Caregiver Stress and Burnout

professional caregiver burnout

If caregiver stress and burnout wasn’t a common condition prior to the Coronavirus shutdown of 2020, it certainly is now. During the height of the pandemic, people found themselves caring for their children (typical and with special needs), elderly parents, and spouses 24/7. 

Caregiver stress and burnout

Prior to this life changing event, caregivers did not realize what a blessing school and daycare were, in terms of lifting some of the responsibilities and stressors for a few hours.  During the shutdown in 2020, caregivers flocked to social media, and were incensed that they had to be the ones to teach their children at home, or provide circle time and socialization all day.  

As a therapist and parent of grown daughters, I was frustrated by the comments from these angry parents.  I wanted to exclaim, “this is YOUR child!”  YOUR responsibility!  I understand the toll caring for others takes on a person, however I never considered teachers to be a requirement, or a given; they were privileges and gifts. 

Instead of unleashing fury about having to take care of your loved ones, let’s rewrite the narrative.  How about, “this is hard, day after day. Their teachers must be miracle workers. Or, “I can’t understand how their daycare teachers manage this so well,  I’m exhausted.”

caregiver stress and burnout

No matter what the narrative is or was, the end result is caregiver stress and burnout. Ron Ingbur, JD writes, “caregiver stress syndrome is a condition characterized by physical, mental and emotional exhaustion. It typically results from a person neglecting their own physical and emotional health because they are focused on caring for an ill, injured or disabled loved one”

Check out this article on caregiver stress. People were (and still are) blurring the boundaries between their roles, trying to do too much, not wanting to ask for help, and attempting to be perfect in this imperfect world.

The OT toolbox has a great post on family wellness and a research article on wellness that are good resources to have.

Professional Caregiver Burnout

Caregiver burnout and stress is not limited to families. Healthcare workers, daycare attendants, teachers, therapists, and many more adults take on the role of caregiver, often neglecting their own needs. 

Professional caregiver burnout is a real thing.

As an Occupational Therapist (and a mom and wife)  I hit a wall right before the pandemic took over. I tried changing jobs, reducing hours, decreasing my caseload, none of these relieved my symptoms.  The pandemic was a blessing of sorts for me. 

While it was not 100% solitude, (my husband and teenage stepson still roamed the house looking for food) it was eye opening to realize the change that was happening in my mental and physical health, by having a few months off of work to breathe and reflect.

The lesson I learned, (too late) was I should have taken better care of myself and my needs, before hitting a wall I could not recover from.  Check out these self-care strategies for therapists.

A self-reflection journal for therapists can be a great tool to add to your own toolbox when battling professional caregiver burnout.

common signs of caregiver stress and burnout

Though everyone differs, the common signs of caregiver stress syndrome are:

  • Changes in appetite, weight, or both
  • Depression – feeling blue, hopeless, irritable, helpless, loss of interest in activities
  • Withdrawal from friends and family – these are just one more added stressor
  • Changes in sleep patterns – either sleeping too long due to exhaustion and burnout, or not getting enough sleep due to responsibilities and stress
  • Getting sick more often – not only are caregivers exposed to more illness, their own immune systems are often compromised by their exhaustion and stress
  • Negative thoughts of wanting to escape, hurt yourself, or the person you are caring for
  • Emotional and physical exhaustion
  • Anxiety – intrusive thoughts, obsessions, perseveration on beliefs and feelings

Caregivers find they snap at the ones they love, have nothing left to give when they come home, can not spread their attention across everyone in the family, or constantly feel they are failing.  

caregiver burnout quiz

Think you might have caregiver burnout? 

In addition to the emotional toll caregiving places on a person, there are physical manifestations as well.  According to Igbur, 45% of caregivers reported chronic and possibly life threatening conditions, 58% of respondents said their eating habits were not the same as before, and 72% reported they did not go to the doctor as often as they should.  

What about the little things?  I see caregivers who have not had a hair cut, been to the dentist, or bought new clothes forever.  One of my patient’s moms was wearing old shoes that were duct taped together, using a computer missing several keys (she is a writer, so this is kind of critical), because she put everyone else’s needs so far above her own.  

Once you (or a loved one) recognize the symptoms or caregiver burnout, it is time to take action.  Caregivers who feel they need to do it all, (I was one of them) are the most reluctant to get help.  It is important for these caregivers to realize that they are not going to be of any help to anyone if they are lying in a hospital bed, dead, or having a nervous breakdown.  

how to alleviate caregiver stress and burnout

  • The first step is to take a break.  While a two week vacation in the Bahamas is just what everyone needs, this is not always possible.  Sometimes a break means twenty minutes of alone time in the bath, or a stroll through Target without anyone asking for anything.  Seek assistance from friends, family members, neighbors, church members, groups, organizations, or professional respite care agencies. Caregivers do not need to leave the house while their respite carer, or other helper is in their home.  They can take a nap, do some gardening, lie in the sun, watch Netflix, or whatever they find relaxing. Some of these respite care resources are voluntary, grant funded, or paid agencies.
  • Next, lighten the load.  What tasks or responsibilities do you have that someone else could easily do?  Maybe someone else can clean the house, do the grocery shopping, pick up the other kids at school, take grandma for a stroll, or deliver meals.  Don’t be too proud to share the workload.
  • If you are working outside of the home, talk to your employer about your options.  Maybe you can flex your hours to include a little downtime, take family medical leave if necessary, or cut down work hours.  People are often afraid to ask their bosses for fear of being laid off. To reiterate, if you are so overworked you end up in the hospital, or deceased, your job won’t matter.
  • Once a little time has been freed, take care of yourself. Go to the doctor, visit the dentist, talk to a therapist, join a support group, reconnect with friends, get your hair colored, get some rest, exercise, meditate, color, take a bath, or whatever you have been neglecting while caring for others.

Whether you are a parent, child, healthcare worker, teacher, spouse, or other caregiver, make sure your entire tribe knows what responsibilities you have.  Let your child’s OT know you only have about 15 minutes to spare each day to work on their home program. Talk to their teacher about what amount of homework you and your child can get done each week. Have a discussion with your coworkers about dividing the workload more evenly, and speak to your friends and family so they understand what you should/not take on, and how they can help.  

control what you can

In a caregiver role, there are many things out of your control.  As a teacher you may not be able to control the number of students in your class, but you could streamline your day to be more efficient, or get a housekeeper and a cook to lessen the load when you get home.  You may not be able to decrease your hours at work, but you can make the most of your lunch time by going outside for a walk, eating a yummy snack, taking a nap, or catching up with a friend. Parents may not be able to send their children to school or afford daycare, but they may be able to swap babysitting hours with a friend, join a meal sharing group, or create a playgroup, where there is emotional support as a group while the children play.

Caregiver stress and burnout is huge.  Not just because of the Coronavirus. Adults are living longer, possibly needing more care from their children. There is an increase of children who have special needs requiring extra care, therapies, and appointments.  People are taking on multiple rolesk while juggling a busy job and household. Overscheduling and committing are becoming the norm.

The hardest step to alleviating caregiver stress and burnout

While the first step is recognizing the problem, the HARDEST step is doing something about it. It takes a lot of swallowing your pride, compromising, and feeling the agony of defeat, to ask for help.  Caregivers will find it tough to watch someone clean their house while they take a bubble bath or rest.  Some with find it even more difficult to let a respite care worker take care of their loved one, while they head out to the movies.

This article has some great resources and websites to learn about and combat caregiver stress.

You will thank yourself later.  While I love the job I landed in, I can’t help but wonder what path my career might have taken if I had recognized the burnout sooner, and done something about it. Now that my girls are grown, I constantly reflect on my parenting with doubt and angst, thinking I might have been more patient if I had taken that nap.  

Victoria Wood, OTR/L

Victoria Wood

Victoria Wood, OTR/L has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

*The term, “learner” is used throughout this post for readability, however this information is relevant for students, patients, clients, children of all ages and stages or whomever could benefit from these resources. The term “they” is used instead of he/she to be inclusive.

Receptive Language

receptive language

This blog discusses the importance of receptive language and how it impacts development. Learn why understanding directions directly correlates to a child’s behaviors. You will discover receptive language activities to support preschoolers in complying with age appropriate requests. Read in this blog how auditory processing and attention play a huge role in receptive language.

Receptive language information and tools

What is Receptive Language?

Receptive language refers to how we understand spoken words, the language around us, and the ability to hear/understand/comprehend spoken language. Language is needed for learning, play, communication with others, understanding directions, safety, and participation in everyday activities. Functional participation requires receptive language in order to thrive and communicate wants, needs, thoughts, and ideas.

Receptive language can include spoken, written, and implied language. It is the intake of information, therefore receptive language can include un-spoken words. 

How about Expressive Language?

Receptive language is the information that is taken in.

Expressive language, in contrast, refers to the use of language to communicate with others. Expressive language is “expressed” through speech, sign, written words, picture symbols, gestures, body language, or alternative forms of language to communicate wants, needs, thoughts and ideas.

Receptive and expressive language are different aspects of language but are closely connected.

Receptive and Expressive Language

Expressive and receptive language fit together like important puzzle pieces. Any form of communication such as sign language, alternative forms of communication, and non-verbal cues, are types of both receptive language and expressive language. 

There are many different components that affect a child’s behavior, including the environment, co-regulation (link to co-regulation blog post), sensory needs, emotional vocabulary development, relationships, and developmental milestones. 

As children develop, their comprehension skills and ability to interact with the world changes.

Receptive and Expressive Language in Tantrums

Miscommunication occurs between adults and preschoolers when children are given directions in ways they don’t understand. When a child has difficulty with understanding what is asked of them, the result is often a tantrum. The same is true when a young child does not have the words to express themselves.

There are many reasons why preschoolers have difficulty following directions, or responding to age appropriate prompts. Sometimes they do not understand the directions.

Other times, toddlers do not want to do what is asked of them. When they are upset, overwhelmed and uncooperative, give children the tools to settle down.

Once a child has calmed down, try giving the direction again. Encourage them to use words to communicate why they are feeling frustrated about the direction, and if they have a different idea on how to complete a task.

You can see how the receptive language input and expressive language communication output, along with auditory processing, or sensory processing of auditory input, all connect and impact one another as they play a role in tantrums vs. sensory meltdowns. It is all connected!

Why is receptive language important? This article covers receptive language development.

Receptive Language Development

Toddlers and preschoolers learn new words at a rapid rate. One morning you may hear your child say a three word phrase, and the next day they say a five word sentence. A child’s brain is magnificent, growing rapidly through the first five years of their life. Because development is complicated, it may feel overwhelming to new parents. This article explains important milestones by age. 

When children are born, they understand facial cues, the sounds and tones in voices, and follow gestures. As they grow, children start to understand pointing, hand gestures, spoken words, and picture vocabulary. Receptive language is the foundation to a child’s ability to understand what is being asked them, or others in their environment. 

As children learn about the meaning of gestures and words, they are able to anticipate and respond to the needs of those in their environment. The process of how our brains collect and decode language, is complex.

When children are learning how to process language, adults can support their comprehension by providing directions in simple phrases, incorporating gestures, and being patient when a child forgets to complete a task. Being mindful of the environmental surroundings also plays a key role in making sure children are able to focus on the words being directed towards them, with minimal sensorial distractions. 

For instance, if a parent yells a three-step direction from the kitchen while their four year old is watching a television show in the other room, it is likely the child did not hear the entire direction.

They may hear the first, middle, or last part of the phrase instead. When a child is given a direction that is new to them, or that they don’t fully comprehend, it may take a few moments for children to process and understand what is asked of them.

One important tip for receptive language skills is to give a child a moment to process directions before repeating them. If they still do not understand, speak slower, with shorter commands.

Students who are strong in these skills may be auditory learners.

The Anatomy behind language

This peer reviewed article on “The Functional Neuroanatomy of Language states:

  • Recognizing speech sounds is carried out in the superior temporal lobe bilaterally
  • The superior temporal sulcus bilaterally is involved in phonological-level aspects of this process
  • The frontal/motor system is not central to speech recognition, although it may modulate auditory perception of speech
  • Conceptual access mechanisms are likely located in the lateral posterior temporal lobe (middle and inferior temporal gyri)
  • Speech production involves sensory-related systems in the posterior superior temporal lobe in the left hemisphere
  • The interface between perceptual and motor systems is supported by a sensory-motor circuit for vocal tract actions (not dedicated to speech)
  • It is very similar to sensory-motor circuits found in primate parietal lobe
  • Verbal short-term memory can be understand as an emergent property of this sensory-motor circuit.” 

No wonder language is so complicated!

Receptive language activities and strategies for receptive and expressive language

Receptive Language Activities

Focusing on receptive language activities support the development of receptive and expressive language, because these types of language are so closely tied together.

Talk

Encourage children to take part in everyday activities to build language comprehension, understand social cues, and follow directions given to them on a daily basis.

Talk with them all the time. Have conversation in the car, name all the items in the grocery store, talk about their daily schedule, and encourage opportunities for them to express themselves.

Age-appropriate activities

When children are provided with age appropriate cues, and a calm down spot to process their feelings, they can thrive in all aspects of development.

Focus on auditory attention during these age-appropriate tasks.

Here are nine simple ways to ensure your kids are hearing and understanding directions:

  1. Make sure to give directions in simple form (one step directions for children under 20 months old; two-step directions for children under three years old; three step directions for children under five years old).
  2. Use visual and auditory cues when giving directions, such as pointing, gestures, words and picture cues. 
  3. Give directions when you are in front of the child, kneeling down at their level. 
  4. Make sure you have their undivided attention (no television, music, electronics, or other distractions).
  5. Encourage eye contact if appropriate (some children with neuro-diverse needs have a harder time making eye contact and this is not appropriate. It is always important to address individual needs, strengths, and goals).
  6. Make sure what you are asking the child to do, is developmentally appropriate for their current skill level. 
  7. Use these first/then visual cards to communicate what you are requesting. 
  8. Implement a visual schedule to support requests around transition times. 
  9. Try the activities in the Auditory Processing Kit found on the OT Toolbox. This printable resource offers tools to support listening skills, whole body listening, listening comprehension, active listening, and auditory processing needs. This printable packet contains active listening activities, hands-on strategies, activity cards, visual cards, handouts, and more.
  10. Try a DIY whisper phone to focus on auditory attention, sounds, and focus on a whisper.

Why is receptive language important?

Receptive language development directly affects all areas of development, from attention span, to literacy, social skills, and many more.

Receptive language development is important for:

  • Learning
  • Comprehension (hearing and deciphering between auditory cues- suffixes, pronunciations, tone, etc. in speech)
  • Communication skills
  • Social emotional development
  • Safety
  • Play and interaction with others
  • Functional development
  • Many other task and participation skills!

It’s easy to see how language challenges with nuances of receptive input can impact so many areas. These are just some of the difficulties a child with delayed receptive language development may present with. 

Challenges related to receptive language include:

  • Attention and concentration challenges- Sustained effort is involved in understanding language, and being able to hold that information long enough to get the task done.
  • Behavior challenges- Not being able to understand and perceive directions, can result in social emotional challenges, or maladaptive behaviors.
  • Literacy challenges- Reading and writing struggles can occur in the classroom with if a person has receptive language struggles.
  • Social skills concerns- Participating in social situations can be difficult when engaging in reciprocal interaction with others (either verbally or nonverbally). This can impact social situations, social emotional learning, and functional participation.
  • Sensory processing needs- Auditory registration of sounds, language, and information can be impacted through sensory processing disorders. 
  • Executive functioning requires using auditory information that is received and processed, to complete higher order reasoning and thinking skills, following directions, participating in tasks, and using working memory.
  • Expressive language delays- Expressive language can be impacted by not understanding language from others (receptive language delay), because it is not accurately received correctly, in order to be processed. 
  • Planning and sequencing concerns- Receptive language impacts direction following, and accurate sequential completion of multi-step tasks 
  • Auditory Processing issues- Difficulty in the ability to hear sounds, distinguish between similar sounds or words, and separate relevant speech from background noise.

A final note on receptive language

Receptive language impacts a variety of areas of development. When teachers and other caregivers slow down speech, and support receptive language skills, all other areas of a child’s life will benefit.

Starting at birth, singing, talking, and reading to children, helps develop neuron and synapse development in the brain. 

Don’t forget to check out all of the great resources on the OT Toolbox, including the Auditory Processing Tool Kit.

Auditory Processing Kit

Jeana Kinne is a veteran preschool teacher and director. She has over 20 years of experience in the Early Childhood Education field. Her Bachelors Degree is in Child Development and her Masters Degree is in Early Childhood Education. She has spent over 10 years as a coach, working with Parents and Preschool Teachers, and another 10 years working with infants and toddlers with special needs. She is also the author of the “Sammy the Golden Dog” series, teaching children important skills through play.

Fine Motor Milestones

Fine motor checklist

Let’s break down child development into the fine motor milestones typically seen at each age. This compilation of early childhood physical development includes a fine motor milestone checklist for each age range, birth through six years. This fine motor milestones list can be helpful for parents of young children, teachers in preschool through the early grades, and occupational therapy professionals looking for fine motor developmental resources. 

Fine Motor milestones impact function. Get this printable fine motor checklist and support kids development of fine motor skills.
Fine Motor milestones impact function. Get this printable fine motor checklist and support kids development of fine motor skills.
Access at the bottom of this blog post.

Fine Motor Milestones

Developmental milestone guidelines may be shifting as reported in this Evidence-Informed Milestones for Surveillance Tools article, but your friendly neighborhood occupational therapist can help you understand what to look for at each stage of child development. 

Most children follow a general developmental pattern in early childhood physical development. Understanding the typical and expected development of skills, is important when identifying potential areas of concern. Fine motor skills, the area of development detailed in this post, entails the actions of the arms, hands, wrists, and fingers, in order to manipulate objects. 

It’s important to note that these fine motor milestones indicate a developmental progression. While not every date is a hard marker, it is important to see progression, and the ability to achieve the motor skills that make up pre-writing skills. Pre-writing fine motor skills are the important skills needed in preschool, before a child is asked to write.

It is critical that the child is developmentally ready for writing, by learning these early fine motor skills first. 

If you know a child who is not meeting the early childhood physical development suggestions below, don’t fret – there are many ways to address fine motor skills through these fun activities found on the OT Toolbox! 

FINE MOTOR MILESTONES – BIRTH to 6 MONTHS

In the newborn stage of life, starting in utero, foundational movement skills are practiced. Babies move their hands and arms generally and reflexively (check out this article on primitive reflexes), while they learn their bodies and the environment. As they start to grow, you will see a very active and capable 6 month old baby – see below for a fine motor skills checklist.

NEWBORN – 2 MONTHS

  • Has a strong grasp; Opens and closes fists
  • Brings hand to, or near mouth 
  • Arms stretch out and hands open 
  • Scratches fingers along blanket or clothing
  • Looks toward outstretched hand (often eliciting the ATNR reflex)

3 – 5 MONTHS

  • Holds a toy when placed in hand
  • Uses arms to purposely swing at toys
  • Brings hands to mouth consistently
  • Pushes up onto elbows/forearms when on tummy

6 MONTHS 

  • Consistent, purposeful reach using vision to guide movement
  • Transfers objects hand to hand
  • Finger feeds large foods (e.g., biscuit)
  • Shakes/bangs toys 
  • Leans on hand/s to support seated position

FINE MOTOR DEVELOPMENT 7 to 24 MONTHS

Gross motor development is very noticeable at this time, therefore fine motor development slows during this stage. Crawling, furniture cruising, and walking usually occur. What about fine motor skills? Read on to see all of the development that occurs in the “small” motor movements in the way of fine motor milestones for toddlers.

7 – 9 MONTHS

  • Plays using arms (Peek-A-Boo; So Big!)
  • Index finger use to “poke” 
  • Raking cereal with fingers to grasp 
  • Purposeful grasp and release of objects into containers
  • Grasp on thumb side of hand 

10 – 12 MONTHS

  • Grasps with thumb and 2 fingers
  • Pincer grasp develops; picks up cereal/small objects with thumb and index finger
  • Imitates tool use (e.g. brushing hair, using a toothbrush)
  • Uses hands to push, pull, squeeze and rotate
  • Removes socks 
  • Stacks blocks; may not balance them

12 – 24 MONTHS

  • Self feeds using hands or utensils
  • Points with index finger
  • Complete simple form shape puzzles (circle, square, then triangle)
  • Brings hands together to midline for use 
  • Scribbles on paper spontaneously 
  • Holds crayon with fisted hand
  • Stacks 2-6 block tower

FINE MOTOR MILESTONES FROM 2 to 4 YEARS

As children develop from toddlers into preschoolers, and gross motor development has reached major milestones, tons of fine motor skills begin to shine! Check out this checklist of fine motor milestones for young preschoolers.

2 – 3 YEARS

  • Pushes, winds, slides to activate toys
  • Self feeds with utensils and open cup, some spillage. 
  • Screws/unscrews lids
  • Strings several large, 1 -1.5  inch beads
  • Imitates, eventually copies from a model, vertical, horizontal lines, and circle 
  • Holds crayon with thumb and fingers
  • Stacks 6-8 block tower, begins to follow block designs
  • Uses scissors to snip paper
  • Turns single pages in book

3- 4 YEARS

  • Self feeds with utensils and open cup, little spillage.
  • Strings small beads
  • Snaps clothing, zips with assistance, begins to manipulate large buttons
  • Folds and creases paper
  • Imitates, then copies a cross (“t”) 
  • Draws a two part person
  • Holds pencil with thumb and fingers
  • Stack 9-10 block tower, begins to copy block designs (train, bridge, wall)
  • Uses scissor to cut along a thick, straight line 

FINE MOTOR DEVELOPMENT FROM 4 to 6 YEARS

Fine motor milestones for kindergarten and young elementary ages are a huge part of development during these years. Somewhere around this time, children with start school. Many of the fine motor skills will be tested here. Think of all of the crafts, puzzles, books, and small play items that they will encounter! 

4 – 5 YEARS

  • Self feeds with utensils and an open cup, no spillage.
  • Imitates 4-6 part block designs
  • Buttons clothes
  • Laces sewing card
  • Opens all fasteners
  • Imitates then copies a diagonal line, square, triangle, and X
  • Draws a 3 part person
  • Uses scissors to cut simple shapes 

5 – 6 YEARS

  • Builds complex designs with Legos, Tinker toys, etc. 
  • Imitates, then copies a rectangle
  • Connects two dots with straight line
  • Copies, then prints first name from memory
  • Copies letters and numbers
  • Draws an 6 part (or more) person, and recognizable pictures
  • Uses scissors to cut complex shapes
  • Ties laces together 
  • Cuts food with butter knife 

RELATED: Interested in more than just fine motor? Read all about Child Development!

Free Printable Fine Motor Checklist

Want a printable Fine Motor Checklist with ages for developmental milestones of these fine motor skills? Use it to support child development, progression of fine motor skills, and to check off fine motor accomplishments.

Want to add this resource to your therapy toolbox so you can help kids thrive? Enter your email into the form below to access this printable tool.

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FREE Fine Motor Milestones Checklist

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    Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
    background is in Human Development and Family Studies, and she is passionate about
    providing individualized and meaningful treatment for each child and their family. Sydney is also
    a children’s author and illustrator and is always working on new and exciting projects.

    occupational therapy for children with cerebral palsy

    cerebral palsy occupational therapy interventions

    Occupational therapists (OTs) treat a wide range of conditions in children. This post focuses on occupational therapy for children with cerebral palsy and treatment. One of the more common neurological diagnoses that OTs treat is cerebral palsy. This post breaks down what cerebral palsy is, and how an occupational therapist can provide interventions and services to address the functional deficits caused by this condition. Some families may need to start with this post: What is Occupational Therapy?

    Occupational therapy and cerebral palsy

    WHAT IS CEREBRAL PALSY?

    Cerebral Palsy (CP) is a group of disorders that can affect the body in different ways, depending on the type and severity. According to the CDC, it is the most common motor disorder among children in the United States.

    The broad condition is better understood by breaking down the meaning of the words: “cerebral” meaning brain, and “palsy” meaning muscle weakness. In the case of CP, the muscles of the body become weak due to an injury to the brain. 

    This injury in the brain can happen during the brain’s development in utero, or early on in an infant’s life. The neural pathways get interrupted or damaged, causing a dysfunction in the way that the brain communicates to the muscles of the body. 

    types of cerebral palsy

    It’s important to cover the various types of cerebral palsy because each type can involve differing occupational therapy interventions. The most common types are spastic, ataxic, dyskinetic, and mixed cerebral palsy.

    Spastic Cerebral Palsy- The most common type of Cerebral palsy is spastic CP. The term”Spastic” refers to the presentation of the musculature affected by the condition. The muscles are spastic, or stiff and tight. The stiffness in the affected muscles, or increased muscle tone, causes difficulties with movement. They may be too “stuck” to move properly. 

    Occupational Therapy for Spastic Cerebral Palsy

    Occupational therapy for spastic Cerebral Palsy can include:

    • Self care interventions
    • Participation in meaningful activities
    • Education on adaptive tools
    • Build on strengths
    • Manage sensory and emotional regulation needs
    • NDT interventions
    • Splinting
    • Positioning
    • Adaptive equipment
    • Compensatory techniques

    Ataxic Cerebral Palsy- Results in balance and coordination deficit. This type of palsy results in abnormal gait patterns, decreased safety in mobility, low muscle tone, tremors, and generally reduced coordination for fine or gross motor activities. 

    Occupational Therapy for Ataxic Cerebral Palsy

    Occupational therapy for Ataxic Cerebral Palsy can include:

    • Environmental modifications
    • Weight Bearing
    • Self-Care
    • Participation in meaningful activities
    • Education on adaptive tools
    • Build on strengths
    • Manage sensory and emotional regulation needs
    • Positioning
    • Adaptive equipment
    • Functional mobility
    • Compensatory techniques

    Dyskinetic Cerebral Palsy– This type of CP describes many different muscle deficits: dyskinetic means uncontrolled muscle movement. Those with dyskinetic CP may have too tight or loose muscles, uncontrollable movements that are fast or slow, or an ever-changing combination of any of these symptoms. In more severe cases, these uncontrollable movements occur often, resulting in requiring more assistance for daily activities. In milder cases, the involuntary movement may be smaller and infrequent, therefore the individual can be more independent. 

    Occupational Therapy for Dyskinetic Cerebral Palsy

    Occupational therapy for Dyskinetic Cerebral Palsy can include:

    • NDT interventions
    • Self-care interventions
    • Participation in meaningful activities
    • Education on adaptive tools
    • Build on strengths
    • Manage sensory and emotional regulation needs
    • Splinting
    • Positioning for safety and function
    • Adaptive equipment
    • Compensatory techniques

    Mixed Cerebral Palsy– There is also a category of “mixed” cerebral palsy, meaning more than one type of palsy is present. The diagnosis of Mixed Cerebral Palsy is given when a child shows symptoms of multiple types of cerebral palsy. When this occurs, there may be differences in different areas of the brain. Mixed cerebral palsy type can present with a wider variety of physical and neurological symptoms.

    Occupational Therapy for Mixed Cerebral Palsy

    Occupational therapy for Mixed Cerebral Palsy can include:

    • Any of the occupational therapy interventions listed above, depending on the specific needs of the individual and based on symptoms.

    No matter the type of CP, every case will be different, because each child comes with their own unique abilities. 

    Cerebral palsy occupational therapy interventions

    Occupational Therapy for children with Cerebral Palsy

    Aspects of the occupational therapy interventions for cerebral palsy are listed below. Because each individual with cerebral palsy diagnosis is so different in the way of tone, musculature, abilities, difficulties, environmental considerations, family environment, and other aspects, there will be no two treatment plans that are exactly alike.

    Neurodevelopmental Treatment (NDT): NDT is a holistic movement based approach, involved in handling and moving the child. In the most serious cases of cerebral palsy, an individual may require total assistance, or be dependent, for the majority of their activities of daily living.

    An OT and a PT provides treatment to control the muscles, and reduce the likelihood of joint contractures. If a joint is bent for too long due to high spasticity, the bones of the joint may begin to “fuse” and a joint contracture is formed.

    This happens often at the elbows, hips, and knees preventing that joint from moving.

    In order to avoid joint contractures, therapists can provide skilled therapy, such as NDT, to correct the spasticity and promote functional movement in the affected muscles.

    Splinting for Cerebral Palsy: In milder cases, a child with spastic CP may be able to perform most tasks independently, but benefit from a splint to guide their upper extremity posture.

    A commonly used splint is a thumb splint with a supinator strap. Many children with cerebral palsy present with tightly closed fingers, and a pronated forearm.

    A thumb splint with a supinator strap can help to position the thumb, wrist, and forearm in a more functional position. This splint is typically prefabricated, made of a soft fabric, attached with velcro. 

    Environmental Modifications: Safety is the number one priority. Occupational Therapy and for children with cerebral palsy might involve an environmental assessment for safe mobility in the home.

    Recommendations may include: non-slip mats, professional railings installed in bathroom/ hallways/stairs, lighting accommodations, removal of clutter/cords/rugs/other tripping hazards, depending on the unique needs of the child.  

    Weight Bearing: Occupational therapy for children with cerebral palsy includes upper extremity weight bearing activities. These can be used on the affected arms to help increase muscle tone in a child with ataxic CP.

    Weight bearing can also increase bone density, to reduce the chance of fractures. It can also improve sensory awareness and proprioception that sends information to the brain about where the body is in space.

    Effective strength and sensory processing can increases safe, functional movements. To make weight bearing fun and playful, try placing the child prone over a physioball, having them reach for preferred toys with one hand, then the other.

    Adaptive Equipment: Feeding tools like the ones in this article on adaptive feeding equipment from the OT Toolbox, may help increase independence, by compensating for shaky movements while feeding.

    To increase coordination for handwriting skill, a variety of adaptations can be used (Amazon affiliate links):

    It is important to make these activities as client-centered and motivating as possible. Having uncontrollable movement can be very frustrating, especially for small children who don’t understand what his happening to their body. Celebrate the little victories and find out what motivates your client to try, try again! 

    Compensatory Techniques: Based on the unique movement needs of the child, occupational therapy for children with cerebral palsy may include alternative methods for the child to complete activities as independently as possible. One example; practice and identify the most functional order to get dressed and undressed.

    Teach which arm to thread into a sleeve first, when to pull the shirt over their head, or how to orient the shirt to efficiently motor plan the following step. Create a song, social story, or picture book to help the child and their family learn.

    A Final Note on occupational therapy and cerebral palsy

    It is important to note that while some children with cerebral palsy may also have cognitive deficits, it is not a trademark of this diagnosis. Many children with CP meet their cognitive milestones.

    A cerebral palsy diagnosis does not mean an individual can not learn, see, hear, and communicate as well as their peers. Seizure disorders, communication deficits, feeding, and swallowing disorders are common comorbidities for individuals with cerebral palsy.

    Be sure to understand the medical needs of your clients in order to provide the best practice and occupational therapy for children with cerebral palsy.

    As with any other patient, once you understand what their barriers and goals are, therapy can be meaningful and fun! 

    Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
    background is in Human Development and Family Studies, and she is passionate about
    providing individualized and meaningful treatment for each child and their family. Sydney is also
    a children’s author and illustrator and is always working on new and exciting projects.

    Hand Clapping Games

    hand clapping games

    Do you remember hand clapping games and activities as a kid? I do! We didn’t have the time occupiers of video games and an abundance of technology, so it was bike riding, roller skating, basketball, board games, and well, hand clapping. This was done with a sibling or a friend, and definitely a go-to when there were sleepovers and visits to the neighbor’s house.  But, did you ever think about the eye-hand coordination benefits, or bilateral coordination, and even crossing midline benefits?

    Hand clapping games and activities using clapping rhymes

    Clapping Therapy?

    Hand clapping games are a fun and engaging way to interact with kids during therapy. Have you tried it? It’s a fun activity, whether it be to a classic game, a made-up song, or just as a quick transition between activities.

    There are so many benefits to hand clapping games, from motor skills, sensory motor, visual motor, and even executive functioning skill development. We cover how each of these areas (and the sub-skills) are developed through the simple clapping activity in therapy.

    But did you know there is a thing called “clapping therapy”? This was a new concept to me but one that piqued my interest. Essentially, the use of clapping therapy is the act of clapping hands to heal. This is considered a viable therapy because clapping the hands together activates skin and joint receptors in the hands (and upper extremities) to activate various systems within the body and brain.

    Some of this idea is linked to reflexology but other considerations can be connected to the proprioception. We know that heavy work or deep pressure through the joints brings awareness and “wakes up” the muscles and joints. So clapping hands is a great way to activate the sensory systems.

    Another consideration with clapping therapy is the fact that clapping stimulates blood circulation. This can be a potential way to promote healing.

    I wasn’t able to find research on clapping therapy, but these are some things to think about when using hand clapping games to build on therapy goals.

    hand clapping therapy games and clapping rhymes

    Build Skills with hand clapping Games

    Hand clapping actually does have many benefits to skill development, and can be a great way to work on specific skills with children. Why? Hand clapping activities are the ‘no-tools needed’ approach to building so many skills!

    In fact, research shows that hand clapping rhymes and games make an improvement in motor and cognitive skills. The study found that kids that participate in hand clapping games have neater handwriting, write better and make fewer spelling errors.

    Read on to see what skill areas the simple use of hand clapping can help develop:

    • Executive function skills– To complete a hand clapping activity, a child develops cognitive skills, but some of the softer skills might be overlooked. When playing a cooperative game like clapping together, there is a component of impulse control, task completion, working memory, attention, sequencing, self-reflection, emotional control, and self-monitoring. These skills can be carried over because of the confidence built up while playing with a friend in a low-stress situation.
    • Eye hand coordination skills– clapping hands together with a friend requires motor coordination to move and place hands together at the same time and positioning. Too far and you over-shoot the target. This is a great way to work with a friend on hitting targets and visual motor integration.
    • Bilateral coordination – hand clapping activities work on the use of both hands and arms to coordinate and reach with good timing either to a song, rhyme, a game with a partner, and even when hand clapping alone.
    • Motor planning – Most any clapping game involves a lot of motor planning to practice the movements needed repetitively. Once the movements are learned, they become more automatic.
    • Crossing midline – Let’s consider crossing midline for a moment: left to right, right to left, reaching diagonally across going up or down. Adding verbalizing the correct hand when in use, will help them to build left and right side recognition, and improve body awareness. 
    • Visual tracking – During hand clapping games with a partner, children must move their eyes continually from left to right, up and down. With a song or rhyme, children also learn to visually track with fluidity and rhythm. They need to watch and track their hands and their partner’s too.  
    • Sequencing – Many hand clapping games involve some sort of story telling in the sequence. This helps some children recall the lyrics more easily. When using hand clapping games and songs that tell a story, children develop important sequencing skills. They may also make a mental picture of that story in their minds as they play. Clapping along to a metronome app is excellent for building sequencing and rhythm.
    • Cognitive skills – The brain gets quite a workout when learning and doing hand clapping songs and games. You can use hand clapping to help children learn to spell a problematic word, or even learn the alphabet! Children can use a problematic word, or the alphabet as part of the song which can help them to recall the letters in sequence. They can also learn to sequence a storyline, making it easier to learn how to include a sequence when writing in the classroom. 
    • Social skills – Have a group in therapy? Hand clapping is ideal to help develop teamwork, collaboration, tolerance, and patience, which are all essential to successful socializing within a peer group. Switch it up and have kids work with varied partners, or work together as a larger group. These varied interactions can help build self-confidence, and proper interaction during play.
    • Memory – Let’s consider memory for a moment. Significant memory skills are needed when recalling simple to moderately complex hand clapping songs, these can require various levels of memory. Think about the lyrics and movements needed for: Patty Cake, A Sailor Went to Sea, Down, Miss Mary Mack, See See My Playmate, Miss Susie, etc.
    • Rhythm – Hand clapping is a great tool for rhythm and beat development, as the hands must develop a rhythm to match the lyrics and time with a partner.  Interactive Metronome is a popular program involving rhythm and timing.
    • Listening – It is a given that hand clapping games help work on listening skills, in order to learn the movements that match the lyrics. During this process, children are also developing the skills needed to combine memory, rhythm, and sequencing, as they listen attentively to follow the directions that are given within a song or rhyme.
    • Vocabulary skills – Many hand clapping rhymes or songs include singing the lyrics while clapping which can help build new vocabulary as the songs are learned. When working with a partner, communication skills can be addressed too. 
    • Proprioception– Hitting the palm of the hand against another hand offers feedback through the fingers, wrists, and whole upper extremity with heavy work input. This quick jolt of force through the upper body is a way to add proprioceptive input through play. The benefit for learning the clapping rhyme hand movements and positioning is through practice and that physical touch feedback is a loop that builds on itself.
    Miss Mary Mack hand game

    Hand Clapping Rhymes

    Below is a round-up list of hand clapping rhymes and/or games that you will probably recall from your childhood, but if not, there are links below to YouTube videos that will demonstrate them for you. It is a great idea to practice these before performing with your students.

    Patty Cake Patty Cake Baker’s Man

    Pat-a-Cake – Actually titled Pat-a-Cake, many children call this rhyme Patty Cake Patty Cake Baker’s Man. This one is instructed by a physical therapist and I love it because she adds great motor planning movements and does it with her 3-year-old co-instructor. 

    Here are the lyrics: 

    Pat-a-cake, pat-a-cake, baker’s man.
    Bake me a cake as fast as you can;
    Roll it, pat it, and mark it with B, (or any letter of your first name)
    Put it in the oven for baby and me.

    miss mary mack Hand Game

    Miss Mary Mack – This one is instructed by a K-5 music teacher. She makes the video using a complete tutorial to teach the lyrics and the movements slowly, and then in rhythm to the song by herself, and then with a partner. The Miss Mary Mack clapping game is a fan favorite among children.

    Here are the Miss Mary Mack lyrics: 

    Miss Mary Mack, Mack, Mack
    All dressed in black, black, black
    With silver buttons, buttons, buttons
    All down her back, back, back.

    She asked her mother, mother, mother
    for fifty cents, cents, cents
    To see the elephants, elephants, elephants
    Jump over the fence, fence, fence.
    They jumped so high, high, high
    they reached the sky, sky, sky
    And didn’t come back, back, back
    Till the 4th of July, -ly, -ly.

    rockin’ robin clapping game

    Rockin’ Robin – The Rockin’ Robin clapping game is demonstrated and instructed by a homeschool mom who gives a short demonstration of the hand movements needed to complete the hand clap patterns to the lyrics, in slow motion. It’s only four hand movements that stay repetitive to the lyrics of the song, so it’s an easier one to teach and to do.

    Here are the Rockin Robin lyrics:

    He rocks in the treetops all day long, hoppin’ and a-boppin’ and singing his song 

    All the little birds on Jaybird Street love to hear the robin go tweet-tweet-tweet 

    Chorus: Rockin’ robin, Rock-rock-rockin’ robin’ Go rockin’ robin ’cause we’re really gonna rock tonight 

    Every little swallow, every chick-a-dee, every little bird in the tall oak tree 

    The wise old owl, the big black crow flappin’ their wings singin’ “go bird, go” 

    Chorus: Rockin’ robin, Rock-rock-rockin’ robin’ Go rockin’ robin ’cause we’re really gonna rock tonight

    double this double that

    Double This Double That – This clapping hands rhyme is also demonstrated and instructed by the same homeschool mom who will show the simple hand movements needed, and discusses briefly how it can be used as a fun elimination game. You can do this one at various speeds, making it a super coordination activity in therapy. Use it with a partner, or part of a group activity. 

    Double This Double That Lyrics:

    Double, double this this,

    Double, double that that,

    Double this, double that,

    Double, double this that.

    twinkle twinkle little star

    Twinkle, Twinkle, Little Star – This one has a unique teaching approach performed by an occupational therapist using this familiar song to work on hand movements in three different patterns. Go OT! I like this one as it can be done on the table top, but you could easily do the same movements with a partner too. There are no actual lyrics with this version of the activity, but they can easily be added during game play. 

    Twinkle Twinkle Little Star lyrics:

    Twinkle, twinkle, little star
    How I wonder what you are
    Up above the world so high
    Like a diamond in the sky
    Twinkle, twinkle, little star
    How I wonder what you are

    clap RHyme

    Clap – This Clap rhyme activity uses hand clapping as an exercise that is great for a whole-body warm-up, or as a sensory break. It uses upbeat music that the instructor claps along with, showing other body movements that are used in coordination with the clapping to improve body awareness, motor coordination, and endurance too!

    There are few lyrics with the Clap rhyme activity, but there is a tune or beat that is played in the background as the video plays. 

    avocado Hand Game

    Avocado – This hand clap video is demonstrated by Miss Mortimer who is a K-5 Music Teacher. The video is funny because the dog feels left out, and wants to participate too!  She does a great job doing the demonstration of the Avocado hand game slowly, then along with the lyrics. Later Miss Mortimer shows an additional hand movement to make this clapping game more challenging. She also shows how you can speed it up, and then how you change the song when you lose the game. 

    Here are the lyrics to the Avocado hand game:

    Avocado, avocado, avocado, is the name of the game

    If you mess up you have to change the name

    a, b, c, d, e, f, g, h, i, j, k, l, m, n, o, p, q, r, s, t, u, v, w, x, y, z.

    Hot cross buns Rhyme

    Hot Cross Buns – This hand clapping demonstration is done by a homeschool mom with her child. They demonstrate how to do this hand clapping to the Hot Cross Buns rhyme in a variety of ways. I like the hand movements she uses as they incorporate a variety of motor planning skills. 

    Here are the lyrics to the Hot Cross Buns rhyme:

    Hot cross buns!
    Hot cross buns!
    One ha’ penny, two ha’ penny,
    Hot cross buns!
    If you have no daughters,
    Give them to your sons
    One ha’ penny,
    Two ha’ penny,
    Hot Cross Buns!

    Concentration Clapping Game

    In the concentration clapping game, you sit or stand across from a friend. Clap hands together after saying each line from the rhyme. This game supports development of attention, working memory, focus, and impulse control, as well as emotional control when the inevitable mistake happens. Players can list out numbers or they can substitute the numbers for different categories such as fruits, animals, sports, foods, etc. The slaps and claps can be hitting hands face to face followed by crossing the arms to clap. Then player one, continuing the rhythm, says a number or other word (colors, sports, foods, etc.) twice. Then the other player repeats those words and adds their own words in the same category. This goes back and forth as the players keep adding more words to the list.

    Here are the lyrics to the Concentration Clapping Game:

    Concentration (slap slap clap clap)

    Are you ready? (slap slap clap clap)

    If – so – (slap slap clap clap)

    Let’s – go! (slap slap clap clap)

    For example: cat, cat (slap slap)

    The other player then does the same, starting with their own number and following with someone else’s:

    cat, cat, dog, dog (slap slap clap clap)

    Use these clap games in therapy or at home

    So, do you feel inspired to get your hands clapping yet? Does this bring back memories of the playground songs, “Say Say my Playmate, Down Down Baby, or Miss Suzie? Once you view these fun videos, you’ll want to start using hand clapping as an intervention tool in your therapy sessions where you’ll start seeing children build important developmental skills while having some fun and getting a few laughs in too!

    Pair these concentration clapping games with hula hoop activities and backyard tag games for old school fun!

    Regina Allen

    Regina Parsons-Allen is a school-based certified occupational therapy assistant. She has a pediatrics practice area of emphasis from the NBCOT. She graduated from the OTA program at Caldwell Community College and Technical Institute in Hudson, North Carolina with an A.A.S degree in occupational therapy assistant. She has been practicing occupational therapy in the same school district for 20 years. She loves her children, husband, OT, working with children and teaching Sunday school. She is passionate about engaging, empowering, and enabling children to reach their maximum potential in ALL of their occupations as well assuring them that God loves them!

    The Development of Balance

    Development of balance

    Balance development is a pivotal part of child development. Gross motor coordination, balance and motor planning are all part of the processes of acquiring these skills. Here, we cover balance development, strategies to support this skill, and specific balance activities.

    Development of balance from infancy through preschoolers.

    Balance Development

    Acquiring or practicing balance can be seen in a toddler swaying step by step, a child pretending the sidewalk curb is an Olympic balance beam, or a teenager managing their new crutches.

    Strong standing and walking balance equal safe mobility, which opens the door to so many wonderful new things; running, jumping, cartwheels, backflips…you get the picture.

    Achieving physical balance plays an important role in the development of many different skills, some of which may surprise you!

    WHAT IS BALANCE?

    Before officially diving into the development of balance, we first need to define and understand it. 

    • Balance – According to the Harvard Medical School, balance is the ability to distribute your weight in a way that lets you stand or move without falling, or recover if you trip. Good balance requires the coordination of several parts of the body: the central nervous system, inner ear, eyes, muscles, bones, and joints
    • Static Balance – maintaining body position during an unmoving task, such as sitting or standing
    • Dynamic Balance – the ability to remain standing and stable while performing movements or actions that require displacing or moving oneself

    The various muscles of the body contract or relax in order to maintain the proper balance for our daily activities, as controlled by our balance center in the brain; the cerebellum

    In addition to the cerebellum, the inner ear also sends signals to the brain, to give a status report on the environmental changes that affect balance. The inner ear is where the vestibular system is located.

    Its’ fluid picks up on the motion and position of the head, constantly sending information back to the brain via the eighth cranial nerve. When there is a medical issue within the ear, such as an ear infection or torticollis, it may affect balance. This is generally in the form of dizziness or unsteadiness. 

    The primary source of information for the following list of balance developmental milestones was primarily sourced here.

    Information from different sources may vary slightly, largely due to the fact that developmental patterns fall into different ranges. For a general list of developmental milestones, refer to the CDC resource here.

    Balance Development in the first year

    Prenatally

    • The vestibular system is developed at five months pregnancy

    0-3 MONTHS

    • Primitive reflexes (uncontrolled movement) lay the groundwork for future motor development
    • Tummy time develops vision and postural control required for optimal balance later on 

    4-6 MONTHS

    • Rolling prone to supine (front to back), then supine to prone (back to front)
    • Supported sitting, then unsupported sitting

    7-9 MONTHS

    • Picks up a dropped toy, may fall while reaching
    • Begins to army crawl, cruise crawl, or scoot
    • Holds majority of their own weight while standing supported
    • May squat up and down while standing 

    10-12 MONTHS 

    • Pulls self up to stand, then stands unsupported
    • Manipulation of toys/ movement of arms while sitting unsupported 
    • Moves in and out of laying and seated positions with control
    • Cruises along furniture or walks supported

    Development of Balance in Toddlers 

    13-16 MONTHS

    • Walking unsupported, but may tumble easily
    • Crawls up and down furniture and stairs with support for safety
    • Begins to learn how to walk faster/run 

    17-19 MONTHS

    • Is able to get onto small chairs without help
    • Walks up stairs while holding on with one hand
    • Runs stiffly and falls often
    • Can pick up objects while standing, without losing balance

    2 YEARS

    • Pulls off socks without losing balance
    • Runs with improved coordination
    • Can kick a ball without losing balance

    Development of Balance in PReschoolers

    3 YEARS

    • Can briefly balance and hop on one foot
    • May walk upstairs with alternating feet (without holding the rail)
    • Able to pedal a tricycle

    4 YEARS 

    • Hops on one foot without losing balance
    • Throws a ball overhand with coordination

    5 YEARS:

    • Skips, jumps, gallops, and hops with good balance 
    • Stays balanced while standing on one foot with eyes closed 

    The majority of our balance skills have developed by age 5, but will continue to fine-tune up until around age 12. Remember to keep in mind, these are averages for the typically developing child. 

    Balance is required to do just about anything in daily life. 

    Balance is needed to stand at the mirror while brushing teeth, get out of the car, and put on socks, to name just a few. Without the development of this balance skill, support aids (walkers, crutches, braces) may be necessary for safety and function.

    Static Balance

    Did you know that balance is also related to non-physical, or static tasks?

    Research suggests that when balance is improved, so are attention and learning skills. Good balance helps children develop better reading, writing, and language skills, as well as improved concentration. 

    One way balance is theorized to improve academic skills, is through increased body control, and knowing where the body is in space (proprioception). Having better body control and knowing how to coordinate movement in various environments is important.

    Correct body awareness makes it easier to have a comfortable seated posture. Good balance also makes activities such as sitting still while moving the head to look up at the chalkboard, and then back down to write easier. 

    Check out these Body Awareness Activities from the OT Toolbox.

    Without proper body control, it is just that much more difficult to perform the tasks of a student: copying from the board, holding and reading long textbooks, carrying materials from space to space, and supporting an upright seated posture for many hours a day.  

    How to Support Balance Development

    Knowing the huge impact that balance has on the body, what can you do to improve it?

    Check out this blog post on balance activities.

    The OT Toolbox has great articles on gross motor skills, that will suit the needs of your children. Check these out and let us know your favorites!

    If you love all of the great resources found above, consider becoming a member.

    Want to add this resource to your therapy toolbox so you can help kids thrive? Enter your email into the form below to access this printable tool.

    This resource is just one of the many tools available in The OT Toolbox Member’s Club. Each month, members get instant access to downloadable activities, handouts, worksheets, and printable tools to support development. Members can log into their dashboard and access all of our free downloads in one place. Plus, you’ll find exclusive materials and premium level materials.

    Level 1 members gain instant access to all of the downloads available on the site, without enter your email each time PLUS exclusive new resources each month.

    Level 2 members get access to all of our downloads, exclusive new resources each month, PLUS additional, premium content each month: therapy kits, screening tools, games, therapy packets, and much more. AND, level 2 members get ad-free content across the entire OT Toolbox website.

    Join the Member’s Club today!

    Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
    background is in Human Development and Family Studies, and she is passionate about
    providing individualized and meaningful treatment for each child and their family. Sydney is also
    a children’s author and illustrator and is always working on new and exciting projects.

    Ultimate Guide to PLAY DOUGH MATS

    Play dough mats

    After reading below about the benefits of playing with play dough mats, go grab some of them for FREE. When using these fun play dough mats, you will start helping children work on important developmental skills. In addition to all the fun children will have while using these mats (which is a win), they will be developing the necessary fine motor hand skills needed for everyday functional tasks such as; fastener manipulation, classroom tool use, grasp patterns, and overall dexterity/manipulation used in multiple fine motor tasks.  

    Play dough mats

    The benefits of using play dough mats

    Play dough is an AWESOME tool in itself! 

    With all of the attractive colors, and the sensory feel of it, playdough can be very enticing to children. With a little preparation and care, play dough mats can be almost mess-free! If pieces fall off, just tap with another blob of dough, and it blends back in with little need for clean-up. (Just avoid the carpet!) While engaging with these super fun play dough mats, children can stay occupied for a lengthy time in either independent play, or cooperative play with a partner.  

    You can easily use play dough mats during an OT session, as part of a home program, or as a fine motor station in the classroom. Each mat provides a theme to compliment any learning or skill building you might be looking for. After you read about all of the benefits, you’ll want to get all of these mats and start right away, but first let’s look at those specific skills they help develop. 

    Play dough can easily be made or purchased, and used with play dough mats to focus on developing so many skills.

    Many Benefits of play dough mats:

    • Hand and finger strengthening skills – squeeze, press, poke, and pinch the play dough while manipulating. Hand strength is a skill needed for most functional tasks. This helps build intrinsic hand musculature, and improves fine motor endurance.
    • Grasp skills – Tools such as plastic knives, scissors, cookie cutters, pizza cutters, and rolling pins, provide the opportunity to work on varied grasp patterns.
    • Bilateral integration skills – use both hands together in a coordinated manner to manipulate the play dough, therefore building bilateral coordination. They adjust the dough’s size, shape, and weight as needed for mat play. Bilateral coordination skills are needed for functional tasks like writing, dressing, cooking, and essentially all functional participation.
    • Manual dexterity skills – manipulate the putty to shape and pinch the dough to match the theme the of each mat. This gives them the opportunity to develop precise finger movements and thumb opposition.
    • Self-regulation skills – When children squeeze, press, poke, pinch and roll out the dough, they get deep proprioceptive input, which can be soothing and calming to a child. 
    • Eye-hand coordination skills – While creating and placing the shapes on the play dough mats to match the theme, learners are coordinating their hand and eye movements, working on important visual motor coordination skills. Eye hand coordination skills can impact functional participation.
    • Gross motor skills – Engaging with play dough works the larger muscles of the upper extremity (shoulder and arm) in order to push, pull, press, and roll the dough. Don’t forget, development occurs proximally to distally, so those larger muscles need engagement!
    • Creativity and play skills – Learners use their play dough creativity and imagination to add their own details to the mats, with their own play dough creations.  They can add small beads, sequins, buttons, or pegs in addition to their playdough shapes. 
    • Social skills – If mats are used with a partner, children will have the opportunity for cooperative and collaborative play They will be learning self-control and communication, coupled with pretend play, as they work to build items together on a single mat, or by trading mats and sharing details. These would make a great tool for social skill groups!
    • Visual perceptual skills – Play dough mats work on visual figure ground skills, as learners visually scan the boards to locate the circles for play dough ball size, location, and placement. Visual discrimination skills are needed to identify any size differences in the circles, and make the play dough balls larger or smaller as indicated. 
    • Olfactory skills – Adding a little scent, such as an essential oil to the play dough will provide children some olfactory input, making the experience more multi-sensory. 
    • Tactile skills – The addition of a little glitter, rice, or sand to the play dough, will provide children further tactile input. For some learners with tactile aversion, working with playdough may be difficult at first.

    Play dough does not need to be store bought. Go to our link here for some of the Best Dough Recipes.

    how to use play dough mats

    How to Use Play Dough Mats

    Using play dough mats is pretty self explanatory. Kids love using the fun and engaging play activities and often times don’t realize they are developing skills at the same time. These steps will help with using your play dough mats in therapy, the classroom for a fine motor brain break, or in the home for a play activity:

    1. You’ll need to print off the play dough mat that works for your needs. You can find different printable playdough mats for different themes.

    2. Laminate the page, or slide it into a page protector sheet.

    2. Select play dough, either home made or store bought. Select play dough consistency and resistance based on the individual’s needs.

    3. Consider how to adapt the activity based on the needs of the individual. Some considerations include thinking about fine motor skills, bilateral coordination needs, visual motor needs, or sensory needs.

    4. Position play dough mats and play dough to meet the needs and areas of development for the individual.

    5. Work on opening and closing the play dough container if this is an area of concern (it’s a great functional activity!)

    how to use play dough mats for occupational therapy

    Adapting Play Dough Mats

    Play dough mats can be used in occupational therapy to develop skills and work on goal areas through play. They can also be used to support needs and integrate adaptations in play for practice.

    Play dough mats are a fun way to play and build skills at home, too. They can be used in the classroom for a brain break, a sensory break, or a tool to build fine motor skills with a classroom theme.

    How can you adapt playdough mats for specific skill adaptations in OT sessions? There are so many ways…

    Motor Skill Needs- For individuals struggling with motor skills, you can tape the page protector sheet to the table surface. Another idea is to use sticky tack on the back of the page protector. This can secure the play dough mat to the table and limit it’s movement during play.

    Another motor skill strategy is to use a play dough mat with larger areas or smaller areas for the play dough. This can require more or less small motor movements, and can offer more or less opportunities for precision work.

    Bilateral coordination needs- Encourage bilateral coordination by asking the user to hold the play dough mat on the table. This is a great way to encourage paper positioning during writing tasks, too.

    Sensory needs- Play dough consistency will provide a varied tactile experience such as, sticky, slippery, firm, and partially dry. Much like different grades of thera-putty, different play dough recipes can be used to build fine motor skills or offer more or less heavy work through the hands.

    Some play dough to meet tactile preferences and tactile challenges include:

    Some play dough to meet tactile preferences and tactile challenges include:

    Regulation needs- Building on the sensory aspect, you can offer movement-based heavy work through the hands and upper body by offering less resistant play dough (more of a silky and fluid feel to the play dough consistency) or you can offer more heavy work using a heavier grade to the resistance.

    Visual needs- For users with visual processing needs, there are ways to adapt the play dough mats. Try outlining the areas where play dough is placed for a darker visual cue by using a dark marker. You can then slide the sheet into a sheet protector and play from there.

    Core strength/Stability/Visual Gaze- For some, maintaining an upright posture is difficult. You can easily position play dough mats on a slant board, easel, or vertical surface using sticky tack, tape, magnets, etc. This positioning strategy can be used to either support positioning and visual gaze needs to to challenge these areas to reach a “just right” level in therapy sessions.

    Free Printable Play Dough Mats

    Each of the free play dough mats below can be printed off and used over and over again. A few tips for using play dough mats in therapy or in the home or classroom:

    Space Play Dough Mat | gives learners the opportunity to strengthen their hands while developing essential skills that are needed for pencil writing, as well as the dexterity and precision skills that are needed for many daily, fine motor tasks. The simple thing about this outer space mat, is that it works on a specific set of muscles in the hand. 

    Astronaut Play Dough Mat | can be used as part of space theme, or a solo activity. Ask your learner to pull off a small piece of play dough and roll it between the fingers and thumb of one hand. It’s important to use just that one hand as it’s part of the challenge! Doing this hand activity will help build hand strength, dexterity, coordination, and endurance of the smaller muscles of the hand and fingers. 

    Play Dough City | complements any geography lesson as children fill in the circles of the city sky, while helping them to build their fine motor skills and endurance, which are needed for tasks like writing/coloring, pencil control for forming letters, functional pencil grasp, manipulation of clothing fasteners, opening/closing containers, and so much more. This cute mat can be used along with any other city activities including books, travel, and anything about city life.

    Ice Cream Play Dough Mat | create small balls of play dough that fit on ice cream images, while working on hand strength and other motoric skills needed for pencil grasp, endurance for coloring, accuracy with scissors, and dexterity for manipulation of buttons, zippers, and coins. This mat can be a great take home mat for use over the summer break. Be sure to include instructions on what you want the child to do!

    Toy Theme Play Dough Mat | helps children use their fingertip and thumb to roll a small ball of play dough, placing and pressing the dough onto the circles on the mat. They need just a small piece of dough to make the ball small enough to fit into the circles. This is a great activity for developing and defining the arches of the hand, strengthening the intrinsic musculature, and boosting visual perceptual skills too! This toy theme mat builds on the fundamental “job” that kids have, which is play! Use this themed mat during down time, or a rainy day, to add a little productive playtime.

    Play Dough Bird Mat | gives kiddos a hand workout, while they create small balls of dough rolled with their fingers, to match the circle sizes on the mat. There are various sizes to challenge the child’s precision and dexterity. Children can count the birds and match the colors of the birds too.  Another way to use this mat is to write numbers or letters in the circles in random order and then have the child scan the mat to challenge their visual perceptual skills.

    Roll and Write Play Dough Mat Bundle | all about helping kids warm-up their hands prior to handwriting. It makes handwriting more fun when using one of these 7 themed play dough mats. Children warm-up using dough, then work on letter formation, words, and sentences. 

    These printable play dough mats include a themed play dough area plus a writing area. Use the play dough as a fine motor warm up and then move to the handwriting aspect.

    Numbers 1-20 Sky/Ground Play Mats | helps children to work on 1-20 number formation, provides sensory input, encourages motor planning, and spatial relations. 

    A-Z Sky/Ground Play Mats | work on upper case and lower case A-Z letter formation, provides sensory input, encourages motor planning, and spatial relations. 

    Intrinsic Muscle Strengthening Play Dough Mat– This simple play dough mat limits the visual background and offers different sizes of circles. Users can create small balls of play dough to build intrinsic hand strength.

    All of the free play dough mats are available in our Member’s Club. There, you can just click and download the play dough mats!

    Want to add this resource to your therapy toolbox so you can help kids thrive? Enter your email into the form below to access this printable tool.

    This resource is just one of the many tools available in The OT Toolbox Member’s Club. Each month, members get instant access to downloadable activities, handouts, worksheets, and printable tools to support development. Members can log into their dashboard and access all of our free downloads in one place. Plus, you’ll find exclusive materials and premium level materials.

    Level 1 members gain instant access to all of the downloads available on the site, without enter your email each time PLUS exclusive new resources each month.

    Level 2 members get access to all of our downloads, exclusive new resources each month, PLUS additional, premium content each month: therapy kits, screening tools, games, therapy packets, and much more. AND, level 2 members get ad-free content across the entire OT Toolbox website.

    Join the Member’s Club today!

    A final note on play dough mats:

    Do you want to use any of the play dough mats multiple times? Simply laminate them, or place in a sheet protector so children can use them repeatedly, any time they want. Play dough mats are a fun and engaging way for young children to work on problem-solving, pretend play, pre-academic skills, and other developmental functions. They don’t even know they are doing it, as they are having so much FUN!

    Regina Allen

    Regina Parsons-Allen is a school-based certified occupational therapy assistant. She has a pediatrics practice area of emphasis from the NBCOT. She graduated from the OTA program at Caldwell Community College and Technical Institute in Hudson, North Carolina with an A.A.S degree in occupational therapy assistant. She has been practicing occupational therapy in the same school district for 20 years. She loves her children, husband, OT, working with children and teaching Sunday school. She is passionate about engaging, empowering, and enabling children to reach their maximum potential in ALL of their occupations as well assuring them that God loves them!

    Note: Only use play dough with the appropriate aged children. take sensible precautions with small or differently abled children, as play dough and small manipulatives can be a choking hazard. Adult supervision should be provided. 

    Trauma Informed Occupational Therapy

    trauma informed occupational therapy

    In this blog post, we are addressing trauma informed occupational therapy, including trauma informed interventions and how to take a trauma informed approach in occupational therapy.

    Trauma informed occupational therapy is based on the 6 principles of trauma informed care in OT interventions.

    Imagine your mental, physical, and emotional health as a backpack. Some days, that backpack may be really heavy, full, and wear you down. Other days, it may be a bit lighter, and you are quicker on your feet, but the backpack is always there. This is the visualization of health that I think is just perfect when discussing trauma-informed occupational therapy practice

    Trauma Informed Care: the hypothical backpack

    Everyone wears this hypothetical “backpack”; young and old, rich and poor. It’s up to us as health care professionals, to do our best to consider what we know about what load a person is carrying, while knowing that we won’t ever fully understand someone’s story. 

    Included in this “loaded backpack” is the connection between emotional regulation and executive functioning skills, where both emotions and the ability to self regulate, impacts cognitive actions.

    Having an awareness of this emotional health, allows one to shift perspectives on how one behaves, acts, speaks, and functions. Cognitive and emotional health can be a large factor of someone’s overall health.

    trauma informed occupational therapy

    WHAT IS TRAUMA-INFORMED PRACTICE?

    It’s important to understand the definition of trauma informed practice.

    The effects trauma and adverse childhood experiences have on a person have been understood for some time now. Infant, child, and adolescent mental health is still a growing field.

    The “backpack” visual helps to remember that even though occupational therapists may not work in a mental health setting, an individual still carries their traumatic history, anxiety, or depression as they walk into your office. 

    Trauma informed care is different than trauma-specific interventions. Where trauma informed refers to the awareness and recognition of various traumas and the impact of organizations or systems impact individuals, families, groups, communities, etc. the specific interventions address assessments, treatments, and specific recovery supports to impact trauma.

    Example of Trauma Informed occupational therapy

    Take 5-year-old ‘Thomas’ as an example. His aunt brings him to therapy at your outpatient clinic, and you notice that he is really shy and resistant to join you in a treatment room.

    Thomas was referred to OT for delayed fine motor skills, but you are unable to convince him to do much with his hands at all. He won’t even look at you for more than one second.

    After a few sessions pass, and there are no improvements in his participation, you ask the aunt how things are going at home, and learn a new perspective about Thomas’ overall health. You still must provide services for his fine motor skills, but now you do so through a new lens that respects, and includes his needs as a child with a traumatic history. 

    An individual’s traumatic history may not be the reason they are seeking services, but it should always be considered, and assess for. Traumatic experiences shape the way we perform our occupations.

    The trauma response and/or triggers should be considered in all aspects of practice; when writing treatment plans, speaking to the individual and their family, and designing the treatment environment. 

    This is trauma-informed occupational therapy practice in a nutshell.

    GUIDELINES FOR TRAUMA-INFORMED Occupational Therapy

    How will you adjust your services to meet the unique needs of an individual who has experienced trauma?

     “Given the long-term effects of adverse experiences in childhood, it is particularly important that all disciplines working in health care assess trauma; address safety in schools and the community; build strengths and resilience; and provide opportunities for educational, economic, and social successes” (AOTA, 2019).

    Evidenced-based practice is always the best place to start. The AOTA’s guidelines from the May 2019 continuing education article Understanding and Applying Trauma Informed Approaches across Occupational Therapy Settings, breaks down trauma-informed practice in occupational therapy. This resource highlights best-practice standards from the Substance Abuse and Mental Health Services Administration (SAMSHA).

    6 Trauma-informed Principles:    

    The 6 principles of trauma informed care are as follows:

    1. Safety 

    2. Trustworthiness and transparency 

    3. Peer support and mutual self-help 

    4. Collaboration and mutuality 

    5. Empowerment, voice, and choice 

    6. Cultural, historical, and gender issues.

    The table below is a modifed version of Figure 1 from the AOTA (2019) article. It provides examples of what to do and what not to do in accordance with the principles above. 

    Trauma Informed Occupational Therapy Do’s and Don’ts

    Table Adapted From Figure 1, AOTA (2019)

    Do Don’tPrinciple
    Ask permission before doing anything. Assume an individual’s comfort level.#1 Safety 
    #4 Collaboration and mutuality 
    #5 Empowerment, voice, and choice 
    Acknowledge what you cannot change Ignore things over which you cannot control#2 Trustworthiness and transparency
    Always ask preferred pronounsAssume based on appearance, etc. #6 Cultural, historical, and gender issues
    Recognize that trauma manifests in many different ways.Automatically attribute challenging behaviors to personality #1 Safety

    Becoming a trauma-informed provider is not an easy shift for everyone. Considering the current pressures that healthcare professional face, having to adapt towards trauma-informed care is not always supported by staff or administration.

    The AOTA provides resources and valuable information for occupational therapists based on the setting they work in. 

    The table above takes into consideration, the Four R’s of Trauma Informed Care: realize, recognize, respond, and resist re-traumatization.

    Four R's of trauma informed care

    Trauma Informed Strategies for Occupational Therapy

    Many of the following guidelines will assist all healthcare providers, educators, and caregivers in learning trauma-informed practices. 

    Early Childhood Settings: Increase Collaboration to Promote Prevention 

    • Promote early bonding through skin-to-skin, kangaroo care, private rooms, and opportunities for parent decision-making
    • Increase the amount of collaboration with all involved, and identify the barriers to involving family members in the care of their child
    • Celebrate family advocates
    • More ideas and resources are available at Zero to Three, The Center of Excellence for Infant and Early Childhood Mental Health Consultation, and Think Babies

    School Settings: Recognizing Common Trrauma-based Responses

    • Trauma has negative effects on learning, and should be addressed school-wide (not just for students who receive special education)
    • AOTA suggests that OTs frame school behaviors through a lens that recognizes potential triggers and responses
    • Common traumatic stress behaviors include: “intrusive thoughts, irritability, arousal, anxiety, fear, difficulty concentrating, dysregulation, aggression against self and others, dissociative symptoms, somatization, and character issues” (AOTA, 2019)
    • Trauma-Sensitive Schools Training Package 
      • Online training offered by the National Center for Safe, Supportive Learning Environments. 
      • AOTA reports using this training as a Tier 1 intervention, educating the staff and ensuring common understanding. 
    • Cognitive Behavioral Intervention for Trauma in Schools (CBITS) intervention
      • Created by Wong and colleagues specifically to target children subjected to community violence
      • Suggested use as a Tier 2 or targeted intervention
    • Trauma-Focused Cognitive Behavioral Intervention (TF-CBT) 
      • Similar to the above, but suggested practice in Tier 3 intervention, including students and their families, in collaboration with community mental health providers. 

    The AOTA (2019) offers more information about occupational therapy’s role in trauma-informed care in various settings, including primary care, community, residential, and foster care settings.

    Regardless of the setting, location, or age group you may work with, trauma-informed practice is necessary.

    We hope this article gave you some insight on a very important topic, and ideas on how to incorporate trauma informed care it in your practice – wherever you are. What will you do to move towards a trauma-informed practice? 


    Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
    background is in Human Development and Family Studies, and she is passionate about
    providing individualized and meaningful treatment for each child and their family. Sydney is also
    a children’s author and illustrator and is always working on new and exciting projects.