OT X-Ray

Today was an awesome day for OT! Even though I went to bed and woke up with no desire to go to work today, I pushed through and ended up having a really good day. It was hard, because of the shadow of the terrible events in Boston hanging over me. I love that city and I know we will push back stronger than ever before. But these horrific events need to stop happening!

Back to my day. I started by cleaning up my room, and then changed things up a little by sitting on the other side of the shared therapy room. I think that changing my perspective on the room helped my brain start firing in a different way. I only brought a couple other items with me, and figured that maybe something would “come to me”!  The tools that I used today were:

A big bag of playdough – homemade with lemon jello (recipe from Modern Parents Messy Kids)

A couple of pairs of long tongs like these  from Therapy Shoppe – any sort of chopsticks or tongs would work.

A piece of paper – we used double-lined Handwriting Without Tears paper – you only need one sheet for the whole day!

A dry erase board or scrap paper (for students who need a near-point model)

And that’s pretty much it! Here’s what we did.

First, I talked to the students about how we make bread. It was really surprising that not one had ever made bread before! We talked about kneading, and I demonstrated how they were going to use the heal of their palm to push the dough, and then fold it, and repeat. Looking at it through an OT x-ray – this activity is a great warm up and provides proprioceptive and tactile input (heavy work!). (The scent from the playdough had faded already but would have been nice.) It is a strengthening activity, but also requires the student to follow a 2 step direction. I also had the students alternate hands when kneading.

Then, we rolled the dough out into a “snake” A few students got a little silly and started calling it “snake bread” – we went with it! Many had difficulty with this task. It requires that one push down on the dough, hard enough to lengthen it, but not so hard it gets squished – something called “grading” of movement. Not only that, you have to roll the dough back and forth at the same time! In this task, both hands were supposed to be doing the same work at the same time. A lot of coordination of movement is required, and it showed! I encouraged them to participate, and helped them by letting the students place their hands on top of mine, to feel the movement needed, as well as put my hands on top of theirs, so they could see how much pressure is needed. Another benefit of this task is the immediate visual feedback that you get when working with dough!

Once I coaxed, assisted, instructed, and managed to get each student with a decently long snake, we moved on to the next step. The students used the thumb and index finger of their dominant hand to squish the snake into a flat ribbon. In addition to working on strengthening grasp, the students need to reach and stay working across midline. I needed to remind them to squish the whole line, and not leave any spaces between. Now our “snake bread” started looking like snake skin!

The next step was using those same two fingers to roll up the ribbon, starting from one end until the other. It looked just like a cinnamon roll! One of the neatest parts of this activity was that the students needed to slow down, and reach from above. As the cinnamon roll grew, the number of fingers used to move the dough grew, and the web space (the space between your thumb and index finger) opens up!

After all this hard work, we squeezed the dough back into a ball – gotta get all the tension out! Then we used both hands together in coordination, but increased the challenge by requiring each hand to do something different. The student holds the ball of dough in the non-dominant hand, and pinches off a small chunk of dough (these became the donut holes!). Then each small chunk was rolled into a ball using the fingertips. Many students tried to “cheat” at this point, using the table, both hands, or even their stomachs to try to roll the ball! It was important that they not lean on the table and use those fingers, but nearly all the students needed reminders. This activity worked on coordination, dexterity and finger strength, tactile perception, grading of movement, crossing midline, postural control and motor planning. Whew!

We weren’t even done yet! Once the student had a number of donut holes, we got out tongs out, and picked up each, one at a time. The student held the plastic bag in their non-dominant hand (working on coordination again!), and then zipped the bag with a demonstration of a pincer grasp. Again, we worked on crossing midline,  strengthening (this time the tripod grasp), bilateral coordination, grading movement, motor planning, and independence in activities of daily living (opening/closing sandwich bags).

After all of this, we had a quick debriefing on the activities and goal of the session. Then I posed a question to the students: What can they do at home to strengthen the muscles of their hands and fingers? It was interesting to hear their responses. Some had no answers for me! We talked about it, and came up with an activity per student. Last, they wrote or copied the activity onto the sheet of paper, creating a list of activities. Some of the answers the students contributed independently were “pushing dad’s mower”, “volleyball”, and “playing catch”. No too many fine motor activities there! I helped others find activities, and we added “shred junk mail with my hands.”

Overall, it was a pretty successful day! All of my students were sufficiently challenged with the activities, and I was able to incorporate more postural challenges and sensory input for some of my students with the use of a large ball that served as a chair. If I could do it differently, I would maybe use a cinnamon scented dough, and maybe come up with a story for the task. It would be awesome to take pictures of the students, and combine it with the story to send home as a fine motor exercise program!

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