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Below, you will find information on the tactile sensory system and how tactile challenges to the sensory system can result in difficulties tolerating clothing textures. The strategies below are helpful tips for getting sensory kids to wear winter clothes. 

Use these tips to help kids with sensory processing difficulties to wear winter clothes.

Tips for Getting Sensory Kids to Wear Winter Clothes

The Tactile Sensory System is one of the earliest developed senses of the body. The skin is the largest and the most prevalent organ. The skin performs unique duties for the body. Most importantly, the skin protects and alerts us to danger and discriminates sensation with regard to location and identification. The sense of touch alerts us to both discrimination and danger. These two levels of sensation work together yet are distinctively important. 

Tactile discrimination allows us to sense where on our body and what is touching us. With discrimination, we are able to discern a fly that lands on our arm. The second level of the tactile system alerts us to danger. It allows us to jump in response to the “fight or flight” response when we perceive a spider crawling on our arm. 

When either of these levels of sensation are disrupted, tactile dysfunction can result. This presents in many ways, including hypersensitivity to tags in clothing, sensitivities to heat or cold, a dislike of messy play, difficulty with fine motor tasks, a fear of being touched by someone without seeing that touch, a high tolerance of pain, or a need to touch everything and everyone.

The information received from the tactile system includes light touch, pain, temperature, and pressure. When the tactile system is immature or impaired, the brain can become overly stimulated with resulting poor organization and regulation of input. Children can then experience difficulty with behavior and concentration as a result.

When children with tactile discrimination issues need to wear winter clothing, meltdowns can result. The heavy winter coat is just not tolerable. Use the tips below to help sensory kids wear winter clothes.

Winter Clothing Sensory Strategies

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1. Layer! Use a compression garment under clothing. A simple lycra sun shirt can be a big help for some students when worn under clothing. Tight stockings or bike shorts can be worn under pants. Other ideas include:
  • An Under Armour shirt (this one has a crew neck to reduce a tight feeling around the neck.)
 2. Utilize seamless undergarments (for girls or boys), clothing or seamless socks, or clothing with flat seams. These can be added under a layer of heavier socks or used in isolation.

3. Tighten or loosen shoe laces as prefered. A tighter shoe lace can provide compression through the feet.

4. Becoming overheated can be a big cause for a sensory meltdown or refusal to wear winter coats. Consider trying a fleece or lined sweatshirt instead of a puffy winter coat.

5. Cut labels from clothing. Don't forget the gloves, hats, jackets, and coats!
6. Wear two layers of socks or try wearing socks a size smaller for additional compression through the feet and ankles. Try using a knee-high length in isolation or under a second pair of socks. This can help the child who isn't able to tolerate socks slouching down inside shoes or boots.
7. Wash new clothing in hot water several times to loosen clothing textures.
8. Rub a thick cream such as aloe gel or cocoa butter on the body before dressing. Dry skin can cause itchiness during the winter months where dry heat is prevalent.
9. Provide a blanket in the car if a winter coat isn't an option.

10. Use fabrics such as cotton, fleece, and flannel. Avoid polyester blends.
11. Wear full body zipper pajamas (made for big kids!) with or without a compression layer underneath.
12. Use a winter vest or removable sleeves to quickly adjust for temperature changes.

13. Use a poncho or a car seat poncho instead of a winter coat. 

Looking for more information on sensory processing? Grab this free sensory processing booklet:

Parents and teachers will love to pass on this free sensory processing disorder information booklet.

Use these tips to help kids with sensory processing difficulties to wear winter clothes.

Many times kids who struggle with handwriting problems or challenges need some handwriting accommodations in order to complete written work in a legible and efficient manner. The handwriting strategies listed below are handwriting accommodations that can be used in a variety of classroom settings or in the home. The compilation of instructional ideas and handwriting accommodations may be trialed and presented by therapists, teachers, or parents, or anyone who works with kids who struggle with handwriting

Handwriting accommodations ideas and strategies should be presented in a fun manner and as a tool for promoting independence.  

These handwriting accommodations can be used across the curriculum or in individual settings depending on the child's particular needs. 

Remember that every child is different. What accommodation or strategy works with one child may not work successfully with another child who presents very similarly. The trick is to try the accommodations over a period of time. Don't give up if the accommodation doesn't immediately cure any handwriting struggles. Trial and keep track of responses. Then, move on to another accommodation after a period of trial. 

Use these handwriting accommodation strategies that can help kids with handwriting problems in the classroom.

Handwriting accommodation strategies

Fill in the blank worksheets- Fill in the blank form to limit the required hand writing tasks. 

Students can use an app to scan worksheets onto a tablet and type in the responses.  

Use adapted handwriting paper such as color coded paper

Trial use of bold lined paper. This Christmas modified Handwriting Paper can be a big help this time of year.

Practice and writing using color changeable markers to address letter formation and motor planning needed for letters. 

Use manipulatives such as magnets to write answers to problems and written responses. 

Use a dry erase marker and whiteboard for written responses. 

Modify a worksheet by using multiple choice answers rather than writing out lengthy responses.

Students can write using large graph paper with boxes for individual letters. 

Trial use of spacing accommodations such as highlighted margins. More spatial awareness tricks can be found here

Try using a sensory tray or writing manipulative tray for letters for students to respond to multiple choice problems. 

Limit the amount of work required nine use a sheet of his damn paper under written work for feedback in letter formation in line awareness. 

Use a computer for spelling test and vocabulary test. 

Provide more space for the child to copy to: Provide larger spaced paper.

Teach students to use graph paper for copying one letter/number per square.

Position the child closer to the chalkboard or classroom homework station with less had turn needed for copying written work. 

When copying from a book, use a copying tool such as a folded piece of paper to line up with the work.  Can also try an index card with a cut out "window" for copying to reduce distracting information. You will find more strategies to address spatial awareness here. 

Require single word answers or use magnetic alphabet letters on a desk with a cookie sheet for single answer problems. 

Answer questions verbally or ask another student to transcribe written work.

Provide adapted spelling test and vocabulary test using multiple choice problems where students can correct the can choose the correct answer by circling a letter. 

Use a highlighter for tests and worksheets where students can highlight the correct answer. 

Use a dot apps which can adapt worksheets into tablet form. 

Explore several different pencil grips and pencil types to reduce the amount of pressure a student requires when writing. Here are a few options:

Add a red or green dot to margins to help students identify starting and stopping points for writing. 

Try using letter stamps for responses on worksheets. 

Use a handheld recorder to copy notes in older grades. 

Trial use of a gel pen to reduce friction on the paper with the traditional lead pencil.

Teach students to write into boxes formed for the size of individual letters. This is a strategy that works well for copy work.

Use these handwriting accommodation strategies that can help kids with handwriting problems in the classroom.

As Occupational Therapy practitioners, we value evidence-backed resources to use in clinical practice intervention and evaluation. But finding evidence-based resources can be a struggle for therapists. There are many reasons for difficulties in finding this information including time, effort, cost, opportunities, availability of resources, and other issues. Below you will find various ways to obtain evidence-based resources as occupational therapy practitioner.

First, we'll dissect the various levels of evidenced based practice that OTs may encounter in searching for evidence based literature.

Hierarchy of Evidence Based Practice

Understanding the level of evidence-based practice is essential when determining the validity of sources. A framework for ranking evidence provides a hierarchy to enable different research methods to be ranked according to the validity of their findings. This link explains various grades and levels of evidence, defining types of evidence that provide reliable answers and best practice, while also describing the strength and rigor of a study.

Hierarchy of evidence within Evidence Based Practice is effective in identifying quality and high-level research backed information.

The Sackett method of ranking evidence is one method for outlining levels of evidence in EBP:

1A = Systematic Review of Randomized
Controlled Trials (RCTs)
1B = RCTs with Narrow Confidence Interval
1C = All or None Case Series
2A = Systematic Review Cohort Studies
2B = Cohort Study/Low Quality RCT
2C = Outcomes Research
3A = Systematic Review of Case-Controlled
3B = Case-controlled Study
4 = Case Series, Poor Cohort Case Controlled
5 = Expert Opinion

Understanding the levels of evidence is necessary when investigating a topic area in the literature.

Ways to obtain evidence-based resources as an occupational therapist

1.) Continuing education opportunities- When obtaining professional development units needed to maintain licensure, therapists are able to connect with other therapists and are exposed to resources related to a specific question or topic. The struggle with this source of evidence-based practice is that continuing education opportunities can be pricey and limited. 

2) The American Occupational Therapy Association (AOTA) publishes the American Journal of Occupational Therapy (AJOT) along with Special Interest Sections as a quarterly resource. AOTA  has online resources with evidence-based practice information and articles available to members. The struggle with this means of obtaining evidence based practice and literature is that topics are limited and therapist may not be able to to obtain the evidence they need related to specific clinical questions. Another issue is that the cost of membership.

3.) National Board for Certification of Occupational Therapy (NBCOT) The national certification board for Occupational Therapy professionals provides an online portal for certificants, including evidence-based literature. Pro-Quest is one source for obtaining evidence-based articles needed in practice or for when researching needs. RefWorks is another tool for obtaining evidence-based literature that allows individuals to organize research references and easily create citations and bibliographies.

4.) American Occupational Therapy Foundation (AOTF) is an educational organization striving to  It support occupational therapy research and public understanding of the important relationship between everyday activities (occupations) and health. AOTF creates a quarterly publication, the journal OTJR: Occupation, Participation, and Health.

5.) AOTA and AOTF jointly support OT Search, a literature database of occupational therapy and related health articles. OT Search requires a paid membership.

6.) The Australian Occupational Therapy Association (OTAUS) is another source of current research. Journal articles in the Australian Occupational Therapy Journal are available in the Wiley Online Library.

7.) The Canadian Association of Occupational Therapists (CAOT) publicizes the Canadian Journal of Occupational Therapy (CJOT).

8.) Royal College of Occupational Therapists (RCOT) offers the  British Journal of Occupational Therapy (BJOT) to it's members.

9.) The American Society of Hand Therapy (ASHT) offers the Journal of Hand Therapy 
Finding the time to search various journals can take effort and energy out of a therapist's busy schedule. These searches are often done on a therapist's own time.Other journal options include the British Journal of Occupational TherapyAmerican Family Physician

10) Networking with co-workers- Evidence related to a clinic or therapy setting's particular needs can be shared in team meetings. This form of professional development is performed with colleagues or within small groups at a working place. However, many therapists have said that their workplace is limited in the number of therapists or they may even be working in isolation. This is especially true in the school based environment.

11). Magazines such as Advance for Occupational Therapist PractitionersOT Practice published via AOTA, and Occupational Therapy Now (OT Now) published by RCOT can be a source of locating recent research through article archives. However taking the time to read through it and find specific answers can be a struggle for therapist.

12.) Online sources Today in OT is an online source for obtaining continuing education credits. 
College or university courses, meet-ups. Additionally, alumni are able to access research libraries in many cases.

13.)  EBSCO Information Services provides research databases, e-journals, magazine subscriptions, e-books.

14.) State Association memberships and meetings.

15.) National Institutes of Health is a library of electronic journals, e-books, and databases
PubMed has more than 27 million citations for biomedical literature from MEDLINE, life science journals, and online books. 

16.) The Agency for Healthcare Research and Quality  promotes evidence-based practice and reviews the evidence in order to  facilitate the translation of evidence-based research findings.

17.) The Cochrane Library is part of Cochrane, a network of researchers, professionals, patients, carers, and others, in order to produce valid and reliable health information that is free from commercial sponsorship and other conflicts of interest.

18.) Guideline is a division of the US Health and Human Services that provides a public resource for summaries of evidence-based clinical practice guidelines. 

19.) Google Scholar. Therapists are able to search online for evidence-backed research using Google's tool titled google scholar. Simply type google scholar into the search bar and a library of research is available at your fingertips. However it can be difficult narrow down questions specific to clinical questions. Google Scholar offers a broad search for scholarly literature from a variety of sources including articles, theses, books, abstracts and court opinions, from academic publishers, professional societies, online repositories, universities and other web sites. 

20.) Online Communities like The OT Toolbox Community. The OT Toolbox Community is an online source of networking and collaborating with occupational therapy practitioners from around the world. Members can share resources, add links to evidence-based practice, write blog posts, upload documents, and ask and answer questions. Explore the Evidence Based Practice Library (coming VERY soon!) and add resources that you love with therapists as you promote and enhance the profession! Join us in The OT Toolbox Community!

Where do you find occupational therapy evidence based literature? Let me know at and I will add it to this list as a resource that others can use to find the evidence they need in practice!

Sackett DL, Strauss SE, Richardson WS, et al. Evidence-Based Medicine: How to Practice and Teach EBM. Philadelphia, Pa: Churchill-Livingstone; 2000.

When teaching cursive writing, kids can recognize that cursive letters come in groups. These cursive letter families are how we can teach kids to write letters in chunks of similar pencil strokes. Teaching cursive letters in this manner can be a helpful strategy for allowing kids success when learning the pencil strokes needed for forming cursive letters.  Below, you'll find a subcategory of cursive letter groups: How to write cursive tow rope letters!

As we previously discussed, a specific order a teaching cursive letters doesn't matter as much is teaching a group of letter families together in a block. When students learn cursive letters it is beneficial to learn the pencil strokes associated with cursive letter families. We have covered all of the different cursive letter families including wave letters letters loop letters bump letters. There is a subgroup of cursive letter families that have a slightly different connecting pattern to them. These are the cursive tow rope letters.

Use these tricks and strategies to to teach cursive letters that have a tow rope connection, this includes teaching lowercase cursive letters b, o, v, w.

How to Teach Tow Rope Cursive Letter Connection

If you’ve been following The OT Toolbox over the last month, then you know that there’s been quite a lot of information related to cursive handwriting. We’ve talked about letter formation, cursive slant, cursive writing speed and rhythm, and even how pencil control is needed in cursive handwriting.

Today, we’re finishing up with a last cursive handwriting post in the series. Below you’ll find information on forming cursive letters that contain a “tow rope” connector to the letter following them.

Tow Rope letters are those lowercase cursive letters that connect to the next letter using a horizontal line at the middle line. Most cursive letters connect with a curved line from the baseline. Tow Rope letters connect horizontally and can change formation of the letters that they connect to.

Tow Rope Letters include cursive letters b, o, v, and w.

How to teach cursive Tow Rope Letters

Teaching the cursive tow rope letters is not much different than teaching other letters of the alphabet. 

Use of a cursive writing plan can help, as can kinesthetic methods and multi-sensory strategies. Using tools such as sand paper or writing trays can bring a textural aspect to learning these cursive tow rope letters.

You can read more about teaching each individual letter as they were broken down into cursive letter families:

Loop Letters (Cursive letter b)
Wave Letters (Cursive letter o)
Bump Letters (Cursive letter v)
Tree Letters (Cursive letter w)

Use these tricks and strategies to to teach cursive letters that have a tow rope connection, this includes teaching lowercase cursive letters b, o, v, w.

Trick for teaching cursive letters with a tow rope connection

Teaching kids about the visual of a tow rope that connects a tow truck to it's haul or a boat to a raft  can be helpful in teaching children to write cursive letters with proper connection between these letters and the letter they connect.

If the tow rope sags or dips down, it can affect how the letters appear and result in inaccuracies.

To show kids how to recognize and recall use of tow rope connections, draw a small truck at the end of the tow rope connecting lines.

Practice cursive letter connections for tow rope letters

Practice the combinations of cursive letters that contain tow rope letters:
-ba, be, bi, bl, bo, and by
-va, ve, vi, vo, and vy
-wa, we, wi, wo, and wy

-Letter o can be practiced with every letter of the alphabet as a vowel letter.

Use the verbal cues associated with each letters cursive family to formation of these letters. 

However pencil stroke exercises can be influential in behind and horizontal line to connect. Additionally practice with commonly connecting letters can make a big impact.

In this way students with practice tow rope letters that connect to other letters as a group. These letter blends commonly and within minutes.

How to Teach Lowercase Cursive b

Teach students to practice be connected to letters that may occur within words. This includes ba, be, bo, bl, br, by.

How to Teach Lowercase Cursive o

Students can practice the commonly connected letters used in words as the letter connects to the second letter. As a vowel, the letter o may connect to every letter of the alphabet. Because of this, students who are learning cursive can practice the formation of o to the individual pencil strokes that are part of different cursive families. That is, practice o connected to the bump of bump letters, the o connected to the wave that occurs wit wave family letters, the o connected to the spike of tree letters, the o connected to the bump of bump letters, and o as an ending letter.

How to Teach Lowercase Cursive w

Students can practice the connection of lowercase cursive w to vowel and some consonant letters:
Wa, we, wi, wh, wr, wl, wm, wn, wy.

How to Teach Lowercase Cursive v

Students can practice the connection of lowercase cursive v to vowels and commonly used consentent letter combinations. This includes: va, ve, vi, vo, vr, and vy.

Use strategies such as creative cursive to practice these letter combinations in innovative manners to prevent boredom.

Try these creative ways to practice cursive writing to help kids learn to write cursive letters and write legibly.Creative ways for kids to work on cursive writing including letter formation.

Recently, there was a question in our Sweet Ideas for Handwriting Help facebook group about Christmas activity ideas that promote the development of fine motor skills. These Christmas Fine Motor Activities are creative ideas that boost dexterity, build fine motor strength, promote precision of grasp, enhance separation of the two sides of the hand, and enhance tripod grasp. 

These fine motor ideas can be used in the classroom as a Christmas craft that doubles as a fine motor activity and can be used to help kids develop the underlying fine motor skills that are needed for so many functional tasks.

Go through the activities below and find your favorite way to play and develop fine motor skills this holiday season!

Check out the Sweet Ideas for Handwriting Help Facebook group for lots of handwriting resources.

Use these Christmas fine motor activities to develop skills like hand strength, grasp, endurance, prehension, bilateral coordination, visual motor skills, and more in order to help kids with pencil grasp, handwriting, scissor use, and more.

Christmas Fine Motor Activities

When kids make crafts or holiday decorations, they are using and developing many skills. Manipulating tools such as scissors, glue, hole punches, tape, glitter, etc, kids experience various tactile experiences.

Creating with paper or other material requires visual motor skills (eye-hand coordination), fine motor manipulation and strength, dexterity,  bimanual coordination, visual perceptual skills, visual attention, prehension, midline crossing, and visual spatial awareness.

By using tools such as scissors or a hole punch, children can gain proprioceptive input that can be calming within the classroom environment. 

Here are Christmas themed Fine Motor Activities that can be used in the classroom, home, or clinic this holiday season:

Use this Christmas Tree Hole Punch activity to develop strength in the hands and more. This activity uses a hole punch to create lights for each Christmas tree. The bonus with this craft is the learning and math component. Add a colorful twist by adding colored tissue paper to the backs of the trees with glue. 

Use crumbled tissue paper to create this Fine Motor Christmas Tree from Crafts on Sea. Crumbling paper develops the arches and builds strength in the hands. 

Kids will love this Christmas Jingle Bell Sort activity and won't even realize they are building skills they need for development. This activity can be used all season long to help kids develop in-hand manipulation and separation of the two sides of the hands as kids sort colored jingle bells.

Make these Fine Motor Lacing Christmas Trees from Happy Hooligans to develop skills like visual motor integration, bilateral coordination, tripod grasp, and more. 

Creating this Snowman Fine Motor Craft is a fun way to develop skills like bilateral coordination, pincer grasp and more. This craft is one that builds fine motor strength and precision while creating a fun holiday decoration. 

Boost fine motor skills like grasp, strength, and more when making these Craft Stick Christmas Trees from Easy Peasy and Fun. 

This Fine Motor Christmas Tree Craft addresses many skills needed for development and function. This craft has been very popular here on The OT Toolbox. It's a way to recycle egg cartons while working on various skills: bilateral coordination, fine motor strength, visual attention, spatial awareness, arch development, wrist extension and stability, and more. 

These Fine Motor Christmas Trees from Stir the Wonder are fun decorations that promote bilateral coordination skills. 

Use recycled bottle caps to make this Bottle Cap Fine Motor Christmas Tree Craft. This fine motor activity can be a holiday decoration that boosts fine motor skills such as precision, in-hand manipulation, tip-to-tip pincer grasp, rotation and dexterity of the fingers needed for in-hand manipulation, and bilateral coordination.

You can find more Christmas themed play and fine motor crafts and activities here on this 25 days of Christmas Play series that we shared a few years back. 

Working on handwriting with kids this Christmas season? Grab your copy of the Christmas Modified Handwriting Packet. It's got three types of adapted paper that kids can use to write letters to Santa, Thank You notes, holiday bucket lists and much more...all while working on handwriting skills in a motivating and fun way! Read more about the adapted Christmas Paper here

Use these Christmas fine motor activities to develop skills like hand strength, grasp, endurance, prehension, bilateral coordination, visual motor skills, and more in order to help kids with pencil grasp, handwriting, scissor use, and more.

When visual perceptual skills interfere with handwriting, students can be limited in copying skills, placing letters and words on lines, and in given spaces on worksheets. There are other red flags related to visual processing and handwriting. These challenges really impact legibility, letter reversals, letter size, and overall neatness of handwriting.

While parents and teachers can be aware of these issues and the need for intervention in order to address underlying needs, it can be difficult to pinpoint exact strategies for improving problem areas.

Use these strategies to address visual perception needs for better handwriting.

Visual Perception Needs and Handwriting

Visual Perceptual Skills consist of several abilities that allow us to utilize the information we see visually. We process and use that visual information to interpret what we see. Visual perceptual skills include the following skill areas: 

Visual Memory

Visual Closure

Form Constancy

Visual Spatial Relationships

Visual Discrimination

Visual Attention

Visual Sequential Memory

Visual Figure-Ground

Each of these visual perceptual skills is described further in this post that shares helpful visual perceptual tools for improving on these skills. 

Visual perceptual skills play an important role in letter formation, copying words and letters, spatial awareness, left-to-right orientation and organization on a page, line use, size awareness. 

When visual perceptual skills coordinate and integrate with motor skills, a child demonstrates functional visual motor integration and is able to copy and form letters appropriately when writing.

Strategies to Help with Visual Perceptual Needs and Handwriting

Try these handwriting accommodation strategies to address a variety of handwriting challenges. 

A common tool for therapists is to use modified paper when visual processing issues interfere with handwriting legibility and functional use.

One way to work on handwriting legibility is to add bold lines to the paper.  This is just one easy way to help kids attend to the lines on the page, visualize a stopping point for letter formation, and draw attention to the writing space.  

Adding bold lined paper into the classroom can be a struggle as well. Given a variety of worksheets, a simple marker can be one way to address this need for creating a bold baseline. 

Adding a highlighted space to the lines can be a way for students to form letters of appropriate size. 

Using color-coded lines as visual tools for starting and stopping points can be a valuable strategy to help kids with placement on lines accurately. One of the most impactful areas to address when working on overall legibility is to address letter size and spacing. When these two areas are addressed, written work can be much more legible overall. 

Given these three strategies for improved legibility, can can be difficult to know what works best for each individual student.  

Having options to trial with each student can make a big impact in success of the student and motivation to try handwriting tasks.

Read about the Visual Perception, Tangrams, & Handwriting Workbook

For the student who struggles with handwriting, practice can many times be a source for stress low confidence.

That's one reason why the Christmas Modified Paper Handwriting Packet was established. 

The packet of 30 different types of paper uses a Christmas theme to encourage students to practice handwriting with various lined paper options. Included are color-coded lines, bold lines, and highlighted spaces. Students have the opportunity to address visual perceptual needs while working on handwriting with a Christmas theme.

Included are holiday writing prompts that can be used as a guide for initiating handwriting activities with the different paper styles. 

Use these strategies to address visual perception needs for better handwriting.

Working on Handwriting?