Glossary
Time to get neurologically nerdy, so bear with me here. Deep pressure input is a combination of tactile and proprioceptive input in which sustained pressure is applied to a large part or the whole body to aid with calming the autonomic nervous system (ANS). The ANS is responsible for controlling heart rate and breathing, so when deep pressure is applied, your breathing and heart rate slows down and you feel more relaxed. Massages, swaddling an infant, wrapping an older child in a blanket to make a “blanket burrito,” weighted blankets, hugs and squeezes are all examples of deep pressure input and can be used as tools and strategies to help with regulation.
Fine motor coordination is another tenet of fine motor skills, which is the “coordination of small muscles in the hands and fingers to perform tasks that require precision and dexterity,” (OTToolBox.com). These tasks include using pencils, scissors, manipulating glue sticks and tape dispensers, opening and closing containers, tying shoes, buttoning clothes, building model Lego sets and so much more. Fine motor coordination refers specifically to how the small muscles of the hand and wrist work together to manipulate objects. From sun-up to sun-down, we are actively using these tiny muscles to brush our teeth, open and close vitamin bottles, tie our shoes, zip up our lunchbox, lock the front door, type on a keyboard, paper clip a stack of papers, change a diaper, chop veggies for dinner, and spray down the kitchen counter. The best way to develop fine motor coordination is letting kids experiment with and explore manipulating small objects (with close adult supervision of course!) Playing with lidded containers, small building/stacking blocks, small latches, and clothing fasteners are examples of great fine motor coordination activities.
Fine Motor strength is one of the tenets of fine motor skills, which is the “coordination of small muscles in the hands and fingers to perform tasks that require precision and dexterity,” (OTToolBox.com). These tasks include using pencils, scissors, manipulating glue sticks and tape dispensers, opening and closing containers, tying shoes, buttoning clothes, building model Lego sets and so much more. Fine motor/ hand strength is needed for grasping and pinching objects so they are secure in your hand. Having optimal fine motor strength gives kids (and adults) the endurance to use their hands for daily tasks for extended periods of time. There are dozens upon dozens of creative ways OTs incorporate fine motor strengthening through activities and exercises (just do a quick internet search and you’ll get lost in ideas). Some of my favorite fun activities for hand strengthening include pinching and pulling apart play-dough or putty, playing games involving tongs or tweezers, ripping apart paper for craft or art projects, wringing out wet towels (my boys love doing this as part of clean-up after bathtime), and painting with small cut-up sponge pieces.
Proprioceptive feedback or “proprioception” is sensory input to the muscles and joints that detect the position of our body in space. Knowing where our body is in space helps us to plan our movements and make adjustments so we can “stay in an optimal seated position in a chair, hold writing or feeding utensils, not bump into furniture or people in our environment, or plan how much pressure to exert when writing with a pencil, closing a door or pushing a chair in” (Mailloux, 1993). In the school setting, I observed SO MANY kids falling out of their chairs, tripping, bumping into kids in line, writing with too much force that they would break their pencil, writing with too little force that their work could not be seen, or giving too forceful hugs or high fives. These kids weren’t necessarily angry or aggressive, they just lacked intact proprioception, which is sadly VERY common among children these days. Why? Because kids aren’t playing like they used to and naturally getting enough proprioceptive feedback throughout their day (that’s another topic for another time!) Having poor proprioception feels like your body is floating in outer space- you feel out of control and ungrounded. So if you have a kid that may have poor proprioception, try incorporating push/pull type activities (pulling weeds, taking out the garbage cans, carrying grocery bags, pushing a full basket of laundry), jumping games, making a “sandwich” out of your child with pillows or couch cushions, having him (NOT YOU) carry his own full backpack, giving gentle but firm massages, or having him sit under a weighted blanket while reading or watching a show. These tasks and activities may help your child feel more grounded and regulated.
Source: Discover Proprioception: A “Hidden” Sense, Zoe Mailloux, MA, OTR, FAOTA, 1993
The body’s sensory system can be broken down into three subsystems. The first is exteroception, which processes sensory information that comes from outside the body such as touch, sight, sound, taste and smell. The second sub-system is kinesthesia, which processes sensory information that comes from muscles and joints in the body, such as position, balance, and vestibular sense. The final sub-system is interoception, which processes sensory information such as hunger, heart rate, internal temperature, and emotions. Each sense in each sub-system is equally important to maintaining self-regulation. If there is too much or too little of one or multiple sensory inputs received and detected by the brain, and the brain has a hard time adjusting or habituating to that level of sensory information (as is the case when feeling stressed, tired, sick), you get dysregulation! For a kid (or even an adult), dysregulation can be expressed through various maladaptive behaviors (whining, complaining, shutting down, avoiding/escaping) or sensory seeking behaviors (wanting/needing more of that particular sensory input through repetition).
When was the last time you felt dysregulated or overstimulated and what helped you get through it? Deep breaths? Taking a break? Going outside? Eating a snack? Wearing headphones? Calming scents in an essential oil diffuser? As adults, we typically can regulate our sensory system much easier than kids because we have the planning and thinking abilities, language, and experience. Kids, especially those with special needs, often lack at least one of these abilities and therefore need our guidance to help them regulate themselves. Re: this is our job as parents and caretakers!
What’s the best way to help kids learn this self-regulation skill? YOU modeling your strategies and practicing them together. Books and shows are good options too, but modeling and practice is much more effective. Sometimes, it’s pretty easy to determine if it’s a sensory issue making your kid act in a certain way. For example: super bright fluorescent lights and an incredibly loud flushing sound in a public bathroom could make your kid avoid using the bathroom in public altogether, leading to tantrums or accidents. But for many cases, it takes a whole lot of skilled observation and sometimes specialized testing to determine what is really going on with your kid’s sensory system. If you have concerns with your kid’s sensory processing, please see your kid’s healthcare provider and ask to see a pediatric OT- we love this stuff!
Source: Making Sense of Our Senses lecture, University of St. Augustine, 2017
“Separation of the sides of the hand refers to the imaginary line drawn from your wrist directly down the middle of your hand and between your ring finger and middle finger, separating the precision side of the hand (thumb, pointer finger, and middle finger) with the power side of your hand (pinkie finger and ring finger),” (TheOTToolBox.com). These two sides of the hand work together to provide precision and power for many fine motor tasks. Without this separation of hand sides, we’d be using all five fingers to open our toothpaste bottle, zip up our jacket, hold a pencil, cut our food with a knife- it would be very ineffective and difficult. Hand side separation develops with experience and practice with all sorts of fine motor strengthening and coordination activities and tasks.
Tactile input is a fancy OT term for touch. The body’s tactile system is the largest sensory system and is constantly activated. Think: what are you sitting on? What are you wearing? Are you barefoot or have socks and shoes on? Is your environment hot or cold? Is there a breeze from the AC? Can you feel the tag of your shirt? Do you still have crumbs on your face from lunch? A lot of you will now have adjusted something impacting your tactile system after I’ve brought all these factors to your attention… haha!
Touch is SO important because it’s one of the first senses experienced in the womb and in infancy (think: as mom rubs her pregnant belly and the immediate skin-to-skin contact with mom right after birth). However, a lot of kids can be hyper-responsive to touch which can cause many day-to-day issues if they do not know how to modulate or habituate to different touch sensations. For example, do you have a kid that cannot stand the sensation of a t-shirt tag? Or do you have a kid (like my oldest) who can barely tolerate slime, playdough, or getting glue on his fingers? One trick that works for most mild cases of tactile sensitivity is to “prime the hands” (or whatever skin area is coming into contact with the object in question) with deep pressure input. Squeezing or massaging the hands, bear crawls, hanging on monkey bars, or climbing up a ladder- all of these provide deep pressure input to regulate the tactile systems so that a non-preferred touch sensation isn’t so… well, sensational!
Source: Making Sense of Our Senses Lecture, University of St. Augustine, 2017
“Tripod grasp is the opposition of the thumb to the pad of the pointer finger and middle finger when grasping and manipulating objects,” (TheOTToolBox.com). In this grasp, the ring and pinky finger are “inactivated” and tucked into the palm. It’s considered the most optimal grasp for holding writing and coloring utensils because it’s ergonomically and biomechanically most efficient and comfortable BUT it’s not the only way to grasp utensils (more on that for another time). The tripod grasp typically emerges between three and four years old and begins as a “static tripod grasp,” in which the hand and wrist rest on the writing/coloring surface and move as one unit. Later, typically between five and seven years old, a kid will develop a more mature grasp pattern, one of which is a “dynamic tripod grasp.” Here, the distal (meaning “far”) end of the fingers are moving to produce writing/coloring strokes while the rest of the hand and wrist remain relatively still. What’s the best way to develop a tripod grasp? A lot of pinching and pulling activities starting at an early age! Once a kid is writing and coloring more, then I use visual cues on writing/coloring utensils (i.e. the wavy “racing stripes” on Crayola markers or a sticker near the distal end of a utensil) to show kids where to pinch the utensil. For beginner writers and artists, I have kids write/draw on a vertical or slanted surface to provide their little wrists support so their fingers can focus on maintaining a proper grasp. I said it earlier but it bears repeating: a tripod grasp is an optimal grasp but NOT the only functional one- I’m a prime example of this fact! So if you’re worried about your kid’s grasp, look for more posts about alternative grasp patterns.
Tummy time is when you position your infant on his stomach while he is awake. It’s actually your infant’s first “exercise” to help strengthen the muscles in his back, neck, shoulders, and arms. Because infants spend A LOT of time on their back while sleeping (a safety measure to reduce the risk of SIDS), in a carrier, or in a car seat, they need extra dedicated time on their stomach to work those core/postural control muscles. Pinterest and numerous child development blog sites can lead you to 101 ideas of how to make tummy time a regular, engaging part of your infant’s daily routine. My favorite ideas came from Rachel Coley, MS, OT/L at CanDo Kiddo + Family. See her post here.
My oldest child was a tummy time grump (and still doesn’t love laying on his stomach to color or read a book). But, he liked laying on my lap while I was sitting on the couch, my feet on the floor with our dog at my feet, while he layed looking at our dog. I think it was a cool visual perspective of our dog that he wouldn’t otherwise have seen and I was holding him so he felt safe. A final note about tummy time: it doesn’t have to end when your infant starts cruising or walking! Those postural control/core muscles are still developing well into late childhood and can be strengthened in adulthood (think: bird-dog and cobra yoga poses, or bent over rows). So you can still encourage play or rest in a tummy time position (also called “prone” position) for children and adults of all ages!