupational Profile form plus two other freebies that will help with you and your students! Subscribe T- Time limited Writing an annual goal is SOOOOOO difficult. I mean it is ONE ENTIRE YEAR AWAY! That is why we not only write an annual goal, but also develop short term objectives as well. When looking at this step, establishing a baseline is crucial even if the student does not perform the task at all. It may be that prompting and cues are within my short term objectives; however they would not be in the actual annual goal. A Baseline for Jacob needs to contain similar verbiage as the goal. Jacob’s Baseline might read: Jacob independently holds writing implements with a functional digital grasp in 0 out of 4 opportunities observed over a 2 month period. Note: I did not write a baseline stating Jacob holds his pencil with a fisted grasp. Or Jacob has difficulty holding his pencil. The reason is that this is not establishing a baseline from which to measure the goal. When considering short term objectives I may incorporate adult support in the form of prompting For example: By reporting period 1 When provided with demonstration cues from an adult Jacob will demonstrate functional digital grasp (i.e. a tripod grasp) of writing and coloring implements when performing classroom writing tasks in 3 out of 4 opportunities observed over a 2 month period. By reporting period 2 When provided with verbal cues from an adult Jacob will demonstrate functional digital grasp (i.e. a tripod grasp) of writing and coloring implements when performing classroom writing tasks in 3 out of 4 opportunities observed over a 2 month period. By reporting period 3 When provided with no more than one verbal cue from an adult Jacob will demonstrate functional digital grasp (i.e. a tripod grasp) of writing and coloring implements when performing classroom writing tasks in 3 out of 4 opportunities observed over a 2 month period. At the final objective he would become independent. So remember: S- Specific M- Measurable A- use of Action words R- is Realistic and Relevant T- Time limited Here's a color coded version of the goal for you to reference to you. By his next annual IEP Jacob will independently sustain a functional digital grasp (i.e. a tripod grasp) with writing and coloring instruments when performing classroom writing tasks in 3 out of 4 opportunities observed over a 2 month period. Final words: I absolutely loved writing this short article. It made me more aware of my own process when establishing IEP goals. I hope it helps with your goal writing in the future. I typically try my best to collaborate with teachers, parents, and even the student when developing relevant goals and hopefully I am not the only individual responsible for measuring the goal. The majority of the skills OTs work on are performed everyday within the classroom setting. Writing S.M.A.R.T. IEP goals will not only make your job easier in the long run but it will help to better assist the team in monitoring child progress, needs, and help to determine the continued need for occupational therapy. I hope reviewing S.M.A.R.T. IEP goals helps with your next IEP as I’m sure writing this blog post has made me more aware of my own goal writing! If you enjoyed this article and would like to know when we post another, subscribe below! When you subscribe, you will also receive a digital download of our Gray-Space paper package which includes 9 pages of adapted paper to help kids with writing in at all grade and skill levels.
Essential Components to Every School-Based Occupational Therapy Evaluation
Let’s face it. Writing school-based OT evaluation Reports in today’s public education climate can be hard, hard, hard…. I was personally inspired to take a more proactive approach to report writing after a parent went through one of my assessments with a red pen. Talk about getting my butt handed to me. I was not only blind-sided, I was immediately thrown into a defensive and anxious state of mind. I felt my professional opinion was being hijacked by my anxiousness. If you have ever had this happen, having a report that is clear, concise, and well written can be your saving grace. Assessing any student in “all areas of suspected need” can be daunting and confusing. Prioritizing and interpreting those findings can take us down a rabbit hole of possibilities. In this post I’m going to review my personal process that I have improved upon since experiencing this tuff meeting. I want all of us (Teachers, OTs, and all other providers) to go into IEP meetings confident and with reports that serve the student. May we all be able to review our report findings with confidence and make recommendations to the IEP team that can be clearly implemented with fidelity. So, you've received that referral, gotten signed permission from the parent and that 60 day timeline is ticking down....what do you do first? 1. First thing is first Start at the beginning. Getting a strong developmental history and background for the student is essential to understanding the student’s suspected areas of need. As OTs, we call this an Occupational Profile. I have often found IEP teams and parents requesting OT, PT, or other services are not entirely certain of why it is they are requesting the evaluation. In developing my occupational profile, I make sure to include: A) Student Interview- what are the student’s interests? Do they enjoy school? Why or why not? What are the student’s favorite classes? Why? What are their least favorite? Do they have friends? B) Priorities from the perspective of both the parents and the classroom teacher(s). You may also want to check in with other service providers. C) Review both previous educational and medical assessments if available, including psycho-educational, occupational therapy, speech therapy, etc. D) Educational background (grades, time in special education, behaviors, attendance, etc. E) Developmental History and medical diagnosis. 2. Identify why the student referred for occupational therapy assessment? Find out what has been tried with the student as part of Response to Intervention (if anything has been tried?). In our district, I have instructed teachers and personnel to invite me to IEP meetings whenever there is a concern related to occupational therapy (i.e. low VMI scores, poor handwriting, possible behavior related to sensory processing difficulty etc.). This way I can hear first hand what the problems are. If I am unable to attend, I ask that they thoroughly fill out a referral form. At the IEP, you may be able to suggest strategies for the teacher to try and begin collecting data on at this point. This step and the first step should be conducted as soon as possible in the assessment process if possible. 3. Collaborate! If you’re lucky enough (as I am) to have an amazing Special Education team and department, I have found collaborating with the school psychologists and any other service providers prior to writing the report can be a huge benefit to present accurate and relevant findings to the IEP team! I think back to a middle school student who was demonstrating difficulty with behavior and self-regulation during writing/reading tasks. Speaking with the school psychologist and speech therapist proved invaluable as the student had both auditory and visual processing deficits. Therefore, using tools to help access in these areas would prove to be more beneficial than say a chew tool! Remember we are looking at the whole child not just the deficits. 4. Observe! Observe the student in their natural learning environments! I feel student observation is probably the most valuable part of your assessment. Observing in multiple settings during times which the student is performing in areas of strengths, as well as those times in areas of weakness. How do they do with transitions and unforeseen changes in their schedule? This all can be looked at through observation. What are your observations of the main classroom environment? What could the teacher easily implement in this environment for the student? (a correctly sized chair?) Observations can tell us what could potentially be barriers to implementation of strategies for this student. How often have you become frustrated with the lack of follow through and carry over? Did you observe the natural setting to see if what you were recommending was able to be implemented with fidelity? These are important things to ask yourself and these will come up in the IEP. So best be prepared now! 5. Assess the student Assess the student in “all suspected areas of disability” related to occupational therapy services. Do not leave any stone unturned and follow the rabbit hole should you find one. Be thorough! I utilize both functional skills observations as well as standardized assessments. Neither one by itself is sufficient in justification of service level recommendation and both provide valuable information that can inform your assessment. Remember occupational therapy is a wonderfully gray field. It was built on the “art and science” of occupation. Embrace that concept when you look at your assessment. It’s both the challenge and the grace of our profession. Then look to the guidelines of your state. Be sure you can adequately defend your reasoning behind your recommendation. 6. Make it School-based! Be prepared to explain medically based services versus educational based occupational therapy services. (Have a pre-planned speech that sites state guidelines and of course the main difference being access to education!) 7. Speaking of state guidelines, add them into your report. They will be the most objective means of determining the need for occupational therapy services or in some cases not needing OT services. Site them in your interpretation of findings. Remember you are needing to have the student access education in the Least Restrictive Environment. The purpose of school is EDUCATION not occupational therapy. If your state guidelines are like mine there is a great deal up for interpretation. I focus on function and access to academics. 8. Intervention Plan Develop an evidence-based treatment plan or intervention plan based on your assessment report and findings. This should reflect the needs and strengths of the student which you will likely also list in the IEP. Your goal in your plan should be clear and concise (Check out our post on writing S.M.A.R.T. IEP goals). Because our IEP writing software does not allow it; I write my short term objectives on my remediation plan. I may also list treatment strategies and collaboration/consultation plans. This is also where you will develop your progress monitoring strategy for your proposed IEP goal. 9. Evidence-based! Look up and maintain relevant research to support your treatment/remediation strategy. You may find articles on self-regulation/handwriting/visual motor skills to prove valuable in supporting your recommendations. It could be useful to create and keep a binder of relevant research articles in your office and update it often. Evidence –based practices in schools is required by law this is any easy way to ensure you are doing so and have easy references for meetings. 10. Plan for discharge! I have found that exiting students from occupational therapy services is DIFFICULT! Often parents and/or the IEP team do not want to let go of the services they perceive as benefiting their child. OT services are not meant to remain on an IEP indefinitely. Creating a remediation plan with clear objectives is going to lead to a recommendation of exiting the student from service once they no longer need the support. The IEP team determines the need for occupational therapy services and is a team decision and that decision is based on our evaluation, treatment, and progress reporting. I also exit a student with an assessment but its good to have those conversations up front even if discharge does not happen for 3-6 years. Hopefully we can work together to get our students thoroughly and accurately assessed. I know that this list may seem overwhelming; however in a world of due process and standards I think its best to take the time to complete a thorough OT assessment. It will save you trouble in the long run and give a great foundation for treatment and progress monitoring! Let us know in the comments and on Facebook what you're doing to assess your students! Whats on your OT evaluation checklist? Have you had a meeting where you've had your cage rattled? How did you handle it? Thanks for checking in! Subscribe to our mailing list below. If you you liked this article please share! Abby
Cheers To 2017 & On To 2018! We Can't Wait!
Launching only a short three months ago in October, OTSchoolHouse.com has already been a tremendous success in our opinion. We have received feedback from so many of you and nearly over 300 of you have subscribed and downloaded our Gray-Space paper. More than 400 of you follow us on Instagram and still others follow us on Facebook and Twitter. For that, Abby and I are immensely appreciative of each and every one of you! Thank you for your support! It means the world to us. Going forward, we of course want to continue to bring you more stimulating conversations and information you can use at your school sites. But before heading into 2018, we wanted to take a moment to recap what we have learned in our short three months since starting this project and also what you can expect from us going forward. So let’s start with the 3 things we have learned thus far on this adventure. 1) This project that we have embarked on is possible to maintain. Abby and I both work full time in a district in southern California. As you know, work never stays at work. We work 7:30-4 and work follows us home after that. However, we set aside Tuesday evenings and at least one other day to put in time toward the School House. While time consuming, this project has given us new life at our "day job" and we could not be more happy when we get to work on a new blog post or other project. We love putting our thoughts out there and hearing back from you all. 2) Although titled the “OT School House”, We have more than just OTs and COTAs interested in what we have to say. My goodness, yes! We have had teachers (general and special education) PT’s, BCBAs, Speech Therapists, APE teachers, and others subscribe and read our content. Many want to know how they can work with OTs to helps their students. It’s great to see that professionals in other spheres value our opinion and want to team up with us. Call us bias, but we feel that OTs can be an integral part of many IEP teams and other school site planning committees. 3) We have an active reader base that is hungry for more information. For any of you who have reached out to us, you know how much we like to talk and work out problems with you. Whether on facebook, instagram, email, or twitter, we love it when you take a minute to chat with us. This is how we know not just OTs are following us, you all have told us. Even some of the teachers in our own district have found us online and stop us to talk at the school site. What we are hearing from you! Your comments and feedback are helping us to shape the direction of the OT School House. So, we wanted to let you in on the top three questions you have asked and the ideas we hope to cover in the coming year. 1) What is RTI and how can OTs and other educators use it on a daily basis. This is one of our main focuses on the website and we have heard from many of you that are starting to use RTI in your schools. One thing about RTI that makes it so special is that it takes a team and that is why we look forward to talking to experts outside of OT to discuss this topic with us. If you want to talk RTI, we would love to hear from you. Email us now! 2) Many COTAs are asking for content geared toward COTAs in school based OT practice. Alright COTAs, we hear you! And we want you to know that you can absolutely partake in RTI. In fact a few weeks ago, an previous colleague of mine who is a COTA convinced her site administrator to purchase the HWOTears.com Mat Man for all of their preschool classes. Now, she is working with the teachers on how to use mat man in a variety of ways. That was really cool to hear. We also know how important communication is between an OT and a COTA and will be focusing on this topic in the coming months from both the OT and COTA perspective. 3) And finally, many of you expressed your concern for the lack of consistency in our field across states, counties, and even neighboring cities. This right here is a huge problem. It is why we made our map of OT guidelines and it is one of the many reason why we want to continue the OT School House project. Right now we have a long term goal of improving this and breaking down some of the barriers that cause this, but for now we are going to try and take one small conversation at a time. Who knows, with your maybe maybe we will get there. Please help us by sharing us on twitter, facebook, Instagram, or via email. That is how you can help to unite OTs and other special education providers. Thank you for taking a moment to share us. Looking back at the last 3 months, we find it amazing that you all have had so many of the same concerns that lead us to start this site. We know our concerns are also your concerns and we want to address these as we look forward to 2018. With that said, here is what you can expect from us this year. 1) Continued stimulating blog posts geared toward all special educators. We absolutely look forward to continue posting content 2-4 times per month. Topics we want to focus on are RTI, legal IEPs, Collaboration between providers, and evaluation and daily treatment documentation. We feel that these are areas that can be utilized by OTs, COTAs and other educators of all types 2) A podcast with a mixture of “solo” episodes and interview episodes. The podcast is in production and we are only a few weeks from our first episode - “Putting Occupation Back Into OT” I won’t say too much, but this title isn’t just in reference to treatments. There are many ways that we can assist in schools without treatment and we hope to help you discover these ways. We will be hosting two types of episodes. One type will be “solo” episodes which entail Abby and I discussing a hot topic such as difficult IEPs or treatment planning for instance. Other episodes will feature an interview with someone we work closely or another person who is making a difference in the school based OT and special education world. We have an entire year’s worth of interviews already lined up with people who we know you will benefit from hearing their stories. We can’t wait to bring this to you! 3) A course on tiered interventions (RTI) and how to incorporate successful interventions through collaboration with other educators. This here is our newest project. While just an idea plotted on workflowy (a free tool we use) currently, we will be bringing this video based course to you this summer so you can start implementing RTI based strategies with your colleagues when the 2018-19 school year gets started. Don’t worry, we’ll be there to guide you through it with pre-recorded and live video sessions as well as handouts that you can use to get up and going. Be sure to subscribe to get the heads up when the podcast and class are ready for you. Subscribe Now! Man, I’m excited! After writing that last paragraph, I can’t wait to finish up this post and get back to work on 2018. I hope you are excited to hear more from us and I hope you know how much we appreciate your support. Even more importantly, I hope you realize how much your students appreciate the help you provide them everyday! I’m sure they’re excited to see you come January. With that, I hope you all have a great and safe New Year and enjoy the rest of your break if you are lucky enough to have one. Until Next Year, Cheers! P.S. Please help us grow by sharing us. Just click on your prefered social media emblem below! Thank you so much!
Play-Based Education: Teaching The Way They Learn
Hey Everyone, Welcome back to the the OT School House for our first post about PLAY! (Yay!) But before we get into play, can I share something with you real quick? January was a tough month. Somehow, the stars aligned just right, and both Abby and I got supper swamped with assessments and IEPs. In fact just yesterday, I attended 4 IEPs starting at 8:30 and ending close to 5... It's been a long day. So I must say, I am ecstatic that January is over! But looking back on January, there is one thing I found myself saying over and over again during those IEPs. That phase was "play-based education." Although, yesterday I slightly modified it to "academic based rewards" in an IEP where we were discussing the need for a student to use assistive technology. I must admit, as a team we have failed to provide this student academic experiences through play, let alone, play in itself. Even at recess, this 5th grade student with autism simply walks around the playground, occasionally moseying up onto the play structure and then paces back and forth. Since finding this out, I have spent a few recess sessions working with him on how to climb the ladder, go up the slide, and now we are working on climbing the rock wall. These activities are much more meaningful to him than copying a sentence... So anyways, I want to talk about play-based education today. As students move on from preschool and kindergarten, too often the emphasis on fun academics dissipates. This is unfortunate in general education classes, but even more so in our special education classes where many of our students are still functioning social-emotionally at a 4 year age, or perhaps younger. They may have a higher vocabulary and write slightly neater than students that are younger than them, but they may still be at a stage where they are unable to understand the importance of work and thus simply refuse to do pencil and paper work. When a student is at this stage and a teacher or therapist has a mentality that the only way a student can learn to add is though desk work, what you'll often find is an adult complaining about behaviors and a student not making much progress. And it's not fun, or beneficial for either of them. It is in this circumstance that I try to educate the teacher and IEP team on play-based education and education-based rewards. If a child can’t learn the way we teach, maybe we should teach the way they learn. -Ignacio ‘Nacho’ Estrada What is Play-Based Education? Play-based education allows for the student's inherent desire to play, drive their potential to learn. By tapping into the student's intrinsic motivation for play, we can modify their play in real time to "squeeze" in the academics. If that sounds a bit tricky, it's because it is. You have to know exactly what academic skill you are working on and then think on the fly during what could be a small group session. Here's an example. A teacher has graciously welcomed you into her classroom to collaborate with her and the other adults in the classroom for centers that last about 20 minutes. So you and a classroom aide will have a group of 5 students and are asked to work on memorizing sight words. In many classes this center may look like a fill in the missing letter worksheet or simply copying the words. In a play-based environment though. The students may use K'nex or magnetic letters to build and spell the sight words. Or, perhaps they play Hangman to discover the word. A good gross motor game would be to form the letters with your body; it could be made into a dance even. Design a dance move for each: S, K, and Y to help the kids remember how to spell sky I know, it may sound corny, but the possibilities are only limited by your (and the students') imagination. Before I move on, I want to acknowledge that play-based education does not work in all classes. There are some students who will try to take advantage of it and get out of work. In other classes, it may not be feasible with the staffing or logical with the students' learning style. That is why I don't recommend this for all classes. This is definitely something that works best for younger students and students that display delayed social-emotional skills. Academic-Based Rewards! This is pretty straight forward, so I'll make it quick. Whenever possible, the teachers and I always try to make rewards for doing academic work a more fun version of the work they complete. For instance, a student who is motivated by iPad time may get to play Writing Wizard on the iPad after completing a spelling test. The same might go for playing Prodigy on the chromebooks after completing a math lesson. If you are in a pinch and are having trouble thinking of one, might I suggest Tic-Tac-Toe with any given numbers, letters, shapes, or spelling words. It's quite surprising how easy it is to get students to write words five times correctly when it's a game. Hopefully, by using the academic rewards, your student will not only be more inclined to complete the initial task, but will also improve in academics from the rewarded activity. So, that is all I have for today. I know not every student will benefit from the two tips today, but even if only one does, it was worth writing this post about play in academics. If you enjoyed this article or any other article you have read on our site, we welcome you to sign up. We'll send you a copy of our Gray-Space adapted paper as a thank you. Simply Click Here or subscribe below. Thank you, everyone. We appreciate you visiting us! Until next time,
Stages of Play & Improving Recess For Our Students
Hey everyone, Continuing our "Month of Play" theme here at the OT School House, I wanted to use today's post to run through the importance of play and Mildred Parten's 6 stages of play to help refresh what OTs should be looking for in a student's ability to participate at recess and other times of play. In the third version of the Occupational Therapy Practice Framework (2017), the American Occupational Therapy Association (AOTA) used Parham & Fazio's definition of play as “Any spontaneous or organized activity that provides enjoyment, entertainment, amusement, or diversion” (1997).And over the years there have been many articles which document the importance of recess time and the play exhibited during this time. Furthermore, AOTA broke down play into "Play Exploration" - the planning and structure of play, and "Play Participation" - having the ability to access the physical environment. So as we discuss the stages of play, we will be looking at the students' ability to engage in play exploration to participate meaningfully at recess. Parten's 6 Stages of Play 1. Unoccupied Play Seemingly unorganized to an observer, unoccupied play is typically seen in infants and is a way for infants to understand the world around them. Waving their hands in front of their face, randomly clapping their hands, shaking anything that they can get their hands on; these are all forms of unoccupied play and allow for the child to learn about their environment. 2. Solitary Play The next step up from unoccupied play, solitary play is characterized by meaningful play in isolation. Where in unoccupied play the infant shook a rattle randomly, now the child is shaking the rattle with reason, perhaps to a beat. The key component here is that the child is focusing on an activity for a length of time rather than jumping from one activity to another and so on. Solitary play is typically seen in children ages 2-3 years. 3. Onlooker Behavior This phase in play is seen in younger children as well as they look toward their peers and at adults to see how they play. It may be interpreted as being shy, but this onlooker behavior is integral to learning. I like to think of this step as a data collection period for children. They intently observe to learn about concepts like gravity and social cues. 4. Parallel Play Frequently seen at about the same time as onlooker behavior, parallel play is the act of doing the same play activity as a peer, but not with the peer. For example, two children playing with their own set of Legos a few feet apart from each other, but not really interacting with each other. You may see some onlooker behaviors and imitation, but little to no social interaction. 5. Associative Play This is the beginning of socialization in play. Typically beginning to develop slightly before a child's fourth birthday, many kindergarteners enter school at this stage. Children in this stage are learning the foundations of interacting with peers. They are playing with each other and commenting on each others tower, but are not yet working together to build something or taking turns. You often have a lot of tattling at this stage because some children are okay with sharing, and others are not. 6. Cooperative Play By the end of kindergarten, most students should have reached cooperative play where they can have positive interactions with peers and play by rules agreed on by the peers (not necessarily adult provided rules...). It is through cooperative play that children learn to problem solve with peers and to "give and take" in situations where there is not necessarily a winner or loser. Relating the Stages Back to School Function Alright, so those are the most popular stages of play. While some scholars have expanded on this list on to more advanced stages of play, I feel that if a child has reached the cooperative play, they have reached a level that is functional within schools. Thus, I tend to not look beyond that during my assessments. But yes, I do assess a students level of play during my assessments if there are any social or behavioral concerns- especially if I am assessing a younger student. So what do I do? I typically will observe a full recess session and talk briefly with the teacher(s) or aide(s) who monitor recess. I often find that if an aide knows exactly the kid I'm looking for, that student is either frequently in trouble or frequently isolated from their peers for one reason or another. Both are problematic and should be looked at more thoroughly. Many times the reason or reasons for difficulties at recess can be seen by a trained eye during observations. Is the student engaging in parallel play when his/her peers are actively participating in cooperative play? Does the student have the bilateral skills required to climb a ladder or the motor planning abilities to time out when to jump the rope? A few times, I have seen a student get in trouble for pushing or shoving. I know from working with them that they are receiving speech services because they have difficulties expressing themselves. I ask more about the situation and observe the student and I come to find that this student does engage in this behavior, but it is because they do not know how to appropriately ask/tell a peer to move out of the way. This is a form of communication and is a manifestation of their disability. They should not have recess taken away. With the help of the OT and Speech provider, this situation should be used as a learning experience for the student. What Works? Recess is the best time of the day for so many students and rightly so. I think we owe it to them to make sure they all get to participate and enjoy it. So what can we do as OTs? Just like we talk to teachers about how to grip a pencil, we should be working with the recess supervisors about how to facilitate play among our students with disabilities. Some students may just need a structured and specific play task where there is one person leading the game rather than 10 students all making up the rules. A few years ago I working with a student on the Autism Spectrum and we put in place a recess jar. Every day before recess he would pull out a piece of paper that had a game on it and then give him the materials needed to play (ball, jump rope, pool noodle, etc.). Not only did this give him an idea of what to do on the playground, but it also gained interest in that game from other peers. It didn't work out every day, but it did increase overall social play interactions. Alright, so that about wraps things up. I just want to encourage you to get out on the playground and observe your students out there for a bit. You are almost guaranteed to learn something new about your students and they may even surprise you. Also, I recommend checking out the resources below. All can be accessed with an NBCOT account. Thank you for checking out this post. If you'd like to be in the know about future posts and have free OT tools delivered to your inbox Subscribe here! Hope you are having a great week! Until next time, References: Creating Effective Learning Environments EncouragePlay.com Michigan State University Extension - The Power of Play Occupational Therapy Practice Framework: Domain and Process (3rd Edition). Ramstetter, Catherine L, MS,PhD., C.S.C.S., Murray, Robert,M.D., F.A.A.P., & Garner, Andrew S, MD,PhD., F.A.A.P. (2010). The crucial role of recess in schools. The Journal of School Health, 80(11), 517. Retrieved from https://search.proquest.com/docview/757825015?accountid=143111
7 OT Approved Alternative Indoor Recess Ideas
This time of the year, our students can get a bit antsy when the snow, rain, and wind prevent them from going outside for their play breaks. In California, we have had a dry spell this winter. Here's to hoping there's some rain coming soon. But in the Midwest and on the east coast, I know many of you have been getting pounded. With that in mind, I wanted to share with you all some of my favorite indoor alternative recess activities. Some are more up to date than others, but I think they are all better than watching a moving for 15 minutes. I mean, that's not even long enough of a time to get to the good parts... Along with the activities, I'll share some performance skills that each work on so that you can justify to others why they might want to try these activities rather than putting on a movie. Again, to be completely transparent, some of these links are affiliate links which me at no additional cost to you, the OT School House So let's just right into it. 1. Snowball Fight Two years ago my mom had my 2 sisters and I open a fun Christmas gift at the same exact time... You can imagine what ensued as all 3 of us 25+ year olds opened our own pack of snowballs. It was the most EPIC snowball fight to ever occur in a place it rarely snows. If you have frequent inside recesses, you can invest in these snowballs here. Otherwise, you can have the students crumple up some paper, preferably scrap paper. Both methods work on visual tracking and gross motor planning skills, but crumpling up the paper also works on some bilateral hand skills and strengthening. 2. GoNoodle I'm sure most of you have heard of GoNoodle by now. It's a website full of videos that can be used during alternative recesses, PE, or even cool down/warm-ups before and after a test. I especially like the Moose Tube videos GoNoodle works on so many skills. Praxis, bilateral integration, balance, imitation, social skills, Rhythm and many more. 3. Rhythm Works Integrative Dance (RWID) Looking for some dance moves that are more individualized than GoNoodle? The RWID program and the Dance In A Box flash cards (1-2-3 Dance and Hip Hop in a Box) give teachers and students the opportunity to develop their own dance routine! The cards also allow for the option to modify the moves for students who may not be able to participate fully. I recommend checking Rhythm Works out at RhytymWorksID.com I currently run a weekly group with a class of children with moderate to severe disabilities and the teacher, students, and aides all love the program. 4. 4-Corners My personal favorite as a kid, 4 Corners is an iconic rainy day game that works on more skills than you might think. The Corner picker has to rely on auditory, tactile, and even proprioceptive input from the floor vibrating through their legs to identify which corner the most students may be in. The other students roaming from corner to corner learn about to self-regulate during a rather heightened arousal level game. Social and problem-solving skills are also tested as children learn to pick the corner least likely to be picked. 5. Arts and Crafts Table With so many schools cutting back on the arts, an indoor recess can be a beneficial alternative to a movin' and groovin' recess. Slime making or letting kids create and solve their own paper mazes can be fun ways to work on fine motor, visual motor, and planning skills Oh, and don't forget that sometimes the process is more important than the product. A student who creates his own craft will typically be more proud of his/her own creation than a creation completed mostly by an adult. 6. Building You don't have to be at a STEM (Science, Technology, Engineering, and Math) School to bring in some building materials. Below are some fun building materials that can be purchased for relatively cheap considering how long they will last. They all help to build fine motor, copying, planning, and hand strengthening. Be sure to encourage your students to both follow picture directions and create their own designs. Both methods work on separate important processing skills instrumental to learning. K'nex ($31.98) PlusPlus ($7-$25) Brain Flakes ($12.99) 7. Escape Room/Box This one is for the creative teachers out there that perhaps like to build and design things themselves. Set up a scavenger hunt for your students in your room to find clues and secret keys to open a treasure box or door. Incorporate mastered academic problems or history buff clues to make it extra meaningful. Purchase this Magic Box ($11.99) to make your students feel like they just found the "National Treasure" I have not yet tried this one, but it would be fun to collaborate with a teacher to create this. If only we had rainy days here in SoCal... (Doing my rain dance right now) So that's 7 OT School House approved indoor recess activities. Of course, there are many more we could include, but I think this provides a good starting point. What do think of our games? Would you create an escape box? Let us know in the comments or on Facebook. Or share with us what your go-to indoor recess activities are or even what your favorite was growing up. Until next time,
Collaboration Geared Toward Classroom Participation (Article Review)
Alright, So as you all know, here at the OT School House Abby and I are all about Response To Intervention (RTI) and working in partnership with our teachers. So with my partial day off due to presenting at my high school alma mater for career day, I spent part of the day digging for some research about collaboration. I searched the American Journal of Occupational Therapy (AJOT) and initially found an article from 1996... I have nothing against 20-year-old articles, but I was just looking for something a bit more contemporary today. So I dug a little further, and I came across a brand new article (2018) titled, "Effectiveness of the Co-PID for Students With Moderate Intellectual Disability". The article was put together by a group of researchers out of Israel and was aimed at looking at the effectiveness of a "Collaborative Consultation" model versus a traditional "in-service" model Article Reference: Selanikyo, E., Weintraub, N., & Yalon-Chamovitz, S. (2018). Effectiveness of the Co-PID for students with moderate intellectual disability. American Journal of Occupational Therapy, 72, 7202205090. https://doi.org/10.5014/ajot.2018.024109 The acronym Co-PID, in case you are wondering, stands for "Collaborative Consultation for Participation of students with Intellectual Disabilities". And by their account, the Co-PID Model is characterized by 3 key processes which are: 1. Freely sharing knowledge between the OTs and teachers 2. Jointly setting intervention goals and programs, and 3. Sharing responsibility for the student outcomes As soon as I read these 3 key ingredients, I was hooked. This is what I have been begging for from the admin and teachers in my district. Constant communication, collaborative goals, and the shared responsibility for goals and interventions! I'll be the first to sign up for a team that works like that! After calming down I continued reading. I was a little sad that they were not comparing this collaborative model to a direct pull-out model, but who knows, maybe that's next on their agenda. Anyways, as opposed to the traditional in-service model which for this study included a hour and a half in-service on participation and two additional 45-minute meetings spread over 4 months, the Co-PID experimental group of teachers partook in the hour and half in-service along with a workshop session where the teacher and OT basically went through a mock lesson and follow up discussion. The Co-PID group also held 45-minute consultation meetings every two weeks during the 4 month period to brainstorm activities that could increase participation. With participation being the "P" in Co-PID, it makes sense the outcomes looked at by these researchers was participation in the classroom - specifically communication, choosing, and initiating - and the transferability of these participation skills into other environments. To measure these outcomes, they used a structured observation developed alongside the Co-PID model called The Structured Observations of Students Participation in Classrooms (SOSPiC). The SOSPiC was designed to evaluate functional communication, the ability to make choices, and the ability to initiate. The SOSPiC is designed to be a 45-minute classroom observation in which the observer completes a 4 point Likert scale. The Goal Attainment Scale (GAS) and the Participation section of the School Function Assessment (SFA) were also used as part of their pre/post testing. So they went about their intervention and came to find some mixed conclusions. Between the two groups, no significant difference was found in improved communication or initiation skills. However, the Co-PID did make greater improvements in "choosing", goal progression on the GAS, and increased participation in areas other than just the classroom on the SFA. Now before I get into my own analysis of what this means to me and possibly you as a school-based OT, the study did have a few limitations that should be noted. One limitation pointed out was the design and length of the in-service group, which wasn't fully detailed in the article. In my opinion, they also had a relatively small sample size (12 teachers and ~65 students at two school sites). I also feel that it is just really difficult to complete a study at a school site. There is just so much going on that it is hard to account for external factors such as teachers and aides training experience, recess time and activities, attendance, etc. Despite these factors though, the study seems to have been completed with acceptable rigor. How Does This Study Impact Us? Well, I already mentioned this aspect, but I hope the researchers will complete a similar study with their model compared to a direct pull out model. By definition and cited in this article, students with Intellectual disabilities demonstrate poor carryover so I would be interested to see how skills carried over from OT session back into the class. Recently, we have also been having a problem in our district with IEP team members wanting us to pull a student with moderate intellectual disabilities out of the classroom to work on skills that are likely out of their developmentally appropriate range. Regarding that problem, I like that this article clearly states the importance of participation in class and other activities rather than specific skill sets. Students are school to participate in class My biggest concern with this model in relation to my district (and quite possibly yours, too) is the time constraints. Every 2 weeks the OT met individually with each teacher for 45 minutes. If you have multiple school sites that you service, you know how difficult it can be to schedule a 45-minute period when both you and the teacher would be available, especially if you have 5+ teachers to do this with. It would be a struggle, but not completely impossible in my district, I think. I think it's safe to say that I see the pros and cons of this model and will definitely be keeping it in my research binder for when I need to reference the importance of collaboration to an IEP team. I think sometimes our IEP teams (me included) still gets stuck on a deficits models rather than a strengths and participation model. It's an article like this that reminds me a student is at school to participate in his/her class, not to be pulled out for OT sessions where carryover to their classroom is minimal What about you, do you keep a research binder or journal in your workspace? Or better yet, do you reference articles in your reports or at IEPs? Let us know in the comments! If you agree with this article and subsequent analysis, please share it by clicking on your favorite social media icon below. Until next time,
11 Ways To Use Stickers In Your OT Sessions
Cutting to the stickers Cutting stickers on a line or shape can be a huge motivator for a kid who’s already bored of trying to cut to a highlighted dot . Especially, if you’ve got some really cool stickers. This is a great activity for both kids just starting to cut or those trying to improve their cutting skills. Cutting around stickers For other kids, trying to cut on a line in order to prevent cutting a sticker can be a huge motivator. Grab yourself some of these emoji stickers and your kids will go wild. This is also a great activity that can be shared with you teachers as an RTI/MTSS strategy Place a sticker where the student places their thumb when cutting For those kids who can use the scissors, but struggle to manipulate the paper with their non-dominant hand or try to hold the paper with their thumb down, place a sticker where the child should put their thumb while cutting. Connecting the stickers Just like you can cut from one sticker to another, you can also have your student connect the dots with their favorite color writing utensil. Add some letter or number stickers to add an academic flare to it. Sticker chart/card When used with fidelity, a sticker chart in the classroom can have great benefits. However, since the students often come to me, I have them carry a sticker card. Every time they come to therapy and complete an agreed upon task, they earn a sticker. Be sure to follow up with the agreed upon reward when they get all their stickers. Spelling words Another great activity to introduce to your teachers and kids. Building spelling words with stickers not only makes the task more fun, but also provides a fine motor skill building opportunity. Typing There are a few ways stickers can be used to promote typing skills. One way is to cover up the letters on the keyboard with stickers. That way, the kids have to rely on remembering where the letter should be and what finger to use. The other way is to code the keys with stickers that identify which finger to use. For example, keys, y, h, n, m, j, and u may have red stickers signalling that my right index finger is to be used. You can find stickers specifically for this use on amazon. Spacing words Does your student have difficulty understanding the abstract idea of a space in between words? Let them add a sticker in between each word until they are able to space without them. You can also have them write a few words or even a sentence and then see if a sticker will fit in between each word. Place the sticker on the _____________! The simple act of peeling and placing a sticker on a pre-determined spot, whatever the spot may be, is a great fine motor and visual motor integration activity. Incorporate body parts, classroom tools and multiple steps to work on a variety of different goals. Starting dot for letters Just like us adults need a little help to get started on a new goal, so do our students. Stickers as starting dots for their letters help them to develop a top-to-bottom, left-to-right approach. Be careful with some of your “Magic C” letters though. There’s more than one way to start a circle at the top. Finger twister Check this out! One of my favorite games from childhood now comes in finger size. Great for small groups, this game will help your kids to build manual dexterity skills along with gamesmanship and body awareness skills. Purchase it HERE, Or you can use a few different stickers, like I did over here --------------> and save yourself a few bucks. So, grab some stickers and go have some fun with your kids. They’ll love the fun and you’ll love the progress they make. Check out these cool Emoji Stickers to get you started! What are some of your favorite therapy treatments involving stickers? We’d love to hear about them!
5 Lessons Learned from Joann Sorg, A School Based Telehealth OT
As many of you following OT School House on Twitter and Facebook know, this past weekend Abby and I had the opportunity to attend the Occupational Therapy Association California (OTAC) Conference in Sacramento. One session we both attended was titled “School-Based Telehealth: Bringing Services to Any Child, Anywhere” presented by Joann Sorg, M.S., OTR/L Although neither Abby nor I practice via virtual means, we both came away from this session actionable lesson learned that us "traditional" SBOTs (Yes, I am making up a term to shorten School-Based OT) can greatly benefit from. With the obvious difference between traditional and telehealth school-based OT being the location of service, Joann quickly emphasized the necessary organizational skills required. But, there were five key takeaways that stuck with me that I thought we could all benefit from. So let’s jump into it! 5 Tips Learned Don’t Waste Time! Neither Yours, nor Your Colleagues As a telehealth provider, Joann is not able to simply pop into a classroom. She has to schedule a time with a teacher or paraprofessional who then has to log the student into her virtual classroom. If there is lack of communication, this process can take up valuable time. Unnecessary conversations with aides, teachers, or other staff can also cause a child to be waiting for her to login at another school site. Like Joann’s time, your time, the teacher’s time, and also the student’s time is unfortunately limited. And we cannot afford to waste any of it with high workloads and several schools to be at. In order to prevent wasted time, we must be organized and set boundaries. There should be dedicated times scheduled for treatment and dedicated times scheduled for collaborations, IEPs documentation, and other functions of your job. Stay tuned for a post about how to complete a workload study to help justify needing another OT or COTA! If you need to collaborate or consult with a teacher, schedule a time in advance with the teacher. With technology now, it's so simple to communicate and plan a consult. Likewise, make sure you schedule your services with the IEP team to ensure no overlapping services or wasted time while waiting for a student to come back from recess. I used to have one parent who required a calendar of all service times for her child. As much as it frustrated the IEP team to have to do this, it was nice knowing that that student would be expecting me or the COTA every Wednesday at 9. It was our time and everyone knew what to expect. We All Need to Change Our Mindset About Service Model Delivery Do you default your service frequency to 2 or 4 times a month for 30 minutes per session in a pull out setting? If so, how are you justifying the same treatment frequency for each Individualized Educational Program (IEP)? Do they all really need the same amount of time, or is it just easier to schedule in 30 -minute blocks? I am definitely guilty of this. Occasionally I will change my minutes to 15 if it is a consult or a young kid who has a limited attention span, but for the most part my kids are mostly scheduled for 30 minutes even though I know some require more than others. It’s time to get out of this rhythm and really evaluate how much time is necessary to meet the child’s goals. Remember, goals drive services, and if you can help a student meet their goals in less than 30 minutes per week, then go for it! Having the Right Materials The first question that popped into my head while listening to Joann was “How do you know what materials the school site has to work with? Do you mail them materials?” The simple answer: No, she doesn’t. She simply uses what is available at the school and in her office She actually has the benefit of having her own office at home with all the materials she could possibly need (and then some, with all the tools on the computer). But what I took away from this was that even though she was on a computer, Joann still had a room to work with the student and the on site aide had materials at her disposal should Joann ask to use them. I don’t know about you, but I might give up my right leg to have a room with adequate materials at each school site... Later that night at the conference, someone compared OTs to surgeons. They said, “You wouldn’t ask a surgeon to operate outside an operating room, so why should we be asked to treat in a closet?” I feel like this is true and I’d love to hear how you all are advocating for our need to have an appropriate work space and materials. I have figured this out at some schools, but not all. Drawing With Letters Okay, this one is pretty straight forward. I just thought it was a really cool idea that I was surprised I hadn’t heard of before. And it really is simply drawing with letters! As you can see in the 2 links below, these resources help kids to learn their letters through pictures in a similar way teachers use animals and objects to teach sounds. Check them out by clicking on the affiliate photo! Don’t worry, they will open in a new page so you can finish reading ;) And finally (and possibly my favorite lesson learned) Building Capacity in Teachers and Aides! I feel as though us OTs often take our perspective and knowledge for granted. This often leads us to not communicate valuable tips to teachers, aides, and parents even. For instance, we might see a student and think to ourselves “this kid needs a footstool so that he can support his trunk and improve upper extremity use instead of holding onto the desk for dear life.” But we just say he needs a footstool… That there, was a missed opportunity! We could have explained to the teacher why we are doing what we are doing and what they can look for in other students who may require similar supports. By explaining to our colleagues the reason behind our seemingly odd suggestions, we help to build capacity in their ability to help many other children who we may never encounter. Likewise, we can build capacity through inservices. I’d like to challenge you to approach your principal and ask if you can give an inservice at an after school teacher meeting. Maybe it’s a simple 15 minute lesson on ergonomics for both students and teachers. Or maybe it is more specific like an Autism Awareness training at a site that has several students with autism. Either way, you are building capacity in the people who really do have the power to help make your job easier and help more students. So, to finish this one up I hope you feel encouraged right now! Hopefully, some of you will even take me up on this challenge and let me know how it went. Or, if you already have done this, please share your experiences below. I look forward to hearing how you all are making a difference at your sites. Until next time, Jayson
Top iPad Apps To Improve Pre-writing & Writing Skills (With Videos)
Have you ever heard the term FOMO? FOMO is the: Fear Of Missing Out And with 2.2 million plus apps on the app store, how can you not experience at least a bit of FOMO? Especially when you realize new apps are being added everyday! I mean, I’ve had my ipad for more than 4 years, and I still download new apps a few times a month that I feel could benefit my students. Aside from having a FOMO on new apps, my other biggest fear is paying for an app and then never using it. Yeah, they may only cost a dollar or two, sometimes ten, but it adds up. That’s why I decided to put together this resource of apps that work on the foundational skills needed for writing. Here, you will find the apps I use specifically for treatment. Along with the name of the App, I have also made a video of the app so you know exactly what to expect when you purchase and/or download it. So, I hope these videos help you decide where to spend your time and energy. Quick note: Links included are Affiliate links. This means that the OT School House may earn a small commision from paid apps at no additional cost to you. We appreciate your support by using our links. Let’s get started. 1) Montezuma Puzzle Price: Free Montezuma Puzzle, like many of the games below, is a great reward game that still works on many valuable skills such as problem solving and planning. Add in a stylus and you can also work on pre-writing skills and a pencil grasp. Get it here! 2) On The Line (OTL) Price: Free OTL is a fantastic game to work on pencil and visual-motor skills with a stylus. Super simple, just stay in the white area while the screen moves downward. I have sped the video up here for times sake, but it is very child friendly. Highly recommend this one. Get OTL Now! 3) Letter School Price: $6.99 Free "lite" version also available Here Letter school is my first go to for a letter formation learning app. Students (and adults for that matter) really love the challenge of the "ghost letters" as I call the 3rd step in the letter writing process. Check out the video to see how the app progresses from teaching the starting points, to tracing, to independently writing each letter and number. Be sure to use a stylus! (Noticing a trend with a stylus) Get it here! Need a stylus? Click on the picture to the right to get a pack of 10 for about $5. That way you have extras when give them out to teachers =) 4) Writing Wizard Price: $4.99 To mix up the writing apps for my students, I also use Writing Wizard. What is great about this app is it's ability to customize settings and words. You can put the student's name in or even their entire spelling list. Like Letter School, Writing Wizard keeps the students very interested in writing. Stylus, you ask? Of course! Get Writing Wizard Here! 5) SnapType Pro Price: $4.99 Free Version Here Snap Type provides a great alternative to those students who are limited by their writing and can type more efficiently than they can write. Snap Type allows the user to take a picture of anything, click anywhere on the picture, and begin typing. Pair a Bluetooth keyboard for even more functionality. Forget SnapChat, Get SnapType Pro! 6) Little Finder ABC Price: Free Little Finder ABC provides a fun way to assess and practice letter recognition. I often get referrals for students who can copy but can't write letters without a model. I refer this game to teachers to help the student identify letters before we start working on writing without a model. Check out the video. Get Letter Finder! 7) Ready To Print Price: $9.99 At first I was turned off by this app, but as I learned how powerful it is, I fell in love with it. It is so adaptable and the settings can be changed to make it fit your needs. It also keeds data for you so you can see progress made by your student. Print Now! 8) Dexteria Jr. Price: $3.99 Dexteria Jr. is my favorite Pre-writing skills app. After the student completes tracing and erasing the lines, they get to take a SELFIE! And not just any selfie, a distorted selfie that is so much fun! Along with the pre-writing skills, there are also two fine motor games: Squish the Squash & Pinch the Pepper game. Check out the video! Get Dexteria Jr. Here 9) Dexteria Price: $4.99 On to Dexteria (senior). I'm not the biggest fan of their tracing game, but the Tap it finger separation and sequencing game is very cool. Keep your thumb on the blue circle and tap the triangles in the correct sequence with your other four fingers. Get Dexteria 10) Vision Tap Price: Free with in-app purchase available Another one that confused me at first with it's several games, Vision Tap has a lot of great things going for it. It may look a little dry, but it is powerful as a vision skills assessment and tracking tool. Good for those students who you think has some poor ocular-motor skills. Click Here for Vision Tap! 11) Spatial Line Puzzles Price: Free with in-app purchases available for more levels Possibly my favorite of the 12 games, Spatial Line Puzzles is simple to learn and fun to master. Start with connecting dots to match the sample and move on to memorizing a picture to copy when there are no dots. check out the video to get the best idea of why I like it. Complete The Puzzles! 12) Piko's Blocks Price: Free Piko's Blocks is another visual spatial game, but in 3D. Better for the older kids, they like it because it reminds them of Minecraft. Not only do you have to match in this game, but you also have to create a mirrored image, which can be a tricky, but necessary skill. Start building now! So that's it, my Twelve favorite apps for working on visual motor and spatials skills related to handwriting. Oh and don't forget the Stylus Let me know what you think of my list. I tried to make sure there were some free ones in there, but some of the 3, 5, even the $10 one pays off in my opinion. I wouldn't recommend them if I didn't think they would help your students. What Apps do you use? Did I miss any good ones? Do you know someone that could benefit from this list? please share us with them. We love to help as many people as we can! Thanks for visiting! -Jayson
What is the Sensory Integration and Praxis Tests (SIPT)
The use of Ayres' Sensory Integration and the Sensory Integration & Praxis Tests (SIPT) is a hot topic in school districts across the nation. More and more parents are requesting it and thus more school districts are looking for occupational therapists that can administer the SIPT and provide a sensory integration model of therapy. In fact, searching for School-based OT jobs on Edjoin.org you will often find a description that looks a little like this: So what are your options when it comes to gaining knowledge about sensory integration? If you have worked in a pediatric setting of any kind, you have no doubt picked up at least some sensory-based strategies as well as some theory on SI. The University of Southern California Sensory Integration courses cost thousands of dollars and at conferences such as AOTA, you can attend seminars to get small snippets of sensory integration techniques from various OTs. And a google search of "what is sensory integration" yields an endless amount of professional organizations that attempt to provide the definition in a way that parents will want to seek it out for their child. Not to say that parents shouldn't seek SI out, but it is not exactly the information an OT might be looking for. As far as the Sensory Integration and Praxis tests goes, in this post I wanted to give you a brief overview of the 17 (yep, 17) individual tests that make up the SIPT While long and exhaustive, I must say I appreciate how the SIPT is composed of individual tests that are each norm-referenced. Unlike the BOT-2 where you get a standard score for a group of tests related to visual-motor integration, the SIPT provides you with a score for each separate test. The 17 tests that make up the SIPT 1.Space Visualization This first test reminds me of a toy you might find on Amazon. It consists of 2 plastic form boards with a peg that can be moved so that only a certain form can fit correctly into the form. for each form board, there are 2 corresponding forms (an egg shape and diamond shape) with a hole in each shape for the peg to fit into when correctly placed into the board. On this test, you record the accuracy of choosing the correct form, the hand used by the child to pick up the form, and the time taken for the student to pick which form they think will fit. As you can likely imagine, this test looks at a child's ability to visualize in their head which form will correctly fit. It is also measuring, however, the ability to cross the midline and unofficially the handedness of the student. 2. Figure-Ground Perception Similar to other visual perception tests commonly used, the figure-ground test looks at a child's ability to find the pictures/shapes hidden within a larger picture. The student is instructed to identify the 3 out of 6 options that are hidden in the larger picture. Along with accuracy, the time to process each answer is also recorded for this test. 3. Standing and Walking Balance Just as the name indicates, this test looks at a child's ability to balance in various static and dynamic positions with their eyes open and then closed on most items. A wooden dowel (shaped like a tine speed bump) is used as a way to measure balance on a stationary raised object. Much of sensory integration is based upon the proprioception and vestibular senses, both of which assist us every day to stay on our feet or seated upright in our chair. 4. Design Copy This is the SIPTs version of a visual motor integration test such as the Berry VMI. What I really like about the Design Copy test is how it's scaffolded. The child starts by connecting dots in a horizontal and vertical line on a dot plane, then the dots from the stimulus image disappear. Finally, all of the dots disappear and the drawing becomes even more intricate. This test is graded on several "should have (SH)" and "should not have (SNF)" factors including line deviation, mirror or flipped drawings, and where the child starts the drawing. Think of it as objectively measuring all the nuances that you take notes on while watching your student try to draw the overlapping pencils on the BOT-2 5. Postural Praxis One of the more fun test, but also more difficult to grade, is the postural praxis test. During this test, the assessor assumes a not so normal position, and the child aims to mimic the body position they see in front of them. A child is given full credit if the correct position is assumed in 3 seconds or less, partial credit if within 7 seconds, and no credit beyond that. This test can reveal much more than you would think. 6. Bilateral Motor Coordination You likely do this one with your kids already, but here it is standardized. In this test, the student mimics your 4-8 steps bilateral drumming patterns. After your done with the hands, move on to the feet. This assessment is based upon a 3-point scale; incorrect, approximately correct, or correct. 7. Praxis on Verbal Command As the name suggests, this test is looking at how the child responds to you giving them a 1-2 step verbal direction. An example is "Put the back part of your feet together and your toes apart." For this test, you simply grade whether it was correct or not, and how long it took to get there (up to 15 seconds). 8. Constructional Praxis This test and the Postrotary Nystagmus test are the two tests I think people most associate with the SIPT. The constructional praxis test includes a prebuilt "fort," for lack of a better word, and the blocks needed to recreate that fort. The assessor then helps the child to get started with the building and then allows the child up to 15 minutes to complete the structure. This is probably the most difficult test to score as you have to measure each of the 15 blocks against 8 different criteria. Grading this block fort is an assessment in itself for an assessor. 9. Postrotary Nystagmus A classic part of the SIPT, the Postrotary Nystagmus test involves spinning the child on a spin board 10 times over a period of 20 seconds with their eyes open. after ten turns, you look at and time how long the nystagmus reaction occurs. For the SIPT, the norm reference for how long this reaction should occur after being stopped is 10 second with a small room for error. Precaution: It a child has a history of seizures, you may not want to administer this test. be sure to complete a chart review and/or ask the child's doctor for any precautions. changes in light while spinning can cause the onset of a seizure. 10. Motor Accuracy For this test, the child traces over a black line that spans over a construction sheet sized paper (11"x17" I think). The line is wavy in nature and it does not cross at any time like a figure-8 does. The child attempts the task first with their dominant hand, and then again on the backside of the sheet with their non-dominant hand. This test is scored by the time it takes to complete the task, and by using a rolling measuring tool to see how frequently the child stayed on the black line or within a given area. It's always interesting to compare the dominant hand trial versus the second trial. If they look the same, it's probably not a good sign... 11. Sequencing Praxis Similar to the Bilateral Motor Coordination test, on this test the child mimics your hand "clapping" sequence. This time, however, each step builds upon the previous step. For example, I clap twice then the child claps twice. Next, I clap twice then knock the table, child mimics. Now I clap twice and knock the table twice... and so on. This continues on until it becomes a 6-step process. Along with full hand gestures/taps, this test goes on to include finger taps as though you were typing. Ex. index, middle, index. 12. Oral Praxis Another fun one, in this test the assessor does something with their tounge, lips, teeth or combination of those and the child mimics. Two examples include "put tongue in left cheek" (assessor does this then child mimics) and "smack lips" Score as an incorrect (o), poor quality (1), or well executed (2). If you have already, please give your eyes a break from reading this. If you have read this far, you may like to know that I produce a podcast with my partner in crime, Abby Parana, all about Pediatric OT. You can find it here or on iTunes. Be sure to subscribe so you get all future episodes Alright, back to the SIPT. 5 more to go 13. Manual Form Perception The Manual Form test is a clever one. With their eyes occluded, the child is first asked to find a shape described by yourself. After that, they are to feel a shape with one hand and find that same shape with their other hand. Some shapes are very different, while others are very similar. The hardest part for you on this test is holding the folder to block the child's vision while timing them. Good luck. 14. Kinesthesia Another clever one with the child's vision blocked. The child starts with their index finger on point "A". You then move their hand and finger to point "B" then back to point "A". It is then their job to try and move their finger back as close as they can to point "B" on their own volition without looking. You find out a lot about a child's body awareness through this test. This is something you could do in just a few seconds without the SIPT and I don't use it nearly as much as I should. 15. Finger Identification Again, with the child's vision occluded, the assessor taps on one or two fingers of the child's hand and then the child identifies which finger or fingers were touched. This is simply scored as a "0" or a "1" if correct. We are mostly checking to make sure the tactile system in all okay here. 16. Graphesthesia For this test, you draw a design on the back of the child's hand with your finger while the child cannot see. You then see if the child can recreate the design with their own finger. So you occlude the child's vision while you draw the design, then they are allowed to look while they draw the design. Designs vary from a straight line to a simple star. 17. Localization of Tactile Stimuli And the last one, LTS! For this test, we use a special pen to mark a spot on the child's arm or hand with their vision occluded and then they touch that spot with their vision still occluded. Again, this gives you a good insight to the child's body awareness. WOW, that was all 17! This is not a short set of tests by any means. On the few occasions that I have given the SIPT, it has taken two-to-three sittings of at least an hour each. That is the main reason I don't use it more frequently. The scoring is also time-consuming and requires a computer software and USB key to get the final results. The best administrators of the SIPT say they can get it done in a single 90 sitting. Of course, it really depends on the child as well. To wrap this up, I am SIPT certified and I completed the WPS/USC training about 4 years ago. It has since been discontinued. USC now offers a series of courses that can be taken in southern California, but they are costly. I recommend them if you are interested in getting a deep dive into sensory integration. I hope this intro to the Sensory Integration and Praxis Tests gets you interested in learning more at least. If you have any questions, feel free to email me! Until next time, Jayson
The Common Core and Kinder Fine Motor Development
Over the last several years, state after state has adopted what is called the Common Core State Standards (CCSS). These standards are research based and have been implemented in large part to develop critical thinking skills in students at an early age. Each grade has a set of Mathematics Standards and English Language Arts (ELA) Standards starting in Kindergarten. By the end of their kindergarten year, our first year students are expected to: There are a lot, so I am going to summarize and condense the best I can. For a full list, visit the CCSS Website Mathematics Count objects and compare different whole numbers up to 19. Understand simple addition and subtraction. Compare and sort objects by a measurable attribute. Identify shapes as well as compare and compose them. English Language Arts (ELA) Ask questions regarding a text as well as identify key concepts and details such as characters and setting. Derive the meaning of unknown words from a text. Compare illustrations and stories. Scan a page from left to right, top to bottom, and page to page. Understand that words represent text. Recognize that words are separated by a space on paper. Identify and print all upper and lowercase letters. Pronounce and count syllables in spoken words. Produce the primary sounds of each letters. Read similar, yet different, sight words. Use drawings, text, and dictation to compose stories, opinion, and explanatory pieces. Use commonly used nouns, verbs, prepositions, and question words to form complete sentences. Use capitalization for first word of sentences and use punctuation at the end of a sentence. Spell simple words phonetically As you can see, in kindergarten our students are learning the foundations of their educational careers. For this reason, it is important to ensure they are using the most efficient methods and mechanics so that they may continue to learn and achieve for the rest of their lives. Development: Students typically are enrolled into kindergarten at the age of five; thus, I will be focusing here on the development of fine motor development that occur as a student reaches his/her 5th birthday. These skills will be geared toward beginning to compose written work including shapes, letters, and numbers. Before a student reaches school, much of what they do is unstructured and “free play.” As they start school, they will learn strategies to further their scribbles into shapes and letters. One of the foundational developmental skills that I tend to look for first is whether or not a student has established a clear dominant hand. By age 5, hand dominance should be established. While some students may appear to be ambidextrous, at this age they should really be favoring one hand over the other. Developmentally, it is more functional to have one hand that works really well, rather than both hands working moderately. At this point, our students should also be able to use their non-dominant hand to stabilize the paper they are writing on, even if they requires a cue from the paper moving to do so. The second skill I look for is their grasp on a pencil and how well they are able to manipulate the pencil. Research has indicated that both a 3-finger grasp and a 4-finger grasp are considered functional (Schwellnus et al.). The key points to emphasize here are encouraging the student to hold the pencil with the tips or pads of their fingers and to keep an open web space between the thumb and index finger. Examples of functional grasps. Top Left: Dynamic Tripod grasp; Top Right: Quadrupod grasp; Bottom Left: Unconventional Tripod; Bottom Right: Tripod Grasp with Thumb Wrap (Mickey is clearly interested) Finally, once I see that they have an established dominant hand and appropriate grasp, I look to see what muscles they are using to manipulate the pencil while writing. They should be using their fingers and wrist to manipulate the pencil rather than their entire arm. If a student is holding the pencil with a fisted grip it would be unfair to expect this because they would not be able to use their fingers to manipulate the tool. Writing on a vertical surface (wall, chalk/white board, easel) can sometimes facilitate a more dynamic grasp which will then likely transfer over to other pencil and paper tasks. Quick pause: Here is one fun and easy DIY activity I use to promote a pencil grasp while working on some academics skills like colors, shapes, and sequencing. Okay, back to the article: By looking at these three prewriting skills in a student, a parent, teacher or guardian can help a student get a good start to kindergarten. If a student appears to have these skills down and is still struggling to trace simple shapes and letters as they progress through school, it may be an indicator that an Occupational Therapy evaluation is appropriate. Be sure to follow the RTI Process Bringing this back to the CC state standards, I want to let you all know of a trend I am beginning to see. More and more district are starting to add in on their goals pages what specific CCSS the goal is aimed toward. I feel like this used to only be for “educational” goals, but as the lines dissolve between traditional “educational” and “OT” goals, I am seeing more and more OTs include the CCSS their collaborative goal relates to. Are you all seeing this at your district? We would love to hear your thoughts (or perhaps your district’s lawyers thoughts) on this topic. Comment below if you have an opinion or any other info related to this. Well that wraps it up for this one. Thank you all for stopping by again. Until next time, Jayson