As parents, therapists, and teachers, we have specific goals we want our kids to be able to achieve, whether it’s something like brushing their teeth at home, drinking water from an open cup, or working on their handwriting.
What we don’t always think about are those underlying skills that we need them to establish before they can actually work on and achieve those specific goals.
Today, on All Things Sensory, we are going to talk about how to address those underlying skills for specific goals. Some of these underlying skills include bilateral integration, primal stability, coordination, strength, visual perception, and attention, and these are just a few!
So, stay tuned for today’s episode, where we go through some specific goals and all the underlying skills kids need to master in order to achieve their goals.
We don’t just stop there; we actually go into some specific activities that relate to these underlying skills, and explain how you can practically assist the child to better their skills.
“What’s important to remember [in these underlying skills] is “proximal stability before distal control.” — All Things Sensory[0:09:08]
“We want the child to feel confident in their ability to button across all environments which means school, home, OT, grandma’s house, everywhere.” — All Things Sensory[0:11:03]
“You know we have these specific goals – parents, therapists, we all do — so let’s focus on those underlying skills. Break the task down, see what needs to be worked on, and focus on that.” — All Things Sensory[0:21:13]
[0:00:00.9] RH: Hey guys, I’m Rachel.
[0:00:02.0] JH: I’m Jessica and this is All Things Sensory by Harkla. Together, we’re on a mission to help children, families, therapist and educators live happy and healthy lives.
[0:00:10.9] RH: We dive into all things sensory, special needs, occupational therapy, parenting, self-care and so much more. In each episode, we share raw, honest, fun ideas and strategies for everyone to implement into daily life. Thank you so much for joining us.
[0:00:28.5] JH: We just want to take a minute and talk to you about our company Harkla, our mission at Harkla is to help those with special needs live happy, healthy lives. Not only do we accomplish this through the podcast but we also have therapy products, easy to follow digital courses and the Harkla Sensory Club to try to bring wholistic care to you and your family.
[0:00:46.2] RH: Listeners of the All Things Sensory Podcast get 10% off their first purchase at Harkla with the discount code, SENSORY. We’d recommend checking out some of our bestsellers like the compression sensory swing, weighted blankets, or our course on sensory diets.
[0:01:02.2] JH: Here’s the best part. 1% of each sale gets donated to the University of Washington Autism Center to support autism research and fund scholarships to families in need to receive in clinic therapy for their child.
[0:01:15.3] RH: Learn more about Harkla and all we have to offer at Harkla.co and don’t forget to use the discount code “sensory” to get 10% off your first purchase. That’s “sensory” for 10% off.
[0:01:37.3] JH: The best part is, all Harkla orders come with a lifetime guarantee and free shipping.
[0:01:43.7] RH: You really can’t beat that.
[0:01:44.7] JH: No.
[0:01:45.6] RH: No, you can’t. Okay, let’s go back to the show.
[0:01:49.1] RH: Hey, friends. Welcome to All Things Sensory by Harkla. You are listening to Rachel and Jessica and this is episode 143.
[0:01:59.3] JH: I can’t quite match her energy, I’m so sorry. Okay, today, we are going to talk about how to address underlying skills for specific goals. This is a great episode if you're a therapist. However, this is also really great for parents, educators and whoever else is listening so that you can kind of get an idea of how to just, you know, teach your kid how to do everything.
[0:02:27.0] RH: Going along with that, you know, as parents, we have goals for our children so we’re going to stick with the goal of doing buttons throughout this podcast. You have these goals for your kiddo to learn to do buttons. Instead of just teaching them how to do buttons, we’re going to teach you how to work on all of the underlying skills that go into buttoning in order to improve buttoning but without actually working on buttoning if that makes sense.
[0:02:53.2] JH: That’s a lot of words but yeah, this podcast is for everyone, not just for therapists.
[0:02:58.4] RH: That’s what we are trying to get out there.
[0:02:59.5] JH: There you go. We made it. Okay, specifically for us as occupational therapy assistants, we have specific goals for our clients and these goals are based on age level deficits, identified using standardized testing as well as these goals are based on family goals.
These goals that we have drive our treatments and what we do in our sessions.
[0:03:25.7] RH: Yeah, they basically create a treatment plan for us. These are the activities that we’re setting up with a focus on meeting those goals or helping the child meet those goals.
[0:03:35.4] JH: Oftentimes, we have very specific goals related to daily activities like dressing, self-feeding, handwriting, those types of things. It can be really easy to do just one specific goal during your sessions. For example, you know, we’re using the buttoning and if the goal is, the child will button and unbutton three buttons within one minute.
It’s really easy to just sit there and put your timer on and see how fast your child can button or unbutton, right?
[0:04:13.0] RH: It’s easy for therapist to do this but raise your hand how often you do this? Hopefully none of you raised your hand.
[0:04:18.7] JH: If you are raising your hand, that’s fine, just stop.
[0:04:21.8] RH: But we’re glad that you're listening to this episode.
[0:04:24.2] JH: Stop. Just stop.
[0:04:29.2] RH: Yeah, like Jessica was saying, instead of just turning your phone on and starting your timer and seeing how fast they can button the buttons, turn it into an entire treatment session working on an obstacle course with incorporating buttons as one of those steps.
That way you’re working on the gross motor skills, the proximal stability, the strength, fine motor skills, dexterity, all the things and we’re going to talk about that later.
[0:04:49.9] JH: Exactly. If you have a buttoning goal, it’s probably because your child wasn’t able to do a buttoning task on the standardized test as well as the family probably wants the child to be able to dress themselves. It makes sense, right?
In order for your child or your client to actually be successful in this area, they have to be able to do buttoning in a variety of settings not just one, with different types of buttons, not just on a button board and they need to master those underlying skills as well.
[0:05:25.5] RH: Absolutely. When we talk about the underlying skills required for buttoning, there is a lot that goes into it. Things like bilateral coordination using both hands.
[0:05:36.0] JH: You’ve got a lot of finger dexterity going on so we’ve got that fine motor piece but also strength and the ability to move your fingers in a coordinated way.
[0:05:46.0] RH: Yeah, it does take a lot more strength than you initially think about. Think about buttoning your pants and actually stop and while you're buttoning your pants, think about how much strength is required to actually hold the button through and stabilize the material. There’s a lot for sure.
[0:06:03.2] JH: Then we’re also looking at some somatosensory processing and stereognosis and that’s being able to do something by the feel of it, you know? You're not always going to be able to see the buttons that you're doing, depending on what you’re buttoning.
[0:06:19.7] RH: Yeah, exactly. Think about – do you have to look at your pants to button them or –
[0:06:24.5] JH: No.
[0:06:25.1] RH: Can you just button without looking? That should be the goal. I’m glad that you were going to do that in your head there.
[0:06:29.6] JH: I had to think about it and should I do my button really quick?
[0:06:34.8] RH: Or if you're like you know, most of us nowadays, you just wear yoga pants all day.
[0:06:38.4] JH: That’s fair.
[0:06:39.2] RH: You don’t even have to worry about it.
[0:06:40.8] JH: That’s so true. Okay. Instead of just teaching the goal of buttoning, let’s develop those underlying skills and let’s talk specifically about those underlying skills right now, right?
Bilateral integration, being able to use both hands, one hand to stabilize and one hand to do the fine motor work.
[0:07:00.4] RH: Yeah, just a quick note you guys, we talk about empathy so much. You should be practicing these skills with your kiddos or you know, making sure that you know exactly what is required, don’t just throw a button in front of them and say, “Here you go.” You should be going through the motions and feeling it so you know what they’re dealing with and you can identify what they’re struggling with after you complete it yourself and like, “Oh man, no wonder they can’t do it, they can’t hold both sides of the button together.”
[0:07:25.7] JH: Yeah, I think that’s such a good point because if you can watch your child and how they’re struggling with this task and you can identify specifically, yes, it’s a strength or yes, it’s the bilateral or it’s the attention or the visual perception then you're going to be able to develop that specific skill versus trying to do all of it.
[0:07:46.9] RH: Yes, okay. The next skill that we wanted to address was the visual perception side of it. This is specifically spatial relations to be able to understand how the button and whole relate to each other as well as how to hold each piece with the button and to figure out, which part of the button actually goes through the hole and which part you have to stabilize and pull back around the button.
[0:08:07.6] JH: Yeah, it’s a lot.
[0:08:08.5] RH: It sure is.
[0:08:10.9] JH: All right, we already talked a little bit about the fine motor strength and the dexterity, you have to be able to hold that material for a specific amount of time to be able to do the fine motor component and that’s going to require a lot of pinch strength.
[0:08:27.1] RH: This is one that we kind of forget about.
[0:08:29.3] JH: All the time, for sure.
[0:08:30.9] RH: I’m talking about the next one.
[0:08:31.7] JH: Yeah, I know.
[0:08:32.0] RH: Okay.
[0:08:33.1] JH: I think, I know exactly where we’re at and I know you always forget about this.
[0:08:37.0] RH: Do you guys know what it is, can you pick up on what we’re putting down here? It’s the postural control and proximal stability.
[0:08:44.6] JH: Did anybody get that?
[0:08:46.9] RH: What this means is can the child even sit up, they can have the adequate core strength, can they hold their bodies up against gravity, do they have the right amount of shoulder strength and stability to even complete this fine motor development and what’s important to remember is this quote that we learn in school that says, “proximal stability before distal control.”
What that means is you have to have strength and stability in those muscles closer to the body like your shoulders before you’ll have control of those distal muscles, which is like your fingers. You have to be able to have those strong shoulders in order to be able to work your fingers efficiently.
[0:09:23.2] JH: For sure. Then you’ve also got a lot of visual motor going on here and that’s basically your hand-eye coordination so that goes right in to the visual perception, the fine motor as well. Then I think I mentioned this earlier but attention, right? Does the child have enough sustained attention to not get distracted by other things in their environment?
[0:09:46.2] RH: Yeah, that’s a big one. I struggle with it sometimes.
[0:09:48.7] JH: All the time.
[0:09:50.0] RH: The last thing that we want to touch on is primitive reflex integration. If you listen to our podcast, you know that the last one here is primitive reflex integration because holy cow, if you have reflexes that you are holding on to, specifically that palmer reflex, then you're not going to be able to do anything that you want to with your hands.
[0:10:10.0] JH: I was even just thinking when I’m buttoning my pants, since you gave me that example already, if I’m looking down and I’m getting that neck flexion, what are my arms going to be doing if my primitive reflexes aren’t integrated?
[0:10:23.9] RH: True, yeah. All right, if your client has a buttoning goal, you're going to want to address all of these underlying skills and do your treatment session, as well as practicing buttons.
[0:10:35.5] JH: Right, I think maybe there is some confusion earlier in the session when we said don’t practice buttoning, I mean, you still got to practice buttoning, yes. You want to incorporate those skills into every treatment fashion.
[0:10:47.5] RH: Absolutely. We want the child to feel confident in their ability to button across all environments which means school, home, OT, grandma’s house, everywhere.
[0:10:59.6] JH: Yeah, friend’s houses, so they’re not embarrassed at their friend’s house when they’re trying to get dressed. It’s crazy. We wanted to give you guys a couple of other examples, I hope all of this is making sense.
[0:11:11.6] RH: It is.
[0:11:12.8] JH: Yeah, you think so?
[0:11:13.1] RH: I hope so. If not, just ask, you guys know.
[0:11:16.3] JH: That’s fair.
[0:11:16.9] RH: On Instagram.
[0:11:18.1] JH: That’s fair. We got a couple of other examples for you guys here and how you can address different skills that are required for different tasks.
[0:11:30.4] RH: This is why you’re all here.
[0:11:31.3] JH: You want the specific examples, we’ve got them for you. The first one would be cup drinking. We do get a lot of questions from people on how to help their child drink from an open cup and there’s a lot of skills that go into it.
[0:11:46.2] RH: We actually just put a handout in the club on this because we had someone ask about it. If you guys need more specific resources in what we’re going to be in here. Just join the club.
[0:11:56.6] JH: Yup, there’s links in the show notes that you can find that super easy. One of the first skills that we need to have for cup drinking is going to be bilateral integration. Now, I think most of us probably use one hand to drink from a cup but when a child is learning how to drink from an open cup, they are going to use both hands to bring it up. They need to be able to coordinate both hands, both arms in order to do this. One of our favorite activities to work on bilateral integration is Zoom Ball.
[0:12:29.2] RH: If you don’t know what a Zoom Ball is, Google it.
[0:12:31.9] JH: You’re missing it out.
[0:12:32.7] RH: Yeah, it’s super fun and we can use it for a ton of different skills, which you’ll learn soon. Another way that you can work on cup drinking and specifically the bilateral integration is catching and throwing. Catching a bean bag, a ball, a rock, a pompom, whatever –
[0:12:49.1] JH: A rock?
[0:12:49.6] RH: I was thinking, you know, whatever you have in your environment, work on catching and throwing.
[0:12:54.6] JH: Yep, totally. Another skill that you’re going to need for cup drinking is mid-range control and this is basically the ability to have good control of your arms and your hands to do a task smoothly and fluidly.
[0:13:08.8] RH: Yep, so one of our favorite activities for promoting mid-range control is Jenga or just stacking blocks because you have to lift those muscles up against gravity and gently place the block or pull the Jenga blocks, so it’s a good one. That’s fun.
[0:13:25.1] JH: Yeah, super fun and then the other one is Suspend and I forgot about this game but this game is so cool, oh my gosh.
[0:13:31.9] RH: It is an awesome game and we also like to attach like exercises or activities onto each piece. You can incorporate that into the activity as well. There you go, another treatment activity for you and one other skill that we want to work on for cup drinking is convergence. Being able to bring your eyes together almost like you’re going crossed-eyed and guess what the activity is to work on that?
[0:13:57.6] JH: Zoom Ball.
[0:13:59.4] RH: All right, so get Zoom Ball. It’s like $10 on Amazon. We’ll link it on the show notes.
[0:14:03.6] JH: You’re going to use it all the time.
[0:14:04.9] RH: Yes.
[0:14:06.6] JH: All right, let’s talk about another goal that many clients have and that is going to be handwriting, specifically sequencing the letters. The idea here is that we want our kiddos to have easy fluid handwriting skills. We don’t want it to be hard and so in order to do that, they need to be able to sequence their letters in a specific way and if you guys are familiar with handwriting without tears, they have some great activities to use to help sequence those letters.
A lot of those underlying skills are going to be visual. Specifically visual perception and spatial relations and I like spatial relations the most because it’s just so important. Understanding where the top is, where the middle is, where the bottom is, left versus right, so those are some really specific skills that you need for handwriting.
[0:15:03.1] RH: Yeah, I mean if you don’t know which way is up and which way is down, which way is left or right, how are you going to be able to write efficiently?
[0:15:08.3] JH: You’re not.
[0:15:08.8] RH: No, so think about that. I mean address these underlying skills before you even start working on handwriting or before you even put a pencil on your child’s hand.
[0:15:16.9] JH: Yeah, some ways that you can work on that would be to do a draw a person activity and identify where the head is, where the body is, where the legs are and then do it with yourself in the mirror so that the child is physically looking and touching and feeling their different body parts and where they are, top, middle, bottom, left versus right.
[0:15:36.4] RH: Yeah and another way that you can work on some of those visual perceptual skills are search and find games like Where’s Waldo.
[0:15:43.5] JH: Yes, that’s a fun one or like those “I spy” games. They have those board games and card games for I Spy.
[0:15:51.1] RH: I just gotten a book for a trip that’s like, “Where’s the dinosaur?” and it’s the same thing.
[0:15:54.8] JH: That’s perfect.
[0:15:55.5] RH: Yeah, you know so anyways, another aspect that you want to address with handwriting is sensory, duh?
[0:16:03.3] JH: Duh.
[0:16:06.6] RH: Just think about different ways to draw letters, different tactile mediums like sand or Jell-O or apple sauce or rocks.
[0:16:14.9] JH: Well, this is a big one. A lot of times we get questions on how to help kids with spelling and learning their spelling words and I always say use a different tactile medium to practice writing those letters.
[0:16:26.5] RH: Yes.
[0:16:27.2] JH: Because it’s really going to just reinforce that memory component.
[0:16:30.6] RH: Definitely.
[0:16:31.4] JH: One last skill that you need to focus on with handwriting is going to be memory. You need good visual memory. You need good working memory. You need good memory overall in order to remember how to sequence those letters. Anytime you can play like, what’s the one game where you put the cards faced down and you have to –
[0:16:49.9] RH: Memory.
[0:16:50.1] JH: The game Memory, oh my gosh, okay.
[0:16:52.3] RH: Well, there’s so many different versions now.
[0:16:53.8] JH: Yes.
[0:16:54.5] RH: With cards and there’s cars and dinosaurs and mermaids and stuff.
[0:16:59.0] JH: Yes, so that would be a great game to use.
[0:17:01.0] RH: Okay, so let’s move on to the last goal, which is brushing your teeth. Okay, the first underlying skill is proximal stability. Any type of weight-bearing activity would be fantastic, so things like bear crawls, push-ups, wall push-ups, wheelbarrow walks.
[0:17:19.0] JH: I was even thinking like some hanging activities like get out to the playground and get like just hang from a bar.
[0:17:26.0] RH: Grab on straight arm hang, yeah.
[0:17:27.1] JH: Straight arm hang and you know, challenge your kiddo to see how long they can do it and then do it every day and have them try to beat their time every day.
[0:17:34.8] RH: Love that, yeah.
[0:17:36.0] JH: It’s so easy.
[0:17:36.5] RH: Yeah.
[0:17:37.0] JH: Except when it’s cold because then those metal bars are cold. They are cold but you make it work.
[0:17:42.4] RH: So many people have home gyms now.
[0:17:44.6] JH: That’s true.
[0:17:45.3] RH: Just put a pull-up bar and put one of those ones that goes in the doorway.
[0:17:49.3] JH: Yes, a pull-up bar in the doorway that’s perfect.
[0:17:51.7] RH: Then make it into a family competition.
[0:17:54.0] JH: I need to do that.
[0:17:55.0] RH: Me too. The next underlying skill that we want to work on is your grasp. One thing that we can work on to address your grasp is pulling a rope while you’re on a scooter board. If you don’t have a scooter board, then you can pop your kid up at the top of the slide and attach something onto a rope onto the bottom of the slide and have them pull an item up the slide with the rope and work on like the reciprocal one hand in front of the other. It’s a challenging thing to coordinate.
[0:18:26.0] JH: You also want to make sure when they’re doing this that they’ve got like a full grasp with their thumb going across because often times kiddos with, you know, who struggle with grasp skills, they are compensated and have their thumb like up by their finger or up by their fingers and their hand versus like coming and wrapping all the way around. I hope you guys can see that as I am doing it.
[0:18:47.6] RH: It’s almost like the letter S with sign language instead of the letter A.
[0:18:53.2] JH: Oh yeah, there you go.
[0:18:55.2] RH: There’s your visual.
[0:18:55.9] JH: There it is, thank you.
[0:18:56.5] RH: Now, you know what to Google if you can’t picture it.
[0:19:00.2] JH: Another really great one to promote grasp strength and skills are monkey bars or like we were just saying like a straight arm hang and making sure that thumb is wrapped all the way around the bar.
[0:19:10.9] RH: Yep. Okay, the next underlying skill is sequencing.
[0:19:14.5] JH: Yes, this is really, really hard for a lot of kids and you know, going along with the sequencing, it’s just like organizing the materials and planning and that working memory piece to know what comes next.
[0:19:27.2] RH: Here’s what I want you all to do. Try to brush your teeth and put the toothpaste on your toothbrush with your opposite hand and that will put you in the shoes of either your kiddo or the kids that you work with and that’s empathy you guys. You’ll realize how awkward it is and you’ll take a step back and really work on these underlying skills once you know what that feels like.
[0:19:51.0] JH: I was just thinking, I don’t even want to try brushing my teeth with my left hand. That is just – I am not going be able to do it very well.
[0:19:58.1] RH: No, so there you go.
[0:20:00.2] JH: Okay, but also use a visual schedule. Visual schedule, super simple and easy, just have the pictures of each step including clean up and have that in the bathroom.
[0:20:14.0] RH: Yep. Okay, the last underlying skill like we are kind of saying is oral motor skills. Can your child spit the toothpaste out? Can they keep their mouth closed around the toothbrush? Can they move their tongue where it needs to be?
[0:20:28.1] JH: Can they tolerate that input whether it’s from the taste of the toothpaste or the feeling of the toothbrush, does it cause them to gag? Do they have an immature gag reflex?
[0:20:40.2] RH: They might, yeah.
[0:20:41.7] JH: Yeah, it happens a lot.
[0:20:42.7] RH: What we want to do is play games working on blowing and sucking to some desynthesization with vibration or just like a different tactile input inside their mouth. Practice gargling and spitting and it’s challenging to teach a kiddo to spit.
[0:21:00.7] JH: It really is.
[0:21:01.5] RH: Good luck with that. I don’t think we can verbally teach someone how, to teach another person to spit on a podcast.
[0:21:10.3] JH: No, just try it though.
[0:21:11.3] RH: Sorry guys for letting you down.
[0:21:13.7] JH: All right, so hopefully this gives you a good idea of kind of what we’re talking about. You know we have these specific goals, parents, therapists, we all do and let’s focus on those underlying skills. Break the task down and see what needs to be worked on and focus on that.
[0:21:29.4] RH: Yeah and if you tried any of these like empathy activities, let us know because we want to hear how you empathized with your kiddo. Put those sensory goggles on and you’re just ready to rock and roll.
[0:21:44.4] JH: There you go. If you have a minute, you could leave us a review on iTunes. It really helps us to get out there and reach more people. You could also screenshot this episode and share it on Instagram.
[0:21:56.7] RH: Yeah, tag us. We’d love to share that and let us know your thoughts.
[0:22:00.4] JH: Yep.
[0:22:01.0] RH: You all are great, we love that you spend time here with us whether you’re listening in your car or cleaning your house or whatever.
[0:22:10.1] JH: Driving, yeah, whatever.
[0:22:11.2] RH: Yeah, okay. We’ll see you next week.
[0:22:13.6] JH: Okay, bye.
[END OF DISCUSSION]
[0:22:14.3] RH: Thank you so much for listening to All Things Sensory by Harkla. If you want more information on anything we mentioned in the show, head over to harkla.co/podcast to get all of the show notes.
[0:22:26.9] JH: We always have the show notes and links plus full transcripts to make following along as easy as possible for everyone. If you have follow-up questions, the best place to ask those is in the comments on the show notes or message us on our Instagram account, which is @harkla_family. If you just search Harkla, you’ll find us.
[0:22:47.1] RH: Like we mentioned before, our podcast listeners get 10% off of their first order at Harkla, whether it is for one of our digital courses, one of our sensory swings, the discount code “sensory” will save you 10%. That code is “sensory.” Head over to harkla.co/sensory to use that code right now so you don’t forget.
[0:23:10.7] JH: We’re so excited to work together to help create confident kids all over the world and work towards a more happier healthier life.
[0:23:17.1] RH: All right, we’ll talk to you guys next week.
[0:23:24.7] JH: We are so excited to work together to help create confident kids all over the world and work towards a happier, healthier life.
Just a friendly reminder: This is general information related to occupational therapy, pediatrics and sensory integration. We do not know you or your child, therefore we do not know any specific needs. Therefore, you should always refer back to your pediatrician and occupational therapist for more information.
BORING, BUT NECESSARY LEGAL DISCLAIMERS
While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science and art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties and what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.
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