18/04/23 1

Children & Young People’s Occupational TherapyH&F SENCo Forum

Gross and fine motor skills: Easy Solutions to common problems

Sheena Lorusso 07958 467884 ShTeam Lead Children & Young People’s Occupational Therapy

Central London Community Healthcare NHS Foundation Trust

• CLCH aim “To provide the best healthcare for people in their homes and communities”

• CYPOT is provided over 3 boroughs – HF KC W as a community service • Urgent complex needs children and non complex children with health and or

educational needs• Children are seen through direct referral – non- complex needs and the CCDS

for complex needs• Non-complex needs assessment clinics • Complex needs Multi Disciplinary Assessments and urgent direct assessment • 12 week package of intervention • Groups and 1-1 direct intervention • Training 1-1 and group to parents, schools and learning support assistants other

professional groups• Discharge• Consolidation • Re- referral

18/04/23 2

Safeguarding

• CYPOT services are involved with some of the most vulnerable groups of children – 5% of children in borough fall under complex needs and we are involved with children at all thresholds of complex and non-complex needs

• It is essential we provide accurate information to support co ordination of services around this group of children

• Please inform us if the child we are to work with has any safeguarding concerns so that we can support the child and family most effectively sharing and coordinating services as recommended by best practice from recent local and national Serious Case Reviews

• Liaison and advice with safeguarding as well as health visiting and school nursing alongside GP’s and paediatricians and recommended through the Care and Quality Commission and Laming Report

18/04/23 3

18/04/23 4

OutlineOutline

X Understanding: What could be the

problem?

X Tips

X But first……..ACTIVITY

18/04/23 5

Building Blocks of Building Blocks of DevelopmentDevelopment

Praxis

Postural Stability Awareness of two sides the body

Ocular Motor Skills

Academic Learning BehaviourDaily Living Activities Emotional Control

Auditory Visual Olfactory OralTactile Vestibular Proprioception

Visual Motor Integration Visual Perception Auditory Language Skills Attention

Body SchemeReflexes

Postural Stability Awareness of two sides the body

Ocular Motor Skills

Auditory Visual Olfactory OralTactile Vestibular Proprioception

Starting with the building blocks

• OT’s assess to find out what affects our ability to function – to do what we need to do or want to do in the occupations of– Work

– Rest

– Play

• Treatment approaches

• Functional difficulties

• Specific activities- gross and fine motor skills

18/04/23 6

18/04/23 7

Sensory Integration• Sensory processing is the ability to organize

the info from senses (hearing, vision, touch, movement, body position, smell and taste).

• Affects our ability to function – to do what we need to do or want to do

• The right level of alertness and focus for different tasks. For example driving vs TV

• Children with difficulties staying in a calm, alert state.

• “wild” or be constantly “on the go”.

18/04/23 8

Sensory Integration : TIPS

• Which of the 7 senses?

• Hypersensitive/ sensory seeking?

• Trial weighted vests, movement breaks, ear defenders, soft music in walkman, chewing/crunchy snacks, trampoline etc

• …… consult OT to assess

18/04/23 9

Gross MotorGross Motor

• Motor planning

• Body awareness: Head, shoulders, knees and toes:

d b / 0

18/04/23 10

Gross MotorGross Motor

•Shoulder stability

•Core stability/ tummy muscles

•Proprioception

18/04/23 11

Muscle ToneMuscle Tone

• “It is the tension within muscles that allows them to be ready for movement.”

• Usually our muscle tone is neither too tight nor too loose, it is just right, therefore we don’t have to use much effort to move our bodies or keep ourselves upright.

18/04/23 12Chair supports

thighs

Feet flat on floor or footrest

Knees at 90o

Head is upright

Ideal PostureIdeal Posture

Table at elbow height

Pelvis in neutral

90 degree RULE

18/04/23 13

Midline CrossingMidline Crossing

• Midline - A line between the eyes, separating the body into left and right sides.

• Midline crossing – the ability to use one side or part of the body (hand, foot or eye) in the space of the other side or part.

• Problems with: Using cutlery, scissors, reading, handwriting and copying from the board.

18/04/23 14

Bilateral IntegrationBilateral Integration

• ‘The ability to use both sides of the body together in a smooth, simultaneous, and coordinated manner.’

• If a child has problems crossing the midline, coordinating the two sides together will be problematic.

18/04/23 15

Gross motor TipsGross motor Tips

• Gross motor play!!!

• Activities such as jumping, therapy ball games, animal walks

• Movement Breaks

• Improve tummy muscles / shoulder stability

• Different positions: Work in lying if possible.

18/04/23 16

Gross motor TipsGross motor Tips

• Posture pack, desk wedge, move’n’sit, box.

18/04/23 17

Fine Motor Skill Fine Motor Skill DevelopmentDevelopment

•Isolating finger movements

• Pincer grip

•In-hand manipulation

•? Joint laxity?

18/04/23 18

Fine Motor Skills TipsFine Motor Skills Tips

• Funky finger groups?

• IDEAS

18/04/23 19

Visual perception Visual perception

• 20:20 vision, but cant find Wally?!

• Visual motor integration

18/04/23 20

Visual perception TipsVisual perception Tips

• Eye test?!..

• Handouts

• Distractions, position from board

• www.eyecanlearn.com

• www.eyecanlearn.com

18/04/23 21

HandwritingHandwriting

Skills Used:•Gross-Motor Skills•Fine Motor Skills•Visual Perception•Visual-Motor Integration•Sensory Issues•Cognitive e.g. Memory•Environmental•Behavioural

Problems Seen in…• Slouched Posture at the table• Poor Pencil Grip• Paper Position and stabilisation•Line use, spacing, size and speed•Hand Tires easily•Reversing letters/numbers (age)•Pressure through the pencil•Legibility (mum only?)

18/04/23 22

HandwritingHandwritingPre-requisite Shapes:

Pre-requisite Patterns:

18/04/23 23

EfficientEfficient Pencil Grasps Pencil Grasps

18/04/23 24

InefficientInefficient Pencil Grasps Pencil Grasps

18/04/23 25

HandwritingHandwritingTipsTips

• Build on foundation skills: (see fine motor tips)• Hand Strengthening – Putty, marbles or coin games. • Paper Position: left and right handed• Posture at the table ‘Feet flat, bottoms back, arms on table’• Poor Pencil Grips• Pressure Through The Pencil – Strengthening and colouring on

polystyrene, brass rubbings • Spacing – 2 finger space, lollipop stick, stamper pens, stickers• Line Use – double width of average middle letter, sky/grass/soil

paper• Legibility and speed – Pre-writing patterns on the blackboard• Handwriting without tears

18/04/23 26

HandwritingHandwritingTipsTips

• Touch typing: http://www.bbc.co.uk/schools/typing/

• Neo Alpha smart- indestructible laptops- great for primary schools

18/04/23 27

Pencil GripsPencil Grips

• Types of pencil aid

– ultra cross guard grip

– handy writer

– stubbie grip/stetro grip

– wide but short pencils e.g. cut down hand hugger pencil.

NB- When using pens, a gel ink pen is easier than a cartridge pen or ball point pen.

Note:

18/04/23 28

Tools Tools

Alligator Easy Grip Ruler

18/04/23 29

• SCISSORS• Mini-Easy-Grip Scissors• Easy-Grip Scissors• Long Loop Easy-Grip Scissors • Long Loop Scissors• Self Opening Long Loop Scissors • Pushdown Table Scissors

Peta UK Telephone: 01245 231 118 www.peta-uk.com

18/04/23 30

Equipment

Move ‘n Sit

Posture pack

Referral

• Referral options – Service provision

– Advice

– Assessment

• Front page – General information

– GP

– Consent

– Other professionals and safeguarding

– Ethnicity and Cultural considerations

– Additional needs for communication and literacy

• Reason for referral – Goal setting – engaging in your health care plan

– Describing functional difficulties with mobility- gross and fine motor skills

– Describing delays in daily living skills

• Children’s play and cognitive development compared to peers

• Sensory aspects of concern

18/04/23 31

18/04/23 32

How to tell….How to tell….

• Observe and gather info e.g. PE

• Speak to child

• Speak to parents

• Compare to peers…. Average for age?

Current Referrals

18/04/23 33

0 1 2 3 4 5 6 7 8 9 10 11 12 130

10

20

30

40

50

60

70

Volu

me

Age

Age & gender profile of children attending CYPOT service

Male

Female

18/04/23 34

Question /Discussion of Specific Issues…