Victoria Wood OTR/L, Author at The OT Toolbox

Sensory Rooms in Schools

March 14, 2024March 6, 2024 by Victoria Wood OTR/L

Today’s post on sensory rooms in schools is part of a series focusing on sensory rooms. We are going to explore the benefits of sensory rooms, including why having a sensory space in schools supports student needs. We’re also covering things to consider, cleaning materials, supervision, and recommended use by teachers and aides. The thing is that sensory needs are much-needed in schools and classrooms, so we wanted to offer a resource on creating this support.

Other posts in the sensory room series highlight sensory room rules, building a sensory room on a budget, and things to include when designing a sensory room.

sensory rooms in schools with therapy equipment like trampoline, climbing toys, balance toys and more.

What is a Sensory Room?

Sensory rooms are a space in the school that offers a sensory break for those who enter. Sensory rooms might be an empty classroom that has been transformed into a space with sensory tools and is used as a movement break for students.

Sensory rooms typically offer therapy tools or sensory materials that offer sensory input, including proprioceptive input, vestibular input, auditory input, visual input, and tactile input.

Some schools have a whole room dedicated to this calming and regulating space. Others have just a nook in a hallway with a few sensory materials. Still others have a closet or cupboard with a few sensory items.

As a school based OT, I’ve seen sensory rooms used for:

self regulation
sensory diets
movement breaks
brain breaks
organizing dysregulated sensory systems

School sensory rooms have specific equipment designed to support various needs. We’re covering an extensive sensory room equipment list in another blog post.

We actually created a virtual sensory room for online therapy sessions, which is a huge help for therapy providers working in teletherapy.

Why have sensory rooms in schools?

There are several factors that contribute to the need for sensory rooms in schools:

We as occupational therapy providers tend to be involve in creating and implementing sensory diets. The sensory room is a great place to incorporate sensory strategies within the space, while meeting the goals of a sensory diet.
Sensory needs during the school day- The incidence of Autism is now 1 in 34. That is just Autism alone. Along with sensory processing disorder, attention deficit disorder (ADD) and other attention needs. There are many other special needs in students in the classroom and many of these students may struggle with self-regulation.
Districts are allowing larger class sizes to balance their budget. This means more bodies per classroom. Sensory rooms can support body awareness.
Movement opportunities may be less than they were in years past. Recess time is often reduced and outside of school, kids may not be playing outside.
Because of least restrictive environment regulations, more children with special needs are mainstreamed into typical classrooms.
Teachers without specific training in sensory processing and working with students with special needs, are finding it increasingly difficult to effectively teach their lesson plans.
COVID – there was two years when young children did not get much sensory stimulation. We have now thrown them back into mainstream education, and it is proving to be too much for many students to handle.
Other contributing factors leading to poor sensory regulation might include: too much technology and screen time, lack of exercise, poor diet, and increased sensitivity to environmental stimulants.
Students need a safe space to work on self-regulation and get back into their “just right zone” so they can perform in their classroom (Read about the Alert program for more information non this.)

What are the benefits of a sensory space?

There are many benefits to students and staff of having sensory rooms in schools. This is more than just a free for all play space.

Sensory Integration Therapy: Teachers and therapists can use this space to provide sensory integration therapy, a form of treatment designed to help children with sensory processing issues. This therapy involves specific activities that challenge the child’s ability to respond appropriately to sensory input
Sensory Diet implementation: I love to use a sensory room in the schools for a specific sensory diet location. You can set up a schedule for students to follow each day or as part of their schedule.
Emotional regulation needs: You can use sensory rooms for emotional therapy, especially for children with autism. The calming and engaging environment can help manage emotional outbursts, sensory dysregulation, and reduce anxiety
Visual Stimulation: One of the nice things about a sensory room is that you can alter the visual input with wall decorations, lighting, and reduced glare from overhead lights.
Motor Skills Development: OTs, PTs, and ST staff in the schools can use a sensory room in therapy interventions to support their student’s goal areas. It might be used for movement goals for their gross and fine motor skills, or the space can be a general treatment area for therapy.
Relaxation and Calming: If you walk into a sensory room, you might notice the calming and regulating environment. The calming environment of a sensory room can provide a safe space for overstimulated students to relax and regain control so students using the space can return to learning.
Social Skills Development: I love using group self regulation activities with a small group of OT students. Group activities in a sensory room can encourage interaction and cooperation.
Individualized Learning: You can adapt the space to meet the specific needs and preferences of individual students, while exploring what works for each student.

Considerations for creating a sensory room

There are things to consider when creating a sensory room in schools…

You’ll need a space, a budget for purchasing the sensory room equipment and therapy items, and then a few other considerations.

The available space, budget, clientele, and purpose are just a other things to consider when building and using a sensory room in schools.

Many times, OT is consulted when a sensory room is being set up. If an occupational therapy provider is setting up a sensory room, or being used as a resource in creating a sensory space in the school building, then these are things that should be considered.

By the way, we always recommend reaching out to OT staff for appropriate suggestions for the sensory space.

When creating a sensory room, you should ask these questions:

What is your clientele/students/population that will be using the school sensory room?

You need to get the most bang for your buck; therefore, it is important to select sensory room equipment that meets the needs of most of your learners. While you may love the idea of a specialized piece of equipment for one student, it is not cost effective when you have a limited budget

What do you want to accomplish with your sensory room?

First decide the goal of your school sensory room. Is it a quiet relaxing space, a place for students to do some heavy work, a spot for independent play, or teacher led activity? It can be a hybrid, if you have the space to divide your areas.

What type of equipment will be used in the sensory space?

We know that school students are rough on materials. Because of that you’ll want to choose durable equipment. I cringe every time teachers bring in preschoolers for some sensory time. Without one-on-one direct input, equipment can be damaged very easily. When you are on a tight budget, it is painful to see something broken.

Check the rules to see if you can have home made equipment. This is easier on the budget, but against the rules in many places due to safety regulations. This is a tough rule to follow, as much of the home-made equipment is made better than the mass-produced sensory room equipment.

How will the sensory room in the school environment be used?

You’ll definitely want to think about how are you going to use this space. Is the room going to be exclusively used by therapists and their students, or accessible by teachers (who may not have the skilled training, or supervision) to bring their class. School administration often has jurisdiction to determine how their space is used. If this is the case, make sure you plan your sensory room equipment accordingly.

Who has priority over the sensory space?

Finally, it’s important to consider who will be “in charge” of the school sensory room. Is it an equal space for anyone, or does a treating therapist working with a student have the right to refuse more students coming in. Is this space going to be used by other members of the IEP/504 team like school counselors, mental health professionals, teacher assistants and aides, speech therapy, etc.

Staff Training for School Sensory Rooms

Staff Training is a Must when it comes to a sensory room in the school environment.

Unfortunately, chaotic and unpredictable environments are sometimes created when a room is poorly designed, or personnel are not trained how to properly use the room. It is essential that the support personnel understand how to use the room itself, not just the equipment inside it.

It is more important how you use the space not what you have in it. One of the most common mistakes is to go into a sensory room and turn on every piece of equipment. This can be very over stimulating for some. If used incorrectly students can exhibit self-injurious or aggressive behavior. Remember the equipment is only as good as the person using it.

One thing we see all the time is that a student is taken into the sensory space AFTER they’ve had a meltdown or tantrum or are dysregulated. The additional sensory input might get them more “wound up” or out of sorts. A school based OT can help with teacher aides and personnel using the space more appropriately and when a student might need the tools.

Another thing we see all the time is the student that is allowed to spin or swing and this ends up getting them to a worse state or regulation. These are aspects of sensory input that can be dangerous for some students!

Visual schedules should be used and this is an area that will need staff training. A student shouldn’t be set free in the sensory space to run about and move from one item to the next. A planned out set of strategies should be used with intention.

People who do not understand sensory processing difficulties, may see the sensory room as a playground or free-for-all space. While your sensory room is designed for some freedom of movement, use it with some direction and instruction.

Children who are dysregulated are more likely to be less coordinated, have impulsive movements and behaviors, and act aggressively toward others. For this reason alone, it is wise to scope out the room before bringing your class in there. If a child is out of control, or having a sensory meltdown, it is best to wait before bringing your ten students into the sensory room.

Our teachers often call down to the sensory room (also inhabited by therapists) to see who is in there, and if the time is appropriate.

Staff need to understand the rules and protocols of this space. Check out our accompanying post for more information.

Cleaning sensory rooms in schools

Cleaning is a touchy subject that has resulted in some “courageous conversations” this year. Consider the sensory room like any other room in your house. Respect the space and leave it the way you found it (or better).

If your kid makes a mess, clean it up
Have wipes and other sanitizing equipment handy for cleaning items that have gone into student’s mouths
During cold and flu season it is best practice to wipe down equipment after using it. Alternativley, use a sanitizing spray.
When you must leave a mess behind, due to time constraints, or some other circumstance, leave a note and your plans to return. Example: this sensory swing is soiled, please do not use it. I will take it home and wash it.

School sensory room supervision

As a final reminder, supervision is a must in sensory rooms. It is very difficult to make a room that is 100% safe for all students who enter. Some sensory rooms have many different types of equipment, not all that is appropriate for each student.

Watch for flying swings. Keep fingers out of drawers, cabinets, closets, desks, or other “off limits” spaces. Restrict access to the sensory bin if your student is likely to throw birdseed all over the room.

Ideally, a school would have several different sensory rooms. One that is quite safe with padded walls, floors, and soft everything, and another with more equipment for active regulation and heavy work. Until then, make sure you are supervising your students in this space, and training those you work with to do the same.

What type of sensory spaces have you seen used in schools?

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.

Our alerting and calming sensory strategy cards can be used in a sensory room in schools as a tool for adding intentional movement.

Sensory Room on a Budget

March 14, 2024March 5, 2024 by Victoria Wood OTR/L

Today’s post on creating a sensory room on a budget is part of a series focusing on sensory rooms in schools. A sensory room is a controlled and intentionally created space that provides multi-sensory resources to support a student’s sensory needs, to enable them to engage in learning. The sensory room is a calming strategy for school, but the price tag can be hefty when you get into specific sensory strategies. That’s where planning a sensory space on a budget comes into play.

Why make a sensory room on a budget

Creating a sensory room on a budget can be a game-changer for individuals of all ages who benefit from sensory support. As an occupational therapist in the school setting, I’ve seen the power of supporting student needs with movement and sensory breaks. The dysregulation that impacts learning and social interactions can be supported with tools used in the sensory room.

We wanted to put together a resource on how to set up a budget-friendly space for the school environment. A sensory space is a resource for the student and can be used by educators, teaching assistants, occupational therapy providers, school counselors, or other type of professionals working with children.

In the schools, I’ve helped to design a low-cost sensory space designed to support numerous sensory needs. By incorporating DIY sensory room ideas and utilizing affordable sensory room equipment, you can create a space that supports sensory needs without breaking the bank.

Sensory Needs- One of the main benefits of a low-cost sensory space is the ability to support student sensory needs effectively. This may include movement activities that are both calming and organizing through proprioceptive, vestibular, auditory, visual, and tactile senses. For other kids, an OT might recommend a sensory room’s alerting sensory input tools for those who need to “wake up” the senses for optimal learning and functional participation.

Occupational therapy providers may work right in the sensory room, depending on the needs of their students. One sensory room space that I used in the past with students was tucked away in a large closet. Another was in a space above the stage area of a school. The point is that a sensory space can be as frugal and minimal as needed in the given space available in a school.

Sensory Diets- The main goal of a sensory room, from the perspective of an occupational therapist, is to provide a safe and controlled environment where students can engage in sensory activities that help regulate their sensory systems. We as OTs tend to be involve in creating and implementing sensory diets. The sensory room is a great place to incorporate sensory strategies within the space, while meeting the goals of a sensory diet.

Emotional Regulation Needs- Another goal of a sensory room is to addressing emotional regulation needs. For students who struggle with regulating their emotions, having access to sensory tools and activities can provide a healthy outlet that allows them to learn and function.

It’s simple things like squeezing a stress ball, swinging in a hammock, or engaging in deep pressure activities that can be used in a budget-friendly sensory room. There are many coping strategies that can be used on a budget.

Brain Breaks- In addition to supporting sensory and emotional needs, a low-cost sensory space also offers movement breaks and brain breaks, which is very needed in learning environments. When there is a sensory room available in the school setting, students are able to use these regulating movement strategies when they need them the most, all while taking a multisensory approach to academics.

Movement Breaks- We know the benefit of movement and learning. I’ve seen many students that have gone to a sensory room for a movement break and various exercises in the school sensory room and then returned to learn and participate in lessons. That break allowed them to re-energize and refocus their attention. This can be particularly beneficial in educational settings, where students may experience fatigue or difficulty staying engaged for extended periods.

The ultimate goal from a frugal version of a sensory room is to create a supportive learning environment that accommodates diverse sensory and learning needs, at a low cost. The space is a great way to incorporate classroom sensory diet strategies, based on the needs of the individual student.

If the costs are kept low, you can even use these ideas as a sensory room ideas for home or other spaces like church, preschool, daycare, etc.

How to make a sensory boom on a budget

Creating a sensory room does not have to break the bank. Coming up with therapy tools and strategies in a low-cost sensory room is key, especially when so many aspects of sensory needs cost a lot of money.

Other posts in the sensory room series highlight benefits, why have one, things to consider, cleaning materials, supervision, use by teachers and aides, sensory room rules and protocols, and things to include when designing a sensory room.

Another important consideration is that you can use a sensory room with students from the whole school. So, when you look at it as a school-wide support, this can drop the overall “cost” per student. However, most occupational therapists and OTAs will tell you that there is a risk with just taking a student into the sensory room to “play” or blow off steam.

That being said, we’ve used a sensory room with a small group or a regulation station type of event. The space has even been used as a self regulation group activity for several students and their aides at one point or another.

Below, we share several OT-approved tips for setting up a sensory room on a budget.

Creating a sensory room does not have to break the bank.

When you are considering how to set up and create a low cost sensory space, some things to think about include the considerations below. Affordable sensory room setup starts small and will include a plan for using what you have on hand in the way of sensory supports.

Start small: You do not need to create an entire room right away. You can start with a small corner of your classroom, a designated closet, or storage area.
Utilize what you already have: Look around your classroom and see what you can repurpose for use in the sensory room. For example, you might use an old beanbag chair or a stack of blankets for a cozy reading nook.
Shop around: Look for deals and discounts on sensory equipment. You might be able to find items at a discounted price at secondhand stores, garage sales, or online marketplaces.
Donations: Reach out to your community and see if anyone is willing to donate sensory equipment. You might be surprised by the generosity of others!
Fundraising: Consider fundraising to raise money for sensory room equipment. You might hold a bake sale, car wash, or other community events to raise funds.

What are the caveats to these cost saving measures?

Some of the suggestions above will depend largely on the rules at your school.

Many school districts frown on home made items, even though they are more likely better made than mass produced products. These rules have something to do with insurance and liability.
Ask if there are constraints about where you can order items from. When I searched, I found the coolest things online, only to find out we cannot order from large vendors such as Amazon, Target, Walmart, or tiny mom and pop shops. This is very limiting and time consuming to spend more money shopping for sensory items at a preferred vendor, or sacrifice buying what you really want. *If you are using your own money, or donated items, you may have more freedom in where to order or get items from.
The same districts that warn against home made items, are likely to refuse second hand items as well.
Always consider safety and rules of the sensory room. We cover this in another blog post.

Planning an inexpensive Sensory Room

Once you have trudged through the rules and do’s don’ts in your school, you can get started creating your list. Try and think of all the things you would love if you did not have a budget. This will help guide you in determining where your money goes.

When your plan has been hatched, you can prioritize what is most important, and what can wait. You can also see which of these items can be donated, made, bought second hand, or replaced with a less expensive version.

A sensory room does not have to be full of expensive equipment to be effective. Sometimes a clear space with very limited sensory input is just as effective as a buy sensory room.

One key aspect is to include some type of Visual schedule of sensory strategies that can be used by sensory room participants.

You’ll also want to incorporate some type of feelings check in or an emotions check in system to use when entering the calm down area and to help them identify how they are feeling and then use strategies to support those needs.

Frugal Sensory Room Items

Sensory room equipment on a budget can include using sensory supports that are free or are already in place in a space like the school or home. Here are some budget-friendly sensory room supplies:

Crash pad – Here is where your home-made ideas can come in handy. You can buy large foam pieces and stuff them into a duvet cover for a fun (washable) crash pad. A crash pad is a great soft-landing spot for kids who either need a calm down corner, some heavy work, or a safe place to get some frustration out. I have heard there are local mattress factories that have mattresses and foam pieces they can donate.
Stuffed animals – fill your space or crash pads with stuffed animals. Filling a zippered mattress cover with stuffed animals to make a crash pad, will be easier to keep cleaner than washing 100 plushies.
Pickle Balls – Pickle Ball has become an increasingly popular sport lately. I bet there are places that have tons of worn-out pickle balls that can fill your ball pit pool.
Kiddie pool – buy a child size pool (baby pool) to fill with balls, stuffed animals, shredded paper, packing peanuts, sand, or birdseed. Here are some of our favorite ball pit activities.
Fabric scraps – there are tons of crafters out there with bags of fabric scraps. Gather some of these to make blankets, pillows, tents, or soft-landing spots
Sensory bin – we all know the tactile benefits of the sensory bin. The OT Toolbox has multiple posts on sensory bin ideas. In a large sensory room you may have space for a sensory bin made of a child’s plastic pool, or a sand and water table.
Swivel chairs or other flexible seating options (couch, soft chair, floor mats, large pillows, Bean bag chair )
Sit and spin toy
Deflated beach ball seat as a wobble cushion for the floor
Free printable emotions Playdough mats
Brain breaks
Heavy work activities based on animals or themes
A book center with Zones of Regulation books that talk about different feelings and support regulation and processing through feelings
Jumping mat or small trampoline- When children jump, they put pressure on their joints
Weighted blanket– Weighted blankets provide deep pressure over the entire body, making this activity one of the an effective whole-body proprioceptive strategies to help children calm down
Watering plants- Lifting a watering can, can impact joints all over the body. As children stoop down to pick up the watering can, moving it over plants of different heights, they are getting great input
Weighted ball- Lifting and rolling over a weighted ball increases proprioceptive input in the hands, arms, shoulders, and core.
Play Dough- Squishing, squeezing and pulling apart playdough or clay, increases proprioceptive input in hands and small joints. You can add a desk or writing surface for table top sensory play and then add a foot fidget to the chair.
Printable sensory paths- We have many free deep breathing exercises on the website, including:

More elaborate equipment for your sensory room

Parts of your room might call for more elaborate equipment than a few stuffed animals and scraps of fabric. While some sensory equipment can be very expensive, if you think through the needs and design of the space, a budget sensory room design can incorporate just one or two of the more expensive items and use other budget-friendly options.

Here are smore more expensive items that can be used as a center point and then more inexpensive items can be added around these therapy tools.

Sensory wall– A sensory wall can be made of carpet pieces, odds and ends, fabric, sponges, Legos, or whatever textures you can find.
Fiber Optic lights– a commercial light wall costs over $1,000. This one on Amazon can serve the same purpose for under $100.
Bubble tube– A traditional bubble tube is very expensive. There are less expensive versions on Amazon available. Add a mirror behind the tube to create the illusion there is more than one tube. Make sure to secure it to the wall.
Sensory swings- A sensory swing is a high priority in my opinion. There are several different swing options out there, including many that can be do it yourself options. Use fabric to create a hammock swing, or wood and rope for a great platform. Check out our posts on hammock, Lycra, and platform swings. A Sensory Swing used for sensory modulation is an amazing way to provide an option to swing in a home or preschool setting

resources out there for building a sensory room on a budget

When building your sensory room, you will be limited by the constraints at your school, but if there are no rules, the sky is the limit!

This Pinterest post has hundreds of ideas for creating a sensory room on a budget
There are multiple different ideas out there to create rooms of all types
Here is another post on one woman’s journey to create her own sensory room on a budget

Remember, you can start small and build a little more each year.

My Snow Globe

February 23, 2024 by Victoria Wood OTR/L

In this blog post, we have a free My Snow Globe worksheet to work on self regulation and emotions with kids. What does winter mean to you? Hot chocolate, snowball fights, snuggling by a warm fire? Use the My Snow Globe free worksheet to create a magical winter scene! Students (and caregivers) can use this downloadable worksheet to draw and create their vision of winter.

I imagine students from all over the globe have different visions of winter. Growing up in New England it was sledding, skiing, snowmen, skating, and climbing in the snow piles. Now that we live down south, a cold day means temperatures below 70 degrees. Most of my students have no idea what any of the above winter activities are, other than seeing them in movies or books.

This is a great activity for an emotions check in or a feelings check in activity with kids!

My Snow globe activity is great for checking in with how kids feel on the inside.

My Snow Globe Worksheet

Check out some snowflake activities or some of the fun snow and ice activities for hands-on sensory motor activities to go along with this snowglobe worksheet on the OT Toolbox. Other ideas include our snowman crafts and activities or snowball activities. The snow globe worksheet is a great addition to Winter fine motor activities in general!

We also have these snow globe activities to pair with the worksheet:

Free Deep Breathing Exercise: Snow Globe Self Regulation activity
Free Printable Snow Globe Letter Puzzles
There are also many snow globe activities inside The OT Toolbox membership.

The My Snow Globe worksheet is a pretty simple activity.

Draw a winter scene, then describe it on the lines at the bottom. You can keep it very simple; just present the “My Snow Globe” worksheet and ask students to get started, or get creative.

There can be endless variations to this project:

What does winter look like to you?
How you imagine winter
Where you would like to be during winter
A favorite winter memory
The best/worst part of winter
Something unique about winter in a different country
Winter in the artic with polar bears and penguins
A scene from Alaska with glaciers and ice fishing

How to adapt and modify the My Snow Globe Activity

Our learners are not one size fits all, therefore lesson plans are not either. This does not mean 100 different activities each week, but finding ways to modify a singular task to meet the needs of several of your students.

Students can glue items onto their “my snow globe page” to create a winter scene. Cotton balls, pom poms, glitter, sequins, foam snowflakes, and other craft items will make a very cute snow globe. Head to the craft store or check out inexpensive supplies on Amazon (affiliate links). Check out this glitter snow!
Lower-level or younger students can dictate what they want written under their snow globe, whereas higher level learners will write lists or sentences.
Higher level students can turn this into a book cover for a report on winter.
Make this part of a larger lesson plan including gross motor, sensory, social, executive function, or other fine motor skills.
Enlarging the picture or lines may be necessary for beginning handwriting students who need bigger space to write.
Project this page onto a smart board for students to brainstorm as a group
Different levels or types of prompting may be needed to grade the activity to make it easier or harder.
Social skills – sharing resources promotes social function. Talking about a themed lesson plan builds social skills. This can be a fun group self regulation activity for a small group in therapy sessions or in the classroom.
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.

What are the benefits of learning to draw?

Drawing is an important skill. This does not mean everyone needs to become an artist, however drawing is a developmental milestone that can be addressed through creative activities like My Snow Globe.

Building hand strength and dexterity – making lines and shapes builds hand muscles and develops muscle control
Visual motor skills –Combining what is seen visually and what is written motorically. It takes coordination to be able to translate information from visual input to motor output. Coloring, drawing, counting, cutting, and tracing are some visual motor skills
Visual Perception – Developing figure ground to see where one item starts and finishes, scanning to find the differences in each picture, and visual closure to understand that parts of shapes will create something whole are important to academic development
Sequencing – will your learner do the drawings in order? Can they process information from left to right?
Proprioception – pressure on paper, grip on pencil, feedback to muscles and joints
Letter formation – letters are a series of sticks, arcs and circles. Learning to draw these shapes well, makes for an easier transition to letter formation
Copying skills – learning to copy a drawing leads to copying words from a model, transferring the letters or objects from one place to another
Bilateral coordination – remembering to use their “helper hand” to hold the paper while writing. Using one hand for a dominant hand instead of switching back and forth is encouraged once a child is in grade school or demonstrates a significant strength in one or the other
Strength – core strength, shoulder and wrist stability, head control, balance, and hand strength are all needed for upright sitting posture and writing tasks

More skills addressed when completing tasks like My Snow Globe:

Many times, when presenting and documenting an activity, we focus on the motor skills like strength, coordination, precision, bilateral coordination, and motor planning. It is important to pay attention to the executive function and social skills learned:

Attention
Attention to detail
Focus
Sequencing
planning
Behavior, compliance
Frustration and work tolerance
Task initiation, avoidance, and completion
Neatness
Impulse control
Self-regulation
Organization
Social function – problem solving, sharing materials, turn taking, waiting, and conversational skills

It is acceptable, and sometimes advised, to present a task while only measuring social skills, behavior, and executive function skills. Sometimes I present an activity, and manipulate the variables to monitor and address some of these skills.

Manipulate variables with this activity

What do I mean by manipulating the variables? You can manipulate variables, similarly to grading activities, but intentionally changing some of the variables to elicit a response. This can be as benign as having fewer items than your student needs so they must ask for something, or creating a frustrating element to practice tolerance. While this may seem unfair or intentionally creating stress, this is important to practice in a safe environment to build much needed skills.

Provide few directions to address problem solving and frustration
Add a timed element to work on planning, time management, and attention
Create a rubric with several different elements students must complete to receive a grade
Purposefully grade neatness, attention to detail, and task completion
Add distraction to address self-regulation, attention, and focus
Group students together who are not inherently cooperative. This tests tolerance, patience, sharing, problem solving, and social function
Turn your task into a multi-layered one to practice organization, planning, sequencing, and memory
Make the task extra challenging to encourage learners to work harder, deal with frustration, or ask for assistance

Free My Snow Globe Worksheet

It is certainly amazing how one worksheet can be broken down, modified, manipulated, and analyzed. There are even more things to consider when presenting an activity, like documentation, or building it into a lesson plan.

A great project would be to have students from all over the world do a joint project like My Snow Globe, and see how their visions of winter differ. My true vision of winter involves sitting on an island somewhere with my toes in the sand!

Get your copy by filling in the form below. This item is also found inside The OT Toolbox Membership!

What if you had themed, NO-PREP activities designed to collect data and can help kids build essential fine motor skills?

Take back your time and start the year off with a bang with these done-for-you fine motor plans to help kids form stronger hands with our Winter Fine Motor Kit. This print-and-go winter fine motor kit includes no-prep fine motor activities to help kids develop functional grasp, dexterity, strength, and endurance. Use fun, winter-themed, fine motor activities so you can help children develop strong fine motor skills in a digital world.

The Winter Fine Motor Kit includes 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.

Conversation Heart Sort

February 7, 2024 by Victoria Wood OTR/L

Valentine’s day is upon us. Since there is an increasing amount of hype swirling around Valentine’s Day, you might as well jump on the bandwagon and make a lesson plan around it. Let’s face it, breaking up the winter blues with a cute holiday theme is kind of nice. At the OT Toolbox, we want to make your planning just a little bit easier with a FREE conversation heart printable! The Conversation Heart Sort is a great activity to address multiple skills at once while motivating your students with something that is not so “boring.” Simply enter your email address below, and somehow through the magic of the internet, your free PDF will be in your inbox before you know it.

What to do with this Conversation Heart Sort Freebie

There are many ways you can present this Conversation Heart Sort worksheet. On the printable, you’ll see directions for using the conversation heart worksheet.

Have students write the color words underneath the printed word in the hearts.
Then count real conversation heart candies and graph them according to the number of each color.

For this worksheet, you’ll need conversation hearts, crayons or other coloring utensils (colored pencils or markers), scissors, and glue.

You could also use this activity sheet without using actual candies. Use manipulatives, stickers, foam hearts, or cut out hearts in different colors.

You can extend the activity by using real heart candies for a fine motor activity, or you could use heart stickers, mini heart erasers, or other heart shaped manipulatives.

You will need to make several copies of the heart worksheet, otherwise your graph will only have one of each color on it.

Here are some great ideas to use the Conversation Heart Sort worksheet:

Have students fill out the hearts on one sheet, then photo copy the page several times before cutting the hearts out. You will have to remove some of the hearts, or your graph will have all the same numbers for each color
Use this activity with a group of students, having them all put their Valentine’s hearts into the same container. They can take turns grabbing some of the hearts, count them together, or make predictions about their graph
Once you finish this coloring and cutting the Conversation Heart Sort activity, use REAL candy hearts for graphing or sorting onto the color pages
STEM learning STEM stands for science, technology, engineering, and mathematics. STEM fine motor activities are going to be much more important to build these important skills.
Laminate the cards to make them reusable. You can either laminate the finished product, or laminate blank cards for different groups of students to use the same set of cards. Note: while some learners love to use wipe off sheets, others become upset they cannot take their work with them. For those who want to save their work, consider taking a screenshot of it.
Make a memory game out of the conversation hearts. Turn the hearts over while students try and find matches to the color cards. You can make this simple with fewer cards, or more difficult
Decorate the cards to make them fun and flashy. Glitter, sequins, gel markers, and paint can create a masterpiece
Enlarge or shrink the hearts depending on the skill level and handwriting ability of your learners.
Pre-cut the pieces ahead of time if your emphasis is on coloring and decorating
Work in pairs or in a small group to address problem solving, turn taking, and negotiation skills
Gross motor – run across the room collecting pieces to add to the bookmarks. Gather pompoms/sequins/pieces of paper/etc, by squatting and bending to retrieve them

All of these fine motor activities with conversation hearts will be a hit with your kids this time of year!

How to document after using this free Conversation Heart Sort worksheet

I recently read a post on social media from an OT asking about documenting activities. She said she knew they were fine motor or perception, but did not understand the best way to effectively document what her learners had done during the session. These can be measured in percentages, or actual numbers. Recent Medicaid guidelines suggest avoiding vague words such as mild/moderate or good/fair.

Use data to back up your documentation. Avoid or limit phrases such as min assist, fair, good, some, many, etc. They are vague and do not contain the numbers and data critical to proficient documentation. Instead use percentages, number of trials, number of errors, exact sizing, how many letters were written incorrectly, number of reversals, number of prompts, minutes of attention. You get the idea.
Document the percentage of correct letters. This can get tricky. Are the letters correct if they are legible, or only if formed top to bottom like they should be? If you want to be even more exact, document how many letters are correctly formed out of the total written.
Indicate how many letter reversals, omissions, duplications
Indicate the size of letters in relation to the lines OR sizing compared to the size they are supposed to be (tall versus short letters).
Line placement in handwriting – how many letters sit on the line (or within a certain distance), as well as how many hanging letters are below the lines
Spacing in handwriting – is there correct spacing between the letters, or are they spread out/clumped together
Note their grasping pattern and hand dominance
Document attention to detail, following directions, number of prompts and reminders needed, type of prompts
Can your learner scan the page and do near point copying? Are they recognizing what they are writing, or merely copying lines and circles?
Can your learner correctly hold and manipulate the scissors/pencil? How much assistance do they need to grip the scissors and cut (remember to use number and types of prompts in favor of “min assist”.)
Can your student continue to hold the scissors while trying to manipulate the paper? How far are their snips from the lines? Can they don scissors independently?
How many times do you need to repeat the directions so your learner can follow them?
How many reminders does your learner need while doing this activity?
Before documenting, determine what goals and skills you are addressing. Are you looking strictly at letter formation, and scissor skills? Or something else entirely such as executive function and behavior?
Focus your observations on the skills you are addressing. It is alright to address one, or ten skills at once, just be sure to watch for those skills during the activity. This can take practice to watch everything all at once. Newer clinicians often videotape sessions to go back and review clinical observations they may have missed.

This type of documentation may feel foreign at first if this is not what you are used to, however insurance and governing agencies are becoming stricter about accurate documentation.

Conversation Heart Activities

The world wide web is a huge source of information. Sometimes too big. You could spend hours gathering ideas for your treatment plans.

Here are some other tools to use along with your conversation heart sort activity:

Printable Valentine’s Day Cards– These printable cards have differentiated lines to support many handwriting needs. Cut a heart out of construction paper and create your own conversation heart message on the front. Then glue it to the front of the Valentine’s day card.

Lucky for you, the OT Toolbox has a Valentine’s Day Fine Motor Kit. Pick one or several to incorporate into your lesson plans. So many of the pages in this resource could be used with conversation hearts in mind…

Valentine’s Day Activity Sheet– Line conversation hearts up on this page to match the images. This activity supports visual scanning, visual memory, visual peripheral skills, form constancy, fine motor skills, eye-hand coordination, dexterity, pencil control, motor planning, coloring and more.

Valentine Matching Alphabet Cards– Cut out these love letter cards and match uppercase to lowercase letters. These cards are used for cursive letters to build skills in letter recognition, visual discrimination, and more.

Valentines Fine Motor Worksheet– Perfect for using with conversation hearts, you can have fine motor races with candy hearts. Use tweezers to move conversation hearts along the path. There are so many ways to play and develop skills with a conversation heart theme!

If fine motor and visual motor skills are needed, try some Valentine’s Day crafts and ideas. I tend to keep looking for bigger and better, even after I have found a handful of great ideas.

Valentines Day I Spy activity is a free printable that is perfect for visual motor and fine motor skill-building. Cover matches with conversation heart candies or mini erasers.

Valentine’s Day Hat Craft– Print off this hat template and work on coloring skills, scissor skills, and executive functioning to build and create the Valentine craft.

Valentine Hole Punch Cards– These free pintables are perfect for occupational therapy Valentine parties. Use the printable activity to build skills in eye-hand coordination, hand strength, bilateral coordination, arch development, visual scanning, and more.

Heart Deep Breathing Exercise– This printable goes really well with a conversation heart theme. Print off this heart poster and use it to develop skills in mindfulness, self-regulation, and even proprioception through the chest and upper body. It’s a very calming activity that can be a great addition to the sometimes chaos and unexpected situations in a classroom Valentine’s Day party. Use it to support sensory needs at a Valentine’s Day party!

I love adding fun or obscure facts about whatever we are learning. Valentine’s Day is no exception. Here is one about conversation hearts: “Weirdly enough, the story of conversation hearts first began when a Boston pharmacist named Oliver Chase invented a machine that simplified the way medical lozenges — used for sore throats and other illnesses — could be made. The result was America’s first candy-making machine, because the pharmacist soon started shifting his focus from making lozenges to candy instead! Chase founded the New England Confectionery Company, or Necco, and the candy lozenges soon became what we know today as Necco wafers.”

If Valentine’s Day is an excuse to get free candy and chocolates, count me in!

Free Conversation Heart Sorting Page

You can get our Conversation heart worksheet as a free download by entering your email address in the form below. We’ll send you a copy to your email inbox!

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!

Platform Swings

March 5, 2024January 22, 2024 by Victoria Wood OTR/L

We at the OT Toolbox, have created a series of posts about different types of therapeutic swings. A swing is more than just a fun gadget. When selecting treatment plans, it is best to understand the equipment, and treatment methods when using them. Today’s focus is on Platform Swings. We will discuss activities, tips, safety precautions, and the benefits of this type of swing. Platform swings are just one type of sensory swings in our arsenal of therapy tools!

If you have any type of suspended equipment at your disposal, it can be a great asset to your treatment. Check out this article on What to Know about Sensory Swings for a general overview.

Platform swings are found in occupational therapy clinics, however, we shared the value of purchasing a platform swing in our blog post on sensory rooms on a budget. Even if this is the one piece of sensory equipment that is purchased, it’s a huge value for meeting sensory needs.

What is a Platform Swing?

If you’ve seen a therapy space, you might be familiar with a platform swing as one of the sensory tools.

What exactly is a Platform swing? It is a suspended piece of sensory equipment, made of in the shape of a platform, or a large flat surface. A platform swing provides vestibular input and encourages righting reactions through balance training. This is a tool to target sensory modulation.

One feature of a platform swing is the actual platform, or the base where the student or child sits or lays. It is a large, sturdy, flat surface that offers a surface and allows for many positioning options for sensory activities.

A platform swing offers a variety of sensory input, based on the positioning on the swing:

Sitting
Laying prone to “fly”
Standing
Kneeling
Squatting
Laying in supine

A Platform Therapy Swing can be beneficial to individuals who crave sensory input, particularly proprioceptive and vestibular input. The Platform Therapy Swing can help their brain regulate stimuli and provide a calming sensory activity. Platform swings can be made from items you have in your garage, or purchased in several different sizes and shapes.

Types of Platform Swings

There are different types of platform swings available for purchase, from home made to deluxe versions. The following are examples of these swings, not endorsements for these products.

The basic Platform swing is a square piece of wood, padded for safety and comfort, that attaches to the ceiling. To install simply find an open area, drill a hole into support beam of ceiling, screw in hook, and hang swing. There are different types of platform swings, and the swing seat with a wooden platform requires more core strength and stability. It also offers a stable surface for standing and playing prone.
Other platform swings available on Amazon (affiliate link) use a soft surface which offer less support, but is a less expensive option. It secures from a single hook.
This Giant 700lb 60 inch Saucer Tree Swing for Kids Adults gave me a laugh. I was expecting a giant swing that weighed 700lbs! The swing is rated for 700lbs of load capacity; however, the wording does not reflect this.
Waterproof platform swings are available with a platform swing with a mesh bottom. It does not look like it has bounce to it like a trampoline, but made from mesh to drain better and be cleaned easier.

Here is a video with instructions to make a DIY platform swing:

Use the instructions to make an outdoor sensory swing, or you could modify the instructions to make an indoor platform swing.

PLATFORM SWING STANDS

There are several types of support mechanisms for sensory Platform swings. The traditional method is to secure an eye bolt in a support beam in the ceiling. However, not all areas have accessible beams or are feasible.

Affiliate links listed below.

Stand Frame for Platform swing. It is simple to assemble, allowing you to adjust the horizontal-bar height (no wrench required) ranging from 70.86’’ to 100.4’’ This swing stand can bear up to 440.9 lbs. Convenient and easy to move, this KT swing stand can fit anywhere within your home/office and takes LESS THAN 10 SECONDS TO FOLD UP after use. Easy to add or remove other accessories besides the platform swing, and add kits such as foam handle grips, hanging hook, swing chair for kids, or TRX straps.
A Frame stand: this free-standing frame fits several types of swings. Clearly the amount of movement is restricted when compared to swings bolted to a ceiling, but work in areas where a ceiling hook is not feasible, or you want something portable.
This is a Mediterranean stand, or the kind you imagine on back patios or at resorts. One consideration with this type of swing stand is that it isn’t appropriate for larger motions of the swing so it’s use can be limited.
Another option is this A-frame deluxe stand for hanging all kinds of suspended equipment. You can change the swing out to include linear swinging or use the swivel attachment to spin.
Doorway swing bar: Fits 26″-36″ door frames. Needs 2-1/4″ flat space for brackets. Weight capacity 220 lbs (100kg). Your door will close with this swing in place
Six piece doorway swing set attaches without damaging the door frame.

Platform Swing SAFETY TIPS

Before jumping into the fun platform swing activities and benefits, we need to take a moment to talk about safety with the platform swing. Everything we do poses risks, and swings are no exception. And this is especially true in an occupational therapy session where sensory input may challenge a child’s “safe” level of regulation.

We might see hyper responsiveness or hypo-responsiveness following use of a platform swing.

Secondly, kids with special needs do not have the natural reactions and responses as their neurotypical counterparts, therefore they are more at risk for injury.

Check your equipment. Make sure your hanging device is secure and rated for the weight and size of your participant. This is important on a regular basis. I worked in a clinic that had several swing hooks. One day we looked up and the carabiner was almost worn through! This was a lesson to be more vigilant with all the equipment, including ropes, netting, ceiling attachments, and hooks, not just the platform swing itself.

Provide some sort of padding or crash pad. Concrete floors are not forgiving. For a therapy space when a tool like the platform swing is used, you can’t always predict motor and sensory responses.

Plan for the movement of the swing. Children should stay a safe distance from other kids on swings, being careful not to run or walk in front of or behind moving swings. In a busy clinic, this is often a big hazard. While I am a big fan of natural consequences, some parents frown on their child being knocked over by a moving swing.

And, when it comes to planning for how the platform swing will move, be sure to leave enough space between your suspended equipment and the wall or other pieces of equipment.

Supervision- Adult supervision should be a given when working with children with special needs. They may have poor impulse control, muscle movement, and reaction times. I had a student who fell on his face out of a swing. He said he did not know he was falling until he hit the ground. Luckily it was a short drop!

Supervision is especially needed when a sensory room is used as a calm down space in the school setting. Some schools have a sensory room with a swing like a platform swing (or other options). Supervision is always required in these spaces.

Watch your child for different reactions. Look at their eyes for signs of nystagmus indicating their body senses the movement. Too much movement may cause dizziness and vomiting. A child can go from being fine to vomiting in a split second. These things happen.

Finally, be aware that accidents will happen. As noted in the child above, I was standing two feet from him when he let go of the ropes all of a sudden, and took a nose dive onto the floor. He was seven years old and generally not accident prone.

benefits of the sensory Platform swing

All swings have some benefit, and the Platform swing is no exception. Let’s cover the benefits of a sensory platform swing so that you can focus on supporting therapeutic needs using a sensory platform swing.

If the best benefit is fun and enjoyment, you have picked a winner! Swinging has many more benefits than just providing a good time.

When a child is on a playground, they are using their body in a healthy way. As they play on a playground, they are sending oxygen to their muscles while at the same time producing endorphins that have positive effects on their mood and activity level. Developing a strong sensory system creates a foundation for more complex learning later in life.

With so much technology and screen time consuming much of their day, children do not have as many opportunities to develop the vestibular (balance), tactile (touch) and proprioceptive (helping us move through space and move our bodies effectively) areas of their brain. Time on the playground swinging, climbing, and sliding allows these important systems to develop.

One important consideration to note is that some children feel unstable on this swing and need to start by sitting with their therapist or being able to touch the ground while swinging.

Some of the benefits of using a platform swing in therapy sessions include:

The unstable surface challenges a child’s body positioning, promoting improved motor planning, balance, coordination, and righting reactions.
Sensory: not only does swinging help develop and organize several of the different senses, it can change overall arousal level. You can target a variety of sensory needs using a platform swing. Swinging can be calming and alerting, depending on the type of movements produced. Slow rhythmic movement is calming, whereas rapid unpredictable movement can be alerting. Some sensory seekers will need rapid movement first to fill their sensory cup before being able to benefit from the calming effect of swinging.
Calming effect: slow rhythmic movement while sitting or lying down on the platform can be calming
Proprioception is crucial in regulating and accurately coordinating movements, making it an essential aspect of sensory processing. Regarding platform swings, the gentle swinging motion offers a soothing and organizing deep pressure input to joints and muscles, benefiting the nervous system.
It is beneficial to a child’s spatial awareness. This supports spatial awareness development but also awareness of the body as it moves through space.
Swinging stimulates the vestibular system, vital for maintaining balance and coordination. The integration of proprioceptive and vestibular input can have a regulating and soothing impact on the nervous system, resulting in heightened attention and concentration.
Balance and coordination- From the first step onto the platform swing, balance and coordination is challenged. Then, add additional challenges and you challenge the visual sense, core, shoulder and hip girdle, ankles, and stability of the feet. The platform swing benefits balance and coordination in many ways!
Integration of primitive reflexes through elongation, activation, strengthening and grading of multiple muscle synergies throughout the body, especially in the core, to achieve refined three dimensional movement

Platform swings develop a child’s core muscles and helps with the development of balance.
Improves strength and stability of the shoulders, arms and hands through grasp, weight-bearing and weight-shifting, and of the pelvis, knees and feet through weight-bearing and movement changes.
Dynamic stability with controlled mobility throughout the body, preventing fixing/holding or compensatory patterns.
Holding onto the ropes of the platform swing while sitting or standing helps strengthens muscles. Maintaining a seated position or squat strengthens muscles as well while challenging balance and coordination. Additionally, holding onto the the edges of the platform in prone or while sitting on the needs or in criss cross apple sauce or other seated position strengthens in isometric exercise.
A platform swing is a tool for social interaction and development as there is often give-and-take with the therapist and the child.
Swinging helps develop fine motor skills—grip strength, hand, arm, and finger coordination.
Spinning on a swing stimulates different parts of a child’s brain simultaneously. This is important for learning skills such as spatial awareness, rhythm and balance and muscle control.

We explore more of these benefits below in the platform swing activities section.

Platform Swing activities

Beyond the relaxing back and forth movement of the platform swing, there are many various ways to incorporate activities into swinging. These platform swing activities should be individualized to support each child’s specific sensory needs.

Reach- Have your learner prone on the swing. They can reach for beanbags or balls on the ground and toss them overhand into a bucket. They will be building upper body and core strength while they play.
Fine motor skills– Use clothespins to clip lightweight items, such as scarves, ribbons, or streamers, onto the swing ropes. Encourage the child to reach for and grab the items while swinging in a controlled manner. To make this activity more challenging, have the child use only one hand at a time or incorporate counting or color recognition tasks while grabbing the items. This exercise promotes hand-eye coordination, fine motor skills, and visual tracking abilities.
Emotions and Creative Thinking- Platform swings provide an excellent opportunity for engaging in imaginative play scenarios such as riding on a magic carpet, flying through space, or swinging through the jungle. Encourage the child to use their creativity and verbal skills by pretending to be a character or telling a story while swinging. This activity not only promotes physical movement but also helps with social skills, language development, and emotional regulation.
Language development can include receptive language and/or expressive language needs.
Platform swing activities to target primitive reflex integration– This is a hands and knees activity on the swing. Position the child on the swing in a quadruped stance, placing their hands and knees on the platform. Encourage activities such as reading or pointing to a visual chart to enhance their core strength, balance, and motor planning abilities. When children position themselves on their hands and knees, crossing the midline becomes an enjoyable yet stimulating task. It presents a remarkable opportunity to strengthen the STNR reflex and refine ocular motor skills.
Squats on the platform swing- have the child perform a squat while holding onto the swing. This activity can also be used as a calming technique by incorporating deep breathing exercises and slowing down the movements.
Attach a rope to a fixed point. Your learner can pull themselves along the rope, then launch themselves. This provides extra grip strength and upper body strengthening.
Prone puzzles- Another prone activity is putting a puzzle on the ground in front of your learner. They can stay stationary while completing the task, or move themselves around to retrieve pieces
The tornado plat form swing activity- Add a rotational device to your swing hook to add instant rotation. If you do not have a rotation device, you can do a certain number of rotations before the swing gets tangled. To increase the level of challenge, incorporate cognitive tasks like spelling words or solving math problems while spinning. This activity encourages the child to use their vision, balance, and coordination skills while engaging in a fun and dynamic task.
Hide and seek – Have your child close their eyes while swinging. Move to another spot and have them open their eyes. How quickly can they locate you?
Standing on the platform swing- (gasp!) Standing on a platform swing provides a different type of input and takes more muscles and balance to be successful. You can hang the swing low so your learner is jumping off the ground.
Gravitationally insecure children? Hang the swing very low, so your child can experience just a little movement at first.
Tower tumble- This is a great coordination and gross motor core strength activity. Build a tower of large carboard blocks or buckets. See if your child can swing high enough to kick the tower of blocks over. This is very motivating for a child who might be fearful of movement.
Shake the Platform Swing- This platform swing activity offers no linear movement at this point, just vibration and shaking. It’s a great activity for body awareness, core strength, and vestibular input. Can your child hold on while there is so much movement?
Vary the way you push the child. You can push the swing, grab their feet or hands, or push on their body. Changing things up adds to the novelty of sensory hammock swing as well as creating new exercise and sensory opportunities.

Here is a great starter video on Platform swing activities:

Platform swing ideas can be incorporated into other occupational therapy goal areas as well.

Here’s another video to find platform swing ideas, too.

Make sure you check out our other posts in this swing series. You may find you like one swing better than another, or see different benefits in all of them.

Types of Pencil Grips

September 17, 2024January 17, 2024 by Victoria Wood OTR/L

Pencil grips, pencil grips, pencil grips, there are so many types of pencil grips! Do I try this grip or that one? Does this child really need a pencil grip? Will they use this pencil grip? Will it be used correctly if they use it in the classroom? Ugh! So much to decide and so many variables to consider when it comes to handwriting. It is overwhelming! Does this sound like you in your practice as an OT? I’ve been there, and I’ve said these things to myself, and sometimes even to others. This post is here to help you decide what pencil grips to try and why!

Types of Pencil Grips

In this blog post, we’ll dive into pencil grips occupational therapy practitioners may offer as a tool to support handwriting needs.

We’ll address types of pencil grips (with links for purchase) and why each pencil grip is used.

Finally, we’ll cover a variety of related resources and activities to support the development of pencil grip use.

To further explore pencil grasp development, take a look at our blog post, Pencil Grasp Development and get this great Pencil Grasp Quick Visual Guide, which helps Occupational Therapists identify and explain grasp patterns, using pictures to educate, and explain how pencil grasps progress developmentally.

The visuals will help parents and teachers understand grasp development and the goals for an appropriate grasping pattern. My prediction is that these tools will help get buy-in from the educational team and the family. It helps them understand exactly where the child is developmentally and where you, as the OT, wants the learner to head, and why!

pencil grips and Occupational Therapy

First, let me begin by saying that pencil grips are NOT a miracle cure for pencil grasp. They can help in certain circumstances based on the child’s individual needs.

Different types of pencil grips do not help to overcome the root of the inefficient grasp, as these issues must be addressed simultaneously, while implementing the gripper.

In occupational therapy sessions, the OT practitioner is striving to achieve the most effective and functional pencil grasp for each individual. A therapist may have 40, 50, or even 70 students on their school-based OT caseload…and each student will be completely different when it comes to grasp patterns, pencil pressure, positioning of the fingers, preferences, letter formation strokes, executive functioning skills, self-regulation, visual motor skills, sensory preferences, and handwriting considerations. All of these areas play into handwriting.

To meet the needs of the individual student, a pencil grip may be supplied as a tool to support those individual needs.

Before we get into the various types of pencil grips you may see an occupational therapy practitioner recommend, it’s important to cover functional pencil grip.

Pencil grips are designed to support the most functional and efficient pencil grasp a child can achieve.

This is based on many factors including; their current skill level, motivation, and understanding that the pencil grasp should be efficient and effective, but NOT perfect.

Functional grasps have a few basic components, which include; an open web space, skill fingers holding the pencil (thumb, first, and middle fingers), and stability (achieved with the ring and little fingers being curled securely into the palm). This results in an efficient and functional tripod grasp for the most success with handwriting, drawing, and coloring.

Inefficient grasps are used as a child attempts to compensate for lack of stability, skill finger strength, and endurance. With this inefficient grasp comes fatigue, pain, stress on the joints, decreased writing speed and overall legibility.

A pencil grip may be a tool provided to support a functional pencil grasp, depending on the needs of the individual student.

Think of pencil grips as a supplemental tool to aid a child as they continue to work on building the hand and finger skills needed to achieve an independent and efficient grasp.

The type of pencil grip can also serve to support the child as they focus on the writing process, therefore not exhausting their thought and energy, trying to remember to grasp the pencil properly for the best function.

The OT Toolbox has a great Pencil Grasp Bundle available for purchase to support various needs related to pencil grasp.

types of pencil grips

Now, without further ado, let’s proceed to types of pencil grips that most OTs recommend, what their purpose is, and why they are recommended!

There are so many types of pencil grips out there on the market. Some of those listed out include:

Trigangle pencil grip
Grotto pencil grip
Soft foam pencil grip (Classic foam pencil grip)
The Pencil Grip
Crossover Gripper
The Writing C.L.A.W.
Firesara Grip
Twist n’ Write
Handiwriter
Write Right Stylus
Stetro Gripper
Weighted pencil grip

This is just a start of all of the types of pencil grips out there. We’ll go into greater detail on the benefits of each pencil grips, and why you would select one grip over another.

Let’s get started!

Amazon affiliate links are included below for purchase of various types of pencil grips.

Small Pencil Pieces and Small Golf Pencils

Sometimes the easiest way to ensure a better grip on a pencil is by getting a smaller pencil into those hands. Golf pencils are some of the best tools for smaller hands, as they are the right size. The use of larger pencils and crayons leads to compensatory grasping patterns, as they are too long and too heavy for little hands to grasp and hold for long periods of time. A typical sized pencil in the hands of a child, is the equivalent of an adult trying to use a 12 inch pencil!

The physical size of hands and biomechanics of the muscles and joints in a child’s hand can’t possibly hold a large writing instrument unless they grasp it with compensatory efforts. This generally results in inefficient and ineffective grasps. Younger learners have far more maladaptive pencil grasp patterns than older adults, due to the young age at which learners are instructed to write. 40 years ago, writing did not begin until first grade. That gave the hands time to develop. Now writing starts in the two year old class, or in preschool many times. It’s because of the early push to trace, copy, and write letters in preschool that we see poor pencil grips established.

The Pencil Grip (affiliate links):

This grip, simply called “the pencil grip”, is an oldie, but a goodie for some children. It is designed to provide cushiony comfort, with proper finger placement indicators for left AND right-handed writers. The Pencil Grip helps learners gain improved pencil control, while reducing fatigue. This type of pencil grip supports an open web space and tripod grasp. The pencil grip comes in mini, standard, and jumbo sizes, making it available for a variety of children and adults. Recently, I have been unable to find the mini-sizes.

Crossover Grip (affiliate links):

Honestly, this grip is essentially “The Pencil Grip”, with a wing on the front to help prevent the fingers and thumb from wrapping over the pencil shaft. This helps keep the web space open. The crossover grip will aid some children who do not have a strong thumb overwrap pattern yet. If their thumb overwrap is significant, this grip may not be the one for them, as it allows a wrap grasp with little resistance. It is cushiony and does not prevent the learner from wrapping their thumb over the material.

Grotto Grip (affiliate links):

This type of grip is great for the children that have a thumb wrap grasp which closes up their web space. The Grotto Grip is not as cushiony as “The Pencil Grip”, but it is easier to use, as it has molded finger slots for the thumb and index fingers, and an indentation on the bottom for the grip to rest on the middle finger. It also has a wing on the front, and the material is stiffer in design, which can help aid in the prevention of any finger or thumb wrapping.

Left and right-handed writers can easily use the Grotto Grip, as the finger placement is exactly the same, making it less confusing for children to know where their fingers should be placed while using it.

The Writing C.L.A.W. (affiliate links):

This grip has three finger cups to support finger placement, and can be used by both left and right-handed writers with a simple change of finger placement within the cups. The finger placement indicators are on the bottom of each cup. The design leaves little room for error, and supports a variety of children, as it comes in three different sizes.

The Writing C.L.A.W. fits a wide variety of writing, drawing and coloring tools such as standard pencils, primary pencils, crayons, markers, and paint brushes!

Firesara Grip (affiliate links):

This grip is similar to the Writing C.L.A.W. as it has two cups for the thumb and index fingers, but it has a ring for the placement of the middle finger. The Firesara Grip can easily be used by left and right-handed writers. Learners place their thumb and index fingers into the cups, and the middle finger goes into the ring finger of either hand.

Using this grip, helps the three fingers to be fixed tightly to the pencil shaft. The Firesara type of grip is made of soft, durable silicone.

Twist n’ Write (affiliate links):

The Twist n’ Write, also called the Rocket Pencil, is not a pencil grip, but a pencil that has a wishbone-shaped design. This helps fingers to be placed into a tripod grasp with little guidance. It has rubbery sides that double as erasers! The pencil twists at the bottom to push forward more lead. It needs a special tool to add more lead, which makes it a little less efficient for use. It is often easier to buy multiple pencils rather than trying to replace the lead. The pencil design is for not for tiny hands, but is effective for finger placement without the use of a pencil grip, making it more motivating to use.

The Twist n’ Write pencil can easily be used by left and right-handed writers. Some learners or teachers might not like the rocket pencil, because it looks so different from traditional pencils.

Handiwriter (affiliate links):

This is not really a type of grip, but rather a position support for the pencil. There are some children who hold the pencil vertically instead of at an angle, or have a thumb overwrap grasp with a closed web space. The Handiwriter positions the pencil at the correct angle within the hand. This pencil positioner helps to reposition the pencil within the web space, by pulling the pencil back into the web space, while promoting improved finger placement on the pencil shaft.

The “charm” on the commercially purchased Handiwriter is grasped by the ring and pinky fingers, and curled into the palm, providing increased hand stability. These can purchased as pictured, but can also be made with or without the charm support, by using two terry cloth hair bands using these directions, or by following the visual sequence for creating one using elastic bands.

Write Right Stylus (affiliate links):

You can put a grip on an existing tablet stylus, or buy get his great stylus that has a gripper on it! I tried this device with some of the kiddos I work with, and it worked well with the added index finger placement into the cup that is on the shaft of the stylus.

The Write Right Stylus will only work if the index finger is properly placed into the cup, and ensures proper positioning when using a tablet or screen for writing tasks. This placement helps to promote a tripod grasp. The symmetrical design allows it be used by left and right-handed writers.

Stetro (affiliate link)- This pencil grip is efficient when The Pencil Grip is too large and the individual benefits from a smaller “target” to pinch the pencil.

Traditional Triangle (affiliate link)- the Traditional triangle grip is a common pencil grip that is offered to the whole classroom from teachers, parent teacher groups, or in back-to-school kits. The triangular sides offer a flat placement for the fingers, but this grip may not work for all individuals. One therapy tip is to cut the triangle grip in half or in thirds and use the triangular ridges as bumps on the pencil to stop the fingers from moving too close to the pencil point. This way the ridges bring awareness for placement.

Weighted pencil (affiliate link) grips- Pencils with weighted added on are typically an adaptation to support specific needs related to tone, proprioceptive sensory input, tremors. Read about pencil pressure and the benefit of adding a weighted pencil grip for more information.

Classic Foam (affiliate link) for relieving pressure

Adaptive Pencil Grips

The alternative pencil grasp pattern that is successful for many kiddos who simply cannot achieve an efficient grasp is use of an adaptive tripod grasp, or any grasp which enables a functional grip on the pencil. There are adaptive pencil grips that support various needs.

For those struggling to manipulate, use, position, and write with a pencil grip during written output, sometimes an alternative grip is the answer.

There are several alternative grasps for pencil manipulation.

The Adaptive Tripod Grip is appropriate to use when low muscle tone or hyper mobility of the finger joints limits pinching and manipulating the pencil.

It is easy to achieve, and I often use it if I am writing a lot. My husband uses it all of the time, and has since grade school.

In the adaptive tripod grasp, the child places the pencil between the index and middle fingers rather than within the traditional web space. They grasp the pencil shaft with the thumb, index, and middle fingers. The placement of the pencil between the index and middle fingers provides ample support and stability allowing for good pencil control, and less hand and finger fatigue.

This grasp pattern is similar to the “Rocket Pencil” described above. This can be used with different types of pencil grips if needed.

When pencil grips are uncomfortable

One final note on the use of pencil grips, they WILL be uncomfortable to use at first. Learners are having to utilize the correct finger and hand muscles.

They are not used to using them in this way, therefore they will be uncomfortable and met with resistance. With this discomfort comes less motivation and desire to use.

Rest assured, the use of the right pencil grip, when coupled with the activities you are using to get to the root of the problem, will help.

Be patient, encouraging, and rewarding to your learners, as they work on these skills. A good grasping pattern will be essential later in school, as handwriting tasks become longer and more complex. You are supporting their present AND future success!

Pencil Grip Kit

Here is an OT tip just for you! Create a pencil grip kit as pictured below. This will serve you coordinate an approach to determining the best pencil grip for any learner. You will have children that the typical grip will not work for, and you’ll need that one rarely used grip just for them! Have it on hand!

Below is a picture of my own pencil grip kit, which I have used with kiddos to help determine which one is the best grip for them. You can buy pencil grip kits on Amazon that come with several different types of grips.

Make a pencil grip kit for occupational therapy sessions.

Pencil Grip Activities

Be sure to check out our FREE Pencil Grasp Challenge . This is a 5-day email series that will provide you with loads of information about everything you need to know about the skills that make a functional pencil grasp. You will gain quick, daily activities that you can do with learners to help them right now.

Explore the other blog posts we have here at The OT Toolbox regarding pencil grasps by reviewing the convenient list of these just for you:

Pencil Grips for Other writing utensils

It’s important to cover another aspect of using pencil grips on writing utensils like gel pens, golf pencils, or weighted pencils. For some students, a different type of writing tool is needed and you can incorporate a pencil grip that supports sensory motor needs.

gel pen grip uses a pencil gripper on a pen

Gel Pen Pencil Grips

For example, a student that requires a gel pen over a pencil might have needs with proprioceptive awareness or trouble with pencil pressure. In this case, the gel pen offers lower resistance of the pen as it moves across the page. This can allow handwriting that was previously illegible because the pencil marks were too light on the page, to now show up. Other students might not have enough strength to move the pencil across a page given the force required to press through the lead of the pencil over the paper.

For these students, you might want to trial various gel pens that require less force to use.

Pencil grips that can be used with gel pens include any of the pencil grips listed above. Some of the ideal grippers include:

Classic foam grip
Grotto grip
Writing CLAW
Crossover grip

Depending on the needs of the individual, you can use other grips as well. Essentially, a gel pen grip supports a combination of handwriting needs, so combining these tools can target different needs.

Golf Pencil Grips

Pencil grips can also be used with golf pencils. You might want to use a small pencil like a golf pencil to support more precision and fine motor control with the mechanics of the finger grasp on the pencil.

Just like using an alternative writing tool like a gel pen, a golf pencil will fit with a variety of pencil grippers.

Elastic Band Pencil Grip

An elastic band pencil grip is a simple yet effective tool that is easy to make. The elastic band pencil grip is essentially a rubber band or a hair tie attached to the writing end of the pencil. The other end of the rubber band might be loose in a loop or it might have a charm attached.

Students that struggle with holding the pencil up and down might have a closed web space, tightly around the pencil. This means the pencil doesn’t have full motion and there is limited finger dexterity in the tips of the thumb, pointer finger, middle finger, and possibly the ring finger. In this case, using an elastic band that is attached to the pencil and loose (without a charm) can position the pencil into an upright position. You’ll want the student to put the loose end of the rubber band around their wrist. The elastic material then pulls the pencil into a vertical position.

Students that tend to put all four fingers in opposition with their thumb may not use a separated sides of the hand when writing. This means they might not move the pencil as efficiently as they could (and leads to lower letter legibility). In this case, the rubber band attaches to the tip of the pencil and the other end, which has the charm attached can be tucked into the palm of the hand.

In combination with these rubber band grippers or traditional pencil grips, incorporating a few manual dexterity goals can make all of the difference. A true tripod grasp might not be achieved, but a functional grasp is achievable.

The primary purpose of the elastic band pencil grip is to promote a functional and efficient grasp, thereby enhancing fine motor skills and handwriting abilities. Tools that support development of coordination and strength include:

Pencil Grasp Play Book– activities to support dexterity, fine motor strength, coordination, and more, all with an efficient pencil grip in mind.
6 Month Fine Motor Plan– This plan outlines specific and easy fine motor exercises designed around play and sensory exploration that support fine motor skills needed for pencil grasp.

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!

What is Stereognosis?

December 21, 2023December 18, 2023 by Victoria Wood OTR/L

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.

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:

Stereognosis and graphesthesia are tactile discrimination skills of the parietal lobes.

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.

Ball Pit Activities

December 13, 2023 by Victoria Wood OTR/L

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.

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

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!

What is Prompting?

December 12, 2023 by Victoria Wood OTR/L

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.

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:

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.
Partial Physical Prompt- The caregiver moves the client’s hand toward the object.
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).
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.
Positional Prompting- The practitioner places the object next to the learner
Verbal Prompting- Any words said to the child to help them perform a skill correctly
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:

Checklists
Charts
Graphs
Timers
Mind maps
Social Stories
Visual schedules
Lists
Icons
Gestures
Modeling

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

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?
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.
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

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.
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)
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:

Cue
Clue
Hint
Signal
Prompting
Assistance
Support
Nudge
Guidance
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.

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