Gross Motor Coordination Activities

Gross motor coordination activities

Hop, skip, jump, push and pull are all skills needed, to build foundational gross motor coordination.  Gross motor coordination activities are an engaging way to build these skills. Delays in gross motor coordination can impact the academic learning process of a child. These are skills that are needed to sit and engage in the classroom, participate in P.E./on the playground, navigate the school setting/bus, transition between classrooms/within the classroom, doff/don coats and backpacks, and transport of a lunch tray within the cafeteria. We’ve previously covered gross motor toy recommendations, so you’ll want to check out that resource, too.

Gross motor coordination activities for occupational therapy or physical therapy using play to develop balance and coordination.

gross motor coordination

What exactly is gross motor coordination?  Simply stated, it is the use of large muscle groups in controlled movement patterns that includes all extremities. Gross motor coordination is needed for a child to engage in coordinated and free play, navigation in their environments, and overall self-care. 

 If a child struggles with any of the following:

  • core strength
  • balance
  • body awareness
  • coordination
  • crossing midline

they could struggle with attention, focus, and overall engagement in school.

They need to be able to manage themselves in their academic environment so as to be able to learn and grow in their development. Some gross motor movement is all about mindfulness or developing self control.

Gross Motor Coordination involves both conscious use of motor actions and automatic use of motor actions.

Conscious Use of Motor Coordination

Conscious use of motor coordination involves learning a new skill, while focusing on performing the task or exercise, with that being their sole intent.

An example of conscious use of motor coordination is solely focusing on skipping, without adding music, following directions or any variables.

Automatic Use of Motor Coordination

Automatic use of motor coordination involves being able to move through the actions without thinking of the actual movements, resulting in higher levels of skill.

Running while listening to an iPod, moving around obstacles, and drinking from a water bottle is a good example of automatic motor coordination.

Moving from conscious to automatic motor coordination is the end goal. Children must be able to balance and coordinate their bodies automatically, not think about the movements or actions.

This frees up their attention to focus and process necessary academic information, such as listening to the teacher and learning higher level concepts and skills within the classroom. 

gross motor coordination activities

Check out this Gross Motor Activities Book about Core Strengthening with Music and Movement.

Development occurs proximal to distal, which is essentially from the core to the extremities. First, a child must have adequate core strength and stability in order to fully engage in gross and fine motor skill development.

You can find core strength activities on the OT Toolbox website.

basic core strengthening activities: 

  • sit-ups
  • planks
  • push-ups
  • wall-kicks
  • pulling self on a scooter board
  • donkey kicks
  • crab walks
  • yoga poses
  • wheelbarrow walking
  • therapy band exercises
Use these gross motor coordination activities to develop coordinated movement patterns in kids.

gross motor coordination Home Exercise program

At-home exercise programs are important to engage the family in their child’s therapy program. At-home gross motor coordination activities provide the family with some easy and fun ways to work as a family while developing important skills.

A daily routine is most effective, however, the family can work on a weekly routine if that is all the time they have (every little bit counts).

Hopefully, when the family sees the difficulties their child has in doing some of these gross motor coordination activities, and understand the impact it has on their academic learning and overall school success, they will invest more time into their program.

  1. Follow the Leader: Think about sprinkling in some old movements with new ones to help the child feel successful, but also encourage them to participate in the harder or more difficult movements. Ideas include: clapping, marching, arm circles, twirling, side to side jumping, crawling, sidekicks, hopping, stair climbing with hands and feet, and body swaying.
  2. Obstacle course – Think about keeping it simple at first with just 2-3 obstacles and then add additional obstacles as they improve their skills. Ideas include: jumping over pillows, walking around multiple chairs or bar stools, crepe paper laser maze in the hallway or between chairs, tunnels created with tables and chairs, or even pool noodles in the hallway
  3. Dance moves – Find YouTube dance move videos for the child to engage in ,or just try silly dances such as animal dancing, freeze dancing, and animal sound dancing.
  4. Jump rope or hoola hoop moves – Try jump roping by either continuously moving the rope overhead and jumping, or if this is not possible, try flipping rope overhead, pause behind feet, and step over in a continuous manner. If the child is not ready for jumping rope, try wiggling the rope on the ground like a snake while the child jumps over it. If jump roping is not an option, try the same idea with use of a hoola hoop!
  5. Ball dribbling – Use a playground or basketball to do some ball dribbling using one hand at a time and then advance to bilateral hand dribbling from left to right and right to left. You can even have them dribble with the ball by bouncing off the wall to the floor or ground. The OT Toolbox has a few more ideas to work on bilateral coordination.
  6. Target toss – You can use a variety of objects for this activity such a stuffed animals, bean bags, pillows, or balls. Toss them into a basket, try cornhole, toss into tape shapes on the floor, or even at a target on the wall. 
  7. Rolling – Have the child roll themselves down a hill or an incline created with a wedge or other surface. Don’t have an incline? That’s okay, roll up in a blanket or a flat sheet!
  8. Twister or Twister Moves (Amazon affiliate links)– These two games are two of the best games for older kiddos to play in order to work on gross motor coordination! Kids really love them and so do the families! 
  9. Climbing – Have the child climb up a rope ladder, stairs, or the ladder on a bunk bed. Create a coordination exercise with obstacles on the floor to crawl over such as pillows or cushions off of the sofa. Go to the neighborhood playground and use the climbing wall!
  10. Simon Says – This simple game can be a fun way to work on coordination skills. You can incorporate the use of left and right directionality to make it more of challenge.
  11. Tightrope balance beam – Place a jump rope or a strip of masking/painter’s tape on the floor to have the child walk on the line in order to remain on the tightrope – be careful and don’t fall off!  Incorporate heel to toe, side stepping, squatting to pick up items, and walking backwards. A slack line across a canyon will be the ultimate goal! These indoor balance beam ideas will keep you covered for indoor activities and these outdoor balance beam ideas are great for outdoor play.
  12. Hopscotch – Draw a hopscotch board on the driveway or the sidewalk and play this classic game. You can even do it even on a rainy day by using tape on the floor in the home.
  13. Hippity Hop Balls and Pogo Jumpers (Amazon affiliate links)– Many families have one of these at home, and they are great to work on overall gross motor coordination. Hop around the house or create a path to have the child hop on.
  14. Pillow jumping – Create a path around the room with pillows or stuffed animals on the floor and have the child jump over them with two feet or if they are ready for an advanced move, on one foot! If you are in someone else’s home, make sure the parents are ok with their child jumping on pillows or furniture first.
  15. Big shoe walking – Allow the child to walk around the house in shoes that are too large for them. Have them try slippers, boots, sneakers, and sandals. It’s super fun and highly motivating! While not the safest option, children love walking around in high heels!
  16. Crawling – Simply crawl on all fours to maneuver around the room by crawling around, over, or under furniture. It can be the fun way to work on coordination exercise.
  17. Ball rolling on a tape maze – Create a maze on the floor and have the child work on rolling a ball on top of maze lines, either by using their hands and crawling or standing and using their feet
  18. Ball rolling on a wall – Have the child work on rolling a ball up and down the wall with their feet, while lying supine, or roll the ball on a tape maze using their hands. Create the maze in either a horizontal or vertical fashion.
  19. Skateboard – No, this isn’t standing and riding, as this is most likely a dangerous coordination exercise for the child who is challenged with gross motor coordination. However, have you thought about having them sit or lie on the board to use it like a scooter board? It can potentially be a good tool for coordination. 

Need a free printable handout for fun gross motor activity ideas?  Grab it here! This printable set contains an equipment list and activity ideas specifically for the home. 

Gros Motor Intervention Ideas

Intervention ideas for a therapy session can include many of the gross motor coordination activities above that are easy to do without much equipment.

Other ideas can include the use of therapy balls, scooter boards, swings, a trampoline, bucket stilts, and other various equipment. If you don’t have the room for these items, or access to them where you are providing services, there are other ways to work on gross motor coordination too.

Take a look at some of these fun ideas to build motor coordination:

  • Hand games – Any type of hand game is the perfect tool to work on motor coordination for kids. Classic ‘Give me 5’, hand stacking, and slap hands are great for bilateral coordination of the upper extremities. Here are some easy hand games, or finger play songs that you might want to try. 
  • Clapping activities – Use of symmetrical and asymmetrical hand movements can easily be upgraded and downgraded based on the child’s skill level. Try some of the ideas found in Why You Should Teach Your Kids Clapping Games
  • Balloon volley – Have child do balloon volley with a partner in sitting, standing, or even kneeling. This is a super fun way to engage in coordination and you can do partner games easily during therapy. Don’t have a partner? That’s okay, have them try to do it with use of frisbee or their own hands. Add in a baton held horizontally and you’ve got another game! 
  • Rapper Snappers or Pop Tubes (Amazon affiliate link)– Have the child pull these apart and push them back together. This is not as easy at it looks. It makes a great motivator as the sound can be quite rewarding. Don’t do it in a library or a quiet hallway, as it can be quite loud. Don’t ask how I know this.
  • Crab walk soccer – Have the child learn crab walking first. When they are ready for a little extra challenge, have them work on kicking a ball while in the crab walk position. They can play with a partner or simply kick the ball to a target. 
  • Suspended ball hit – Suspend a ball or balloon from the ceiling or a swing suspension system and have them either stand while holding a baton horizontally to strike a ball/balloon back and forth to themselves. If your student can not stand for this activity, they can sit and do the same. Need an extra challenge? Tall kneeling is a good position!
  • Mirror image – Play mirror imaging by having the child copy the moves that you do like looking in a mirror. 
  • Zoom Ball – Have the child work on building coordinated arm movements to pull the handles of the ball on a string and send the ball to their partner. Do it while standing, sitting, and kneeling. You can even try it with your arms behind your back!
  • Laundry basket pulley – Have child sit or stand to pull a rope attached to a weighted laundry basket or box and have them pull the rope hand-over-hand towards themselves to bring the basket/box to themselves. 
  • Resistive Band or Handee Band exercises – The use of resistive bands is a simple way to work on coordination. Using fun exercise cards can keep them focused and engaged by design.  The Handee Band program is designed for younger kiddos, as the cards are designed with fun active characters. 
  • Heavy Work Movements– Actions that incorporate the proprioceptive sense and vestibular sense offer movement with sensory benefits. These Heavy Work Activity cards are perfect for all learners.
  • Hokey Pokey – An easy, classic game that children enjoy and can be played as a small group or individually during therapy.  You can easily incorporate directionality with this game too!
  • Playground equipment – Head out to the playground at a school and voila! Tt’s gross motor coordination opportunities galore! Explore swinging, sliding, rocking, and climbing.
  • Animal walks and other types of movement patterns – Have the child work on some of these fun animal walks as they are one of the best ways to have children work on coordination skills during therapy sessions.
  • Themed Exercises- Other thematic exercises are a super fun way to have children work on the coordination of upper and lower body movements. If you want a print and go resource that utilizes the alphabet, then grab this free printable resource from The OT Toolbox, Alphabet Exercises for Kids.  
  • Rhythm games – Use songs and poems to help a child perform hand or body rhythmic patterns that work on coordination while utilizing an auditory assist. YouTube videos can be a good tool for this activity.
  • Gross motor coordination exercises – These are basic exercises that address overall body coordination while using upper and lower extremities in a coordinated manner:  windmills, jumping jacks, standing cross crawls, supine cross crunches, and toe touches. The OT Toolbox has you covered with Jungle Animal Heavy Work Coordination Exercises.

gross motor coordination Therapy Equipment Ideas

If you need activity ideas to use equipment during therapy sessions, here is a list of ideas that utilize the some of the most common tools used during clinic practice or school settings.  If you want an overall big picture of gross motor toys in therapy, read this Gross Motor Toys article.

  1. Trampoline – Use of the trampoline for jumping is a great form of coordination.  Want to engage the upper body more? Try tossing and catching a ball while jumping to further work on coordination skills with use of a trampoline.

2. Scooter board – The scooter board can be used in a variety of ways to address coordination skills. 

  • Lying supine and pushing off of the wall with the feet
  • Lying prone and pulling self across the floor
  • Pulling self while seated using a hand-over-hand pattern with use of a rope anchored by therapist or a secure hook
  • Driving the scooter board by kneeling and pushing the board to targets on the floor
  • Try this fun deck set (Amazon affiliate link) for scooter boards which provides many activity ideas that focus on coordination.

3. Therapy ball – A therapy ball is another equipment tool that can be utilized in a variety of ways to address coordination skills.

  • Lying supine and having child pull themselves to sitting with support from an adult
  • Lying prone while walking back and forth on their arms and hands – maybe even doing an activity too 
  • Performing therapy ball slaloms with use of cones and a baton 
  • Try this fun deck set (Amazon affiliate link) for therapy balls which provides multiple ideas that focus on strength and coordination.

4. Therapy platform swing – A therapy swing provides ample use of coordination while engaging in fun activities to build coordination.

  • While seated crisscross in the middle, have the child work on batting a balloon or catching a ball.
  • While seated crisscross in the middle, have the child use a baton to reach and ‘catch’ loops or bead necklaces. 
  • While lying prone, have child work on creating ice cream sundaes.
  • While lying prone, have the child pick up and toss bean bags at a target.

5. Bucket Stilts (Amazon affiliate link)– These are fun way to work on coordination skills and kids are always interested in how they work and often ask if they can try them.  Yes, you can!  Just the design and purpose of this toy is what builds coordination. So, really no explanation is needed.

6. Safety cones – These are really inexpensive and can be found at the dollar store. All you need are a few of them to either place on the floor or elevate them on inner tubes like safety cone toe taps to address coordination. 

7. Wobble Balance Board – An effective equipment tool to address coordination skills simply by the use of it. Use it inverted or not! 

8. Shark Run – An easy way to work on coordination skills either in the therapy session or at home. Have the child start by putting two mats or pillows in front of each other and then while standing on the farthest one, bend and reach back to pick up the other pillow or mat, move it to the front and step on it next, then repeat. This creates a path to walk across the room and try to stay out of the water and avoid the sharks!

A Final Note on Gross Motor Coordination

While all of these gross motor coordination activity ideas are great, don’t forget there are other ways to have the child build their skills. They can engage in community activities such as karate, gymnastics, swimming, dance, yoga, ballet or organized sports. While your child says they would rather sit in front of their electronics, these gross motor coordination activities can be just as fun.

Regina Allen

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

Sensory Tooth Brushing Tips for Brushing Teeth

Tooth brushing tips

Is toothbrushing a nightmare in your house? Sensory related toothbrushing issues can be! Need some sensory tooth brushing tips? For individuals with sensory difficulties, toothbrushing challenges mean more than cavities, plaque build up, and gum sensitivities. Sensory toothbrushing issues can lead to meltdowns, anxiety, and daily struggles with nightly and morning routines. Does your child cry when it’s time to brush their teeth? Do you know, or suspect, that they have some sensory challenge with brushing their teeth? 

sensory tooth brushing issues and tooth brushing tips by a pediatric occupational therapist

sensory tooth brushing tips for kids

Brushing teeth can be a challenge for many kids whether it’s from sensory processing challenges, challenges with routine, anxiety, or any other variety of reasons.

This is an area that an occupational therapist (OT) can help you with, by helping you set up a home program to make brushing your child’s teeth easier. Check out the tips below to help make tooth brushing easier for your family! 

These toothbrushing tips are interventions for making brushing teeth easier, or strategies for helping with sensory challenges that impact  tooth brushing.

Teaching dental hygiene to preschoolers or older learners addresses a daily occupation.  Incorporate these tips and recommendations daily to impact independence with tooth brushing.

Amazon affiliate links are included below.

Tip # 1: Use a Visual Schedule 

Adding a visual picture schedule can help reduce stress and anxiety during teeth brushing by providing clear expectations of what’s going to come next. It also helps to reduce the auditory input for following directions, helping your learner focus on the task at hand.

Another perk of using a tooth brushing visual schedule is that it ensures that the same routine is used every time that tooth brushing occurs. This can also help to reduce stress and anxiety by ensuring that the child knows what’s coming next. Which brings us to tip # 2! 

Tip # 2: Create and Use a Consistent Routine 

Create a routine that works for you and your family! It can evolve over time, so don’t worry if it’s not exactly what you want it to be right away. Having a routine helps take away anxiety around the unknown, and establishes what to expect during the situation. 

Once you determine what works, plan to utilize the same language, visuals, toothbrush and toothpaste every time you work on toothbrushing.

It will also be helpful to complete this toothbrushing routine around the same time every day. It doesn’t have to be rigid in that you brush teeth every night at 5pm, but should always follow an event like a meal, or when you first wake up in the morning.

Consistency and practice is key! 

Bonus Tip! Make sure that when you’re done with the toothbrushing routine, follow it up with a fun activity like play or a preferred game.

Tip # 3: Use a Timer 

Similar to creating a routine, using a timer helps to take fear of the unknown out of the picture. It also helps your child see that there is an end in sight to the activity. (Amazon affiliate link) Timers, or counting, are great to pair with a visual schedule. This nighttime toothbrush schedule offers more tips.

Tip # 4: Sing a Song 

If a timer causes too much stress or becomes an object of fixation, you can play a song or count to 10 for each side of mouth, top and bottom.

Brush to the tune of 1, 2, buckle my shoe or any other preferred tune or song that is easily broken into small chunks for brushing each quadrant of the mouth.

Tip # 5: Use a Vibrating Toothbrush 

For sensory seeking children, a vibrating toothbrush is a great way to engage them in toothbrushing! Not only do they get stimulation that they are seeking, they also get a thorough teeth cleaning with the vibration. 

Using a vibrating toothbrush does not need to be solely at toothbrushing time. It can be used anytime during the day.

There are cost-friendly options at most grocery stores and large box stores for families that are concerned with the cost of getting an electric toothbrush, or feel that their child won’t use it. 

Tip # 6: Flavored Toothpaste 

Flavored toothpaste brings an element of fun to a task that can feel like a chore. To add an extra layer of fun, and to encourage buy in from your child, go shopping together for new toothpaste. Get a few different flavors to try, and to have on hand in a pinch if the “preferred” flavor becomes boring or there is resistance to using it. 

Bonus Tip! Offering choices during an challenging activity such as brushing teeth, gives your child some sense of control of the situation. 

Tip # 7: Mouthwash that Shows the Plaque 

Like flavored toothpaste, mouthwash is another tactic to help get buy-in from your child. Listerine Smart Rinse or Plaque Disclosing Tablets are a couple of the many great products that help your child see where the plaque is.

Once they see where the plaque is, make a game out of cleaning all the “junk” out of their mouth. For kids that are older, you can use the visual the mouthwash gives to start talking about cavities, and the effects of not cleaning your teeth. 

Tip #8: Brush Only One Time Per Day 

The American Dental Association recommends tooth brushing twice a day. However, for kids that this task is extremely distressing, sometimes one REALLY good brushing a day is a success, and is a great start, and can be built upon.

The second time a day can, and should, still be attempted, but can have less focus on quality, as you build the child’s tolerance to the task.

The second time a day may have more focus on going through the motions, such as talking about the steps, doing a dry run, or if your child is emotionally regulated enough, attempting to brush their teeth. 

Tip # 9: Take Turns Brushing 

Helping your child with tooth brushing can take away stress over the motor component of coordinating hand to mouth, and challenges with completing multiple steps needed for toothbrushing. 

Taking turns during the tooth brushing process, your child brushing one time a day and you brushing their teeth the second time, can give back some control and insure at least one time a day is done thoroughly.

Find what works for you and your child! 

Tip #10: Use a Water Pick 

If a toothbrush is still causing too much frustration, stress and anxiety, a good option is to change the tool completely, and try to reset the routine and behaviors. This is where a water pick is really great!

While the water jet can be overstimulating and noxious to some, others may find it less so than tooth brushing.

Implementing Tooth Brushing Tips 

These tips can help to break any negative behaviors or emotions that may surround your child’s tooth brushing routine, and give you a foundation to start a fresh routine. Start by trying one recommendation that you think will work for your child, give it a week and if it’s still not working try another. Working through toothbrushing challenges takes time and is a trial-and-error process. Hopefully you find these tips helpful!

Related hygiene tasks:

Incorporate these hygiene and grooming tasks and recommendations:

For specific ways to integrate sensory needs into a daily lifestyle, check out the Sensory Lifestyle Handbook. This resource uses not only a sensory diet strategy into daily activities, but it offers tools and resources to create a sensory lifestyle that uses motivating and meaningful daily tasks to offer much-needed sensory input so individuals can function throughout their day.

Contributor: Kaylee is a pediatric occupational therapist with a bachelors in Health Science from Syracuse University at Utica College, and a Masters in Occupational Therapy from Utica College. Kaylee has been working with children with special needs for 8 years, and practicing occupational therapy for 4 years, primarily in a private clinic, but has home health experience as well. Kaylee has a passion for working with the areas of feeding, visual development, and motor integration.


blank word search

What better way to work on visual perceptual skills AND handwriting, than by adding this blank word search template to your treatment plans? If you’ve seen some of the other St. Patrick’s Day activities on the site this week, then you can add this activity to your March OT lesson plans.

This blank word search is great for visual perceptual skills and handwriting skills.

The OT Toolbox has a lot of St. Patrick’s Day activities including this blank word search template.

Plus you’ll find more free downloads in our Spring Activities headquarters.


When my girls were young, I was forever searching for ways to make their homework more fun, especially while learning spelling words.  Straight repetition and memorization might work for some learners, but for the rest, there needs to be more engaging ways to improve working memory for retention of information.

How can you use this blank word search worksheet?

What I love about simple worksheets like this blank word search PDF template, is the flexibility and usability it offers. 

By thinking outside of the box, dozens of treatment ideas can be created!  (This type of activity analysis would be a great project for therapy students or new teachers).

  • Use current spelling words on your learner’s list for the clues to the wordsearch
  • Add thematic words to your grid (winter, animals, foods, colors, clothing)
  • Write random letters in the grid and use this as a scanning task (find all the A’s)
  • Have learners create a grid for other students to use. This works on critical thinking skills, as well as promoting neatness and accuracy
  • Use the printable blank template as a grid for working on letter sizing, letter formation, and neatness
  • Work on speed and dexterity by seeing how many letters/dots/numbers they can write in a given amount of time
  • Use dot markers for accuracy either with a blank grid or while searching for letters or words
  • Laminate the page for reusability and eco friendliness
  • Extend the activity by having students write a sentence after finding each word, draw a picture, or define the words
  • Younger learners do not need to be able to read or spell these words, this will be a copying and visual memory task for those who can not read
  • Try presenting this without including a word bank.  See how many words your learners can find without clues, or remember what words are on their spelling list
  • Enlarge this template onto a smart board for group work, encouraging students to come to the board, and write vertically
  • What other ideas can you come up with?

What is your objective using this blank word search?

As always, shift your focus and observations toward the skills you are building.  In this task it could be:

  • Fine motor: letter formation,  handwriting, grasping, copying from a model
  • Visual perception:scanning, figure ground, visual memory
  • Sensory: arousal level, pressure on paper/pencil, seating position
  • Speed and dexterity
  • social/emotional skills, following directions, frustration tolerance
  • Executive function: organizing work, work completion, task analysis
  • Strengthening, bilateral coordination
  • Any combination of the above, or something entirely different

If your main objective is visual perception, check out this huge visual processing bundle offered in the OT Toolbox.

what and how to document session using this blank word search page

Using this blank word search in therapy sessions covers a variety of areas and goals. But how do you document? And what do you look for when using a tool like this in therapy sessions?

Here are a few things to watch for when learners use this resource:

  • Document in real numbers, percentages, and actual data
  • Accuracy of finding the words
  • Timing for finishing the task
  • Amount of physical and/or verbal assistance
  • Grasping pattern 
  • Sensory skills/problems
  • Behavior, social function

The resources available for individuals/members visiting the OT Toolbox, are great for new teachers/therapists who feel overwhelmed, needing an organized direction for making awesome treatment plans.

Don’t forget seasoned professionals who are burned out, or looking for quick and easy printables, PDF templates, and activities.  Whatever category you fit in, whether you are a professional or parent, the OT Toolbox has you covered!  

more ideas for your St. Patrick’s Day themed lesson plan

Sticking with the winter theme and tired of Frozen songs and worksheets? Try our Spring Fine Motor Kit full of flowers, butterflies, rainbows, and Spring fun. These reproducible activity pages include: pencil control strips, scissor skills strips, simple and complex cutting shapes, lacing cards, toothpick precision art, crumble hand strengthening crafts, memory cards, coloring activities, and so much more.

Understanding why you are doing treatment, what goals you are working on, how to assess and grade each task, document the lesson plan, and troubleshoot the activities, are the most difficult (and important) parts of treatment.  Picking a worksheet is easy, knowing how to use it is where skill is involved.  That is why it is so awesome that these tools are readily available.  No need to keep reinventing the wheel.  

Use the resources available to you at the OT Toolbox, or wherever else you search for quality materials, then take a moment of free time to listen to the Spring raindrops. Grab those Spring fine motor printables, then settle in with a book and a cup of cocoa.

Free Blank Word Search

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

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

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

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

Join the Member’s Club today!

Free Blank Word Search

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    Victoria Wood

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

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

    SHAMROCK ACTIVITY: Fine Motor Clip Cards

    Shamrock activity fine motor clip cards

    Today on the site we’ve got a great Shamrock activity…Fine motor clip cards with a shamrock theme! This is a great addition to St. Patrick’s Day activities in therapy, home or the classroom, and they work on a ton of different skills. Print them off, laminate the clip cards if you like, and you have a literal therapy pot of gold!

    These shamrock activity fine motor clip cards can help with hand strengthening skills, fine motor control and much more.

    This week as we roll out these fabulous Shamrock Activity (Fine Motor Clip Cards), let us take a moment to be thankful the weather is warming up and we can finally celebrate spring. If you are not fortunate enough to have spring weather yet, I feel for you. 

    According to the news report, people are moving out of California, New Jersey and New York in droves. I am surprised more of y’all from Wisconsin and North Dakota aren’t rustling out of there too!  No matter what the temperature is outside, this cute Shamrock Activity Fine Motor Clip Card spring themed activity will help get you motivated for warmer weather. 

    Shamrock activity for Fine Motor skills

    There is something magical about rainbows and unicorns.  Throw some shamrocks in there for good luck, and it is the perfect spring trifecta! 

    Add them to these other shamrock and St. Patrick’s Day themed activities that support the development of fine motor skills:

    These Shamrock Activity fine motor clip cards are so versatile, they  will be able to be modified for most, if not all of your learners.  Read below for ways to adapt and modify this fine motor activity.  

    How to use this shamrock activity:

    • Have learners count the number of shamrocks and place a mark to designate the number of items on the card.  These cards would be great with a (Amazon affiliate link) Dot or Bingo marker!  
    • Learners can color in the rainbows as they go
    • Cut these ahead of time, or make cutting a part of this fine motor counting clip activity
    • Use clothespins to attach to the shamrock cards to count the numbers.  Decorated clothespins are even more fun!  They are great spray painted gold, or dipped in glitter
    • Color and laminate these cards for reusable fun.  Learners can use dry erase markers to count the objects
    • Enlarge or shrink this page to change the level of difficulty
    • Change the type of paper, heavier weight is easier to handle, but may be harder to cut
    • Colored paper might be more motivating, or provide better contrast
    • Project this onto a smart board to make it a touch task, or have students follow along with the diagram
    • Scatter the cards around the room to include a gross motor component
    • Add these cards to an obstacle course having learners complete the challenge, collecting clips along the way
    • Scavenger hunt to have learners find all of the cards in order
    • Crab walk from one card to the next
    • Create an entire St. Patrick’s Day theme for the week!
    • Add spring fine motor tasks with this great fine motor bundle found on the OT Toolbox
    • The possibilities are really endless, don’t let yourself get stuck doing this fine motor activity  just one way

    Things to Observe with these Shamrock Activity Clip Cards

    When working on this shamrock fine motor activity, there are several observations that can be  made: 

    • Can your learner scan the page and count all of the shamrocks?
    • How many items can your learner correctly count?
    • Does your learner correctly hold and manipulate the scissors, crayon, or bingo marker? How much assistance do they need to grip scissors, cut the paper, or color the rainbow?
    • Do your learners have the strength to open and place the clothespins?
    • Can your student motor plan all of the skills needed for this task?
    • Will you need to modify this activity for success?
    • Can your student continue to hold the clothespins while trying to manipulate the paper?
    • What is the number of times you need to repeat the directions so your learner can follow them?
    • How many reminders does your learner need while doing this activity?

    Use these notations in your documentation to document data and support the development of fine motor skills.

    what skills do my learners need?

    While cutting, coloring, counting, and placing clips is a straightforward task for higher level learners, beginners will struggle with all of the parts needed to complete this task. 

    Think about all that has to be involved to do this counting shamrock activity:

    • Fine motor skills – Resources can be found in our fine motor skills library at the OT Toolbox
    • Strength
    • Bilateral coordination
    • Visual perception
    • Executive function/behavior/social skills
    • Following directions
    • Attention to detail
    • Work tolerance
    • Cutting on a line
    • Coloring
    • Counting
    • Multistep directions 
    • Processing skills

    This is just the start of the list when using these Shamrock fine motor clip cards! 

    Perhaps focus your attention on addressing, or observing, just one or two of these skills.  For example, work on following directions or counting, rather than all of them.

    Need more great Shamrock and St. Patrick’s Day tools?

    Here are a few more spring activities and ideas from the OT Toolbox to get you started. Round out your shamrock theme with this new Color Handwriting Kit with Bonus Rainbow Sheets!

    While spring is a lovely change of pace from winter, summer is really my jam! Bring on the heat!

    Free Shamrock Printable Clip Cards

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

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

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

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

    Join the Member’s Club today!

    Free Shamrock Activity- Fine Motor Clip Cards

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      Victoria Wood

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

      • NOTE: The term, “learner” is used throughout this post for consistency. This information is relevant for students, patients, clients, school aged children/kids of all ages and stages, or whomever could benefit from these resources. The term “they” is used instead of he/she to be inclusive.


      Rainbow template printable

      Coming up is the Rainbow Template Printable! This March activity is perfect for a St. Patrick’s Day theme or a rainbow theme in occupational therapy sessions. Whether you are working on pencil control, scissor skills, eye-hand coordination, or direction-following, this rainbow template can be used to address any skill area.

      This free rainbow template printable is a resource that can be used to work on pencil control, eye-hand coordination, letter formation, scissor skills, and more.

      free rainbow template printable

      What is so enticing about rainbows?  Could it be the pot of gold at the end?  Or the promise of sunshine? I think rainbows don’t make you choose.  You can have all of the colors at once.  For a lot of people, especially those with anxiety, choosing one or two of anything is difficult.  It seems so final and limiting.  Not so with rainbows, you can have it all!

      When I was a child we sang The Rainbow Song, “red and yellow and pink and green, orange and purple and blue. I can sing a rainbow, sing a rainbow, sing a rainbow too.”  Is indigo the new pink?  Maybe it is because we learned this in Australia.  Do rainbows look different there?

      Do you remember the mnemonic for the colors of the rainbow? ROY.G.BIV (red, orange, yellow, green, blue, indigo, and violet). 

      However your learner decides to design their rainbow in this Rainbow Template Printable activity, there are a dozen ways to make this activity fun and functional. 

      Add the printable rainbow activity to our rainbow breathing exercise for more rainbow fun in therapy sessions (or the classroom or home!)

      What ways can you think of to design this rainbow  printable? 

      • Draw vertical lines in each section with the desired color, making sure the lines stay between the top and bottom borders
      • Make small circles in each section, controlling the pencil to stay between the lines
      • Write the first letter of the color,like RRRRRR, across each section
      • If your learner is more of a beginner, simply coloring each section will help develop fine motor skills in this pencil control activity
      • Copy a pattern like wavy, zigzag, or swirl lines in each section
      • Add glitter!  There is never a wrong time to add glitter

      All of the OT Toolbox resources, including this rainbow printable template, can be modified to meet the needs of all of your learners.  There are several posts related to Pencil Control and Rainbows on the OT Toolbox. Here is a post on Rainbow Activities to make lesson planning easier.

      Ways to adapt and modify this rainbow template printable task:

      • Laminate the page for using markers and wipes. This can be useful for reusability, as well as the enjoyment learners have using dry erase markers. Note: not all learners like reusable items, some prefer to take their work home.
      • Printing this rainbow template or some of our other great pencil control worksheets on different colored paper may make it more or less challenging for your learner
      • Enlarging the font may be necessary for beginning learners who need bigger space to write.
      • Have students cut out each section of the rainbow and paste in order on another page – this adds a cutting and gluing element
      • Make changes to the type of writing utensil, paper used, or level of difficulty
      • Have students write on a slant board, lying prone on the floor with the page in front to build shoulder stability, or supine with the page taped under the table
      • Project this page onto a smart board for students to come to the board and write in larger form.
      • More or less prompting may be needed during this activity depending on the level of the task and that of your learners
      • Make this part of a larger lesson plan including gross motor, sensory, social, executive function, or other fine motor skills
      • The OT Toolbox has a great Color Handwriting Kit incorporating fine motor skills, colors, and handwriting
      • A classic book, (Amazon affiliate link) the Rainbow Fish, would be a great addition to this rainbow fine motor worksheet, or lesson plan.  Plus it has GLITTER!  

      What skills are you addressing when using this rainbow template printable

      There are no wrong or right answers to this question.  Your focus can vary from learner to learner, or follow a common theme. 

      • Pencil control
      • Fine motor skills
      • Pre-writing skills

      The three above are the obvious, and more common skills to be measured during this task.  In addition, it is possible to shift the focus and attend to different aspects of the task:

      • Following directions
      • Task avoidance/compliance
      • Frustration tolerance
      • Behavioral reactions
      • Attention, focus, impulse control
      • Ability to complete a task
      • Level of independence
      • Social skills – sharing, turn taking, waiting

      there are no right or wrong answers

      Again there are no right or wrong answers.  The focus might be entirely on developing fine motor pencil control without regard to behaviors, social function, or executive function. 

      Conversely, the data you gather might not include how their fine motor skills look at all.  Of course you can combine all of the above.

      document, document, document

      Be sure to clearly document what you are observing and measuring.  Data collection is what’s required now.  Use percentages, number of trials, number of verbal or physical prompts, or minutes of focus.

      Gone are the days of writing, “learner completed task with min assist.” Min assist can look different to five different observers.  The only clinical phrases that are somewhat accurate are “independent” and “dependent”, meaning 100% or 0%.

      After all of this activity, maybe your learners need to slow down and take a breather with Rainbow Breathing Exercises. However you choose to create your treatment plan, find ways for it to be motivating and meaningful.

      Free Rainbow Template

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

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

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

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

      Join the Member’s Club today!

      Free Rainbow Template Printable

        We respect your privacy. Unsubscribe at anytime.
        • Note: the term, “learner” is used throughout this post for consistency, however this information is relevant for students, patients, clients, school aged kids/children of all ages and stages, or whomever could benefit from these resources. The term “they” is used instead of he/she to be inclusive.

        Victoria Wood

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

        Shamrock Directionality Maze

        Shamrock directionality maze

        No matter how evolved my directionality is, I will never be able to understand “turn west out of the car park” Wait what?  Directionality is being able to follow or discriminate left and right, top and bottom.  Today’s post is offering a Shamrock Directionality Maze freebie to work on both of these skills.  This is especially important when learning to write or read left to right. 

        Following a map with oral or written directions is much more difficult without the understanding of left and right. Try playing Simon Says with a group of your learners.  This will quickly help point out the directionally challenged right away. 

        Before assuming your learner can not learn visual perception, work on teaching and training the eyes and brain to perceive the difference between items. There are ways to accommodate for this deficit, however, try practice first.

        Today’s Shamrock directionality maze goes really well with our other St. Patrick’s Day Activities free resources for this time of year:

        Can your learner see?

        When addressing vision and visual perceptual deficits, it is important to rule out visual acuity issues before addressing perceptual difficulties.  What might appear to be difficulty learning because of perception, may simply be that your learner is not able to see the words correctly. Glasses are a much simpler fix than working out visual perceptual delays.

        types of visual perception

        There are seven different types of visual perception.  Each plays a key role in visual development.  This Shamrock Visual Discrimination Maze focuses on visual discrimination and directionality.

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

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

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

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

        Join the Member’s Club today!

        making this shamrock directionality maze purely visual perceptual

        In order to make this purely a visual perceptual activity, any type of writing or coloring needs to be eliminated.  Adding a fine motor skill, while an excellent way to use this visual discrimination maze, muddies your data.  While making this purely a visual perceptual task, prepare your page by coloring all of the items exactly the same, or leaving them all plain, and laminating the page.  Ask your learner to use their finger to follow the direction of the maze.

        Testing Visual Perception with classic tests such as the Motor Free Visual Perception Test (MVPT), eliminates writing or letter recognition, by asking learners to point, or otherwise indicate the correct answer.

        Teaching kids to follow the directions they need to physically move right, left, up, down requires development of spatial concepts such as spatial reasoning. This can be a real challenge for some kids! 

        Many treatment sessions focus on more than one goal. This is more functional and relevant to classroom objectives than isolating skills.  Worksheets like the Shamrock Discrimination Maze encompass more than one skill such as coloring, cutting, gluing, reading, following directions, etc. Add fine motor skills to this free worksheet, by asking your learner to follow the maze with their writing tool, then color the shamrocks as they follow the path.

        We’ve shared directionality activities before that help kids navigate and use maps with movement.

        Other ways to use this Visual Discrimination Activity:

        • Laminate the Shamrock Directionality Maze to make it reusable.  This is efficient, wastes less resources, and learners love markers! Note: not all learners love reusable pages. Some feel it is important to be able to save their work and take it home
        • Project this shamrock activity onto a smart board to make it a group task, or work on large motor movement and shoulder stability
        • Enlarge the task for beginning learners who need more writing or coloring space.
        • Shrink the task for more advanced learners who need to learn to color in smaller spaces, or follow smaller directions
        • Try different writing utensils. Some learners work better with markers as they glide easier on paper. Did you know that golf sized pencils and broken crayons promote more of a tripod grasp than traditional long versions?
        • Try different colored paper for more or less visual contrast
        • Use (Amazon affiliate link) Dot or Bingo markers to mark the path as the arrows are followed
        • Have learners call the direction out loud as they pass it.  Down, right, down, left, etc.
        • Incorporate other methods to teach directionality, such as playing in a mirror, Simon Says, line dancing, follow the leader, Twister, or the Hokey Pokey
        • Add several visual perceptual tasks to further improve skills. The Visual Brain has informative resources on Visual Discrimination and directionality

        Shamrocks and Spring Together!

        Need more shamrocks? The OT Toolbox has a great post including All Things Shamrocks. Check it out.

        If your theme encompasses Spring, the OT Toolbox has a great Spring Occupational Therapy Activities Book filled with 109 activities

        In the Spring OT packet, you will find:

        • Spring Proprioceptive, Vestibular, Visual and Tactile Processing Activities
        • Olfactory, Auditory, Oral Motor, Fine Motor Spring Activities
        • Gross Motor Activities
        • Handwriting Practice Prompts
        • Spring Themed Brain Breaks
        • Occupational Therapy Homework Page
        • Client-Centered Worksheet
        • 5 pages of Visual Perceptual Skill Activities

        East or West may always be confusing

        For some, directionality, visual perception, and laterality come easy.  Others need to be taught repeatedly with activities like the Shamrock Directionality Maze, or given accommodations and strategies to overcome this difficulty.  I fear I may never be able to follow west/south directions. Is there a google maps adaptation for dummies that would translate west and east into left and right?  I have mastered those directions.  

        Even though summer is by far my favorite season, spring is much better than winter!  Let’s hope you are digging out of the snow and getting some warmer days, so you can get out and head west out of your driveway!

        Free St. Patrick’s Day Directionality Maze

        Want a printable resource to build directionality and visual perception skills? Enter your email address into the form below to access this clover maze. This printable is available inside our Member’s Club during the month of March. Members can log in and quickly access the printable, along with all of the other free items here on The OT Toolbox.

        Free St. Patrick’s Day Maze!

          We respect your privacy. Unsubscribe at anytime.
          Victoria Wood

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

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

          Occupational Therapy for Down Syndrome

          Occupational therapy interventions for down syndrome

          Occupational therapists (OT practitioners) provide skilled services to help many different people, with or without a diagnosis. In this article, we will talk about Down syndrome, more specifically common interventions and strategies when providing occupational therapy for Down syndrome.

          Occupational therapy interventions for children with Down syndrome.

          Occupational Therapy For Down Syndrome

          Occupational therapy practitioners work with many diagnoses. In pediatrics, the diagnosis of Down Syndrome may be seen in early intervention services, in school-based therapy, or in the outpatient setting.

          An occupational therapist will perform an evaluation and develop an individualized plan of action designed to meet specific needs. Occupational therapy interventions may be related to areas such as:

          • Oral motor concerns impacting feeding
          • Positioning and feeding techniques
          • Physical motor skills including gross and fine motor skills
          • Achievement of motor milestones including rolling, sitting, position changes, and use of the arms and legs, etc.
          • Facilitation of self-care skills
          • Refinement of fine motor skills
          • Sensory needs
          • Social or emotional needs
          • Self-regulation needs

          This list may not include every area addressed in occupational therapy. Let’s go into more detail about OT and the individual with Down syndrome.

          First, let’s cover the diagnosis of Down syndrome.


          Down syndrome is a genetic disorder caused by additional copy of chromosome 21. In regard to functional performance, the typical characteristics of Down syndrome include:

          • Low muscle tone
          • Relatively short limbs, including hands, fingers, and thumbs
          • Mild to moderate intellectual disability
          • Developmental delays

          People with Down syndrome are often active members in their communities, able to participate well in school and social events, and can raise a family. Each case is unique, and health professionals such as occupational therapists are available to help improve functional independence along the way. 

          what is Occupational therapy for Down syndrome?

          In order to fully understand the involvement between the occupational therapist and person with Down syndrome, it is critical to learn the role of the OT.

          During the initial evaluation of a person with Down syndrome, the occupational therapist will assess many different skills to determine the specific needs. They will try to answer broad questions like, “How independent is the person with activities like eating, dressing, and playing?”, and specific questions, such as, “What types of grasps do they use?”.

          Developmentally appropriate assessments will be used to measure fine and gross motor skills, cognition, and sensory regulation. 

          down syndrome: Fine Motor Skills

          The whole body is responsible for strong fine motor skills; starting with core then shoulder strength, moving down toward strength and mobility in the hands and fingers.

          The general decrease in muscle tone and joint stability that is common in those diagnosed with Down syndrome, makes the development of fine motor skills more challenging. 

          Physical features impacting fine motor skills

          The hands of a child with Down syndrome have a typical pattern of development, including shorter hands, fingers, and thumb than the average child, that can further decrease dexterity.

          The palms may also lack the curvature that is required for skills like thumb opposition. We call these the arches of the hand, and they are useful during any skill that requires the hand to move around an object, big such as a water glass, or small like buttons. 

          Because of these physical features, coupled with general muscle weakness and loose joints, occupational therapy for Down syndrome will likely offer activities to increase fine motor skills.

          Gympanzees has a great article on developing fine motor skills for children with Down Syndrome.

          Dexterity and Down Syndrome

          • Use small items, like beads/pompoms/Cheerios/buttons, to pinch, place, string, glue down, or count.
          • You can increase the challenge by encouraging holding onto multiple items in one hand, but only placing one at a time – much like we hold a set of coins and use a singular hand to find and place the correct coin. This is referred to as in-hand manipulation

          Joint Protection and down syndrome

          • Braces or splints may be used to help support the joints in a functional position, while the child continues to build strength. 

          Arm Strength and down syndrome

          • Weight bearing through the arms is a great way to build shoulder strength for fine motor development – try animal walks, wheelbarrow walking, or crawling through tunnels!

          Hand Strength and down syndrome

          • Get those fingers moving by shaping playdough or putty; roll, squeeze, poke, smash, and pinch it! Increase the challenge as the skills develop by selecting firmer putty or by adding additional steps to the activity. 
          • The OT Toolbox has great resources for overall fine motor hand development

          Gross Motor Skills for down syndrome diagnosis

          Just like fine motor skills, the base of gross motor skills is the core. A person needs that proximal stability first, before they can build movement skills.

          Increasing the core strength leads to improved balance, coordination and dynamic movement control. These areas are addressed as they impact functional participation in feeding, self-care, learning in the school setting, and participation in functional tasks.

          Individuals with Down syndrome tend to have a more challenging time with strength and motor planning to move from one posture to the next due to low tone.

          For example, moving from a seated position on the floor to standing. The sequence should be: seated on the bottom, to a 4-point crawl position, to kneeling, to a single leg kneels, then standing. This sequence and combination of movements may pose an extra challenge due to limited mobility, strength, and muscle tone.

          Below are some ways to improve occupational therapy for Down syndrome can improve gross motor skills. 

          Core Strength and down syndrome

          • There are so many play-based activities that strengthen the core. Almost any activity can be done in prone (on the tummy), which can improve core strength and offer some weight-bearing in the arms at the same time
          • When you think core strength, think balance. Use balance beams, one-foot stand, wobbly surfaces, etc. Just make sure to prioritize safety and comfort. 

          Positional Changes and down syndrome

          • The more change, the better. Set up a game or obstacle course that encourages movement up/down, side-to-side, rolling, or scooting.
          • The most important goal is to get that body moving!

          down syndrome and Sensory Regulation 

          Are children with Down syndrome more or less likely to experience sensory differences? Yes. This is the reason occupational therapy for Down syndrome and sensory regulation will be an important part of the treatment process.

          There is one clear reason why people with a diagnosis of Down syndrome may experience more sensory processing difficulties – low muscle tone again. Individuals with low muscle tone may have a harder time processing proprioceptive input. This is the sense that our muscles and joints pick up to tell the body where they are in space. 

          Because of this decreased proprioceptive input, people with Down syndrome frequently need more input in order to grade the force of their movements.

          For example, they may experience difficulties in choosing how hard or how soft their movements should be. They may knock something down by pushing too hard, or drop something by mistake by not holding tight enough. 

          This can also skew how an individual with Down syndrome eats food. They may not feel the food in their mouth very well until it is full, and start over-eating or pocketing food in their cheeks. People diagnosed with Down syndrome often grind their teeth as a way to get more input and stability through the jaw.

          • Increased proprioceptive input
            • Weighted items: vests, lap pads, blankets 
            • Exercise, weight bearing, jumping 

          In addition to low tone, another common comorbidity to Down syndrome is hearing loss. This is important to address as a sensory need because an individual may react strongly or under react to auditory stimuli. Sensory tools should be trialed for a few weeks to see what will work best to regulate the child’s sensory system. These tools should be used intermittently throughout the day, and never forced on a child. In order to be effective, they should be voluntary and not be used as a reward or punishment. 

          • Auditory Processing Strategies 
            • Noise reducing headphones
            • Auditory feedback tube (like this)
            • Assistive technology for hearing loss

          A Sensory Diet is a great treatment option for sensory processing and Down syndrome. The OT Toolbox also has a great resource called the Sensory Lifestyle Handbook to address and understand sensory processing needs.

          For more play-based ideas for early intervention for working with learners with Down syndrome, here is a fun article on outdoor sensory activities.

          If you are a fan of the OT Toolbox, you can access all of these resources much easier by becoming a member. As a member, you will:

          • Be able to download each of them with a single click (No more re-entering your email address and searching through folders!)
          • Receive early access to new printables and activities before they’re added to the website (You’ll find these in the What’s New section.)
          • Receive a 20% discount on all purchases made in the The OT Toolbox shop!

          For all of these skills, the most important part of occupationl therapy for Down Syndrome is to meet the child where they are. An Occupational therapist will make an assessment of their learner’s current level of functioning, providing a “just right” challenge, that is motivating for that particular learner. Because of potential delays in cognitive ability, and the physical difficulties associated with Down syndrome, these new skills may not develop quickly, and may not progress at all. Occupational therapy can help with adaptations to approach these tasks in a different way, or modifications to the environment to increase independence. 

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

          How to Use a Sports Water Bottle as a self regulation tool

          Sports water bottle self regulation tool

          Sipping on a hot cup of tea, chewing gum, or sucking on a hard candy are self regulation strategies for oral sensory processing you probably use in your daily life, without even thinking twice.  But did you know that you can use a sports water bottle as a self regulation tool, too? Oral sensory processing tools, or coping strategies, can be an important part of anyone’s life, for self regulation and promoting attention across settings like home, school, and the community.  

          You can use a sports water bottle as a self-regulation tool! This sensory coping trick is great for kids, in the classroom, or while on the go!

          Using a Sports Top Water Bottle for Self Regulation

          While sitting in a waiting room, waiting for your table at a restaurant, or sitting down to pay your bills, how often do you bring along a drink or snack to help maintain your regulation? 

          You probably don’t realize these are great sensory regulation tools, it just seems like a good idea, and has become a habit. As adults, we naturally have strategies we incorporate into our daily lives to help us regulate. 

          For children, these strategies may not be as obvious or innate.  Here’s where using self regulation strategies including those for oral sensory processing, from an occupational therapist may help.

          Related, this Impulse Control Journal from the OT Toolbox is a great resources for writing down triggers, develop strategies, and use self regulation tools to feel more organized.

          What is self regulation?

          Self regulation is a complex process we all use on a moment to moment basis.  It involves registering and responding to your own thinking, emotions, and attention.  Self regulation impacts your focus and your behavior, which in turn impacts how you receive and respond to information in your environment.  

          Self regulation involves the coordinated effort of your sensory processing systems, emotional regulation, and executive functioning.  If this sounds complicated, it’s because it is! 

          Occupational therapists can help children and families, by evaluating their needs across the environments where they live, play, and learn.  One of the areas an occupational therapist will assess, is your child’s sensory processing patterns to determine what, if any sensory strategies and self regulation tools may support their participation and performance at home, in school, or when out in the community.

          Self regulation is a necessary tool for developing impulse control in order to make good choices.

          What is sensory processing?

          Amazon affiliate links are included below.

          In the book Sensational Kids: Hope and Help for Children with Sensory Processing Disorder, Lucy Jane Miller defines sensory processing as “a term that refers to the way the nervous system receives sensory messages and turns them into responses” (Miller, 6).  The sensory systems involved in sensory processing are:

          • Visual (sight)
          • Auditory (hearing)
          • Tactile (touch)
          • Olfactory (smell)
          • Gustatory (taste)
          • Vestibular (movement)
          • Proprioception (body position/awareness)

          If you think your child is having difficulty with sensory processing, you may find this Sensory Processing Disorder Checklist a helpful place to start. This is just the tip of the iceberg in understanding sensory processing and getting help.

          Here are a couple of other popular resources to learn about sensory processing disorder.

          Oral Sensory Processing and Sensory Strategies

          There are hundreds of different ways to support sensory processing when addressing all of the senses mentioned above.  Let’s take a closer look at oral sensory processing and the sensory strategies associated with it.

          Using oral sensory input for self regulation starts at birth.  Infants and babies use their oral sensory receptors as both a source of comfort and for sensory stimulation. 

          Parents use pacifiers, and feeding by bottle or breast to calm and soothe infants.  Babies constantly bring hands, feet, and toys to their mouth to explore.  Because oral input is comforting and soothing, pacifiers and thumb sucking are hard habits to break.

          As babies grow into toddlers and beyond, we see these oral sensory experiences continue to change and adapt into functional strategies that fit into everyday life in the form of chewing gum, sipping a warm drink, or snacking on a favorite crunchy snack.

          These are natural examples of sensory regulation tools.

          For some people, the need for oral sensory input is strong, and they may seek out this type of input in many ways. This may be the child who continues to mouth toys beyond toddlerhood, chew on clothing. 

          While this does provide oral sensory input for kids who need to chew, it is not functional for a child to be chewing on their shirt at school.  School-based occupational therapists may be able to help make suggestions for sensory strategies that can be easily incorporated into the school day to help support student’s oral sensory processing needs.

          Why Using a Sports Water Bottle Helps with Self Regulation

          Using a sports top water bottle for self regulation is a common suggestion by occupational therapists.  Why?

          When using a sports bottle, sensory input is added through the face; The mouth, including the jaw, lips, and cheeks are powerful sensory areas.

          The mouth, face, and jaw are full of sensory receptors.  Using oral sensory processing tools and strategies are often a great way to provide intense or calming sensory input with a fast impact.

          Oral receptors send information to the brain about taste, touch, and they also provide proprioceptive inputs through sucking. 

          Activating the oral sensory receptors through sucking provides intense, calming sensory input.

          Sports Water Bottles for Sensory Input

          Using a sports bottle during the day is a meaningful task for most of us. Kids see their peers using a sports bottle or a water bottle of some type during the school day, during after school transitions on the school bus, in the community, and in many settings. This means that the high-impact sensory strategy they are using doesn’t look out of place to their peers. (While acceptance of differences is widely accepted, it can be helpful for kids and teens to appear to be using the same items as their peers. This is true for all of us, and not just because there may or may not be a sensory need at play!)

          So, what are some OT-recommended sports bottles for use as a sensory tool that have high-impact when it comes to calming supports? Try these sports bottles:

          1. Kids Hydro Flask with Straw
          2. 32 Ounce Hydro Flask With Straw
          3. ADIDAS Sports Bottle
          4. Water Bottle with Straw and Flip Top Lid

          Here are some ways to provide oral sensory input:

          • Use a sports top water bottle such as this one, with resisted sucking throughout the day
          • Try drinking a thick smoothie through a straw
          • Provide chewing gum (usually sugarless in small pieces)
          • Use a battery powered toothbrush – vibration provides proprioceptive input to the oral sensory receptors
          • Encourage crunchy or chewy snacks such as pretzels, bagels, carrot sticks, or stale Twizzlers
          • Sucking on a popsicle or other frozen treat (These homemade lemon lime popsicles are a great way to support this need. Plus kids can help make them!)
          • Blowing bubbles

          A final note on using a sports water bottle as a self Regulation tool

          The most important thing to think about when choosing sensory strategies for anyone, is to think about how it will fit into their daily routines.  A water bottle is a great tool for anyone who needs access to oral sensory strategies, because they will be able to keep it at their desk, in their backpack, or carry it around with them.

          Sensory “tricks” like this; Ones that are specifically integrated into one’s day are the most effective. Similarly, using a battery powered toothbrush on the way out the door in the morning, providing a crunchy morning snack, using a water bottle throughout the day, and offering a thick smoothie with a straw after school would provide your child many oral sensory experiences throughout the day to help meet their sensory processing needs.

          This is a great example of a sensory diet, proven to be beneficial for self regulation in many people.

          Katherine Cook is an occupational therapist with 20 years experience primarily working in schools with students from preschool through Grade 12.  Katherine graduated from Boston University in 2001 and completed her Master’s degree and Certificate of Advanced Graduate Study at Tufts University in 2010.  Katherine’s school based experience includes working in integrated preschool programs, supporting students in the inclusion setting, as well as program development and providing consultation to students in substantially separate programs.  Katherine has a passion for fostering the play skills of children and supporting their occupations in school. 

          References: Miller, L. J., & Fuller, D. A. (2007). Sensational kids: Hope and help for children with sensory processing disorder (SPD). New York: G.P. Putnam’s Sons.