Submitted by Kara Walther, Occupational Therapist
| Before | After |
|---|---|
| Rushed written work; copied 23/26 uppercase letters from a model using large 2” size letters writing very quickly without paying attention to details | Can now copy 26/26 uppercase letters using smaller and more accurate letters (1” in size versus 2”) |
| Scribbled when coloring | Now coloring neatly |
| Poor grasp | Using correct grasp |
| Drew 10 parts from memory but scribbled the body parts on the person versus clearing drawing each body part | Drew a person with 13 body parts from memory, using neat, organized strokes with more details |
| Would sometimes switch hands when using scissors | Using dominant hand when using scissors |
| IEP | No longer requires OT services; transitioning to typical kindergarten! |
CB was 4yr 9mos when I started incorporating strategies from Brain and Sensory Foundations course (November 2017). She was an anxious little girl who would struggle to make a choice in her preschool classroom in what center to play in. She would stand and look from area to area, almost frozen, and require a teacher to help her decide where to play.
She had rushed speech and a nervous giggle. She tended to rush written work versus taking time to complete it accurately. She scribbled when coloring with crayons with ½” accuracy to the border and only used one color for the entire picture. When drawing a person, she drew 10 parts from memory but scribbled the body parts on the person versus clearing drawing each body part. She copied 23/26 uppercase letters from a model using large 2” size letters writing very quickly without paying attention to details. Her grasp on writing tools fluctuated between a mature dynamic tripod grasp to a static lateral grasp with closed web space, requiring help to reposition grasp in 25% of trials. She held scissors correctly to cup simple circle and square, but switched hands from right to left in 25% of trials.
Goals were to:
1. Hold writing tools independently in her dominant hand to copy letters legibly
2. Color with crayons using organized strokes with ¼” of border
3. Draw a person from memory with >10 body parts using organized strokes
4. Cut simple shapes using dominant hand with ¼” accuracy
I started using passive rhythmic movements [from the Brain and Sensory Foundations course] at the beginning of each OT session (1x per week) as a warm-up activity. She enjoyed all positions and even started singing with me. I met with her parents after 4 weeks and showed them the movements and briefly explained the theory. They began doing RM [Rhythmic Movement] at home for a couple minutes each day before bedtime. Simultaneously, I began testing her primitive reflexes. She had mild STNR [Symmetrical Tonic Neck Reflex]and ATNR [Asymmetrical Tonic Neck Reflex]and more significant grasp response (flexed fingers a little bit and said it tickled when palm stimulated). I added stimulating the STNR (looking up and down at a little stuffed animal) before riding the scooter board on her belly down the hall to the OT room. We continued with RM’s (usually 2 per session).
Before doing coloring activities, I stimulated grasp reflex and palmer reflex and did the isometrics 3x each hand, including the pencil sharpener exercise. I occasionally added the joint compression or rocking on hands and knees and donkey kicks. Eventually, she spent the first 10 minutes of session (25 min) on the floor doing scooter, RM, belly exercises (zoo animals), hand isometric exercises. The final 15 minutes were spent coloring, copying letters/shapes, cutting with scissors and a variety of fine motor manipulative activities (building with Kinnex, tiny pop beads, clothing fasteners etc.
Because of symptoms of anxiety and rushing work, I began doing FPR [Fear Paralysis Reflex] stimulation [from the Brain and Sensory Foundations course] in January 2018. She loved this activity and we frequently added it to the 10 minutes of warm up. We occasionally did fear release tapping and hookups in supine. We occasionally worked on the moro [reflex] with monkey hugs and throwing a koosh ball back and forth.
I felt it worked best to do passive RM and developmental movements on the floor before activities to prep their systems for desk top activities. We continued with weekly OT sessions of 25 minutes with the first 10 minutes devoted to Brain and Sensory [Foundations course] strategies. Each week she rode scooter board to OT, completed at minimal 2 RM’s and some other activity on the floor incorporating reflex integration and Developmental activities.
She made excellent progress and met all of her goals (May 2018):
1. She neatly copied 26/26 uppercase letters using smaller and more accurate letters (1” in size versus 2”). She used dominant hand consistently as well as using age appropriate grasp.
2. She colored very neatly, generally with ¼” accuracy or better and used many colors of crayons per picture. Some days she used every color of the rainbow!
3. She drew a person with 13 body parts from memory, using neat, organized strokes with more details. She even added a hat!
4. She used her dominant hand to cut with 1/8” accuracy.
"CB’s parents were very pleased with her progress and she no longer qualifies for OT services! She will transition to typical kindergarten without an IEP!"
[Edited for length and clarity; emphasis added]