Occupational Therapy at Challenge Unlimited/Ironstone Therapies Farm

http://ironstonefarm.org/ironstone-therapy/occupational-therapy/

http://recyclingot.blogspot.com/2014/01/left-neglected.html

Bringing Hands Together to Clap

This was a fun way to teach hand clapping. I placed the Senseez vibrating cushion between a 3 year old's hands. He squeezed it hard enough to make it vibrate and could do this independently.

When I took the cushion away he signed more. But when I tried to bring his hands together to clap first, his hands fisted.

His mom says that when he gets more used to me he will clap. We have only worked together 3-4 times, so I look forward to bonding more and seeing some clapping!!

Removing Shapes from Weavable Toys

 

Removing shapes from weaving strips is a great way to introduce children to weaving.

Many typically developing 2-3 year old children can do this. This activity also helps older children with  challenges to:

• use hands together
• strengthen fingers and develop dexterity
• motor planning to move shapes in correct direction to remove them. 
• count the shapes as they are removed
• name colors of shapes removed
• eye-hand coordination to insert shapes into slot
• Shape identification 

My patent pending Weavable Toys: Basic Shapes provides boards with shapes: square, triangle, rectangle and circle. The strips woven through the boards reinforce concepts of shapes:

• circle
• L
• V
• straight line 

The mushroom shape at the ends of the circles and straight lines prevent the shapes from falling off while adding new ones.

This little girl was particularly ready to focus on this fine-motor activity after 20 minutes of trail riding sensory stimulation !!

http://blog.therapro.com/post/2013/09/04/Using-Movement-to-Motivate-and-Develop-Hand-Skills.aspx

Weight Bearing on Senseez cushion

 The Senseez company  recently provided this cushion for a give away on my Facebook page:
They kindly sent one to me as well , yeah!

I discovered that it is extremely sturdy and well made. One needs to press or squeeze with a lot of force to activate the vibrator.
This is good because it won't accidentally vibrate and wear out the battery unless being used and won't break easily. It is designed to be used as a seating cushion to motivate children to remain seated for short amounts of time as they attend to a table top activity. I think that it is very well made to do exactly that.

However, the 2-4 year old kiddos that I work with during hippotherapy were a bit too small to sit on it comfortably while on a horse. But they enjoyed, pressing down on it. This was a great way to promote weight bearing on hands. 

I helped the little guy in the green shirt to push hard enough to make it vibrate and this helped him to strengthen his shoulders, arms and hands and increase touch toleration to his palms.

The little girl in yellow was able to count the buzz sounds it made 10 times so I integrated it into a counting/sequencing task.   

 
After dismounting from the horse, I placed the cushion between our chests while she gave me a big hug. We both got a kick out of that sensation !

Other possible ways to use the cushion besides sitting is to :

• push it against the wall while doing "wall pushups". The child can count or spell words while doing this
• Put it on a chair and do donkey kicks while pressing hands down onto it.  This is great for heavy pressure stimulation to muscles and joints and bilateral coordination
• Place it inside a tight shirt while rolling down a ramp
• Place it behind the back while  doing sit-ups
• The child holds it between both hands or knees, pressing together- try doing that while the child sits on a therapy ball or swing and it will work even more on postural control and core strength.
• Use in a partner game where 2 children push an elbow or other body part against it to make a buzz. 

Note that I attached small pieces of Velcro to the heart. These can be used in fine-motor activities that involve pulling pictures or toys off that are attached with Velcro.....

I'm sure that there are many other fun ways to use this cushion, so play around and see what you come up with and share....



  http://vimeo.com/67833758

My Cold Ring Stack

During this hot weather, I peak into the freezer at work to see what I can use. I found these frozen treats bought for the campers and borrowed them to use as ring stacks. They lasted just long enough , about 5 minutes in an activity before my volunteer returned them to the freezer.

This little girl loved it. she stood on top of the horse, squatting to pick up each ring. I held the bottom of the "stack" while she pushed the rings down. I think that she just enjoyed the novelty. I was not able to control the camera and work with her while standing at the same time, so just filmed her sitting to stack the rings.

 I saw a little boy smile for the first time when I gave him this to hold. I have only worked with him 4 times, so I am sure there will be plenty more smiles to come.

Nice Ice

It was a sweltering hot day on the farm yesterday. I found a frozen bottle of ice water to toss into the basketball stand. It did a nice job of cooling us down and the kids liked following directions to touch body parts with it.....neck, forehead, nose, ears, belly, armpit, wrists, elbows, knees etc.  

I also realized that I needed to work with an almost 5 year old on answering these questions. ... How many eyes do you have, head, hands, feet, nose, neck etc. she needed prompts to think about the question before answering automatically. I incorporated this into touching body parts with the ice bottle.... Cool :-)

Naming Pictures on Ball

Ask a child to name the pictures on the ball or toss it back and forth and ask the child to name what his finger lands on. Great for developing speech and motor skills.This two year old was also counting !

Ice-cream Cone Hands

 

 I have been telling my clients for years to hold the reins so that they make them look like an ice-cream cone. Then I remind them not to let it "melt". Now I shocked them with ice-cream cone bubbles. It made a nice visual to teach them the concept.

It was also good for pretend play!

Home CEU Course for therapists

https://www.homeceuconnection.com/course/2882/Innovative-Interventions-to-Treat-Children-on-the-Autism-Spectrum

Squeezing Ball between Feet

 One of my cutie pies turns three this week and is leaving hippotherapy. She demonstrated some very nice motor planning, coordination and strength to squeeze a ball between her feet and lift her legs while I counted.  When we let go of the belt, she realized that she needed to  grasp the handle for added stability and she did great. She also enjoyed touching the ball with her feet as I moved it around. When her foot touched it I made the ball squeak.  Many of my 2 year olds do not have the motor planning skills to do this, so I was impressed !

Another client demonstrates in the video how he can pull the rings while stabilizing the bottle with the other hand. This is a great way to teach young children to use hands together and experience working with both the right and left hands to do the skilled part of the task.
The pulling gives sensory feedback and strengthens the arms and hands. He also problem-solved to switch hands before starting again and worked on counting 1,2,3 

Vibrating Cone Stack

Here is a pile of today's toys!

 I mostly used the vibrating cone stack, but I decided to turn this into a 2 part activity. First the children needed to remove the rings that I cut from the top of detergent bottles. They are pretty  flexible and sometimes break but if they do break, that's OK, its easy to get more.

I asked the children to place the rings in a basket attached to the tack behind them.

The child in the photo and video is facing backwards on the horse.

 After removing the rings she reaches for a cone to stack on top of the cone that is attached to the tan door snake (these are sold to place under doors to keep out cold air).

 There is a green massager hidden inside the cone attached to the snake, so when they press downward it vibrates. This seemed like a good way to not only motivate but to build strength because they really needed to push.

I wish that I had a photo of the client  who stood on top of the horse to reach for the cones and then squatted to stack them up. She did this about 20 times which amazed me because she often refuses to stand on the horse at all. The secret is in providing exciting activities :-)

Rolling Ball to make squeaks while Kneeling and more.....

I love bringing in different activities to try out. I set up a pole with a bottle attached on the trail. I filled it with a variety of textured balls and asked each child to reach for them while facing backwards on the horse. They needed to insert the balls into the pink bag hooked onto the tack behind them. The video shows my client opening and closing the pin bag's zipper as I set up the activity.

This was a fairly easy activity which all of my 2-4 year old clients could do with very little help. I designed the ring stack made out the blue swimming noodle to provide a bit more challenge than the usual ring stack - since they have to make the rings fit over the noodle's curves in order for it to go down. You can see the client working on this, although the computer won't let me rotate the photo. She loved the feel of the vibrator that I pushed into the noodle opening. Its the motor from the Squiggly Wiggly pen.  I also attached some fabric through the handle with a blue noodle doughnut shape tied to each end.  I asked them to help me tie a knot to get it out of the way- which they all did very nicely.. ..

The last activity was rolling the ball in the hands to make it squeak. I counted as the children rolled. The girl in the video is kneeling while doing this and I just turned the camera on as she reached 23 or 24. She really enjoyed doing this !!!

Cone and Stringing Activities to Develop Postural Control

 I hung the cone holder that a nice man at Trader Joe's store allowed me to have. It is used for holding flowers but is also perfect for hanging cones in the tree. So while riding down the trail, the children stopped next to the cones. Then I attached the holder inside one of the stirrups while the child faced sideways (facing me).

The first little guy in the video seemed to really enjoy reaching from his left side , rotating his trunk and placing the cone behind his right shoulder. The little girl is facing backwards while doing this. You can see how nicely this challenges their balance, motor planning and postural control and its a lot of fun, too !


















The other activity came out a bit blurry but I want to share it anyway, because it provided a nice challenge for a little girl who has pretty good motor skills.

She loved it and asked to repeat the activity, so she did this while kneeling after stringing the shapes while standing on top of the horse.

I attached the end of the cord to a sensory ring- made by filling socks with plastic bags and sewing the ends.

She first brought this over her head with a little help and down to her waist. Then she stood up on the horse and did the stringing activity. She was able to remove the sensory ring independently after sitting down.

All of these clients are almost 3 years old and I am so proud of them !

Clothes pins into basket

Strengthen those Hands!

 

We spent the beautiful spring day outside and the kids were all in great happy moods.  This little guy is facing sideways while we walk up a hill. I am encouraging him to put weight on his right hand. I gave him some joint compression input to the elbow when not holding the camera, too. He has very low muscle tone and avoids touching let alone grasping objects.  We played the game called "you grasp the chick with both hands and don't let go even when I pull". He is starting to understand that he has to really use some muscle to play this game! 

The video demonstrates very briefly how my client pulled links apart and placed in a container (highly edited to remove her face) and a client who just loved the whooppee cushion to no end. I discovered that if I tell the riders to stay in the 1/2 seat (leaning forward with bum off horse all the way to the top of the hill (about the time it takes to sing the ABC song) I can reward at the top of the hill by playing with the whooppee cushion since they can finally sit down. WHOOPEE!   

When your Hippotherapy Client Cries......

I work with very young hippotherapy clients. My youngest was 11 months old and she cried so much , I told the parents to come back later when older. She did return 6 months later and did very well.

Not every  facility offers hippotherapy services with such young children but I have found that the 18 months to 3 year old early intervention clients are my favorite. They often start out crying, perhaps for a few weeks and then realize how much they love the experience. There was only one child who cried intensely for about 3 weeks and the mom and I agreed that he should stop.

So what to do with the crying hippotherapy client?  Lets take a look at the reasons for crying.....

• the child is not used to and does not want to separate from the caregiver
• the horse is big and scary
• all new experiences are scary
• the child finds the sensory experience (i.e. movement) threatening and scary
• the environment is over-stimulating

Strategies:
1. Its not always possible to work in the ideal environment, but if possible decrease the number of people and horses, sound and action taking place around the sensory sensitive, young child.  I have learned to lower my naturally loud voice as needed.
2. I explain to parents that most young children cry during the first few weeks. It may be beneficial to at first have the parent side walk or walk within view of the child. Sometimes the child does better when the parent is out of view. Some of my parents want to be the side walker all the time (and that's OK) and others enjoy the break. The parents and situations vary, but its good to explore the options that decrease crying during the first 2-3 weeks.
3. Spend time introducing the horse while holding the child, patting, brushing and talking to the horse. Sometimes I spend time playing with the child before even going near the horse so that the child is more comfortable with me before separating from the caregiver.
4.  Once the child is on the horse, get moving, stay moving, sing and talk about what you are both looking at. I hang pictures of animals on the arena walls and if we are outside there is of course, lots to talk about. I also find the song "If you're happy and you know it pat the pony, clap your hands, blow a kiss....." familiar and calming.
5. I encourage the child to bond with me the therapist, by telling the volunteers to minimally  interact  and after 1-2 weeks I encourage the parent in the waiting area to not interact. I turn the child to face sideways so that we can look into each others face, as soon as the child is able to tolerate this because we can bond even better in this position.
6. If I do something that the child really hates (i.e. kneeling, bearing weight on hands) and he or she cries, I do it briefly and count to 5 or 10 or sing the ABC song so that the child knows it will be ending soon. I then switch to a preferred activity or no demands riding.
7. If the child is super upset  and you feel uncomfortable keeping him on the horse, play with the child in the waiting area with the parent nearby or perhaps while the child sits on the parent's lap. Try not to send them home early- that gives the wrong message.
8. Sometimes kids are just feeling sick and the session needs to end early. This is especially apparent when working with a child who usually loves hippotherapy.
9. Discuss with the parent how they feel about the situation. Do they have suggestions? Some parents bring in a favorite toy from home.
10. .......and most importantly, involve the child in choice making with words, pointing or pictures so that they feel in control and have fun!

Using Apps during Hippotherapy

I occasionally use my Iphone during hippotherapy to have fun and motivate my very young clients. They love touching pictures that make things happen-such as an animal that makes a sound. This involves nice finger isolation and motor control. I have to remind some of them to use the index finger and not the middle finger.

In the video you will see how the app motivates him to make sounds. I can also ask the children to find and press the animals I name so that they need to scan and follow directions. That would be a bit more challenging but I will work up to it with this 2 year old.

I have worked with 3-4 year old children doing this same activity while they kneel, stand on top of and are prone on their belly (extending arms like superman)  while the horse stands stationary.

Usually riding is so exciting children don't need much more to motivate engagement but there are a couple of clients who are particularly cooperative when they know they will get to use my phone app either during or at the end of my session. One almost 4 year old who has down syndrome ends her session walking up 3 steps to put her helmet away on a pole. Sometimes I ask her to remain balancing on the top step while pressing some animal pictures. This takes her mind off her fear of falling (while I hold her belt)  while doing something she loves.

http://horsesandhumans.org/Newsletters/Newsletter_Winter_Spring_2013.pdf