Category: Uncategorized

Written By Occupational Therapist Sneha Parikh

With everyone being home at the same time, people are adjusting to what feels like are much smaller confines of their living space — whether it’s a four-bedroom home, a condo or an apartment. For parents with children with physical, sensory or cognitive issues, you may also be trying to continue therapy at home through telehealth.

Occupational therapy helps individuals improve physical or mental limitations by performing daily activities. Therapies that require movement, like occupational therapy are challenging in small living spaces. While at outpatient ICAN clinic, children may use slides or swings during occupational therapy.

But with telehealth, your family may have only a few extra feet to move around in for therapy. 

• Fill a pillowcase with stuffed animals, and pull it up an incline or stairs.
• Take the cushions off the sofa, put these on the floor and army crawl across the cushions.
• Pull other children or heavy items around on a sheet or blanket across the floor.
• Use shaving cream, which helps children who have a negative response to certain textures. You can have your child squish shaving cream between fingers and toes and rub across the body for a soothing, fun activity.
• Perform household chores like vacuuming, sweeping, mopping, dusting, wiping off a table, cleaning windows or changing sheets on the bed.
• Engage in baking activities where your child stirs the batter or kneads the dough.
• Perform yard work like raking leaves, planting flowers or pulling up weeds. Or in an apartment, have your child help you plant seeds inside in empty egg cartons or other found materials.
• Participate in activities like dancing or yoga.
• Push against a wall and try to make it “move.”
• While on hands and knees, color a rainbow with a piece of large paper on the floor or the sidewalk with chalk.
• Use simple puzzles or shape sorters to provide structure to obstacle courses. Put all of the pieces on one end of the room and the puzzle board on the other. Next, have your child engage in a movement they enjoy like doing an animal walk, walking across “a balance beam” or jumping on “lily pad” pillows to retrieve puzzle pieces one at a time.
• Create a sensory bin by filling a plastic tub with a carefully selected material to stimulate the senses. You could use a bucket with beans, colored rice, pom-poms or cotton balls, depending on your child’s preferences.

Your child’s occupational therapist can help personalize activities based on the materials you have on hand and on your space.

Don’t get frustrated if something doesn’t work for your child. Occupational therapy is all about learning what does and does not work for children, so we can help them learn and grow. #ICAN #occupationaltherpay

Written by: Sneha Parikh, OTR/L

Many parents are now working from home and trying to juggle distance learning for their children. Here are some easy resistance activities to help prevent meltdowns and calm and soothe children (and adults) of all abilities. Like a weighted blanket, the activities increase our sense of body awareness, attention span and overall feelings of calm. 

These twelve resistance activities help soothe children with both typical and special needs. And bonus, these can be performed with everyday household items!

1. Chew gum, eat chewy or crunchy foods or drink thick liquids, like a milkshake, smoothie or applesauce, through a thin straw.
2. Fill a pillowcase with stuffed animals, and pull it up an incline or stairs.
3. Take the cushions off the sofa, put these on the floor and army crawl across the cushions.
4. Pull other children or heavy items around on a sheet or blanket across the floor, in a wagon or a wheelbarrow.
5. Perform household chores such as vacuuming, sweeping, mopping, dusting, wiping off a dinner table, cleaning windows or changing sheets on the bed.
6. Engage in baking activities where your child stirs the batter or kneads the dough.
7. Perform yard work like raking leaves, pushing a wheelbarrow, planting flowers or pulling up weeds.
8. Participate in activities like playing on a jungle gym, dancing or yoga.
9. Push against a wall and try to make it “move.”
10. Participate in activities involving running and jumping, such as jumping rope, hopscotch or jumping on a trampoline.
11. While on hands and knees, color a rainbow with a piece of large paper on the floor or the sidewalk with chalk.
12. Do animal walks like the crab walk, bear walk or duck walks.Basically, any activity where your child can push or pull against resistance is helpful. These activities provide calming and soothing sensations for the body. It also increases their endorphin levels, aka happy hormones, and decreases heart rate and blood pressure.

These activities work for people of all ages and abilities, so pick a few you think may work for your situation. Just be sure to monitor your child’s response to any resistance activities in case some exercises have an alerting rather than a calming effect. If your child seems fatigued or overheated, stop the activity.

Written By: Karen Jacobsen, M.S., CCC-SLP

I tend to use what is in the child’s environment during treatment sessions.  Younger children, especially attend better during teletherapy sessions when favored objects and toys are part of the session.  I should also mention that if the resource is not free, I am less inclined to use it.  While I understand the importance of paid content, I do not want to have to pay numerous monthly subscriptions and am mindful of how many clients I can use any given resource with.  If the resource allows me a free trial I can try it out and if I find it useful I will consider purchasing it.  In general, I am willing to put up with a few ads to avoid paid content whenever possible. 

 As part of my crash course in teletherapy I took a couple of continuing education courses online.  Both emphasized gathering volumes of resources so you would never be at loss during a session.  Personally, I have found that a volume of resources makes it challenging to find anything in my bookmarks and I do not want to halt therapy while searching for the perfect resource.  In an effort to maintain fluidity in a session, appropriately engage the child, and target necessary goals I have adopted the following approach:

1.  I look at what the child is doing when they first come to the screen.  For example, last week one of my clients was finishing his snack.  The parent attempted to take the food away and I asked them to leave it.  This client and I had a mealtime conversation and I targeted a goal for expressive prepositions using food.  Silly, yes, but entirely engaging and following this teaching task the client demonstrated an increased use of prepositions throughout the session.
2. If they do not have something already, I ask the parents to grab some favorite toys.  I have one client who is always ready to go with his tub of dinosaurs.  Targeting his receptive and expressive language goals is something I do in the moment with these preferred items.  I usually choose one or two goals to target during dinosaur play which can sometimes last the entire session.
3. Online books are one of the best resources for adaptability across clients.  My workplace has a subscription to Epic books https://www.getepic.com/app/read/39982  and the wordless picture book, “ The Monkey Goes Bananas!”  has been a staple across my treatment sessions for the past two months.  I have adapted this wordless picture book to target language goals with clients from ages 3-11 years.  Of course, there are many book options on Epic, but the monkey book is one most of my teletherapy clients request almost every session. 
4. The online resource K-12 Reader https://www.k12reader.com/ has been an amazing resource for older clients and those with language learning and executive function difficulties.  K-12 resources provide guided instruction in language, reading, spelling and other school related areas all nicely organized by grade.  The reading comprehension units are helpful for targeting specific areas such as main idea and character analysis.  Vocabulary and grammar units target a number of expressive language functions using content that is appropriate for older learners. I have tried a number of resources for elementary school aged clients and K-12 Reader is now the only one I use online to address  reading comprehension, spelling, vocabulary, grammar, syntax, and written language with this age group. 
5. My teletherapy articulation clients are older and I have found Home-Speech-Home https://www.home-speech-home.com/ enormously helpful in finding target words for this age group.  This website has a large selection of vocalic R targets which I have often found difficult to find.  I have set a goal with one of my articulation clients for practicing 100 R’s per session.  His reward for accomplishing this is 5 minutes of control over my whiteboard at then end of the session. Home-Speech-Home has resources beyond articulation, including helpful ideas for games and activities to pass on to parents for home practice and to use when you are seeing clients in person.  

Additional resources I have used include:

YouTube videos with content specific to client interests

The internet is full of resources and this can feel overwhelming.  Many of us are also seeing clients who would not normally be considered appropriate for teletherapy.  It can be challenging to find the right balance and create a productive and desirable pacing and tone in any given session.  Teletherapy is a bit awkward and I think acknowledging that it is not the most natural way to communicate is important.  Ultimately some clients and families will do better with this approach then others.   I have suggested some resources that work well for me and the clients I am seeing via teletherapy.  The important thing is to have a few durable resources that will take you from client to client and that you can go to if your session gets stuck.  Keep things simple, use your best clinical judgement, and be present for your clients and families,  you will do just fine. 

It may seem challenging and unnatural to target social skills via teletherapy. What do you do when you can’t practice with same-aged peers? Don’t worry! I will discuss ways to incorporate social skills instruction into your teletherapy sessions that are fun, engaging, and effective. Below you will find some therapy ideas and resources for the areas of play, conversation, and direct pragmatics instruction.

1. Play Skills: 
   1. Model Toy Play
      1. Requires knowledge of the kind of toys the child has at home and preparation
      1. Examples: car/car ramp, Mr. Potato Head, Playdoh, blocks
      1. Use video models
         1. Youtube has some great examples of children playing with toys that may be beneficial for your therapy session
         1. Share the video and encourage the child to give it a try
   1. Train Parents
      1. Support parents in playing with their child by being a “coach”
         1. Tell parents you will observe play for 5 minutes and then give feedback
         1. Praise parents for all the great things they are doing
         1. Teach one skill to practice during the session, ex. “Today we will talk about following your child’s lead.”
         1. Check in during the next session about how the week went
   1. Include Siblings
      1. Siblings can be a vital resource for functional play and play skill expansion
         1. They can offer a typical model for pretend play
         1. It can be more motivating to play with siblings than just playing with clinician or parents
         1. It is functional since a sibling may be the only peer a child is exposed to at this time.
      1. Provide training to the sibling
         1. “Try waiting for your sister to ask for the spinner, rather than just giving it to her.”
         1. “Let’s pretend the animals on the farm are eating. Can you give your brother a cow and show him how the cow eats.”

• Conversation
  • Model Conversation in a variety of ways
    • Use video models from Youtube
      • You can choose the child’s favorite characters or tv show
      • Analyze the conversation after watching
        • What worked?
        • What could have been better?
  • Practice with a parent or sibling
    • Use visuals to track conversation
      • Zoom’s whiteboard function can provide immediate visual feedback

• Pragmatics Instruction 
  • You can easily target non-verbal language, inferencing, predicting, problem solving, etc.
  • Use videos to make instruction fun and relevant
    • Examples:
      • Pixar Short videos
      • Ellen’s “Epic or Fail” videos
      • Simon’s Cat
      • Lucas the Spider
  • Use wordless books
    • Examples (from Epic):
      • Rosie’s Glasses
      • Captain Barbosa and the Pirate Hat Chase
      • Woodrow at Sea
      • Monkey Goes Bananas
      • Field Trip to the Moon

Targeting social skills may feel daunting in telehealth sessions, however, if you prepare online resources, access interactive tools, and utilize members of the patient’s household, your sessions will put the “fun” in functional!

Written By: Cameron Toughill, MA, CCC-SLP

Chances are, if you choose to work in a multidisciplinary setting, you value the opportunity to collaborate with other professionals. In today’s post, I am going to discuss why collaboration is so vital to our client’s progress and how best to communicate with a patient’s entire team to ensure continuity of care and progress.

As rehab providers (SLPs, OTs, PTs), we have limited access to our patients. We see them for one hour at a time, at best several days a week. How are we able to ensure that our patients are getting the communication opportunities they need throughout the day and that everyone the child interacts with has the same expectations for them? Collaboration! Imagine if a patient leaves your speech session, where he is expected to use 2 words to request, goes to OT, where the therapist also knows to expect that, and then the child has 3 hours of ABA with the same expectations. That’s 5 hours of speech therapy for the price of 1. Progress would sky-rocket! 

To be effective, speech therapy, occupational therapy, physical therapy, or ABA can’t be done in a vacuum. It is not only important to share our personal clinical knowledge, it is necessary to seek out others’ clinical knowledge to ensure you are treating the patient holistically. In order to be effective collaborators, we must first know who is on a patient’s team. The team includes all the clinical professionals involved in the patient’s care (PT, OT, SLP, BCBA, Psychologist), the patient’s educational team if applicable (teacher, related service team), and of course, the parents.  It is more challenging to communicate with outside providers, but initiating those conversations is so impactful for your patient’s care. Here are some steps to initiating and maintaining communication with the entire team:

• Ask parents to complete Release of Information (ROI) Forms for all professionals the child works with. This can be done at the initial evaluation or first session.
• Once those releases are on file, send an introductory email to all parties, including the parents. I like to include the ROIs that were signed as attachments so that everyone is aware that you have permission to speak with them. Other clinics and schools may have policies that require their own release, so be mindful that it may take some time for the team to respond.
• Once everyone is able to communicate, share your goals and ask for what others have been working on. 
• These don’t need to be ongoing conversations that are time-consuming. I recommend checking in at progress note and re-evaluation time. Ask for their input with checklists and standardized assessments when applicable. 
• If an outside professional initiates a conversation with you, include the entire clinical team in your response.

If the child’s team is all on-site, utilize multidisciplinary team meetings. Any major changes to a patient’s treatment plan should be communicated to the entire team, for example: potty training, a new behavior plan, starting to use AAC, starting to use a chewy for mouthing, etc. If you have an impromptu discussion in the hallways with one member of a patient’s team, a follow-up email to the entire team is very helpful to share the information. Because ABA is structured differently than rehab services, make sure that you are only discussing treatment planning with the BCBA and that you do not instruct an RBT to change what they are doing, as they must follow the BCBA’s treatment plan.

Whether you are new to a multi-disciplinary setting or have years of experience, collaborating in a mutually respectful and inclusive way takes practice. As long as you seek out other professional’s perspectives and are open to implementing their strategies, your patients will drastically benefit from the effort. Collaboration isn’t always easy or convenient, but it is always worth it!

Written By Megan Young, M.S., CCC-SLP

Hey everyone! Today I wanted to tell you a little bit about the stages of play. Play development is super important as it is a foundation for later social skills. Below are the stages that play develops from with its typical age ranges. However, it is really important to think about where your client’s skills are at and model and create goals on play accordingly. 

When baby’s are born, they often begin play by exploring how their bodies move which is called unoccupied play (0-3) months.

The next stage of play is solitary play or independent play (6 months-2 years). This is the stage where children begin to play alone with toys for extended periods of times. It is important to think about the variety of toys a child plays with. Some kids will play functionally with one toy, but they are limited in the variety of toys they play with. For children who have limited attention to toys, it is important to slowly increase the demand and time expected for them to play with the toy. For example, a child who is learning to engage and play with cars on a car ramp should not be expected to sit and play for 5 minutes, as that makes the task not rewarding. It is okay to make a goal for 30 seconds of functional play (given a model or independent) and work your way up in the length of time you want them to play. Examples of toys for kids to play with independently include:

• Mr. Potato Head
• Cars
• Trains 
• Puzzles
• Coloring/Painting
• Shape Sorters
• Blocks
• Legos
• Lincoln Logs 
• Music Toys 
• Bubbles 

Considerations for these toys include fine motor movement, attention, motivation, and trunk support. For kids that have a hard time with a grasp, may have a harder time coloring due to the fine motor control that play skill takes. If your child has difficulty grasping items, reach out to an occupational therapist. For kids that have limited trunk support, think about placing them in a chair or position where that will support their body. If their body is not supported, playing with toys becomes even harder. 

Signs your child is moving into the next stage of play include functionally playing with a variety of toys for 5+minutes at a time and beginning to observe other kids playing around them. 

The next stage of play is parallel play (2+ years). Parallel play is when a kid is playing directly next to a kid, but they may be playing different toys. An example of this would be a kid playing cars and a kid playing blocks right next to each other.  Signs your client is moving into the next stage of play is when they begin to show interest in items other kids are playing with. 

Associative Play (2-4 years) is when children begin to interact with other children they are playing with and sharing the same toy. This may look like two children playing blocks together, but they are building their own towers. Associative play can happen with more than 1 other child. They may need to share pieces, but they are mostly doing their own play scheme. This may look like:

• Kids playing on a playground doing different activities (sliding, swinging, running)
• Kids playing blocks together and making different towers
• Two kids sharing markers but drawing their own pictures

Cooperative Play (ages 4+ years) is when children begin to play together and engage in the same play scheme. This may look like two kid building a tower together. Considerations with cooperative play to think about include: 

• Can your child share toys? Sharing pieces and materials is important with cooperative play
• Does your child respond to other kids during play. In order for play to be cooperative, children need to be able to respond to each other and share materials. 
• Language is important to think about with cooperative play. Does your child initiate play with other peers and respond to them? Are they able to engage with other kids and tolerate their presence? 

Symbolic play is when children use objects to pretend they are something else. This develops around 8 months-18 months of age. Symbolic play leads into pretend play. Examples of symbolic play include:

• Pretending a banana is a phone
• Pushing a box on a floor like a car

It is important to model these with your children if they are not engaging in symbolic play, even if your child can or cannot imitate. 

Written By Freda Chamberlain, M.S., OTR/L

All children learn in different ways! Children use all their senses to interpret and learn about the world but they each do so in their own unique way. By determining how your child learns, you can incorporate tips and tricks to best support learning in daily life and academics. The three types of learning styles we will touch on today are visual learning, auditory learning, and tactile/kinesthetic learning. 

Visual learners benefit from engaging their visual system and seeing what they are learning. Visual learners will remember information best when presented in written or picture format. They may have a difficult time remembering spoken directions or seem distracted while you are trying to talk to them. If your child is a visual learner, you can incorporate visual aids such as a written list of instructions or a sequence of pictures. They may also benefit from watching you model an activity before trying it on their own.  Here are some tips to try while teaching visual learners:

• Provide clear written instructions broken down into each step
• Highlight important information 
• Model an activity to visually show how to complete it
• Incorporate picture books into learning
• Show a video on the subject
• Have your child draw or write down the instructions
• Clear the area of visual distractions

Auditory learners benefit from engaging their sense of hearing. Auditory learners will remember information best through verbal instruction, songs, and spoken stories. These children may have a difficult time recalling information they saw written on paper or in picture format. You can help your child make up songs to remember information they are learning or studying. They may benefit from singing the song while or repeating directions out loud while they perform a task such as saying each step out loud as they tie their shoelaces. Here are some tips to try while teaching auditory learners:

• Make up a song or mnemonic to teach instructions
• Have your child verbally repeat directions in their own words
• Allow your child to sing or talk out loud while completing their work
• Use a quiet room without auditory distractions

Kinesthetic/tactile learners benefit by engaging in movement and touch. These children learn best by “doing.” Kinesthetic/tactile learners will remember information when they are able to move their body and interact physically with materials. These learners may have a difficult time sitting still and remembering information they hear or see. Engage your kinesthetic/tactile learner by using their sense of touch, for example tracing letters in sand or making letters out of play dough before writing them on paper. These learners also benefit from whole body movements. Have your child hold a different yoga pose while you explain each step of an activity or do a jumping jack after you read each page of a book. Kinesthetic/tactile learners may need to move their body or use a fidget to help engage their mind. Here are some tips to try while teaching kinesthetic/tactile learners:

• Provide hands-on experiences
• Use sensory trays to practice forming shapes and letters
• Provide instructions while your child is up and moving
• Allow your child to use a fidget while learning
• Provide immediate feedback while your child is “doing”
• Provide various seating options such as sitting on a yoga ball or lying down on the floor while learning

To determine your child’s learning style provide ample opportunities to engage in visual, auditory, and movement activities such as music, art, story time, and obstacle courses. Observe as they engage with different inputs and how they respond. Determine the types of activities they are drawn to and enjoy the most. 

Written By Cameron Toughill, M.A., CCC-SLP

It may seem challenging and unnatural to target social skills via teletherapy. What do you do when you can’t practice with same-aged peers? Don’t worry! I will discuss ways to incorporate social skills instruction into your teletherapy sessions that are fun, engaging, and effective. Below you will find some therapy ideas and resources for the areas of play, conversation, and direct pragmatics instruction.

1. Play Skills: 
   1. Model Toy Play
      1. Requires knowledge of the kind of toys the child has at home and preparation
      1. Examples: car/car ramp, Mr. Potato Head, Playdoh, blocks
      1. Use video models
         1. Youtube has some great examples of children playing with toys that may be beneficial for your therapy session
         1. Share the video and encourage the child to give it a try
   1. Train Parents
      1. Support parents in playing with their child by being a “coach”
         1. Tell parents you will observe play for 5 minutes and then give feedback
         1. Praise parents for all the great things they are doing
         1. Teach one skill to practice during the session, ex. “Today we will talk about following your child’s lead.”
         1. Check in during the next session about how the week went
   1. Include Siblings
      1. Siblings can be a vital resource for functional play and play skill expansion
         1. They can offer a typical model for pretend play
         1. It can be more motivating to play with siblings than just playing with clinician or parents
         1. It is functional since a sibling may be the only peer a child is exposed to at this time.
      1. Provide training to the sibling
         1. “Try waiting for your sister to ask for the spinner, rather than just giving it to her.”
         1. “Let’s pretend the animals on the farm are eating. Can you give your brother a cow and show him how the cow eats.”

• Conversation
  • Model Conversation in a variety of ways
    • Use video models from Youtube
      • You can choose the child’s favorite characters or tv show
      • Analyze the conversation after watching
        • What worked?
        • What could have been better?
  • Practice with a parent or sibling
    • Use visuals to track conversation
      • Zoom’s whiteboard function can provide immediate visual feedback

• Pragmatics Instruction 
  • You can easily target non-verbal language, inferencing, predicting, problem solving, etc.
  • Use videos to make instruction fun and relevant
    • Examples:
      • Pixar Short videos
      • Ellen’s “Epic or Fail” videos
      • Simon’s Cat
      • Lucas the Spider
  • Use wordless books
    • Examples (from Epic):
      • Rosie’s Glasses
      • Captain Barbosa and the Pirate Hat Chase
      • Woodrow at Sea
      • Monkey Goes Bananas
      • Field Trip to the Moon

Targeting social skills may feel daunting in telehealth sessions, however, if you prepare online resources, access interactive tools, and utilize members of the patient’s household, your sessions will put the “fun” in functional!