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Victoria Wood OTR/L

What is Stereognosis?

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Examples of stereognosis- tying shoes, touch typing, braiding hair without looking, feeling for a light switch. Text reads "what is stereognosis"

What is stereognosis anyway? This strange word sounds like a type of dinosaur or a new type of stereo. Stereognosis, or the ability to “see” with your hands, is an important skill you do not think much about, until you do not have it (astereognosis). Read on to find out more about stereognosis, what kind of patients are missing it, how to improve it, and its’ implication on functional performance.

Examples of stereognosis- tying shoes, touch typing, braiding hair without looking, feeling for a light switch. Text reads "what is stereognosis"

What is stereognosis? A clinical definition

Stereognosis is the ability to identify and recognize the shape and form of a objects, by the sense of touch and without other sensory input. It’s a perceptual skill that allows us to identify common objects through tactile perception without the aid of vision.

This ability is an integration of tactile sensory input, pressure, position, motion, texture, weight, and temperature.

This skill is essential to daily tasks.

Essentially, this ability is recognizing and knowing what an object is by touching it without seeing it. It is also known as haptic perception. Normally, your brain stores information about items you see and use and you draw on this stored memory to recognize items with other senses, such as touch.

It’s interesting to look at the etymology of the word stereognosis because this helps understand the definition.

The word “stereognosis” comes from the Greek word for for “stereo,” meaning solid, and “gnosis,” meaning knowledge.

There is a difference between manual stereognosis, using the hands to identify and object, and oral stereognosis, using the mouth to do the same.

“Manual stereognosis requires intact peripheral sensory pathways, namely the dorsal column-medial lemniscus tract (DCMLT), to receive discriminative touch and proprioceptive information. Receival of this information is necessary but not sufficient for stereognosis because it also requires functioning processing centers in the cortex of the parietal lobe.

Stereognosis plays a role in everything we do on a daily basis. You can see the clinic importance in therapy interventions that support daily functional independence.

Examples of Stereognosis

It might be easier to explain this concept by sharing examples of how we use stereognosis every day.

  • We know that we haven’t lost our keys because we reach our hand in our pocket and feel them.
  • A student, while participating in a class lecture, reaches their hand into their backpack to grab a highlighter, feeling around the pocket to pull out the writing utensil
  • When driving, we reach for and press the correct lever to turn on the turn signal, radio buttons, or lights
  • The ability to reach into a dark room and find and turn on the light switch
  • Typing while looking at the computer screen
  • Knitting while watching television
  • Using a fork while talking to others at the dinner table
  • Identifying coins by touch

Stereognosis is more than being able to rummage around your bag to find some gum. Everyday activities are a part of daily dressing tasks that use the sterognostic sense and tactile recognition:

  • Finding the armhole in your sweater
  • Locating the flashlight when the lights have gone out
  • Zipping the bottom of your jacket
  • Donning a bra, necklace, or styling the back of your hair
  • Buttoning your collar behind your neck 
  • Touch typing
  • Braiding your hair
  • Tying your shoes without looking at your hands
  • Tying a necktie
  • Buttoning a shirt without looking at your fingers
  • Texting or doing anything else with your hands while walking in line (stereognosis of the feet/body)

You probably do tasks all day long by touch rather than looking at your hands and the objects you’re manipulating.

The skill of stereognosis plays a huge role in processing speed, motor planning, and fine motor skills.

To accomplish tasks quickly and efficiently, we can’t look at our hands all day and process what the object is, how to pick it up, and how to use the item. This is processing speed in action. Think about it this way: we could not function if we had to visually concentrate on the task of using objects all of the time.

Part of this is having a visual picture in the mind’s eye of the object, the space, body awareness, and other concepts of spatial relationships. Also impacting this ability is proprioception.

Neurologically speaking, this is pretty complex! The ability to conceptualize an object by touch uses experience and awareness in addition to the tactile sensory functions of light touch and pressure awareness.

The neurological components at work include:

  • Dorsal column-medial lemniscus tract (DCMLT), which serves as the primary pathway for perceiving the size and shape of objects. Additionally, comprehension of how this information undergoes processing in the parietal cortex is crucial for a comprehensive understanding.
  • The first-order neurons of the DCMLT have cell bodies in dorsal root ganglia with peripheral processes extending out to sensory receptors (Pacinian corpuscles, Merkel cells, Golgi tendon organs, and muscle spindles) and central processes that enter the spinal cord in the large sensory fiber entry zone of the dorsal horn ascending ipsilaterally in the dorsal columns.” National Library of Medicine.

stereognostic sense

There’s a lot to the stereognostic sense than you might think…and that’s kind of how stereognosis works, right? It’s something you just don’t think about!

I have not thought about Merkel cells and Golgi tendon organs since neurology class. That shows how useful this information has been in my clinical life. Plus, I can not imagine explaining “what is stereognosis” to a parent using terms like dorsal root ganglia or lemniscus!

In short, we use terms that families can understand like touch and vision. Stereognosis is how you can reach into your purse and grab the Chapstick, or car keys without looking. You use your fingers to feel around and identify an object by its’ size, weight, texture, temperature, and other identifying parts (items sticking out, bumps).

Until you have lost this sense (or never had it) you can not imagine how frustrating it can be for both patients and their caregivers. I can not tell you how many times I have asked my husband to just reach in and feel around for a wire, or plug something under the bed. He has very little ability to “feel” for things. I attribute this to the arthritis and thickening of the skin on his hands/fingers.

A person can live without stereognosis, or the ability to sense an object without seeing it, however, life is less convenient and functional without this critical sense.

Astereognosis

When you have lost the sense (or never had it) of stereognosis, this is referred to as astereognosis. 

A deficit in stereognosis means the individual must look at their hands as they do a task. When they visually monitor how their hands are moving in a task, the speed becomes very slow and purposeful.

This description from the National Library of Medicine is a good way to explain this concept: “Astereognosis refers to the inability to perceive the form and identity of an object when physically manipulating it through active touch. By definition, astereognosis necessitates functioning peripheral sensory modalities (pain, temperature, fine touch, and vibration sense) and results from pathology within the central cortical integration of this sensory information. Astereognosis falls under a family of conditions called agnosias, which are classified based on the sensory modality involved (auditory, visual, or tactile). In this terminology, one should also be aware that the term tactile object agnosia is used interchangeably and is practically synonymous with astereognosis.”

Astereognosis indicates that a patient is suffering from a lesion of the primary somatosensory cortex or somatosensory association area of the parietal lobe; this is commonly described as a cortical sensory loss. 

In addition to damage to the parietal lobe, astereognosis can be found with damage to the following:

  • Nerves
  • Spinal cord
  • Brain stem
  • Thalamus 

Many conditions precipitate astereognosis, including but not limited to

  • Cortical dementias
  • Cerebrovascular accident (CVA, or stroke)
  • Meningioma
  • Blood clots that affect the parietal lobe or brainstem
  • Cancer
  • Brainstem tumors
  • Multiple sclerosis, where your immune system attacks your nerves and causes problems with messages sent between your brain and body
  • Cerebral palsy, where your brain cannot send messages to your muscles
  • Head injuries, like a depressed skull fracture that causes a sunken skull
  • Alzheimer’s disease
  • Dementia
Astereognosis is also referred to as tactile agnosia.

Types of stereognosis

There are two types of stereognosis, primary and secondary

  • Primary –The primary type of astereognosis is when you cannot recognize the physical features of an object, such as its shape, texture, or size. 
  • Secondary astereognosis. In this type, your sense of touch might function well, so you can feel how big an object is or whether it is rough or smooth. But you cannot recognize what the object is. You can feel the dimensions and texture of the shape, but you cannot match the information stored in your brain to the object. 
Example of a stereognosis test with form for common items like pencil, key, quarter, and description for items. Text reads "stereognosis tests for occupational therapy"

How to test for stereognosis

Therapists or physicians may perform a couple of tests to determine astereognosis, or tactile agnosia. The purpose of these tests is to evaluate a patient’s ability to identify common objects based on tactile properties.

Tactile Object Recognition Test (TOR) is one of them. The examiner puts an object in your hand and asks you to identify the object with your eyes closed. They rate the level of impairment.

In the Nottingham Sensory Assessment, the examiner presses objects against some parts of your body to see if you can feel light touch, pressure, or pin pricks. They can also test for temperature recognition. They can also move parts of your body around to see if you sense movement (proprioception). 

The third test would be a computed tomography (CT) scan or magnetic resonance imaging (MRI)to diagnose underlying conditions.

You can see deficits in stereognosis in functional tasks, which can be part of clinical reasoning. One way to test for this would be to block a patient’s vision by using a file folder or curtain. Then place common objects such a a pencil, sunglasses, a key, nail, quarter, etc. into the palm of the hand. The patient is encouraged to manipulate the object as they name the item in their hand. If they can not name the item, they should describe the object’s properties.

How to improve stereognosis

The first line of defense in treating this condition is to treat the underlying condition. Some conditions are not curable as we know, but with the right therapy they can be improved. Knowing what the conditions are, and the symptoms is a great starting place.

We are learning more and more about the brain’s fascinating capability to build new motor pathways after an injury.  Targeted practice is just one way to improve function.

The great thing about any of the games below, is that similar games can be made from these ideas instead of purchasing them:

  • Mystery bag – fill a bag with different items. Ask students to put their hand in the bag and identify the item by touch alone. You can grade this activity by having a list of items that are in the bag or photos. We have an example of this mystery stocking game using a Christmas stocking to hold the items.
  • What’s in Ned’s Head (Amazon affiliate link) – this is a great stereognosis game! Students reach into Ned’s head to find the item pictured on their card. No peeking!
  • Touchy Feely game – Touchy Feely is a pop-up container that houses 26 different items with lots of different sensory attributes. There are figures like the Eiffel tower, fake animals like a mouse, crab and rubber duck, and all sorts of toys that could be bumpy, smooth, or prickly. Each item has a corresponding picture card.
  • Ruffs House Tactile doghouse game – kids reach in to match different textured dog bones
  • Tac Tiles– (Amazon affiliate link) This guess and feel game includes a bag and different tiles with textures to match. You can use this activity in many different ways.
  • Tickit Touch and Match Board – a classic tool for matching textures
  • Wooden Touch Recognition game– This is much like a DIY version of a “what’s in the bag” game, but the wooden pieces are shapes, which makes a great tactile discrimination activity. You then match the shapes to the pictures on the cards to target visual perceptual skills.
  • You can rotate themes like holidays, animals, shapes, or household items
  • Alphabet Mystery Box (Amazon affiliate link)- Players reach inside and discover fun miniatures of 26 letters of alphabet.
For more information, check out this OT Toolbox article on the sensory aspect of touch or learn more about developing touch from the tactile archives.

The human body is incredible!  It still amazes me that we are able to type without looking at the keyboard, play the piano, text, French braid our own hair, and thousands of other amazing things just by using our sense of touch.

Victoria Wood, OTR/L is a contributor to The OT Toolbox and 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.

Ball Pit Activities

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Colorful plastic ball pit balls with words reading Ball Pit Activities for Therapy

This article details ball pit activities to use in therapy sessions (and at home) to support skills like sensory needs, gross motor skills, and other occupational therapy goals areas.

Are you lucky enough to have a ball pit at your disposal?  Maybe one at your clinic, school, or neighborhood fun park? A ball pit does not have to simply be a place to blow off some steam. There are great ball pit activities out there that work on critical skills while your learner is having fun. Follow along with this post to find out some great ball pit activities, plus some ideas to create a ball pit on a budget. I probably cannot help with your space restrictions, but a ball pit does not have to be enormous to have some great effects.

Imagine being submerged in the balls, which provide a deep-pressure sensation and a sense of calm. Gross motor and fine motor skills, sensory-motor skills, social interactions, speech and language development, and symbolic play are just some of the domains you can work on while in the ball pit. The calming effect of swimming in a ball pit can be a self-regulation strategy, too.

Colorful plastic ball pit balls with words reading Ball Pit Activities for Therapy

Ball pits are a great occupational therapy tool and you can incorporate OT goals into ball pit play in many ways.

Ball Pit Activities and my win for OT

Before jumping right into ball pit activities, I want to share my “OT win” with you.  I work in a school system, so you understand the rules are high and the budget is low. Imagine if I asked for a $2,500 ball pit? Can you hear the administration laughing and shaking their heads from there? I won a grant to provide some sensory equipment for our school therapy gym and wanted a ball pit but did not want to blow my $1500 budget on one piece of equipment. I ordered a (Amazon affiliate links) cool enclosed mini trampoline, and a few hundred ball pit balls to go inside. 

Not only do my students get the tactile and proprioceptive input from the ball pit (more about that later), but they get great input from bouncing on the trampoline at the same time. 

Because it is enclosed in a net, I do not have to worry about kids falling out, or balls going everywhere.  There are less expensive ways to create a ball pit (read below), but this feels like a big victory for the OT/PT room in our K-2 school. 

Different types of ball pits with words reading ball pit ideas

Different types of ball pits

Of course, there are your traditional ten-thousand-dollar ball pits found at larger clinics and play areas. These are the gold standard of ball pits, and the possible activities in them are endless. Options include:

  • Clinic ball pit frames
  • Budget ball pit options (see below)
  • Soft play ball pits- soft foam pits
  • Inflatable ball pits
  • Foldable ball pits
  • Ball play pens
  • Toddler ball pit tent

Two of the clinics I work at had huge ball pits connected to a climbing frame and pirate ship.  Picture something like a giant pit found in therapy clinics with cushioned foam walls that would hold foam blocks.

My kiddos could jump off the platform into a huge pit of balls, then swim to the other side. I tried to get the boss to add a zip line into the ball pit (like this one), but they were worried about safety. Here is a zipline kit on Amazon. Be sure to install correctly.

There are also options for indoor slides that can be incorporated into a ball pit. There are endless ideas if you have a great budget and a big space.

While not every home or clinic can have a giant, padded clinic ball pit, there are many options available.

budget Ball Pit Options

There are inexpensive options for setting up a ball pit in a home, sensory room or calm down corner, or clinic. Some of these ideas can be used in an outdoor sensory space, too.

Cheap ball pit options include (Amazon affiliate links listed below):

  • Large ball pit with a slide going into it – These can be found in sensory play spaces for kids. However, you can make this as an inexpensive version using a large blow up pool. Add a large 5 foot slide with climbing rope web for added vestibular input. Instead of just playing in the balls, your learners can climb then crash into them!
  • Blow up ball pit – Little Tykes has this blow-up version of a slide/ball pit combination. It probably looks better than it is, but feel free to check it out
  • Inflatable pool ball pit– This option is nice for the home or smaller intervention space. Head to the dollar store and grab a blow-up kiddie pool.  Fill it with balls and you have a small portable ball pit. You can also use a baby pool indoors with this option.
  • Sensory bin with cut up pool noodles– We used an (Amazon affiliate link) under-the-bed storage unit. This ball pit option is on the smaller size, making it nice for toddlers.
  • Pack n Play or laundry basket (Amazon affiliate links)– small toddlers will enjoy ball play in a small enclosure.
  • Foam pit (Amazon affiliate link)- These ball pits are an inexpensive option.
  • Foldable tent– These options are nice because you can buy an inexpensive foldable tent, pop it open, and fill it with balls. The balls stay in the tent for the most part and you can fold up the tent to store it.
  • Play Space Jungle Gym with Tunnel– These are inexpensive ways to add crawling, slides, and small spaces for sensory input and can be used indoors or outside.
  • Trampoline ball pit– A trampoline ball pit can come in any size, depending on the number of ball pit balls you add. There are foldable options, indoor trampolines, or mini trampolines. The trampoline ball pits have mesh walls to hold in the ball pit balls.
  • Rentable ball pits – if you need a pit just for a few days, there are rentable options. I am not sure if you can purchase these as well, but they probably come with a big price tag.

ball pit balls

Once you have a ball pit container, next you fill it up with ball pit balls, or other sensory options.

You can fill your ball pit with most anything soft. You do not have to stick to balls to make a fun pit.

Think outside of the box (or ball pit!). Some ideas include shredded paper, foam cubes, pool noodle bits, small stuffed animals, pillow stuffing, pillows, bean bags (be sure to check out our upcoming bean bag activity post).  I saw a post about a woman who filled hers with aquarium and pea gravel.  That just sounds dangerous AND uncomfortable.  We went to a fair and they had a pit made of feed corn.  It was neat.

Here are some ideas to fill a ball pit:

  • Plastic play balls- You’ll need more than you might think! The plastic play balls can create a single layer in the ball pit, but if you want to sink down into the ball pit, you’ll need more. You can purchase commercial ball pit balls in bulk to fil the ball pit. Here is a set of (Amazon affiliate link) 1500 plastic play balls.
  • Foam cubes– Many gymnastic studios have pits full of foam cubes. Check out local furniture makers to see if they have extra chunks of foam sitting around.
  • Pool noodles – cut up pool noodles to fill your ball pit. This is an inexpensive way to fill a ball pit. Here’s an Amazon affiliate link for a set of 20 pool noodles that can be cut into small pieces.
  • Soft play balls
  • Shredded paper
  • Pool noodles cut into small pieces
  • Stuffed animals
  • Pillow stuffing
  • Pillows
  • Bean bags

Ball pit activities

Once you have found/bought/begged for the perfect ball pit, you might need some fun ideas of what to do in there besides jumping around having fun. Make time for that too, because fun is part of a kid’s occupation. 

  • Seek and find- See if your learners can find items you throw into the ball pit.  This could be puzzle pieces, stuffed animals, action figures, or weighted balls.
  • Obstacle course- Use your ball pit as part of a larger occupational therapy obstacle course. Learners must wade through the balls to get to the next obstacle. I like having kids carry weighted balls through the obstacle course for a heavier workout.
  • Sorting- Ask your kids to find as many of one color as they carry and fill their basket. This could be a solo or race activity. You can come up with many color sorting activities using colorful plastic ball pit balls.
  • Ball toss- Add a basket or basketball net to encourage target practice.
  • Add language- Have learners yell out the colors as they toss the balls, or count a certain number of balls. Work on expressive language and receptive language.
  • Heavy work– Wading through the ball pit provides resistance. Have your learners move objects from one end to the other while wading through the ball pit.
  • The fort game- Use a sheet or other item to divide your pit in half. Set a timer. Learners throw their balls to the other side. At the end of the time, the side with the least balls wins.
  • Catch and throw- Use a cut off milk jug or bucket to catch and throw the balls in the pit while trying to remain standing/sitting/lying down. Here’s a tutorial to make a milk jug catch game.
  • Explore different positions- Learners can work on crawling, rolling, walking, running, or swimming through the ball pit. How fun would it be to make “snow angels” in the ball pit?
  • Jumping in- Set up a slide or tall item next to the ball pit. Learners jump off the item, or slide into the pit. This adds to the proprioception and vestibular input.
  • Add a ball tube using a PVC pipe- Get a large PVC pipe to put in or around your ball pit. Little children love the cause-and-effect game of putting items in and watching them come out. This is a great way to work on hand eye coordination by dropping the plastic ball pit balls into the tube and then catching them at the bottom. Here’s an idea.

Ball pit activities to explore sensory skills

Your sensory seeker often loves being submerged in the ball pit.  The sensory avoider, not so much.  To the body and all its’ sensory systems, a ball pit hits many of them.

  • Tactile– Touching and feeling the balls
  • Auditory Processing– the sound of the balls rustling together
  • Proprioception– Balls have a weight to them that provides a hug type of feeling which is often calming to the sensory system
  • Vestibular– The vestibular system is activated as you roll around in the ball pit
  • Sight– If your pit is full of colorful balls, imagine the amount of visual input this provides. Our pit has “macaroon” colored balls to be softer on the eyes. I find it much more calming than the traditional red, yellow, and blue varieties
  • Smell and taste- These are not the typical sensations you would expect in a ball pit, but everyone explores in different ways

As you can see, the sensory seeker loves this type of activity for all the systems the ball pit alerts. For the avoider, or person who experiences too much, this can be a nightmare. Imagine all those sensory receptors triggered at once!  It can be a intervention that actually leads to sensory dysregulation for some individuals.

Tactile can feel like light unexpected touch, the weight of the balls can feel suffocating, the rustling of the balls can seem like nails on a chalkboard, and it is easy for someone to lose their position in space (proprioception), when their feet are not touching the ground. Body awareness can impact daily activities and the ball pit can be a tool to support needs in this area.

Read about tactile defensiveness and how to support this challenge that might impact daily functional tasks.

Cleaning the ball pit balls

There are several ways to clean the ball pit balls. The classic way is to put them in bags and hose them off.  How about filling up your hot tub with them for a rinse?  Or the washing machine? 

I saw a post idea in which clinic owners filled the back of their pick-up truck and sent it through the car wash!  Not sure if the people were inside the truck, or with the balls, but a fun and smart idea just the same.

ball pits in occupational therapy

There are so many ways to support occupational therapy goals using the ball pit as an intervention tool!

After researching this, I am jealous of the places that have amazing budgets to build or buy great playgrounds with ball pits for their sensory gyms, or neighborhood play palaces.  Forget about all the germs and gross stuff floating around these ball pits and jump right in!

Victoria Wood, OTR/L is a contributor to The OT Toolbox and 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.

What is Prompting?

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Graphics showing visual prompting with head and shapes seen from the eyes, face talking for verbal prompting, and physical prompting with hand touching. Text reads "what is prompting"

In this blog, we are covering what prompting means and types of prompting that is used to support goal achievement. If you’ve seen therapy goals in the past, you may have seen the words “prompts”, but what is prompting and what does this look like in therapy? Let’s discuss prompting in therapy.

Therapists use prompting with their learners continually. We do it without really thinking about it. Things like a helpful verbal prompt and visual schedules that list out the tasks to complete in therapy are part of every therapy session. Parents and caregivers use prompts also. 

Have you ever stopped to critically assess prompting, its meaning, how to use them, grading of prompts, and documentation methods? In this post we will dig deep into prompting to be sure we are using them effectively, in the least restrictive way to elicit a successful response. As we break down prompting you will learn how to best instruct caregivers in the use of prompts.

Graphics showing visual prompting with head and shapes seen from the eyes, face talking for verbal prompting, and physical prompting with hand touching. Text reads "what is prompting"

What is prompting?

Prompting is a cue or signal provided to guide and assist a child with performing a specific skill or behavior. One way to think about this assist is thinking of it as a “clue” or a “hint” to help the student or patient achieve a task. This hint can come in the form of a verbal cue, a visual cue, or a physical cue.

The dictionary definition of prompting is: to request input from, the act of persuading somebody to do something, to cause or bring about an action or feeling, and to cause someone to take a course of action. 

Prompts are a type of modification to the curriculum. When it comes to accommodations vs modifications, prompts are considered a modification because modifying a task includes using instructional strategies to breakdown a specific assignment, task, or curriculum. For example, modifications might include providing the student with a simplified version of a task, reducing the assignment, reducing the number of trials (math problems for example), and/or providing the student with prompts. Prompts might be used in addition to accommodations in the school environment.

That’s not to say that using prompts means that modifications are in place. This is just one way that a task might be modified.

Does this align with your perception of prompting?

In the context of working with children, prompting serves as a supportive tool used by teachers or therapists to enhance behavior shaping and skill acquisition. When a typical trigger fails to evoke the desired response to complete a specific task, prompting steps in to provide assistance, aiming to boost the likelihood of the targeted behavior.

Think of a prompt as a guiding cue or support system employed to encourage a behavior that might not naturally manifest. This approach is particularly crucial in educational and therapeutic settings, where tailoring support to individual needs is essential for effective learning and development

Successful performance of a desired behavior elicits positive reinforcement, therefore reinforcing learning. This means that the “Desired Behavior” or a specific action, response, or skill that is encouraged or expected.

The positive reinforcement component means that when someone does something well or as desired, they receive a positive consequence. The positive reinforcement serves as a consequence that strengthens or reinforces the likelihood of the individual repeating the behavior in the future.

For example, if a student successfully completes a challenging assignment (desired behavior), and the teacher praises them or provides some form of positive feedback (positive reinforcement), the student is more likely to repeat the behavior in the future. This cycle of behavior, followed by positive reinforcement, contributes to the learning and retention of the desired behavior.

A prompt is like a cue or support to encourage a desired behavior that otherwise does not occur. 

Prompts are always antecedents, which means they are given before the behavior starts. In other words, if the client is already completing the skill or task, a prompt is not needed; though positive reinforcement might be appropriate to encourage the behavior in the future.

The goal is to always use the least intrusive prompt possible that produces results. The frequency and types of prompts you use will depend on several factors, including the environment, and will always involve considering what prompts work best for an individual client.

A few things to remember about prompts:

  • Prompts in interventions vary from most to least intrusive.
  • Prompting in interventions should be faded to avoid prompt dependency.
  • A prompt can be anything the practitioner finds effective and that the client responds to.
  • Prompts are a modification to a task or an assignment, and they might be used in addition to an accommodation in the school setting.
Graphic depictions of types of prompting including icon for schedule, nodding, gestures, pointing, visual schedules, and visual pictures. Text reads "types of prompts"

six different types of prompts

There are three general different types of prompts that can be used as graded support for those working on goals. These types can be broken down into different supports (like positional or gestural prompts which are a version of visual prompting).

There are different types of prompts that we use in therapy:

  • Visual prompts- this can include modeling and gestures. This can also include positional prompts, like placing items in a different place or more prominent place that offers a visual clue.
  • Verbal prompts- this can include words or sounds like a bell to change classes at school
  • Physical prompts- this can include hand-over hand support, slight nudges, or light touch.

We have listed these types of prompts from most restrictive to least restrictive:

  1. Full physical prompting– Hands-on assistance given to a child to successfully perform a skill or behavior. The practitioner places their hand over the hand of the client, guides it to the object, and wraps the client’s fingers around the object.
  2. Partial Physical Prompt- The caregiver moves the client’s hand toward the object.
  3. Visual Modeling– Showing the child the correct way to perform a skill/behavior (for example, demonstrating how to put toys away in the basket to show the child how-to pick-up toys).
  4. Visual gesturing- A movement that provides the child with information about how to perform the target skill/behavior (for example, pointing to the top of the paper to remind the child to write their name.
  5. Positional Prompting- The practitioner places the object next to the learner
  6. Verbal Prompting- Any words said to the child to help them perform a skill correctly
  7. Visual Prompting- A picture, icon, or object used to give the child information about how to perform a skill or behavior. This could also include a visual schedule or a list of tasks to complete, like a checklist.

Visual Prompts

One type of prompt that comes up a lot in therapy sessions, either in documentation or in goals, is the visual prompt.

A visual prompt is like a picture-based visual helper. This might include pictures, visual schedules, lists, icons, drawings, or symbols to symbolize a task. This could include highlighting the baseline of writing paper, or creating a bold line when cutting out a shape.

Other types of visual prompts used in therapy might include:

Gestural Prompts

Related to the visual prompt clues is gestural prompts. This type of prompt should be described in more detail because you can create a hierarchy of support and offer different types of gestures to support learning of skills.

Gestural prompts involve using gestures or physical movements to provide support or convey information. Some of the various types of gestural prompts or gestural supports include:

  • Pointing
  • Demonstration
  • Modeling desired actions
  • Hand Signals to communicate information
  • Facial Expressions
  • Body Language
  • Gaze or Eye Contact
  • Nodding or Shaking Head
  • Guiding Movements, or physically assisting someone by guiding their movements or actions.

Verbal Prompts

Another type of prompt worth highlighting is the verbal prompt. A verbal prompt can include a word, a phrase, or a complete direction that supports task completion or learning. Some examples include:

  • A verbal clue
  • The beginning letter sound of a word
  • A hint to begin a task
  • Safety prompts
  • Direct Instruction with clear and explicit verbal instructions on what needs to be done.
  • Brief spoken hints or clues to assist in a task or activity.
  • Asking questions to stimulate thought or prompt a specific response.
  • Feedback, with positive verbal reinforcement to acknowledge and encourage desired behaviors
  • Modeling by describing a behavior or task verbally while demonstrating it simultaneously.
  • Reminders, including verbal prompts to help someone remember steps of a task, or specific information.
  • Social Scripts, or pre-written or verbally communicated scripts to navigate social situations.
  • Countdowns

Different ways to offer and grade prompts

There are several different methods to offering and using prompts. There are at least three different levels of prompting usually used to teach a new skill. The practitioner first identifies the target behavior, and then identifies suitable prompts. 

  • Least-to-most prompting– This is gradually providing prompts to help the child be as independent as possible is key when using least-to-most prompting. At least three different levels of prompts are used to teach new skills. At the first level (usually the independent level), the child is given the opportunity to respond without prompts. The remaining levels include prompts that proceed from least to most amounts of assistance until the child responds correctly.
  • Most to least prompting- This is using more intrusive prompting and fading to least intrusive prompts. You would start teaching a task with the most assistance possible such as hand over hand guidance. Work on fading the amount of assistance until your learner is at the least intrusive they can manage.  This does not always mean independence. Some tasks may always require some prompting for success.
  • Delayed prompts- Sometimes a prompt will be given after a certain amount of time has passed without a response. This is almost the “sit on your hands” method of watching and waiting.

For each of these ways to offer prompts, the teacher therapist or will only use the prompt if the client gives the wrong response. They will give the student a chance to succeed or fail before adding prompts.

Steps to use in Prompting

Prompts support goal achievement. You can use the prompts as a shaping behavior and teaching skills is a three step process.  Those steps include:

  • Prompt
  • Offer reinforcement
  • Fade prompt
  1. Prompt- Identify the least intrusive prompt that is necessary for a correct response to occur. Does a visual prompt work, or is a visual and verbal prompt needed?
  2. Reinforcement- Give differential reinforcement. After a correct response, give appropriate reinforcement that is equivalent to the level of performance independency. At first reward the prompts and relevant cues, not just the prompts.  
  3. Fade- Fade prompts as quickly as possible to avoid prompt dependency.  When a child is first learning a new skill, responding to prompts can be rewarded.  As the child progresses, reward or affirm the child when unprompted responses occur. Fading a prompt means to move from most-to-least prompting. After the child masters a skill, gradually move prompt away or replace with least intrusive prompt.

3 components of prompting

  1. The antecedent includes the target stimulus and the cue. The target stimulus is the “situation” in which we want the learner to perform the target skill. The target stimulus is important because it signals to the toddler that something is expected of him with or without direction from adults. therefore, helping the toddler make this connection and minimizing prompt dependency. This might be getting the table ready to eat, or moving toward the sink to wash hands. The cue is a naturally occurring hint or task direction that tells the toddler the skills or behaviors they should be using.  The cue might be “time to eat.”  Toddlers are more likely to use a skill or behavior accurately when the cue and target stimulus are clear and consistent.
  2. The behavior (target behavior or target skill). This is what you are asking your child to do (sit down, snip with scissors, don a shirt) There are three types of target skills:
    • Discrete skills: single skills of a short duration (e.g., requesting objects, labeling pictures, social greetings)
    • Chained skills: a series of behaviors/ skills that include several steps put together to form a complex skill such as (e.g., dressing and undressing, washing hands, cleaning up a play area)
    • Response classes: groups of responses that have the same function (such as waving hello, tapping someone on the shoulder, giving a high five to greet)
  3. The consequence.  What happens after the target skill is accomplished?  It might be a natural consequence, like getting to eat after washing hands, or a reinforcement such as praise, a treat, or preferable activity.  It will be important to find the right reinforcement for each child for the training to be effective

Other Words for Prompting

There are other ways to describe the concept of prompting and you might see these words in occupational therapy goals. These variations to the word “prompting” include:

  1. Cue
  2. Clue
  3. Hint
  4. Signal
  5. Prompting
  6. Assistance
  7. Support
  8. Nudge
  9. Guidance
  10. Stimulus

How to document prompting

Correctly and accurately documenting progress and the amount of support needed gets tricky.

Therapists have long-used the min, mod, max scale to document the amount of assistance. The problem with this type of documentation is, it is not specific.  What is minimal or 25% of assistance of cutting with scissors?  Based on the information above, you could describe whether you offered full or partial physical assist, gestural or verbal prompts, or visual cues. 

You can further define prompting by the number of prompts given.  “Child needed five verbal prompts to snip with scissors.”  This can be cumbersome to keep track of during a session, but is a great way to document progress, especially when the milestones are met very slowly.

After six months your student might not be able to snip with scissors, but they can tolerate hand over hand assist to open and close scissors.  They may not be able to wash their hands yet, but given continued verbal prompts they can go through the steps without physical assist.

What is prompting in the everyday world?

This may seem overwhelming when you see it written on paper, but you are probably already using prompts without thinking about it.  Now you have the verbiage and documentation strategies to put all the pieces together and instruct a caregiver.

Victoria Wood, OTR/L is a contributor to The OT Toolbox and 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.

Regulation Station Ideas

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colorful toolboxes matching emotions and text reading "regulation stations"

In this blog post, we’re covering what you need to know about regulation stations, or a central space to focus on regulation needs. This can look like regulation centers or other group self regulation activities, or a “safe space” to meet regulation needs. With learning differences on the rise, there is a big need for self regulation, both in and outside of the classroom. Having a central space, or station, to target specific self regulation skills can be helpful, especially when it comes to emotional check-ins, and behavioral supports that meet the needs of self regulation needs. Students can not effectively learn if they are not in their just right zone. If a student (or students) arousal systems are not well regulated, it has an effect on everyone in the classroom. A well regulated student will begin to struggle when surrounded by learners who are out of control.

Teachers are turning toward using calm down corners, centers, or different areas in the classroom for self regulation. Let’s talk about coping and regulation station ideas.

colorful toolboxes matching emotions and text reading "regulation stations"

what is a regulation station?

A regulation station is a catchy term for a calming station, sensory corner, or other area designed to support self regulation needs. A regulation station can be a designated space for learners to use coping tools or supports as regulation tools and strategies to meet specific and individualized needs. It can be referred called a calm corner, regulation station, break area, sensory path, or sensory break place, to name a few. Using sensory supports as a regulation system, the regulation station is a consistent learning tool for different environments.

This sounds a bit like a sensory diet, right? As a seasoned OT, I love to use specific supports to meet individualized needs, and this can be a detailed, scheduled regimen, or it can be open-ended like a sensory room might be.

This does not have to be exclusively in a classroom. Regulation stations are also helpful at home, daycare, camp, amusement parks, the airport, or other sensory loaded environments. Basically, the regulation station is a place to calm or re-organize in a personal bubble, meeting regulation needs so learning can happen.

While practicing self regulation, be sure to emphasize that all emotions are ok, and that it’s ok to identify as one emotional level or another. And, we need to recognize that everyone experiences a full range of feelings throughout the day. What we are working on is the behavioral response to these feelings.

The goal of the sensory space/coping tool/calming corner/regulation station is to create a climate where learners feel safe and supported, no matter their zone or arousal level. Using a regulation break to meet needs can mean adding a few attention-boosting classroom breaks, depending on the needs of the students you serve.

One thing you might see in the school setting, is kids that walk in the hallway or in a busy classroom and bump into others. They might need that proprioceptive input to regulate themselves to create inner organization. We talk about this in our post on tips for walking in line and standing in lines. Having scheduled sensory input breaks in the form of a regulation station is a great way to support those kids.

ot toolbox resources and self regulation programs

Here is a great overview article from Colleen Beck of the OT Toolbox about Zones of Regulation and Self Regulation Activities. In her post you will find self-regulation activities (emotional, internal, and physical regulation strategies) to work on through interactive games.

Colleen mentions other programs to help with self regulation, including; The Alert Program, and programs available on Amazon (affiliate links):

how to implement a self regulation area

Adding any new system to a classroom can seem overwhelming.

By following a some strategies below, adding your own regulation station can be easier than expected:

A emotional regulation space, or even a self-regulation center activity in the classroom serves as a positive and non-punitive space designed to assist students in managing their emotional and sensory states, fostering self-regulation and emotional well-being. This supports the individual in emotional intelligence.

It is not a disciplinary measure but rather a proactive tool to support individuals in navigating different levels of regulation (various emotional and alertness states). It can even look like a check in that happens in the classroom.

Engage the entire class in deciding a suitable name for the self-regulation space. This can help to promote student involvement and ownership.

Using a self regulation area in the classroom, in a school-wide system, or even as a check-in when arriving to therapy is a great asset for emotional needs! Address the needs of learners across different levels of self-regulation, especially those prone to impulsive behaviors that impact learning or safety. The Regulation Station provides a proactive approach to help individuals maintain a sense of well-being by allowing their nervous systems to relax.

Self Regulation Centers

One way that occupational therapy supports educators in the school based occupational therapy setting is through consultation and push in OT services.

Setting up centers in a classroom can be a beneficial approach to support various aspects of child development. In an educational context, centers typically refer to specific areas or stations within the classroom where students can engage in different activities.

Here’s a simple plan to set up occupational therapy centers:

Identify Self Regulation Goals:

For a group activity that focuses on areas occupational therapy supports, like self regulation, you won’t have individualized goals. You might have a classroom-wide or grade-wide goal based on general expectations for the grade level. This can include something like identifying emotions, identifying responses to emotions, etc.

Then, you’ll want to break down the goal to determine the learning objectives you want to achieve through the centers. These could be related to cognitive, social, emotional, or physical development.

Select Appropriate Self Regulation Activities:

Choose activities that align with the learning goals and are suitable for the age and developmental stage of the students. For instance, activities might involve fine motor skills, problem-solving, or collaboration.

Figure out the space needed for Self-regulation centers:

If you’re doing a gross motor activity, the space might need to be a larger area like a hallway or a gym. If you are using brain breaks as a self-regulation too, these can be done in the classroom among desks. Designate specific areas within the classroom for each center. Ensure that there is enough space for students to move around comfortably and engage in the activities.

Organize Self Regulation Materials:

Gather the necessary materials for each center and organize them in a way that is easily accessible to students. This includes any instructional materials, tools, or equipment needed for the activities. Things like deep breathing posters or emotions play dough mats can be printed off and stored in binders.

Establish Rules and Procedures:

Clearly communicate the rules and expectations for each center. This helps maintain a structured environment and ensures that students understand how to participate appropriately.

Rotate Activities:

Consider periodically changing the activities within the centers to keep students engaged and provide new learning opportunities. This can also cater to diverse learning styles.

Rules for a Self-Regulation space

When it comes to implementing a self-regulation space in a school or other space where there are many variety of needs in one area, it’s important to come up with rules and protocols for success.

Here are some general guidelines to consider when setting up a self regulation area:

Assessment, Flexibility, and Planning:

  • Begin with a comprehensive needs assessment to identify the unique sensory requirements of students who may benefit from the sensory room.
  • Design the sensory room with flexibility in mind, allowing for easy modification of the environment based on individual needs and preferences.
  • Make sure use is understood by others who might use the space. Is a schedule needed? Should a sign-in and sign-out access be used?

Design, Equipment, and Budget Considerations:

  • Ensure the sensory room is well-designed with sensory-friendly elements, such as calming colors, soft lighting, and comfortable seating, while also considering budget constraints.
  • Optimize the use of cost-effective sensory tools, exploring affordable options without compromising on quality or safety.

Accessibility and Environmental Factors:

Allow for flexibility within the centers to accommodate different learning paces and preferences. This fosters an inclusive environment where each student can thrive.

  • Make the sensory room easily accessible to all students, taking into account environmental factors such as location, noise levels, and proximity to classrooms.
  • Consider the impact of the sensory room’s location on its effectiveness, avoiding high-traffic areas or spaces with potential disruptions.

Supervision, Training, and Adaptability:

  • Provide thorough training for staff on the purpose and use of the sensory room, emphasizing adaptability in responding to diverse student needs.
  • Foster an environment where staff can adapt interventions based on real-time observations, ensuring the sensory room remains a dynamic and responsive resource.

Consent and Communication:

  • Obtain consent from parents or guardians for sensory room use, clearly communicating the benefits. This might be something that is included in an IEP or 504 plan.
  • Maintain transparent communication with parents about budget constraints, involving them in discussions about cost-effective solutions and potential fundraising efforts.

Monitoring:

  • Integrate the sensory room into therapeutic plans, collaborating with occupational therapists to align interventions with evidence-based practices.
  • Implement a monitoring system that tracks not only the efficacy of the sensory room but also its cost-effectiveness and potential areas for improvement within budget constraints.

Other things to consider:

Clearly define expectations for the use of the self-regulation station, covering aspects such as the number of students, frequency of use, appropriate utilization, cleanup procedures, and respect for materials.

Recognize that some students may require more frequent use, and frame this discussion around the principles of equity versus equality.

Consider placement suggestions for the self-regulation area, preferably off to the side of the room but not at the back. The goal is to ensure visibility and audibility of instructional activities while striking a balance between privacy and safety/inclusion.

ideas and rules for implementing your new regulation Area

Sensory spaces can be set up in the classroom, this can be beneficial for students who need a calming space to retreat to on a frequent basis. A timer can be used to show the student how long they can stay there for. A visual schedule can also be used if needed.

Consider the self regulation environment, and consider how to support a variety of self regulation needs using sensory supports, deep breathing tools, or calming and regulating items. Calm down strategies can be different for every individual, but having a toolbox of supports helps.

The space could look like:

  • Furniture or a separator like a curtain that could be used as a separator, e.g. bookshelf
  • Cozy space like a table with cloth draped over it, or a pop up tent
  • a corner of a room

Consider resources within the space:

These ideas are just the tip of the iceberg when it comes to supporting needs using supports and tools.

adding to your regulation station

Every great strategy including the regulation station, needs a few ideas to make it work. Here is a post with some great Children’s Books on Self Regulation

Here are some Self Regulation Games to incorporate into your space to work on regulation. Challenges in the ability to self-reflect impact functional performance, social emotional skills, and learning. How about some Self Regulation Activities to get you started? The Sensory Lifestyle Handbook by Colleen Beck, has a great overview of sensory processing, and is a strategy guide.

regulation station ideas

Your regulation station can be as unique and customized as you like. It is meant to be a fluid space that changes depending on the needs of the learners who use it.

Generally you will have some sort of calm down area. This is useful for anyone, but targeted for learners in the red or yellow zone. You may also have a quiet area for reflection for those in the green zone, or coming out of the yellow zone, and an quiet alerting area for those struggling with low arousal (the blue zone).

Those students in the red zone are already out of control. They might exhibit anger, rage, physical touching or aggression, inappropriate behaviors, or extreme feelings. In the yellow zone, students are headed toward the red zone, but still have some self control. Students in the yellow zone might be silly, wiggly, anxious, worried, or having difficulty staying on task.

Regulation needs for different students

While creating a sensory regulation station is definitely a challenge, once it is in place and working well, you will see such a change in your classroom, it will be well worth the time invested. Remember, no two students are alike, and not one day is the same as the next. Having several different options in your regulation station, and being open to change, are a couple of the keys to success.

Victoria Wood, OTR/L is a contributor to The OT Toolbox and 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.

Letter Formation Rhymes

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When working on handwriting skills, letter rhymes are a tool to have in your toolbox! Whether you are looking for summer enrichment, or planning for the upcoming school year, the OT Toolbox is highlighting letters with posts on games, activities, worksheets, and this one on Letter Formation Rhymes. Pair these multi-sensory activities with hands-on letter formation activities and letter formation worksheets for engaging and motivating skill-building.

letter rhymes packet on green and white background with text that says "Free Letter Rhymes"

letter formation Rhymes

Before getting into letter formation rhymes, it’s important to understand the underlying skills necessary for writing letters with accuracy and automaticity when it comes to handwriting.

When it comes to auditory processing skills, auditory memory is a factor that improves carryover skills. The auditory memory tool of a rhyme to support letter creation is a spark for legible formation and the functional pencil stroke sequences in letter formation, however if the underlying components are not in place, a rhyme or letter song will not help.

As always, it is important to understand the basics before expanding your activities. Understanding development and the “why” before starting activities and games will improve your effectiveness and efficiency as a therapist. Knowing the reason a student is struggling on a particular task will point you in the right direction when it comes to treatment activities.

Difficulties with letter formation may come from a variety of different sources including:

Our lengthy resource on letter formation covers the reasons why the letter formation aspect of handwriting can be so difficult. Be sure to check out all of the letter formation activities including ways to teach letters that use a hands-on and sensory approach to learning letters. You’ll also find resources on letter order, and information on teaching letters based on child development.

Alphabet formation rhymes

Now that you are familiar with the basics, and have some great resources to get you started, how about adding letter formation rhymes to your toolbox!

Some tips and ideas to get you started with incorporating letter rhymes into teaching handwriting:

  • Use consistent verbal prompts. If you use a particular letter formation rhyme, stay consistent with using that same verbiage each time.
  • Use a visual prompt. You can use our letter formation rhyme printable.
  • Use age-appropriate directions. Younger students may appreciate rhymes and cute visuals to go along with the letter formation directions. Older students may appreciate simple instructions for each letter, such as: “m – start at the top. Down up, over, down again, and over once more to finish your m”.
  • Add whole-body learning. Incorporate movement using our alphabet exercises along with letter formation rhymes that uses body movements to describe the letters.
  • Teach letters in groups based on the pencil strokes that make up the letters. These are called letter families. For example, letters L, E, F, I, H, T are in a letter family. And c, a, g, o, and q are in a letter family. All letters of the alphabet can be grouped with other similar letters based on the pencil lines that make up the letter. This goes for uppercase letters as well as lowercase letters. Teaching letters in a similar group promotes the motor plan needed, as well as improves pencil control skills.
  • Simple verbal cues- Handwriting without Tears (now called Learning without Tears) has great rhymes and songs to go with their learning program. Mat Man is a big theme in their program, and simple yet effective directions for forming letters include: big line, little line, big curve, little curve.
  • Interactive Activities: Plan interactive and multi-sensory letter formation activities that involve students actively participating in the letter formation process. For instance, use large motor movements to draw letters on a whiteboard or on the floor.
  • Try different strategies. Here are 10 ways to teach letter formation that incorporate different sensory tools. Use these activities along with the letter rhymes to really establish a motor plan for each letter.
  • Use consistent letter formation activities along with verbal rhymes for each letter. We have our series of sensory letter worksheets that incorporate the same types of activities on each letter mat. Grab your copy of:

letter formation Rhyme videos

Some therapists and teachers prefer to teach using videos. This is definitely a viable option, however you can also use the videos to learn the songs, then teach them to your students without video aids. Plus, you can send a list of the letter rhyme videos to parents to support handwriting carryover at home as part of OT handwriting homework or a home program.

If you are looking for songs rather than letter formation rhymes, Jack Hartman has many videos on YouTube.

Pairing lowercase letter workout with uppercase letter gross motor coordination tasks can be a great lesson plan for teaching letter formation. This video has a workout for forming upper case letters:

This video encourages air writing for letters:

This video allows users to learn the sign language for each letter as well for fine motor coordination and finger dexterity. This can be a great home program recommendation for targeting manual dexterity goals.

This Alphabet Song is a fun way to add music and movement to letter formation activities:

We also have a series of videos that you can pull specific letter formation tips from. Each letter of the alphabet has it’s own video:

Letter A:

The video can be paired with letter rhymes to teach the motor skills needed for uppercase A.

Letter B:

The video covers how to teach letter B and then carry the pencil strokes over to similar letters.

Letter C:

The video addresses how to create a motor plan for letter C.

and so on…Check out the full letter formation playlist here.

why teach letter formation rhymes?

Incorporating a rhythmic song or rhyme to letter formation is helpful for establishing a motor plan for letter forms. This is especially helpful for those who learn with auditory input. We know that every student has their own learning style. The acronym VARK is used to cover these various styles of learning.

V is for Visual Learners- Some learners are visual. These individuals learn through visual input: reading, watching others complete tasks, visual examples, viewing videos, worksheets, etc.

A is for Auditory Learners- Other learners are auditory learners and need to hear the information for it to sink in.

R is for Learning Through Reading- You may find students who need to read and write the information in order to learn. This may include a combination of visual input and or auditory input by reading back information.

K is for Kinesthetic Learners- There are students who are kinesthetic learners. These learners better retain information by doing the task. A multisensory approach is great for this type of student. One tool to support this learning style when teaching letter forms is our A-Z multisensory learning mats.

Letter formation rhymes can fit all of the VARK learning categories. Videos and visuals help the visual learner. Songs and rhymes satisfy the auditory learner. Reading and writing along with the rhymes or songs can help the “R” learner, while the kinesthetic learner needs to get up and move around with the songs and rhymes.

You can modify the lesson for each individual learner, or provide a plan that has all four styles of learning embedded to meet the needs of your students. Meeting the needs of your students will be far more effective than having them bend to your particular teaching style. The most effective managers and teachers have figured out how to morph to meet the needs of each of their individual students or staff.

Alphabet Formation Rhymes

We’ve created our own letter formation rhymes for uppercase letters and lowercase letters. We’ve also put these letter rhymes into a packet, which includes uppercase letters and lowercase letters.

This takes a developmental approach to writing letters, which is to focus on the uppercase letters first and focusing on the simplest pencil strokes first, which is straight lines down and then vertical lines.

Then, the pencil strokes which can carryover to other letters are covered. We tried to come up with letter rhymes that focus in on these key developmental concepts.

Below, you’ll find the uppercase letter rhymes and the lowercase letter rhymes that we love to use.

We included a visual image (like an apple, butterfly, and cookie) for each letter. This is so the play mat has a small image that the user can color to work on fine motor skills and hand strength.

If you are a member of The OT Toolbox membership, you can log in and get these letter rhymes in a printable activity set.

Uppercase Letter Rhymes

Below are uppercase letter rhymes.

Please don’t copy these and post them in other places. Content on this site is copyrighted and trademarked.

A- A is for Apple, so round and red, To make an uppercase A, here’s what’s said: Slant to the left, a diagonal flight. Then slant to the right, with all your might. Across the middle, a line so true. Completing the A, just for you!

B- B is for Butterfly, vibrant and bright, Let’s learn to write it, with all our might. Line down, from top to base. Then a little curve, adds some grace. Another little curve, we’re almost through. Uppercase B, look at what we can do!

C- C is for Cookie, sweet and round, Let’s learn to make it, hear the sound. Start at the top, curve around in glee. A big, round shape, like a smiling C.

D- D is for Dinosaur, tall and strong, Let’s learn to make it, join along! Start at the top, make a straight line down, a sturdy backbone, with no frown. Curve to the right, like a big smile, Uppercase D, it’s been worth the while!

E- E is for Elephant, strong and grand, Let’s learn to write it, hand in hand. A big line down, from top to base, Uppercase E finds its rightful place. Then three short lines, straight across, E’s horizontal friends, no time to pause.

F- F is for Firefly, glowing so bright, Let’s learn to write it, with pure delight. A big line down, from top to base, Uppercase F takes its rightful place. Two short lines, right across it goes, One on top, the other below.

G- G is for Giraffe, tall and so grand, Let’s learn to write it, holding our hand. A big curve, starting from the top, Round and smooth, it won’t stop. Then a short line, right in the middle, Uppercase G, let’s solve the riddle!

H- H is for House, standing so tall, Let’s learn to write it, one and all. A big line down, from top to base, Uppercase H finds its rightful place. Another big line, parallel and strong, Side by side, where it belongs. Then a short line in the middle, you see, Uppercase H, formed brilliantly.

I- I is for Igloo, tall and grand, Let’s learn to write it, hand in hand. Start with a long line, from top to below, Uppercase I, a letter we’ll know! Add a short line up top, not too far, Like a little hat, it’s just the right star. Then a short line at the bottom, oh so neat, Uppercase I, it’s now complete!

J- J is for Jellyfish, swimming with glee, Let’s learn to write it, come and see! Start with a line that goes down, curving with grace, Uppercase J, taking its place. Then add a short line, standing high, Completing Uppercase J, reaching for the sky!

K- K is for Kite, soaring up high, Let’s learn to write it, reach for the sky! Start with a straight line, from top to base, Uppercase K takes its rightful place. Then make a slant, from top-right to left, Another slant down, with a gentle heft.

L- L is for Lion, strong and bold, Let’s learn to write it, as we’re told! Start with a big line, straight and tall, Uppercase L, stands proud overall. Then draw a short line, just like a mane, Completing the L with a majestic reign.

M- M is for Monkey, swinging with glee, Let’s learn to make it, just you and me! Start at the top, make a mountain peak, Uppercase M, strong and sleek. Downward we go, like a slippery slide, Then up again, right by its side. End with a big line down, no time to frown!

N- N is for Night, starry and bright, Let’s learn to write it, with delight! Start with a big line, straight and tall, Uppercase N, stands proud and all. Then a diagonal line, slanting right, Creating N’s shape, oh what a sight! Finally, a straight line, reaching up high, Uppercase N, reaching for the sky!

O- O is for Octopus, in the deep sea, Let’s learn to make it, you and me! Start at the top, a curve round and true, Uppercase O, a perfect circle for you. Go all the way around, never break the line, Uppercase O, a shape so fine!

P- P is for Penguin, waddling on ice, Let’s learn to write it, it’s simple and nice! Start at the top, a straight line down, Uppercase P, wear your writing crown. Then curve it around, like a little loop, Creating P’s shape, a playful swoop.

Q- Q is for Queen, majestic and true, Let’s learn to write it, just me and you! Start at the top, like a crown so grand, Uppercase Q, take your royal stand. Curve around, like a swooping bow. At the bottom, add a tail, Uppercase Q, you never fail!

R- R is for Rabbit, hopping with glee, Let’s learn to write it, you and me! Start at the top, a line straight down, Hop to the top for a writing crown. Then make a curve, like a little bow, Creating R’s shape, let it proudly show. Add a slanted line, with a tail so neat, Uppercase R, now complete!

S- S is for Snake, slithering with grace, Let’s learn to write it, at our own pace! Start at the top, with a curve so round, Uppercase S, a shape we have found. Then curve again, just like before, Creating S’s form, we explore.

T- T is for Tree, standing tall and true, Let’s learn to write it, me and you! Start at the top, a straight line down, Then add a line across the top, wearing its writing crown.

U- U is for Umbrella, keeping us dry, To write it, let’s give it a try! Start at the top, go down straight, Then curve around, like a smiley gate. Go back up, just like you came, Uppercase U, that’s its name!

V- V is for Violin, playing a tune, To write it, let’s try very soon! Start at the top, with a slanting line down, Then go back up, like a hill’s crown.

W- W is for Whale, swimming in the sea, Let’s learn to write it, you and me! Start with a slant down, then another the same, Climbing back up, like a mountain’s frame. Go down again, a slant it will be, Then climb back up, just like the sea.

X- X is for Xylophone, making a sound, To write it, let’s trace lines we’ve found! Start with a diagonal line, left to right, Then cross it over, it’s quite a sight.

Y- Y is for Yo-Yo, up and down, Let’s learn to write it, top to ground Start with a slant down, left to right, Then slant up, it’s a playful sight. From the center, a line straight and long, Uppercase Y, standing strong!

Z- Z is for Zebra, stripes so bold, Let’s learn to write it, we’ll be untold! Start at the top, a line going right, Then slant down left, it’s quite a sight. Another line straight, from left to right, Uppercase Z, you’re not a fright!

Lowercase Letter Rhymes

Below are alphabet rhymes for making the lowercase letters.

Please don’t copy these and post them in other places. Content on this site is copyrighted and trademarked.

a- a is for apple, juicy and red, To write it, follow these steps, it’s said: A curve on top, like a smile so sweet, Then a line down, to complete. Remember the shape, round and neat!

b- b is for butterfly, colorful and bright. To write it, here’s a simple guide: Line down, then a curved belly. A smaller hump, so lovely!

c- c is for cat, soft and sly, To write it, let’s give it a try: Start at the top, make a curve round, Then a line down, don’t make a sound! A simple shape, like a moon in the sky!

d- d is for dog, loyal and true, To write it, here’s what you can do: Start with a circle, nice and round, Then add a line, curving down. Writing d is easy, you’ll soon see!

e- e is for elephant, big and strong, To write it, it won’t take long: A line across, take a look! Then curve around. Writing e is fun, you’ll agree!

f- f is for frog, leaping so high, To write it, let’s give it a try: Start with a curve and then a line, straight and tall. Remember the line, like a lily pad, Writing f is easy, it’s not too bad!

g- g is for grapes, sweet and divine, To write it, let’s follow the line: A curve on top, just like a smile, Then a line down, it’s worth your while. Add a hook at the end, like a little swing, Writing g is fun, let your pencil sing!

h- h is for hat, worn with pride, To write it, here’s a guide: Start at the top, a line straight down, Then add a line, curved like a crown. Remember the shape, tall and true, Writing h is easy for me and you!

i- i is for igloo, icy and round, To write it, here’s what we’ve found: A line straight down, simple and neat, Dot on top, a tiny treat. Remember the dot, like a snowy flake, Writing i is easy, no mistakes to make!

j- j is for jellyfish, floating in the sea, To write it, let’s follow with glee: A line down, then a little hook, Like a curly tentacle, take a look! Remember the shape, curvy and bright, Writing j is fun, it feels just right!

k- k is for kite, flying so high. To write it, let’s give it a try: A straight line down, then a slant in and out, A shape like half a triangle or a spout.

l- l is for lion, fierce and grand, To write it, here’s what we command: A line straight down, standing tall, A line across, like a grassy stand.

m- m is for monkey, swinging with delight, To write it, follow this path just right: A little line down, like a playful dance, A hump in the middle, a joyful chance. Remember the shape, curvy and round, Writing m is fun, let’s make a joyful sound!

n- n is for nest, cozy and snug, To write it, here’s what we’ll plug: A little line down, Then one bump. Writing n is easy, up and down!

o- o is for octopus, in the deep blue sea, To write it, let’s follow this tip: A simple circle, round and true, Remember the shape, like a watery ring, Writing o is easy, let your imagination sing!

p- p is for panda, black and white, To write it, here’s what feels right: A line straight down, standing tall, Then a curve, like a bouncing ball. Remember the shape, curvy and clear, Writing p is easy, let go of any fear!

q- q is for quilt, cozy and warm, To write it, let’s follow this form: A curve round, just like c, but it’s neat, A tail curling out, like a cozy treat. Remember the shape, round and swirled, Writing q is fun, you’ll rock the world!

r- r is for rabbit, hopping the race, To write it, here’s what we’ll embrace: A line down, like a fast sprint, Then up with a curve. Remember the shape, bouncy and bright, Writing r is easy, let your imagination take flight!

s- s is for sun, shining up high, To write it, let’s give it a try: A curve on top, like a cheerful smile, Then a curve below, it’s worth your while. Remember the shape, like a wave in the sea, Writing s is easy, let your creativity roam free!

t- t is for tree, standing tall and strong, To write it, here’s where we belong: A line down, straight and true, A line across, like branches do. Remember the shape, simple and clear, Writing t is easy, have no fear!

u- u is for umbrella, keeping us dry, To write it, let’s reach for the sky: A line down, with a little hook, Then another line down, just like a book. Remember the shape, open and wide, Writing u is easy, enjoy the ride!

v- v is for Violin, playing a tune, To write it, let’s try very soon! Start at the top, with a slanting line down, Then go back up, like a hill’s crown.

w- w is for wagon, rolling with fun, To write it, here’s how it’s done: Start with a slant down, then another the same, Climbing back up, like a mountain’s frame. Go down again, a slant it will be, Then climb back up, just like the sea.

x- x is for xylophone, making a sound, To write it, let’s trace lines all around: A slant down left, then a slant right, They meet in the middle, just right. Remember the lines, crossing and strong, Writing x is easy, like a joyful song!

y- y is for yo-yo, going up and down, To write it, let’s spin lines all around: A slant down left, then a slant down right, The tail hangs down, just right.

z- z is for Zebra, stripes so bold, Let’s learn to write it, we’ll be untold! Start at the top, a line going right, Then slant down left, it’s quite a sight. Another line straight, from left to right, letter Z, you’re not a fright!

Free Letter Rhyme Play Dough Mats

Want to get your copy of letter rhyme play dough mats? We have put together a set for uppercase and lowercase rhymes.

Each alphabet rhyme play dough mat includes:

  • A large letter with directional arrows
  • A rhyme for the letter’s formation
  • A small picture to color or fill with play dough
  • A space to write the letter

You can laminate the play dough mats, or slide them into page protector sleeves. Add them to a binder and use it as a multisensory workbook for letter writing.

You can also practice the alphabet formation with other multisensory strategies, too:

  • Use wikki stix to form the letters
  • Use a dry erase marker to write the letter and color the letter picture
  • Finger trace the letter

These packets are both free downloads here on our site. You can get them by entering your email address into the form below. The printable packets will be delivered to your email address. This way, you can print them from any device and any location.

These uppercase and lowercase alphabet rhyme printables are also available inside the Membership Club, along with hundreds of letter formation and multisensory handwriting tools. Members do not need to enter their email address for each item, they are all in one place, sorted by topic! Not a member yet? Join us in The OT Toolbox Membership Club!

FREE Letter Rhymes Packet

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    final thoughts on Alphabet rhymes

    If after scrolling through this post and clicking on some of the rhymes and songs, you find yourself humming along to one particular tune, you may have found the perfect one for you! Generations ago, Sesame Street or Barney was the way to learn. Now it seems Jack Hartman and Heidi have taken over. Whatever works for your particular students is the best way to teach!

    Victoria Wood, OTR/L is a contributor to The OT Toolbox and 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.

    Want printable handwriting and sensory motor activities to target the visual motor skills needed for letter writing? Grab a copy of our Letters! Fine Motor Kit. The printable PDF contains 100 pages of hands-on letter writing practice for multisensory handwriting!

    Letters Fine Motor Kit

    Inside the Letters Fine Motor Kit, you’ll find:

    • A-Z Multisensory Writing Pages: Roll a ball of dough letters, ASL sign language letters, gross motor movement, small-scale letter box writing task, finger isolation letter trace, and writing practice area
    • Alphabet Fine Motor Clip Cards– Clip clothespins or paper clips to match letters with various fonts to strengthen the hands and focusing on eye-hand coordination, bilateral coordination, visual processing skills, and more.
    • Cut and place Fine Motor Mazes– Cut out the letter pieces and trace the maze with a finger to work on eye-hand coordination and finger isolation. Place a small letter on the letter spots to address in-hand manipulation and dexterity skills.
    • A-Z Cotton Swab Cards– Includes upper case and lower case letters. Dot the cards using a cotton swab or laminate the cards and use them over and over again.
    • A-Z Pattern Block Cards– These cards include a section for tracing with a finger tip for separation of the sides of the hand, eye-hand coordination, and finger isolation during letter formation. There is also a space to “finger write” the letter using the fingertip. This multisensory letter formation activity can be a great brain break during handwriting or literacy tasks. Learners can then form the letter using parquetry blocks.
    • Fine Motor Letter Geo-Cards– These geo board cards include A-Z in upper case forms. Users can copy the letter forms in a variety of multi-sensory strategies.
    • A-Z Color and Cut Letter Memory Cards– These upper case and lower case letter cards can be used to color for letter formation. Then use them in fine motor matching tasks or in sensory bins.
    • Color By Size Sheets– Help learners discriminate between tall letters, small letters, and tail letters. This visual perception activity invites learners to color small areas, using hand muscles for strengthening and handwriting endurance.
    • A-Z Building Block Cards– These LEGO block cards invite users to copy the cards to form letters using small building blocks. Users can place the blocks on the cards or copy the letter to address visual shift and visual memory. This activity set comes in upper case and lowercase letter forms.
    • A-Z Play Dough Letter Formation Cards– Print off these cards and laminate them to create play dough mats. Learners can form the letters using the arrows to correctly form letters with play dough while strengthening their hands and visual motor skills. Each card includes a space for practicing the letter formation, using a dry erase marker if the cards are laminated.
    • Graded Lines Box Writing Sheets– Users can trace and form letters in boxes to work on formation of letters, line awareness, starting points, and letter size.
    • Alphabet Roll and Write Sheets– Roll a dice and form the letter associated with the number of dots on the dice. This is a great way to work on letter formation skills using motivation. Which letter will reach the top first? This activity is easily integrated with a rainbow writing task to increase number or repetitions for letter practice.
    • Pencil Control Letter Scan– Use the letter bubble tracks to scan for letters. Users can fill in the letters of the alphabet to work on pencil control skills.
    • Color and Cut Puzzles– Color the pictures to work on hand strength and letter formation skills. Then cut out the puzzles and build visual perceptual skills.

    Get your copy of the Letters Fine Motor Kit today!

    Wikki Stix Activities

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    string letters and designs in bright colors, Text reads "wikki stix activities for OT"

    Are you doing any Wikki Stix activities to support fine motor skills, visual motor skills, letter formation, and other underlying skill areas? If you are an occupational therapist, you have most likely heard of, or used Wikki Stix® (Amazon affiliate link). After being prompted to write about these neat little sticks, I started to do some research. Boy, was I missing out on the potential these things have!  Follow along to learn the ins and outs of Wikki Stix, the myriad uses for them, and some great Wikki Stix activities.

    WHAT ARE WIKKI STIX?

    Have you used (or played with) Wikki Stix® before? (Amazon affiliate link) If not, you might be wondering what are Wikki Stix? 

    Wikki Stix are bendable strings covered in colorful wax. These strand-like thingies are sticky sticks of string that you can bend, mold, and form into shapes. In reality, they are made of hand-knitting yarn enhanced with a microcrystalline, food-grade non-toxic wax… the kind used in bubble gum and lipstick. And that is it. (Psst…it is that touch of wax that allows them to stick). 

    Wikki Stix (Amazon affiliate link) were invented in 1989 and called “Sticky Wikki” at that time. While I could not find a specific reference to the origin of this name, the sticky part is obvious. Wikki, I believe comes from the word “wick” as in candle wick.  They were renamed Wikki Stix and Wikki Stix activities were born!

    FUN FACTS ABOUT WIKKI STIX:

    • They stick! No glue, no paste, no mess. Just press them down with light fingertip pressure on virtually any smooth surface and they will stick to itself and to other surfaces. This includes mirrors, dry erase boards, paper, walls, etc.
    • They stick to each other for 3-D creativity and fun. Twist, bend, stick, create. No preparation… no clean-up… no mess.
    • Wikki Stix do not break or tear apart, but cut easily with scissors.
    • Wikki Stix are great for all users, including kids with allergies, because they do not contain dairy or dairy byproducts, latex, gluten, nor peanut or other nut oils or byproducts.
    • Wikki Stix support hands-on, kinesthetic learning
    • They are reusable.
    • Purchase on the Wikki Stix website or (affiliate link) Amazon.
    • They come in endless types of fun packs!
    • Proudly made in the USA.

    NON-TRADITIONAL WIKKI STIX ACTIVITIES

    Before jumping into the more traditional use for Wikki Stix, I want to share some of the cool ideas for using these cool little sticky sticks.

    Some of these ideas are shown in this video:

    In the video, we show how you can use Wiki Stix for several skills: handwriting, spatial awareness, scissor use, pencil grasp, and more.

    Here are tips to use Wikki Stix to support functional areas:

    Wikki Stix for Coloring Skills

    • Use Wikki stix to create a border for coloring in the lines. The Wikki Stix offer a phsyical border for coloring in a given space, which is great for kids who overshoot the lines or need a specific area to color inside of. Outline areas to be colored in with Wikki Stix. This gives a visual and tactile cue where your student is expected to color. You will eventually fade this trick, but it is a great starting tool.
    • Wrap a small piece of Wikki Stix around the tip of a crayon to create a pencil grip. This is nice because traditional pencil grippers don’t always fit crayons and you can make grippers for a whole box of crayons inexpensively.

    Wikki Stix for Handwriting Skills

    • Improve hand grasp and stability by wrapping 1/2 of a Wikki Stix around the base of a pencil as a good reminder to hold it “down low”. We show an example of this activity in the video above.
    • Practice pre-writing lines with Wikki Stix. The bendable sticks can be used as a model or as a writing space.
    • Use Wikki Stix to make borders when handwriting, to keep letters on the line, as well as to indicate where to start and stop on the paper. Can also be used to create boxes to keep letters in.
    • Use Wikki Stix under workbooks or paper for stabilization or a desk positioner. You can support the student that needs assistance to use their non-dominant hand while writing. For the student that has the book or workbook slide from the writing area, this is a nice support.
    • You can even create a spiral with the Wikki Stix to hold the paper in the center onto the desk. Or, cut the Wikki Stix into smaller pieces and use them like reusable tape at the corners of the paper. Put them at the top of a piece of paper to keep in from moving while working.
    • Keep a slant board steady by putting these under the board.

    Wikki Stix for Self-Help Skills

    Gross Motor Activities with Wikki Stix

    FINE MOTOR FUN WITH WIKKI STIX

    • Play tic-tac-toe with Wikki Stix. Use the sticks to create the grid and/or to make the X and O’s.
    • Make a Wikki Stix maze. Learners can zoom cars, marbles, their pencil, pompoms, or other manipulatives through the maze.
    • Create a Wikki Stix racetrack.
    • On paper, use markers to draw a picture with dots. Then ask students to connect the lines using Wikki Stix. You can also use Wikki Stix to connect dots on a regular dot to dot sheet.
    • Use the Wikki Stix to work on visual tracking skills and form constancy to fill in a matching worksheet to connect matching items across the page. Here are free visual perception worksheets to try.
    • Use Wikki Stix to teach kids to tell time. Make a clock on paper or laminated sheet.  Use the sticks as the hands of the clock to practice telling time.
    • Practice cutting the Wikki Stix to make smaller pieces and develop hand strength/snipping skills needed for scissor skills in cutting.
    • Use as a string for lacing beads. Use them for many lacing activities. Use the Wikki Stix to create homemade lacing cards task. This creates more stability and an increased fine motor challenge
    • Use to hold pony beads for counting, like an abacus
    • Decorate rocks – use this sticks to make fun features on plain rocks, like faces, car parts, flowers, and more

    WIKKI STIX ACTIVITIES for Visual Motor Skills

    Some of the more traditional Wikki Stix activities support visual motor skills, include letter formation, creating art projects, making shapes, and other craft projects.

    • Trace letters, number, and shapes with the sticks. Create a page with shapes and letters and laminate the page, or slide it into a page protector sleeve. The students can use Wikki Stix to form the letters or numbers on the page protector.
    • Copying letters, shapes, etc. Cut the Wikki stix into smaller pieces. Show students a picture of a letter/number/shape and then ask them to recreate it with their Wikki Stix.
    • Use Wikki Stix to practice patterns. Create shapes with the bendable sticks and then create a pattern. Ask your student to recreate it.

    Wikki Stix Art

    These Wikki Stix Art activities double as fine motor and visual motor tools.

    • String them together to make longer ropes.
    • Make Wikki Stix glasses.
    • Use drawing prompts to create different shapes and pictures using the Wikki Stix.

    WIKKI STIX Activity Sets

    There are many Wikki Stix activity sets on the market that support various skills. You can use the bendable strings from these larger sets in all of the ways described above. Plus, you can use them in the ways that the Wikki Stix sets intend.

    Here are some of our favorites. These are all Amazon affiliate links.

    The website has endless ideas and products for Wikki Stix activities and creations.

    • Wikki Stix Holiday packs– These sets include dot to dot pictures with a seasonal theme. Use the bendable strings to create a holiday image. Use the pack to create holiday masterpieces!  The Wikki Stix people have created endless templates and packs for further enjoyment. They have Halloween, Valentines, Easter and Christmas Wikki packs. We love:
    • Travel packs -If you are a therapist on the go, or searching for a take along task, the Wikki group have created several travel packs
    • How about Party Favors, or little treats for your students?  Wikki Stix activity sets have you covered!
    • Senior Activity set– The Wikki Stix Senior kit involves more of an art set that uses the bendable wax sticks. Adults and teens will love this set because it doesn’t seem like a kids’ activity but still offers the creative outlet and fine motor work.
    • Bilingual and multilingual packs are available too for French to English speakers.
    • Extra Long Wikki Stix– These are nice because the wax strands come in 3 foot long sections. This is a great activity kit for gross motor skills.
    • There are some imitators such as Monkey String, Fidget Sticks, Wax Sticks, Stringamajigs, and Doodle Stigs.  I have not used any alternative Stix, so I can not attest to their usefulness, pliability, or stickiness

    Benefits of Wikki Stix

    As with anything we tend to recommend for therapeutic intervention, Wikki Stix come with a list of added benefits. These are the reasons we use Wikki Stixs in occupational therapy.

    • Wikki Sticks helps fine motor development. As children bend and mold Wikki Stix into shapes, the muscles in their hands and fingers can develop
    • Kinesthetic learners benefit from learning by doing. Physically creating items helps build their understanding and learning
    • Touching Wikki Stix wax coated yarn stimulates the tactile system. Seekers tend to enjoy this sticky texture, while those who are sensory sensitive might find them harder to adjust to.
    • Wikki Stix help build pincer grasp, bilateral coordination, in-hand manipulation, and prehension
    • Visual perception -Students learn borders for coloring, can keep place in a book, recognize shapes and letters, and copy designs

    I feel like I may have been missing out on the (Amazon affiliate link) Wikki Stix potential.  I have them in my OT Toolbox but rarely use them anymore.  To be honest, I do not like the sticky feeling.  After researching and writing this, I am going to revisit my Wikki stash and revitalize it with my kiddos this week.

    Victoria Wood, OTR/L is a contributor to The OT Toolbox and 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.

    Handwriting Without Tears Letter Order

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    "Handwriting Without Tears letter order" with letter K on a chalkboard and a small piece of chalk

    In this blog post, we’re covering Handwriting Without Tears letter order, or the specific order to teach letter formation based on the handwriting curriculum, Handwriting Without Tears (Learning Without Tears). We’ve previously covered the cursive HWT order so this is a nice resource to have on hand.

    Have you noticed most teachers teach letters in alphabetical order? The first thing they teach is name writing, then writing the alphabet. This seems like a logical progression, but is not the most effective or efficient method. There are several different handwriting programs out there to address this important skill. Many of them do not teach letters in order.

    One program specifically is; Handwriting without Tears (now called Learning without Tears). The Handwriting without Tears letter order is vastly different than writing letters in sequential order.

    handwriting without tears letter order

    The Handwriting without Tears program is popular among therapists for good reasons:

    • It’s a research-backed curriculum
    • The program is designed to be easy to teach and easy to learn
    • Developmentally appropriate sequence
    • It uses explicit instruction combined with guided practice
    • Promotes handwriting automaticity
    • Multisensory learning to support a variety of learning styles, including kinesthetic learners, visual learners, and auditory learners
    • Uses hands-on tools and activities in handwriting lessons
    • Uses intuitive lesson booklets to promote learning

    According to the folks at Learning without Tears, “Pre-K–5 students move through a developmentally appropriate teaching order from capital, to lowercase, and cursive letters. This design helps children master handwriting skills in the easiest, most efficient way. Instead of teaching 52 letter symbols with a mishmash of different sizes, positions, and confusing starting places, we divide and conquer.”

    what is handwriting without tears letter order?

    If you have used the HWT program, you may have noticed the letters are not in sequential order. In other words, the Handwriting Without Tears program does not teach letter formation in order from A-Z.

    This sounds counter intuitive, as students are generally taught letters in order. Child development skills, as found in the Peabody Developmental Motor Scales, demonstrates the visual motor progression of fine motor skills. We cover some of this in our post on drawing milestones.

    When developing writing skills, pre-writing lines emerge. This begins when the stages start at scribbling, vertical and horizontal lines, then circular forms. After these are mastered, more difficult designs such as a cross, square, and triangle are developed.

    Learners who are still mastering the basics of writing lines, do not have the necessary skills to form more complex designs such as the letter A which relies on diagonal lines, or B which requires semicircles. Students often get stuck at this stage if they are unable to form these letters.

    The Handwriting without Tears letter order promotes success, focusing on letters that use the preliminary pre-writing strokes. This is why letters with straight lines are taught first and in a group, known as letter families.

    HWT Letter Order Groups

    The Handwriting Without Tears letter order progresses like this:

    1. L, F, E, H, T, I
    2. U, C, O, Q, G, S, J, D, P, B, R
    3. K, A, N, M, V, W, X, Y, Z

    Handwriting Without Tears Straight Line Letters

    The first letters are L, F, E, H, T, I. Notice all of these letters require only vertical and horizontal lines.

    This is the first developmental skill mastered. Imagine the success of learning six letters right away, rather than struggling on A and B!

    handwriting without tears Circular Letters

    The second set of letters are circular: U, C, O, Q, G, S, J, D, P, B, R. The letters within each section progress in level of difficulty from U to R.

    Notice that letter B is 16th on the list! This is vastly different than the traditional method of teaching it as letter number two.

    While R, is a circular letter, it also contains a diagonal, which segues into the third uppercase letter formation group.

    Grab our Letter B Worksheet for sensory motor practice to form the semicircles that make up this circular letter.

    We also have a Letter C Worksheet for improving the circular motion of the pencil which carries over to other letters (Also known as magic c and is helpful for forming the lowercase letter counterparts).

    Further down the list is letter D, and you can use our Letter D Worksheet to work on the straight line followed by a rotated semicircular motion that then carries over to the remaining letters with the same motor pattern: P, B, and R.

    handwriting without tears Diagonal Letters

    The third and final set of letters are the diagonals. Copying a triangle is one of the last basic shapes to learn as a developmental progression.

    Forming diagonals is tricky. Not only are students crossing midline, they are doing so in a top to bottom fashion.

    The letters in this series are: K, A, N, M, V, W, X, Y, Z. A is number 18 on the list. Now you can see why students struggle to learn the very first letters of the alphabet. They are not developmentally ready for this skill at the time we are insisting on teaching it.

    Try using our Letter A Worksheet for sensory motor practice to form the diagonals and starting the letter in the middle.

    Starting Position for handwriting without tears letters

    An additional method HWT uses to group uppercase letters is their starting position. This is not my personal method of teaching, as I prefer the developmental sequence.

    When focusing on the starting point for letters, Handwriting Without Tears groups the upper case letters into three catagories, depending on where the pencil starts:

    • Frog Jump Capital Letters – F, E, D, P, B, R, N, M
    • Corner Starting Capital Letters – H, K, L, U, V, W, X, Y, Z
    • Center Starting Capital Letters – C, O, Q, G, S, A, I, T, J

    Take a look at the Frog Jump Capitals that start at the left corner (F, E, D, P, B, R, N, M). Notice several of these letters are more complex with diagonal lines. This can be a challenge for some students that struggle with the pre-writing lines, specifically diagonals. Additionally, this grouping of letters includes several different pencil stroke patterns, which can also be a challenge for some students.

    Their second grouping is the starting corner capitals (H, K, L, U, V, W, X, Y, Z). This grouping of letters also includes a mix of straight line letters, diagonals, and curves.

    Lastly, the center starters (C, O, Q, G, S, A, I, T, J) are addressed. Again, this group of letters includes more curved lines, but again, a mix of straight lines, curved lines, and diagonals. Notice how many of the last letters are commonly used letters. This is another reason why this particular HWT letter order might be a challenge for some.

    uppercase or lowercase letter order first?

    There has been some discussion on whether it is better to teach upper or lowercase letter formation first. We cover the developmental reasons in our linked blog post.

    The research has been inconclusive, as there are benefits to both.

    • While lowercase letters are everywhere, capital letters are the first introduced in toddler books and puzzles.
    • Lowercase letters will be used much more than capital, but uppercase letters are much easier to form due to the simple straight lines.
    • There is no retracing or letters that sit below the line in uppercase letters
    • B/D are not as confusing as lowercase b and d when writing capital letters
    • When reading, many agree that teaching letter sounds is more important than their names, therefore teaching lowercase letter sounds first, may be more beneficial than teaching the letter names
    • Consider the age of your learners – preschooler should write uppercase first, as that is their developmental progression stage. Kindergarten and later students may be able to start in alphabetical order, however for delayed students, this can cause frustration

    handwriting without tears lowercase letter order

    For the same reason we teach uppercase letters in a progressive order, Handwriting without Tears lowercase letter order is important also. These letters are formed in developmental progression as with the uppercase.

    • Just like their capital letters – c, o, s, v, w, t (just like uppercase only lower cross)
    • Magic C – these high frequency letters (a, g, d) start with a magic “c”. This helps differentiate between b and d. While “q” is a “magic c” letter, it is taught later to avoid confusion with g
    • The rest of the vowels – u, i, e
    • Familiar from capitals – l, k, y, j
    • Diving letters – these letters dive down (p, r, n, m, h, b)
    • Tricky leftovers – f has a tricky start, letter q is taught here to avoid confusion with g, x and z are familiar but infrequently used
    • Once these are learned, I add another group: the drop down letters. These are the most difficult to write correctly as all of the other letters sit on the line. When I am teaching correct letter formation, j, g, p, q, y are stressed as their own group, after the others have been learned

    cursive handwriting letter order

    As with upper and lowercase letter formation, cursive letters are formed in groups. While HWT has their way of presenting the cursive letters, I prefer (Amazon affiliate link) “Loops and other Groups“.

    This system groups the letters into the way they are formed. There are the clock climbers, kite strings, loop groups, then hills and valleys. Capital letters are taught last, as they are tricky and not used as frequently.

    Here is an interesting post from the OT Toolbox about teaching cursive writing.

    How to Teach Cursive Writing is another great resource.

    resources to support handwriting without tears letter order

    Everyone is different, as are their learning styles. Ultimately the goal is success. Whether that means using the Handwriting Without Tears Letter Order, or another teaching method, whatever helps and motivates your student is the correct choice. Nothing we teach is one size fits all. That is what makes our job so exciting and dynamic!

    Victoria Wood, OTR/L is a contributor to The OT Toolbox and 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 Letters Fine Motor Kit is a supplement to any handwriting curriculum and uses hands-on, multisensory strategies to support letter formation.

    Want printable handwriting and sensory motor activities to target the visual motor skills needed for letter writing? Grab a copy of our Letters! Fine Motor Kit. The printable PDF contains 100 pages of hands-on letter writing practice for multisensory handwriting!

    Letters Fine Motor Kit

    Inside the Letters Fine Motor Kit, you’ll find:

    • A-Z Multisensory Writing Pages: Roll a ball of dough letters, ASL sign language letters, gross motor movement, small-scale letter box writing task, finger isolation letter trace, and writing practice area
    • Alphabet Fine Motor Clip Cards– Clip clothespins or paper clips to match letters with various fonts to strengthen the hands and focusing on eye-hand coordination, bilateral coordination, visual processing skills, and more.
    • Cut and place Fine Motor Mazes– Cut out the letter pieces and trace the maze with a finger to work on eye-hand coordination and finger isolation. Place a small letter on the letter spots to address in-hand manipulation and dexterity skills.
    • A-Z Cotton Swab Cards– Includes upper case and lower case letters. Dot the cards using a cotton swab or laminate the cards and use them over and over again.
    • A-Z Pattern Block Cards– These cards include a section for tracing with a finger tip for separation of the sides of the hand, eye-hand coordination, and finger isolation during letter formation. There is also a space to “finger write” the letter using the fingertip. This multisensory letter formation activity can be a great brain break during handwriting or literacy tasks. Learners can then form the letter using parquetry blocks.
    • Fine Motor Letter Geo-Cards– These geo board cards include A-Z in upper case forms. Users can copy the letter forms in a variety of multi-sensory strategies.
    • A-Z Color and Cut Letter Memory Cards– These upper case and lower case letter cards can be used to color for letter formation. Then use them in fine motor matching tasks or in sensory bins.
    • Color By Size Sheets– Help learners discriminate between tall letters, small letters, and tail letters. This visual perception activity invites learners to color small areas, using hand muscles for strengthening and handwriting endurance.
    • A-Z Building Block Cards– These LEGO block cards invite users to copy the cards to form letters using small building blocks. Users can place the blocks on the cards or copy the letter to address visual shift and visual memory. This activity set comes in upper case and lowercase letter forms.
    • A-Z Play Dough Letter Formation Cards– Print off these cards and laminate them to create play dough mats. Learners can form the letters using the arrows to correctly form letters with play dough while strengthening their hands and visual motor skills. Each card includes a space for practicing the letter formation, using a dry erase marker if the cards are laminated.
    • Graded Lines Box Writing Sheets– Users can trace and form letters in boxes to work on formation of letters, line awareness, starting points, and letter size.
    • Alphabet Roll and Write Sheets– Roll a dice and form the letter associated with the number of dots on the dice. This is a great way to work on letter formation skills using motivation. Which letter will reach the top first? This activity is easily integrated with a rainbow writing task to increase number or repetitions for letter practice.
    • Pencil Control Letter Scan– Use the letter bubble tracks to scan for letters. Users can fill in the letters of the alphabet to work on pencil control skills.
    • Color and Cut Puzzles– Color the pictures to work on hand strength and letter formation skills. Then cut out the puzzles and build visual perceptual skills.

    Get your copy of the Letters Fine Motor Kit today!

    Endurance Activities

    by
    teacher leading kids in a dance activity. Text says "endurance activities"

    One of the ways that occupational therapy supports clients, patients, and students is by targeting the areas impacting functional performance in daily tasks, and endurance activities are one of those underlying skills. When our patients lack the endurance to participate in daily activities, full participation is impacted. Today, we’re discussing endurance activities to support daily occupations.

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    endurance activities

    In this post we will look at some classic endurance activities, as well as learn about aerobic exercises that kids can do without realizing they are “working out”.

    endurance activities

    According to the American Heart Association, “endurance exercise is one of the four types of exercise along with strength, balance and flexibility. Ideally, all four types of exercise would be included in a healthy workout routine”.

    Additional contributions include:

    Also called aerobic exercise, endurance activities include exercises that increase your breathing and heart rate such as walking, jogging, swimming, biking and jumping rope.

    Children, along with adults, need to engage in a certain amount of aerobic or endurance activities to keep their mind and body healthy. These skills enable physical health and overall wellbeing.

    Endurance activity keeps your heart, lungs and circulatory system healthy and improves your overall fitness. As a result, people who get the recommended regular physical activity can reduce the risk of many diseases such as diabetes, heart disease and stroke.

    Endurance activities build muscles and increase the ability to sustain exercise for longer periods of time.

    Not only are endurance activities great for the mind and body, they are excellent for aiding in regulating the sensory system. Endurance activities can help to organize the vestibular, proprioceptive, visual, and tactile systems.

    Endurance also is a tool in improving arousal level. Check out this post on Zones of Regulation and Self Regulation Activities. When you think about how sensory dysregulation appears, it can be a visual picture of low endurance and sensory organization of the nervous system. Having self regulation strategies on hand supports these needs.

    classic endurance activities

    There are numerous endurance activities appropriate for people of all ages. Children should get 60 minutes of aerobic exercise three times per week. Hint: don’t call it exercise, or no one will want to play!

    Classic endurance activities like the ones listed below, are a great way to get moving

    Running – this can include jogging, speed walking, sprinting, galloping, and skipping. Running can also be part of other activities like organized sports or fun outdoor games such as tag games.

    Walking – included is hiking, or taking a brisk walk around the park. Another option is HIIT treadmill workouts.

    Swimming – this does not have to be done competitively in order to be beneficial. Children can spend hours diving for pennies, racing their friends, diving into the pool, or jumping up and down in the water.

    Biking – two wheeled bikes, tricycles, scooters, skateboards, skating, balance bikes, big wheels, or anything else with wheels. Stay clear of motorized vehicles when looking for endurance activities. Here are tips to teach bike riding and ideas to support balance and endurance needs with bike riding.

    Sports – organized sports provide great exercise opportunities. These can be team sports like football or baseball, or individual activities such as martial arts, gymnastics, skiing, or fencing. Not everyone is suited for an organized group sport.

    Jumping rope – this classic endurance activity works on a plethora of skills. In addition to coordination, jumping rope improves balance, endurance, motor planning, and more. Other skills while jumping rope include hopping, one foot at a time, both feet together, and double Dutch. While practicing hopping and jumping, grab some chalk and make a hopscotch game.

    Dancing – jamming to favorite tunes, organized dance class, aerobic fitness class, or following along with videos

    Calisthenics – this is the “old fashioned” word for muscular endurance activities. These include; sit ups, push ups, burpees, jumping jacks, planks, squats, and lunges. Muscular endurance, is all about sustained efforts over a longer period of time.

    Yard work or chores – while these are not generally preferred activities, they are a great way to get the heart rate and breathing going.

    Skipping– This is a great endurance activity. Use some of our tips to teach skipping if motor planning and coordination is a challenge.

    non-traditional endurance activities

    There are definitely a large group of people who resist exercise of any kind. This group might need a little hidden exercise disguised as a fun game. While I am not a fan of electronics, games like the Wii, or Peloton combine exercise and technology. There are tons of other endurance activities that are just plain fun:

    • Tag games– who doesn’t love a great game of tag? Freeze tag, blob, Red Rover, Red Light Green Light, Musical Chairs, Flashlight tag, Duck Duck Goose, Mother May I, relay races, Zombie Tag, are just a few.
    • Ball games like Dodge Ball, Four Square, and Spike Ball are fan favorites
    • Classic outdoor lawn games such as Capture the Flag, Kick the Can, Hide and Seek, Simon Says, and Cops and Robbers will bring back fond memories
    • Obstacle courses – turn your house or backyard into an obstacle course. Become the next American Ninja Warrior!
    • Organized Play – if you prefer, there are great places to take the kids to get some exercise. The playground, trampoline park, mini golf, amusement parks, water parks, rock climbing, are just a few choices. These playground balance activities are more ideas.
    • Brain Breaks– many brain break activities are actually endurance work disguised as themed movements. Try our list of Brain Break videos on YouTube for more ideas.
    • Yoga activities like unicorn yoga improve core strength and stability.

    Endurance Activiies resources

    These activities are designed to develop strength and endurance through play:

    • Jungle Animal Heavy Work Exercises – Need to add heavy work to help kids regulate emotions, or to use as a coping tool for sensory needs? Help kids re-group or add movement into learning with these Jungle animal themed brain break cards. 
    • June Heavy Work Exercises – These adorable movement and heavy work activity cards will not only bring joy to students but also help them unleash their full learning potential, while caregivers can effortlessly provide easy and enjoyable activities. 
    • Fit Deck (Amazon affiliate link) has some great workout flash cards for children and adults.
    • Little Tykes Stationary bike – this includes a video screen for the reluctant learner

    final thoughts on endurance activities

    According to the Centers for Disease Control, “Less than one-quarter (24%) of children 6 to 17 years of age participate in 60 minutes of physical activity every day.” They also state that:

    • Students who are physically active tend to have better grades, school attendance, cognitive performance (executive function and memory), and classroom behaviors (compliance, attention, and on-task behavior).
    • Higher physical activity and physical fitness levels are associated with improved cognitive performance (concentration, memory) among students.

    “When I was a kid…..” we played outside all of the time. We came inside for dinner and went back out again. There also were not as many people with health issues, obesity, attention, or behavioral issues. While people have made many advances in technology and medicine, screen time and technology use has changed things. Let us not forget the basics of play and endurance activities in order to be healthy and well rounded.

    Victoria Wood, OTR/L is a contributor to The OT Toolbox and 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.

    Manual Dexterity Goals

    by
    manual dexterity

    In today’s blog post, we’re talking all things manual dexterity goals. Fine motor IEP goals, or goals designed to target manual dexterity needs can be identified based on dexterity weaknesses that impact participation in the educational environment. You’ll also find many manual dexterity activities in this blog post, including this dexterity activity.

    Be sure to read about IEP and 504 plans for information on where to begin with these processes. Another resource you’ll want to check out is our self regulation IEP goals and identifying student strengths for IEP writing.

    Goals, goals, and more goals! It seems all therapists do is create, work on, and document about goals. Occupational therapy is about play. Where is the fun in that? Unfortunately, therapists are driven by measurable data and reimbursement.

    That being noted, the focus on progress and goals will continue. Writing goals and measuring them can feel overwhelming at times. Today we will focus just on manual dexterity goals.

    manual dexterity goals

    Manual dexterity or precision in fine motor skills, has many underlying factors that impacts graded coordination in functional tasks.

    manual dexterity goals

    Before churning out a dozen goals, it is important to review the basic framework and structure of excellent goals. A

    s much as I dislike all of the documentation involved in providing therapy, having great measurable goals makes it a little easier. When goals are SMART, they are specific, measurable, attainable, relevant, and timebound.

    The key to successful goal writing is to incorporate all five of these elements into each goal. Check out this post on Breaking Down Goals for more information.

    what are manual dexterity skills?

    Manual dexterity refers to the ability to use your hands in a skillful, coordinated way to grasp and manipulate objects and demonstrate small, precise movements. Manual dexterity is one of the components of fine motor skills.

    Other fine motor skills include: speed and precision, visual motor skills, and strength. These skills allow for manual dexterity, or coordinated precision, to happen. Those skills listed out are:

    There are tons of articles and ideas in the OT Toolbox Archives under “manual dexterity” to help gather ideas of what to be watching for when evaluating a student for fine motor skills.

    manual dexterity examples

    Manual Dexterity Examples

    Manual dexterity goals are going to be related to manipulating objects with the hands, rather than the visual motor goals of copying shapes, writing letters, coloring, and cutting.

    Examples of these from the  Bruininks-Oseretsky Test of Motor Proficiency Second Edition (BOT™-2) include the following five items measured in fifteen second intervals:

    • transferring pennies (total pennies into box after fifteen seconds)
    • sorting cards
    • making dots in circles
    • placing pegs into a pegboard
    • and stringing blocks

    Other manual dexterity measurements might include; the Purdue Peg Board, 9 Hole Peg Test, Jebson Hand Function Test, Functional Dexterity Test, and the Box and Block Test.

    It’s important to know about fine motor milestones when assessing these results in order to create fine motor goals.

    Specific examples of fine motor, manual dexterity activities include many components of every day activities. There are many fine motor skills required in the school environment. At home there are just as many!

    It would be hard to list out every single manual dexterity example, but here are some listed below. Some of these are related to the school environment and may be incorporated into IEP goals based on manual dexterity needs in the school-based OT environment. Others are more ADL or IADL based and do not impact education. These dexterity goals may be covered in outpatient or medical model of occupational therapy.

    1. Typing on a keyboard
    2. Handwriting, holding a pencil
    3. Coloring in lines
    4. Writing in a given space
    5. Buttoning clothes
    6. Zipping a zipper
    7. Snapping a clothing snap
    8. Tying shoelaces
    9. Threading a needle
    10. Cutting with scissors
    11. Using chopsticks
    12. Turning a key in a lock
    13. Playing a musical instrument
    14. Operating small tools (e.g., screwdrivers)
    15. Applying makeup
    16. Drawing and coloring
    17. Pressing buttons on a device
    18. Sculpting with clay or manipulating play dough
    19. Braiding hair
    20. Flipping a coin
    21. Manage money
    22. Stringing beads
    23. Assembling puzzles
    24. Crafts
    25. Tearing paper
    26. Playing board games
    27. Painting miniatures or models
    28. Using a combination lock
    29. Applying nail polish
    30. Playing jigsaw puzzles
    31. Building with LEGO bricks
    32. Weaving paper crafts
    33. Operating a computer mouse
    34. Folding origami
    35. Stacking small items like Jenga game pieces
    36. Cutting food with a knife
    37. Putting on jewelry
    38. Playing cards
    39. Folding paper
    40. Flipping a light switch
    41. Opening a door handle
    42. Turning a faucet
    43. Opening containers like a toothpaste lid
    44. Sealing plastic sandwich bags
    45. Using a spoof and Fork
    46. Pouring liquid from a container
    47. Applying lotion or cream
    48. Turning the pages of a book
    49. Using a stapler
    50. Playing with building blocks
    51. Playing with small toys
    52. Using tweezers
    53. Using fingernail clippers
    54. Flossing teeth
    55. Turn a pencil sharpener
    56. Turn a watch dial
    57. Put on a watch

    not so great manual dexterity goals

    How do you translate the data you gathered in a standardized assessment into SMART goals? One strategy is not to be to vague. This is one of the first goals I pulled up when searching for “manual dexterity goals”:

    The student will improve fine motor dexterity skills to manipulate small objects, use tools, or engage in activities that require precise hand movements.

    This goal is missing several components. It is not specific, measurable, attainable (how will you know when the student has improved?), or timebound. While it IS relevant to therapy, it is missing all of the other components that make it a usable goal.

    How about this one?

    In six months, the student will improve manual dexterity skills by improving score on the BOT2 test from 11 to 18 points in 3 of 4 trials.

    There is a big part of me that likes this goal. It has all of the components of a SMART goal. The drawback is you will be constantly teaching and reviewing the specific items on the test, which will nullify the results the next time you retest. Also, school based therapists can not use standardized assessments each time they measure and report on goals.

    Another thing to consider about writing fine motor goals based on the results of standardized testing; This goal is a “no no” in the school system (I found out the hard way this year). Maybe there is a way to tweak it in a long term goal, while having several different short term goals. After all, your ultimate measurement for progress and discharge may be those results from updated standardized testing!

    manual dexterity goals – framework

    The goals I tend to write have several similar components (as dictated by the school district or governing body):

    • In TIME FRAME (one, three, six, 12 months)
    • student will improve manual dexterity skills
    • by…
    • as measured by clinical observation and data collection by occupational therapist
    • 3 of 4 trials, 8 of 10 opportunities, 4 of 5 sessions. I prefer this to percentages because it feels more specific than “75% of opportunities”.

    measurable manual dexterity goals

    The following is a list of goal ideas to get you started. It is by no means an all inclusive list, because students are as different as snowflakes.

    To use an activity in goals, you can add time frames, percentages, number of seconds, assistance, or whatever modifications you need.

    For example, to write a fine motor goal based on a specific fine motor task, follow this format:

    In 12 months (specify date), the student will demonstrate improved manual dexterity skills by:

    • stringing 3 half inch beads on a lace within 15 seconds, stringing one at a time
    • place 9, 1/4 inch pegs into a 5 inch pegboard using dominant hand within 30 seconds
    • pick up and hold 10 pennies without dropping any, using dominant hand only, and a pincer grasp to pick up
    • find 10 quarter inch beads in medium green theraputty using a pincer grasp (this can include picking off the extra strings of dough)
    • independently button/unbutton 4/4 one inch buttons on a standard button strip
    • rotate a pencil in hand from the lead side to use the eraser using one hand only
    • rip one inch pieces of construction paper using finger tips
    • crumple pieces of tissue paper using one hand to reduce to 1/4 the original size
    • independently open screw top containers and replace
    • roll 10 one inch balls of playdough and place them in one inch circles
    • pick up 10 pennies and place into a vertical slotted container in 30 seconds
    • place 15 clothespins accurately on the edge of a plastic container, using dominant hand to squeeze clothespins
    • flip 10 quarters on a horizontal surface using in hand manipulation, without sliding quarters off of table
    • lace a shoe lace through holes x6 holes (does not have to be in correct order)

    Manual Dexterity Activities

    Remember when writing and using goals, these are just the items you are measuring for documentation. This does not mean these are the only manual dexterity activities you do during your treatment sessions. It would be next to impossible to list all of the possible activities you will be measuring in your goals.

    You may end up with 27 goals this way! I often add 3-4 challenges within the goal, as I feel that one item might not be enough to accurately represent my student.

    Manual dexterity intervention strategies can (and will!) include the list of 50 examples of dexterity that we shared above. After all, occupational therapy is all about functional tasks as a tool and a goal. However, some more manual dexterity examples can be rooted in play and the interests of the individual.

    Some dexterity activities to try include:

    Working on fine motor skills, visual perception, visual motor skills, sensory tolerance, handwriting, or scissor skills? Our Fine Motor Kits cover all of these areas and more.

    Check out the seasonal Fine Motor Kits that kids love:

    Letters Fine Motor Kit
    Kit de motricidad fina de verano
    Summer Fine Motor Kit
    Outer Space Fine Motor Kit
    Space Fine Motor Kit
    Spring fine motor kit
    Valentines Day fine motor kit
    winter fine motor kit
    Winter Fine Motor Kit

    Or, grab one of our themed Fine Motor Kits to target skills with fun themes:

    Want access to all of these kits…and more being added each month? Join The OT Toolbox Member’s Club!

    Victoria Wood, OTR/L is a contributor to The OT Toolbox and 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.

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