Submitted by Ilene Miller, Occupational Therapist
| Before | After |
|---|---|
| Poor fine motor skills | Now able to connect interlocking tools; able to easily pick up a small stick to use colored scratch art; using 3-fingered grasp; scissor cutting dramatically improved |
| Poor gross motor skills | Can now commando crawl consistently utilizing reciprocal movement of his left and right legs; able to hold his arm in space; able to crawl 10 feet while holding a stuffed animal under his chin |
| Would pick up items from floor -- such as hair and string -- and put them in his mouth; thumb sucker | Oral sensory seeking completely stopped! |
| Poor upper body strength | Increased upright posture when sitting |
My client, a 3 year, 10 month old boy named ¨Jacob¨ had difficulties with fine motor, visual motor, grasping a pencil, strength, endurance as per scores on a standardized assessment denoting his scores in grasping 1st percentile (poor), visual motor integration 9th percentile (below average), and fine motor 1st percentile (poor).
"Clinical observations indicated that he had additional difficulties with upper body strength, reciprocal coordination of both sides of the body, decreased muscle tone, and oral sensory seeking; putting items in his mouth off the floor such as hairs, strings, and was a thumb sucker. He could not use scissors, a marker, or crayon appropriately as his grasp and very light output and therefore, motivation was not present."
In treating this preschooler, I combined some functional activities, vestibular exercises (log rolling) with Rhythmic Movement with reflex integration [from the Brain and Sensory Foundations course]. I specifically utilized the rhythmic movement directly related to the reflexes I addressed. The reflexes I started with were the TLR [Tonic Labyrinthine Reflex] and the ATNR [Asymmetrical Tonic neck Reflex]. Due to Jacob´s decreased tone and upper body strength, I utilized activities that he would enjoy making them engaging. With commando crawling on belly I realized he only used 1 side of his body. When I shared observations with his mother, she told me that he was premature and did not crawl. This made sense based on my observations (spinal galant) as he did not shift through the birth canal or later on crawl.
Hence, the home program consisted of log rolling (eyes open and closed), mini trampoline jumps, walking on all 4ś with animal tucked under chin as well as on his back, and he did some hand strengthening activities play doh, placing coins in “just right” slots, etc.
After a month, I noticed that Jacob started to use his left leg once to twice during commando crawling but it was not consistent. I noticed after 6 weeks that he was definitely stronger as evidenced by pushing off the trampoline bar at higher altitudes.
"But, it was not until 2 months that everything came together, something neurologically had connected:
- Jacob was able to crawl without dropping his stuffed animal under his chin 10 feet.
- He was able to connect interlocking tools that he did not have the strength for in the beginning.
- His tone appeared to be impacted as indicated by increased upright posture when sitting and doing fine motor tasks.
- He commando crawled consistently utilizing reciprocal movement of his left and right legs.
- He picked up a small stick to use colored scratch art with ease, using a 3-fingered grasp.
- When he colored, he was able to make noticeable improvements in his contrast (much darker versus too light).
- He was able to use the easel and motivated to do it! Holding up his arm in space.
- The most stunning revelation was the oral sensory seeking completely came to a halt. He no longer put his thumb in his mouth nor searched for small hairlike structures to put in his mouth.
- His cutting improved dramatically too. I did use a smaller scissors for his little hands but, he went from cutting paper plates and thicker materials to cutting paper, which was very challenging at first. He can cut along the entire perimeter of the paper maintaining his arm and hand in space and he is learning to cut a circle (rotate with his non dominant hand)."
I attribute this to the nightly rhythmic movement his mother did for 3 to 5 minutes. We did up the time from 3 to 5 minutes at one months time when there was not much noticeable change going on.
I learned that each child progresses at their own speed, nightly assignments greatly assist with integration, and impacting other reflexes was a bonus and unexpected result (oral seeking ) from brain maturity of doing Rhythmic Movement nightly. Additionally, it was stunning to me that in such a short time frame these huge differences occurred. I have not witnessed such dramatic change in such a short time period in my number of years working with students.
[Edited for length and clarity; emphasis added]