Most children we see at Therahappy present with a range of hemispatial neglect in upper limbs, lower limbs, and sometimes both. It is imperative to rule out the possibility of a visual disturbance such as cortical visual impairment. Problems with visual processing and/ or visual acuity can mimic the presentation of hemipatial neglect.

Another thing to consider is presentation of ATNR, or asymmetrical tonic neck reflex. This reflex moves the limbs and body in conjunction with the direction the head is turned. This looks like a “fencer” pose in babies and should integrate by six months of age. When it is retained one side is usually more affected than the other, and can also mimic the presentation of hemispatial neglect.

Lastly, if a child had torticollis as an infant, it is likely that the side that held the restriction in torticollis, will also be the weaker, and often neglected, side by nature. When it comes to torticollis, however, the paradox of which came first, the chicken or the egg – the torticollis or the neurological determinant of a preferred side can be difficult to weed out.

These are all things that should be considered when treating hemispatial neglect in children.

Treating Hemispatial Neglect in Children

There are many ways to bring awareness to the neglected side in children, but tailoring the treatment to the child’s specific needs and “just right” challenge is going to be the key to unlocking the child’s unmet potential.

Weightbearing

Weight bearing is fundamental to treating hemiplegia in stroke patients and it is no wonder this method is the gold standard for regaining, or often in a child’s case, developing function. With access to about 17,000 touch receptors, the palms possess unique and unparalleled access to the neural networks in the brain. The palm teaches the child that they can support themselves, pull themselves up, feel their own body’s force against an object. The palm also detects the many tactile stimuli in their environment. This is why I emphasize to my families that exposing a child with a neurological delay who struggles with unilateral neglect, and aversion to sensation in the hands in particular, that exposing the palms to a variety of natural things in their world will help development their sensory system, and eventually help them use their hands for function.

The Wilbarger Deep Pressure and Proprioceptive Technique

Mostly used by occupational therapists, The Wilbarger Method involves a combination of gentle deep pressure applied to the skin (especially the arms, legs, and back) followed by proprioceptive input through the use of specific techniques like joint compressions or tactile stimulation. This process aims to calm the nervous system, reduce sensory sensitivities, and help individuals organize sensory input more effectively.

Visual Cues

In neuroplasticity we know what fires together, wires together and adding a visual cue to the neglected side like some colorful stickers or therapy tape to the neglected limb(s), can piggyback off the neural pathway of the visual system to fire the motor control of the affected side. This may be more effective in the upper limbs, and of course if the child has functional vision.

Proprioceptive Cues

In children with neuromuscular conditions, it is imperative to consider that their proprioceptive threshold is a lot higher than most typically developing children. They often do not feel their bodies as adequately as others do, and have limited or broken neural pathways that give them information about where their body is in space, and just how much weight each limb is. We can almost be certain if a child is not using one side of their body, their hippocampus or brain map, is a poor presentation of their true body’s physicality. This disconnect between what they are feeling in and about their body, and what they actually are in real life heavily contributes to their motor control on a global scale.

Some tangible proprioceptive cues are adding half or one pound ankle weights to the affected limb(s). Use in small increments of time, and slowly build as the child tolerates more. Some children love this, and others do not as the weight makes movement against gravity more difficult.

Another way to increase proprioceptive input to the affected side is “fast” brushing the limb from shoulder to palm, or hip to foot. This is slightly more forceful than a gentle massage, but not harsh enough to mark the skin. Most of the kids I see, regardless of their muscle tone, LOVE this.

Arm or leg squeezes and joint compressions are another great way to add proprioception before engaging the child in a functional activity.

Constraint Induced Movement Therapy

This modality works by restraining the unaffected limb (e.g., using a sling or mitt) to force the patient to use the affected side of the body. Through repetitive practice and structured tasks, CIMT aims to improve motor function, enhance neuroplasticity, and increase the use of the affected limb in everyday activities. As one can probably imagine, this is an intense measure to take and requires dedication on all who care for the child in order to obtain the results that this modality can bring.

Electrical Stimulation

Often times the children who neglect one side, keep the neglected hand in a fisted position. This is an indication that there is weakness in that side and high sensitivity in the palm. Left in a fisted position for years, this could lead to an irreversible wrist contracture. Using neuromuscular stimulation on the arm and hand of the neglected side is a great way to help build the brain map of the affected side, bring awareness and involve both sides of the body in an engaging activity. Of course, NMES can also be used in lower limbs, too. Always consult with a trained professional on muscle choice for electrodes and parameters for the NMES unit.

Add to the conversation, what are some ways you have used for your child that has helped bring awareness to the affected side?

Disclosure: Any purchases made through the Amazon links will earn me a small commission fee, but no additional fee to you.

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The Moro reflex, also known as the startle reflex, is an involuntary response seen in newborns, where they extend their arms and legs suddenly in reaction to a loud sound or sudden movement. Typically, this reflex fades by around 4–6 months of age as the baby’s nervous system matures. However, in some children, the Moro reflex remains active beyond infancy, which can lead to challenges in development.

What Happens with a Retained Moro Reflex?

A retained Moro reflex means that the child’s body continues to react with a sudden, exaggerated startle response to stimuli such as loud noises, fast movements, or even slight changes in position. This reflex can cause children to feel anxious, irritable, or overwhelmed, and may also lead to difficulties with balance, coordination, and focus.

Children with a retained Moro reflex may:

• Be easily startled or upset by loud sounds, sudden movements, or changes in position.
• Have poor balance and difficulty with activities requiring coordination (e.g., running, jumping, or riding a bike).
• Struggle with emotional regulation, feeling anxious, fearful, or distressed more often than other children.
• Experience sensory sensitivities, such as becoming overwhelmed by textures, lights, or sounds.

How to Help a Child with a Retained Moro Reflex

There are several ways to support a child with a retained Moro reflex, including:

1. Gentle Swaddling or Weighted Blankets: For younger children, swaddling can provide a sense of security. For older children, weighted blankets can help calm the nervous system.
2. Body Awareness Activities: Engage in activities like tummy time, balance exercises, or gentle rocking to help the child develop control over their body and improve coordination.
3. Deep Pressure Stimulation: Activities like massage or brushing therapy can soothe the nervous system and promote relaxation.
4. Gradual Desensitization: Slowly expose the child to mild stimuli that trigger the reflex, helping them adjust without becoming overwhelmed.

Moro Reflex Integration

The videos below illustrate one of many ways to integrate the Moro reflex. The reality is that each child may require varying level of supports, or other motivating activities in order to participate, or be compliant. For a personalized approach for integrating reflexes, Therahappy offers this custom approach. Each family that comes to us for primitive reflex testing is taught how to engage their child in the exercises. No two children are alike, and no two home programs can be exactly the same for this reason.

What Happens When Moro Integrates?

When Moro integrates, there is often still neurological work to do.

Moro is a primitive response to the displacement of the child’s head below their heart, or response to sudden stimuli. This reflex is also one of the central nervous system’s predecessors to Tonic Labyrinthine Reflex, also known as Tonic Neck Reflex. The onset of TLR is a normal progression once Moro is integrated. TLR may also present with Asymmetrical Tonic Neck Reflex (ATNR) and Symmetrical Tonic Neck Reflex (STNR).

Once Moro is integrated, high arm guard and startle responses should diminish. It is typical for reflexes to resurface temporarily during illness, trauma, and growth spurts.

Each primitive reflex is unique and has specific triggers and integration patterns. Be sure the therapist you are working with is able to help guide you on this process.

Disclosure: Any purchases made through the Amazon links will earn me a small commission fee, but no additional fee to you.

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Semicircular Canal Functions

Each semicircular canal detects a specific movement of the head. The superior canal detects movement of the head up and down, like you are nodding “yes”. The posterior canal detects side to side movement of the head, like your ear is trying to touch each shoulder. The lateral canal detects a lateral movement like you are shaking your head “no”.

When your vestibular system is registering movement that your eyes are also perceiving in real time, everything works smoothly without adverse effects. This synchronicity between the vestibular system and the visual system allows us to move fluidly throughout our environment without feeling dizzy. This synchronicity is also referred to as the vestibulo-ocular reflex. This is one of many postural reflexes that should remain throughout a lifetime.

Treating Children with Vestibular Dysfunction

As an occupational therapist who specializes in gross motor development this is one of the primary reflexes I assess and treat, when appropriate. It is incredible how much these two sensory systems can impact a child’s progress in things like rolling, crawling, and walking.

Together the vestibular and visual sensory systems help a child perceive movement, explore their environment and move against gravity as they develop. If a child is not able to understand movement, movement becomes a scary concept which they will fight to avoid. A child may avoid sliding down a slide, or swinging on a swing. A child may hate to lie down on their back, or scream when you lift or move them too quickly. This may present in a variety of ways, but I have discovered that if the vestibular system is not functioning properly, primitive reflexes will often dominate a child’s movements against gravity.

When there is a disconnect between what the eye is perceiving and the body is feeling, it is likely you may see some of the following symptoms occurring in your child:

• car sickness
• motion sickness
• avoidance of swings and similar movements
• closing eyes or covering of the eyes when being moved too quickly
• clumsiness
• gross motor delays
• poor body awareness
• nystagmus
• poor tolerance for lying on the back
• anxiety and/ or fear with sudden movements
• poor visual tracking, especially below eye level
• turning of the head to visually focus rather than using central vision
• muscle tone issues

At Therahappy, we integrate occupational therapy a variety of tools to help children with vestibular rehabilitation. These include TheraSuit, spider cage, DMI therapy, primitive reflex integration, and more. To learn more about this service, please reach out or read more here.

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I like to preface any initial conversation with parents about intensive therapy, that it is hard work for everyone involved. It is hard work for your child, hard work as a parent to see your child doing an incredible amount of work, and lastly, hard work for the therapist working with the child.

That never seems to scare anyone away. However, it is worth noting since it is vastly different than the one or two hours of PT your child receives on a weekly basis.

Here are some things to expect in an intensive program for your child. Of course, the details may vary from clinic to clinic.

Time

The first thing to expect is the amount of time you and your little one will invest into an intensive program. Most intensive programs are anywhere from 45 minutes to 3 hours per day. Some intensives spread the intensive hours throughout the day, while some have sessions scheduled back to back. This will vary on the program, and also what type of sessions you are scheduling for your child.

Different Intensive Therapies

While some intensive programs offer all the things (PT, OT, speech, DMI, etc.), others may specialize in just one or two areas. The programs offered will vary depending on the clinic. Therahappy specializes in TheraSuit, DMI, whole body vibration, and spider cage. We partner with Unity Therapy Solutions for MNRI and feeding intensives.

Education

During an intensive program, you can usually expect to learn some of the techniques to follow through with after the intensive is over. This is to help your child continue to progress. Something magical happens when the child returns home and generalizes all the new skills in their natural settings. A home program should be strong, easy to understand and administer, but also concise and not overwhelming.

If you are in the middle of an intensive and have no idea what to do when you guys leave the clinic, don’t be afraid to ask for a home program!

Modalities Used in Intensive Therapy

With each intensive, you can expect a variety of modalities. Some different modalities include whole body vibration, electric stimulation, TheraSuit, Theratogs, and many more. Your therapist should be able to explain benefits of each modality and how each will be used to reach their goals.

Sleep & Eating

One of the most common things I hear from my families is that their child’s eating and sleeping patterns are changed during an intensive. Some report that their child is eating more, sleeping more, and some report their children sleep surprisingly less. Regardless, good nutrition, adequate sleep, and hydration are vital during an intensive for optimal outcomes.

Seizures

If your child is prone to seizures, it is important to monitor for an uptick in seizures during an intensive. An intensive can be too much for a child with severe seizures. Be sure to communicate with your therapists any known triggers to the seizures, explain how your child’s seizures present, as well as their common frequency. It is always recommended to continue seizure medication as prescribed.

Other Therapies

If you happen to book an intensive local to your home, it is usually recommended to put your child’s other therapies on hold. Your child will most likely be ready to rest after their intensive sessions. It is my hope that the more common intensives become, the less difficult it will be to put them on hold for such important opportunities.

Motility

You will most likely notice that your child has an increased number of bowel movements! The more they move, the easier it is going to be to help things move along. This is huge with so many of my intensive kids struggling with constipation.

Gains in Intensive Therapy

And last but certainly not least, you can absolutely expect to see gains. All kinds of gains. Gains you are not specifically trying to address, but you end up gaining them anyway. Gains you are hoping to achieve. Whether you are in a one week or five week intensive program, some kind of progress will be made. Neuroplasticity is a power to be reckoned with, and in a child the potential is unfathomable. One of the biggest takeaways is the confidence the child gains in themselves in independent movement. It is a beautiful thing to watch, as they learn to navigate their environment their way.

I hope this helps ease your mind a little about what to expect, and maybe even how to prepare for an upcoming intensive.

If you are in the Houston area, I would love to work with your little one. Be sure to join our free email list for upcoming intensive opportunities! Find our more about our programs here.

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The Design

TheraSuit comes in several sizes in order to accommodate ages 2 to adult. The TheraSuit contains a vest, cap, knee pads, shorts, and attachments for the arms and legs. Bungies are attached to all parts of the vest. The Universal Exercise Unit, otherwise known as the UEU, provides a robust therapeutic addition with weights, straps, pulleys, and bungee cords, and can be used with or without the TheraSuit.

Why TheraSuit Works

The TheraSuit allows for isolation of different muscles at any given time and applies resistance gradually as the individual moves through the program. Compression and weight is added to the body through the suit which helps increase muscle strength, improve posture, and re-train the body to mobilize effectively. Additionally, sensory signals are sent to the brain through the suit helping improve coordination, spatial awareness, and proprioception. The muscles, tendons, and joints which are controlled by the vestibular system are also impacted. Thus improving muscle tone, balance, and body awareness. It also reduces pathological reflexes, spasticity, and ataxia as well as other cerebral palsy related symptoms. TheraSuit is used through an intensive program aimed at increasing functional outcomes in a shorter period of time. The program calls for 3-4 hour treatments 5 days a week for up to six weeks.

Recommended for

• Cerebral Palsy

• Hypotonia

• Hypertonia

• Dystonia

• CVA

• Traumatic brain injury

• Developmental delays

• Ataxia

• Spina bifida

• Down syndrome

• Other neurological conditions

Want to know if TheraSuit is right for your child? Contact us for a free consult.

Written in cooperation with Helen Sarver

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Ninety percent of people are right ear dominant, which proves to be anatomically efficient. Problems arise when the left ear is dominant.

Tomatis, a French otolaryngologist and inventor known for the Tomatis Method, suggested that the right ear controls and analyzes sounds. The right ear directly relays sounds to the left hemisphere of the brain, where some of the biggest areas of the speech and language are located – Wernicke’s area and Broca’s area.

When someone has a left dominant listening ear, the message is sent to the right side of the brain where it must be transferred to the left side to process speech and language. This causes a processing delay of information where all or most of the information is misconstrued or missed completely.

This can cause confusion and present as dyslexia, a stutter, and a myriad of learning difficulties, according to Tomatis.

In order to be a good learner, one must listen well.

According to Tomatis, there is an obvious distinction between hearing and listening: hearing is passive, and the detection of sounds around us; listening is active and requires an effort to understand and comprehend a message.

Tomatis found that an individual can be trained to be right ear dominant by increasing input to this ear. In the 1950’s Tomatis developed a device called the electronic ear to correct these listening difficulties. The device lets off sound frequencies to train and stimulate the ear to listen more efficiently.

Since our vestibular apparatus is housed in the inner ear, the electronic ear also affects a person’s balance and movement. For this reason, the electronic ear has the capacity to improve coordination and posture, as well. The listening ear has continued to advance in technology over the years.

Norman Doidge in his recent book, The Brain’s Way of Healing, shared some interesting information on Tomatis’ discoveries and contributions to what we know today about auditory processing. His apprentice (and former patient) Paul Madaule now runs a center in Toronto, The Listening Centre, which follow the protocol of Alfred Tomatis very closely.

Some modern versions of listening programs include:

Integrated Learning System (iLS)

Advanced Brain Technologies

Little Bear Listening

Tomatis Method

Resources

Dichotic Listening Studies of Brain Asymmetry

When Listening Comes Alive

Psychophysical and behavioral peripheral and central auditory tests

Language and the Left Hemisphere

Co-contributor: Helen Sarver

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It is imperative to remember that behaviors are a form of communication, and giving these tools can give the child another piece to the puzzle when it comes to understanding their own needs and expressing those needs with the world.

7 strategies you can use

1. A calm down corner

A calm down corner can be used in a classroom or daycare as well as at home. In this corner you can include comfortable seating such as a bean bag chair or soft squishy stuffed toys and blankets. Noise canceling headphones are a great addition especially in a loud environment. You will also want to include preferred fidget and tactile toys. 

2. A weighted blanket or vest

Using a weighted blanket or vest has been known to have a relaxing effect calming anxiety or stress by providing deep touch pressure to the body. You can also make your own weighted toy by filling a sock with rice or beans and adding some essential oils into the mix for added bonus!

We also love this weighted teddy bear from Amazon! Easy to take with you on the go.

3. Oral sensory input

For some children, chewing can be calming and aid in self-regulation. Crunchy foods such as apple slices and celery, and drinking smoothies through a straw can be a great option. Other ideas include Sensory Chew Necklaces and Toys.

4. Movement

For some children who crave vestibular input, an indoor or outdoor swing can quickly calm big feelings. Rhythmic bouncing or side to side movement on a large ball or peanut can have the same benefit. 

5. Yoga

Yoga teaches deep breathing, relaxation, and mindfulness reducing stress and anxiety. Yoga is a favorite hobby of mine, as I was a yoga instructor before getting into the pediatric therapy world!! I use it on a daily basis in my sessions from intentional breathing, working on good posture, and using the whole body approach to calm a child’s nervous system during a meltdown. Some or our favorite YouTube channels for yoga are Cosmic Kids Yoga and Yoga With Adriene.

6. Music and videos

Music and videos of a preferred choice can help calm an episode or prevent an episode from occurring in the first place.

7. Moving into a different room

Sometimes all it takes is going into another room, turning off the lights, and reducing the noise. Some children can become overstimulated due to noise, lights, and smells. Removing the stimulus can often be enough to calm the episode.

*As an Amazon affiliate, I earn a little bit from any purchases made through these links

Co-contributor: Helen Sarver

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Intensive therapy is a model of therapy that challenges the child for several hours a day, usually several weeks at a time. What a child progresses in a few weeks of intensive therapy can take an entire year in traditional therapy.

At TheraHappy, the big results that come with intensives are one of our favorite ways to provide pediatric OT to Houston kids with motor delays. 

Intensives can often consist of:

• Physical Therapy
• Occupational Therapy
• Speech Therapy
• Feeding Therapy
• Dynamic Movement Intervention (DMI)
• Cuevas Medek Exercises (CME)

Depending on the clinic, different options for the types of therapies offered will vary.

Intensive therapy is based on the Intensive Model of Therapy (IMOT). IMOT is a unique therapeutic approach developed in Poland in the 1940s (source) to treat children with cerebral palsy and other neurological disorders (source). More recently it has gained popularity with more trainings becoming available and more intensive therapy centers opening.

Intensive Therapy Provides the Repetition needed for Brain Changes

• Lasting results
• In-depth caregiver/ parent education for confidence in carrying over home program after intensive
• Your child makes leaps in progress when compared to traditional therapy
• Your child’s brain has neuroplastic qualities, meaning change is WILDLY possible, and intensives provide this avenue for big changes in a short amount of time
• Repetition helps the child create new brain connections
• Every child is capable of the unthinkable with the RIGHT tools

Dynamic Movement Intervention For Your Intensive Therapy

Most intensive programs include at least one session a day of DMI or CME. A key component of this technique is to provide a diminishing level of assistance during exercises as the child progresses.

A key component of intensives working on motor skills is providing new motor experiences. Typically, lots of hands on support is needed and less assistance is needed as a child’s motor skills progress. For instance, at the start of a week-long intensive, the therapist at the trunk or pelvis because these provide the most physical assistance. As the child progresses in the exercises, the point of contact for support will move down to thighs or ankles, increasing the child’s exposure to gravity.

There are several pieces of wooden equipment that can be configured in various ways to challenge the child.

Children need to be at least 4 months of age and are typically under 50 pounds in weight.

Getting Started With Intensive Therapy for Your Child with Motor Delay

The first step is finding the right provider. This can be a challenge because there are more kids who need intensives than therapists trained to provide them.

To find a provider:

1. Search the registry for someone in your area
2. Contact a therapist to travel to you.

If you’re in Houston or willing to travel to Houston, Therahappy is here to provide intensives to address your child’s motor learning challenges.

Our convenient and welcoming clinic is a place of smiles and triumph. Because not every family can travel to us, we available to travel throughout Houston, TX. 

Registered Practitioners

There are also therapists willing to travel to you. Right now I know of On the Fly DMI. If you know of others, please let me know in a comment or email me hello@therahappy.com.

Therahappy offers intensive therapy in Houston area, and those able to travel to Houston. Find out more here.

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Visual tracking is the ability to visually track, or follow, an object or person with ocular (eye) movement in a horizontal or vertical plane, without having to move the head and neck.

The First 4 Weeks of Life

At this stage in life, babies can visually attend or focus on a colorful object momentarily. Hence the craze for the high contrast and stark primary colored toys, as seen below.

1-3 Months of Age

By the first month, a baby learns to stare and fixate on objects or people around them.

Between 1-2 months a baby is learning to track, but with limited range. Think of the range from ear to ear being 180 degrees. Their tracking at this age is limited to what is right in front of them, or their midline.

As their sensory systems develop, their curiosity and nervous system propels them to be able to track the full 180 degrees by 3 months of age.

Their visual tracking skills allow them to begin to visually scan their environment, looking from object to another.

Why it Matters

Visually scanning the environment helps the rest of the sensory system to develop. It makes them naturally curious about their environment. Visual tracking is the first component of visual motor skills, or hand-eye coordination.

If a child cannot track an object in their environment, everything that follows that skill will be super challenging. Moving eyes from one object to another and focusing on objects far and near will be delayed.

Fine motor skills such as reaching and grasping objects will also prove to be difficult. It is very much a snowball effect. Treating fine motor delays is much more than what is going on with the hands. Looking at the whole child is imperative for comprehensive care.

Torticollis and Visual Scanning

Torticollis, or neck tightness, is one of the most common reasons for poor visual scanning in infants. If a child has neck tightness, they will be restricted in visually scanning around them. The tightness may prohibit them from fully scanning one side of their body, which will also limit their physical activity on that side. These activities might include rolling, reaching, and decreased head control.

If You Suspect a Delay

If you suspect your little one is having trouble in this area, it is best to bring it up to your child’s pediatrician. Early intervention is key, especially if torticollis is involved. You can request a referral to an occupational or physical therapist who will be able to further evaluate the condition, and treat if necessary.

Resources

HELP Assessment

High contrast toys for infants on Amazon

What is the Vestibular System?

Conservative Treatment for Torticollis and Plagiocephaly

*Products linked on amazon.com are affiliate links. As an Amazon Associate I earn from qualifying purchases.

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When you start home health for pediatrics, the majority of companies require you to purchase your own activities, games, and supplies. Usually PPE, assessments, and basic things like sensory brushes may be provided but you can assume you will be investing in a few things before you get started. That being said, don’t feel like you have to go out and spend a fortune on new toys right away. Most new home health therapists will gradually build their caseload, so initially you will only need a few things.

Before spending money on brand new toys and supplies, try to build your OT toolbox by:

• asking friends and family with kids if they are willing to part with any toys that their kids have outgrown
• checking garage sales
• shopping at thrift stores
• looking around your home to see if anything you already have can be used in therapy

Now on to what I take with me for pediatric home health visits!

If you can get only three things, I would recommend: a 3D puzzle, paper and markers, and play dough. There are so many things you can do with each of these such as: imitating and tracing lines/ shapes, folding paper, playing simple two player paper+pen games like Tic-Tac-Toe or Squares, cutting shapes (assuming the client has scissors in the home), practicing assembling the puzzle in a variety of positions (prone, side-lying, tabletop, quadruped — all depending on your goals), and the list is truly endless with playdough!

But when you’re ready to diverse your OT toolbox of toys and games below are some of the things I rotate with my kids with developmental delay, and grade them according to their developmental stage and OT goals.

Lacing Activities for Home Health Pediatrics

I find that kids prefer the lacing boards to the beads, most likely because the beads challenges bilateral integration and cognition at a higher level. I like to use both for fine motor goals, to change things up and for carryover to real life functional use.

Scissors For All Ages and Abilities

Up until a few months ago, I never knew there were so many different kinds of scissors! It is wonderful that so many options exist, but like me, so many parents are unaware of all the options out there to make cutting more accessible to their child.

The green ones depicted in the image above are training scissors with lift assist which assists children with opening the blades after completing a cut. Many children actually struggle with this part of cutting, and it just reminds me that we take so much for granted in everyday tasks.

The yellow pair are adapted scissors which assists with opening the blades and does not require the child to have a strong palmar grasp in order to cut. This particular pair is actually very sharp, so take extra caution with these in your bag!

The kids scissors on the bottom are regular kids’ scissors with blunt tips and soft grip handles.

“Let’s Cut Paper” Workbooks

Going along with scissors are these adorable cutting worksheets. Kumon puts these out, and has other similar workbooks for working on folding paper and tracing skills.

Building Blocks

I found a good set on Amazon a while back for my own kids, and when they grew out of them, I knew I’d one day be able to use them in therapy. They have held up pretty good and are easy to wipe down without losing color. If you are measuring a child’s progress with the PDMS-2, these are nice to have as some of the activities in the assessment involve building different things with blocks.

Shape Block Patterns

These are something I finally added in my OT toolbox last week and the kids seem to be loving the addition! If they are mastering 3D puzzles, this is a nice grade up for a visual motor activity. I finally printed and laminated about 10 different designs from PreKinders. She has them in color and black and white. You can use the colored version for grading down, or the black and white version to grade the activity up.

Pencil Grips

These are great for kids who are ready to use a pencil for graphomotor tasks but still need some help with a functional tripod or quadrupod grasp. They are also great for parent education on what things can help in the classroom and at home. The grey one is Dex the Effortless Art Pen Grip from Effortless Art Products. I shared more about Effortless Art products here! And the orange one I snagged in a three pack from Amazon.

Tweezers

These tweezers are great for building intrinsic hand strength, pincer grasp, and handwriting grasp patterns. You can use these for pinching pom-poms, small wads of crumbled paper, rolled up balls of play dough, beads or anything of similar size like beans or macaroni noodles.

Visual Perception Worksheets

For older kids working on visual spatial skills, these are a nice thing to change these up. You can also laminate them to reuse. The ones on the right are copies of worksheets in Building Thinking Skills, one of my favorite visual perception resource, with a variety of level books available.

Theraputty in Home Health

With the surge of kids’ screen time combined with the decrease of fine motor activities in their regular routines like the game of sticks, Cat’s Cradle, marbles, board games, jump rope, bike riding, climbing, tug-o-war, and so many more classic childhood games, hand strength in children has declined significantly when compared with previous generations. For this reason, I would be amiss if I failed to include theraputty in this list! To make it fun, you can hide fun things like marbles, beads, tokens, gold coins, or other favorite toys for the child to pick out.

Dry Erase Markers and White Board

A white board and markers is a no-brainer! Especially if you like to save trees! I have regular sized markers and larger grip markers, for the younger patients. Even opening the lid is a strengthening task in itself for some! Beware though — some kids revert to using their mouth when they cannot pull it off with their hands.

Do A Dot Markers

This are a hit with kiddos working on a functional palmar grasp. They can make quite a mess so bring plenty of paper and wipes, but the mess is often worth it! This also reinforces the joy of graphomotor tasks and the ability to create art. I find that kids are more proud of the things they make with these than even regular markers. Easy Peasy Learners has a lot of free Do A Dot Printables for these paint markers. Additionally, you can simply draw a shape and encourage them to paint inside the lines of the shape you drew.

Some other things I like to use in home health is:

• Balancing Tree Game – this is WONDERFUL for encouraging bilateral coordination, and the kids on the spectrum for me who need symmetry and balance in their play enjoy this one
• Stickers and small rewards – given some kids, especially oral sensory kids, are not appropriate for “small” things, so just use your best judgment but don’t be stinfy with verbal praise, that is always best anyway! Stamps and “high fives” work well too!
• Wipe Clean Workbook – this is one of my FAVORITE tools to use, with a variety of lines and shapes to learn to trace. It gives variation when working toward simple tracing/ imitation goals.
• Scrapbook Organizer Bag (with wheels!) – this is a new way for me to organize all my home health toys and activities without wasting time searching for something at the bottom of my bag. Talk about pocket HEAVEN.

What would you add to this list?

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