Occupational Therapy in Charlotte

In an occupational therapy evaluation at Child and Family Development, we use a holistic approach and look at the whole child. This may mean that we will include a vision screening.

In a screening, we don't determine whether or not a child's vision is 20/20 or if their eyes are healthy. We determine whether or not the eyes work together as a team, such as while tracking moving objects while the head remains still or moving smoothly without any jumps.

If we do suspect that eye movements may be a contributing factor to a child's skill difficulties or visual understanding of what they see, we may recommend a full developmental optometry evaluation.

One of the community providers who our team works closely with is Dr. Philip Bugaiski at the Developmental Vision Center in Charlotte. Click here to read some information that Dr. Bugaiski offers parents about vision therapy and vision assessments. 

If you are concerned about your child's handwriting, fine motor coordination, cutting, or visual skills, an occupational therapy evaluation may be helpful to narrow down the contributing factors. After we find the underlying difficulties, skill develoment can be targeted so that your child can be more successful.

Click here to visit Child & Family Development's website and learn more about the Occupational Therapy services and staff at our Midtown and South Charlotte offices. 

Click here to download a brochure about Occupational Therapy Services at Child & Family Development.

The Sequential-Oral-Sensory Approach to Feeding training that I recently attended discussed some of the top myths that our society and parents believe about feeding. This program was developed by Kay Toomey, PhD and the following information is her intellectual property.

Myth: Eating is a 2 step process.

The truth is, eating is one of most complex activities of the human body and is a 25 to 32 step process. The process begins with only tolerating the food in the same room with you and has a long way to go before you will ever put it in your mouth.

When using the SOS Approach to Feeding, we identify what a child is comfortable with in those steps and through play, allow the child to learn more about a food. As they learn more about the food from different sensory aspects and engage with the food, they will eventually be able to put it in their mouths.

I recently attended a three day training on the SOS Approach to Feeding.

SOS stands for Sequential-Oral-Sensory and the approach was created by Kay Toomey, PhD. Visit www.spdfoundation.net to learn more.  The approach looks at the whole child in order to assess why a child is not eating or has a very limited diet.  Intervention then begins within a child’s comfort level and children are allowed to explore and learn about food in a non-threatening way, through play! I am excited about using this approach in my own practice because I have watched kids have great success right here in our offices.  

If your child is a very picky eater or has a highly limited diet, consider scheduling a free phone Intake with a pediatric Occupational Therapist at Child and Family Development to determine if an evaluation is recommended.  Along with myself, several OTs at both of our Charlotte locations are trained in many feeding interventions and SOS, including Marion Wilm, Courtney Stanley, Ellen Bruce and Megan Bevington.

As summer ends, there is an excitement about a new school year, a new teacher, time with friends, new clothes, new school supplies, and a fresh start. A favorite part for me is a fresh box of crayons. They come out of the box perfectly sharpened and with an assortment of colors. 

As the school year passes, don't be too quick to throw out the used up and broken crayons. I actually recommend breaking crayons almost every day because they help to facilitate a tripod grasp. When the crayons are short enough it is impossible to hold them in any other way. Many of the children who come in for occupational therapy services at Child and Family Development have difficulty with fine motor skills, controlling the pencil, and holding the pencil in the correct way. By 3 1/2 years of age, a child should be able to hold a writing utencil with a tripod or quadropod grasp and move their whole hand and arm to control it. Using broken crayons when coloring is just one way to help facilitate and strengthen the development of grasping skills in a natural way.

If your child has difficulty with forming letters, shapes, or has an awkward grasp, an occupational therapy assessment may be beneficial to address these concerns. We hope you have a great year as you head back to school and we want you to know that we are here should you need help along the way- with new and used crayons!

August 13th is Left-Handers Day!

Developing strong handwriting skills can be just a little bit different for kids who are left handed. People who write with their left hand have to push against the paper to move from left to right; whereas right handed people pull against the paper. When left handed people push against the paper, this can cause the pencil to dig into the paper and rip it. They also sometimes form letters differently than right handed people and may appear to have difficulty with smooth letter production.

One of the curriculums that we often use in occupational therapy is Handwriting Without Tears. There are a number of benefits of Handwriting Without Tears, but one is that it provides easy copying for both right handed and left handed children by providing lists for copying on both the left and right side of writing sections.

Here are some tips for instructing left handed writers: 

- Try to use harder pencil lead to prevent it from smearing (such as a #3 pencil). 

- Tilt the paper to the right.

- Encourage your child to point the pencil eraser toward their left shoulder. 

- Try using anchor lines for visual cues. One idea is to place a green line for "go" on the left and a red line on the right for "stop", to help with left to right directionality.

- When copying, list words on the right side of the page, or provide a student with a separate list to be placed on their right side.
 

A weighted vest is a vest which has had weight added and provides compression to the upper body or torso area. When an occupational therapist recommends adding a weighted vest in a therapy session or to a home sensory diet, it’s our goal to add more proprioceptive or heavy input (or “heavy work”). Heavy input impacts the proprioceptive system, which is read by our muscles and joints and tells our brains where our bodies are in space. 

When an occupational therapist adds additional weight or work for the proprioceptive system, it can have a calming and organizing affect. It also helps to provide additional feedback about where our bodies are in space, which can help to make motor planning and coordination easier for kids with sensory processing difficulties. Weighted vests are beneficial for some children with sensory processing difficulties, but not liked by all of them! They are worn for short periods of time and their use should be guided by an occupational therapist. 

If you are interested in learning more about the benefits of weighted vests and other pediatric therapy equipment, contact an occupational therapist at Child & Family Development in Charlotte.  

We can create a sensory diet just for your child. 

In my occupational therapy work, a current interest is working with children who have both difficulties with handwriting and visual perceptual skills. I am always looking for new ways to work on skills, while having fun.  One area of visual perception that can be developed through toys and games is figure ground skills. Figure ground skills are the ability to find hidden pictures or objects in a background of other objects. A good practical example of this is trying to find an object in a cluttered drawer or freezer. 

When I, as an occupational therapist, evaluate handwriting, I often further evaluate visual perceptual skills. These are the skills that allow you or your child to understand what it is that they are seeing and interpret that information so that it can be used. Visual perception is not as simple as it may sound, and is broken down into a number of categories. These areas are both necessary for handwriting, as well other functions of our everyday lives and include:

When an occupational therapist evaluates handwriting, we not only look at handwriting samples and copying tasks, we also look at underlying factors. There are a number of underlying factors that support the development and success of handwriting. Some of these areas include postural and core support, hand and pinch strength, visual attention and concentration. More directly handwriting requires fine motor coordination, visual perceptual skills, and visual-motor integration. Motor coordination is necessary for holding and manipulating the pencil successfully. Visual perception is the ability to look at a picture and interpret it in your mind. Visual-motor integration is when you are able to combine visual perception (understanding what you see) and motor coordination (controlling the pencil) to create or reproduce images or letters. If any one, or more, of these areas are affected handwriting, per-writing, and drawing can suffer.

If handwriting is very difficult or even impossible for your child, an occupational therapy evaluation may be able to identify obstacles and help to remediate them.

The Child and Family Development Occupational Therapy team in Charlotte is ready to help! 

Just as some children can be picky eaters, others with sensory challenges may seek out different types of oral sensory input. This can lead to difficulty with social acceptance when children reach older ages or eating or mouthing dangerous objects.

Signs of oral sensory seeking behaviors can include: 
- craving certain foods
- putting objects in their mouth, like hands or pencils
- licking or chewing on non-food objects
- showing strong preferences for certain tastes or smells
- seeking out certain smells or tastes

If behaviors like these, or other sensory behaviors, are impacting your child's life, an occupational therapist may be able to help. Give us a call to find out more about occupational therapy and speech therapy services at Child and Family Development. We'd be happy to provide you with guidance and information on sensory processing and interventions.

Just as some children can be overly sensitive to touching typical textures or fabrics, other chldren with sensory difficulites may display "tactile" seeking behaviors. These behaviors may go unnoticed unless they begin to negatively influence everyday functioning or they are paired with additional sensory challenges.

Signs that your child might be seeking touch input, can include:
- irritating others because the child touches objects or people often
- is unaware when someone touches them on the arm or back
- prefers to be barefoot and avoids wearing shoes
- doesn't appear to notice when hands or face are messy
- decreased pain or temperature awareness
- unusual need to touch certain textures, surfaces, or toys

Parents are often aware that their child demonstrates some sensory activities that may stand out from the crowd. As an occupational therapist, it is my goal to intervene when children begin to demonstrate difficulty with everyday tasks or demonstrate delayed development. If you are curious about whether or not your child would benefit from an occupational therapy evaluation, call Child and Family Development to schedule a free phone call with a pediatric therapist to address your concerns.

I recently attended an online webinar on Therapeutic Listening: Listening with the Whole Body. Therapeutic Listening is a sensory integration intervention for children with sensory processing disorders, attention challenges, and motor planning issues. It is specifically designed to address auditory sensitivities; however, because of the anatomy of the inner ear, sound is able to affect both hearing and the vestibular systems simultaneously. This affects hearing, sound localization, and the awareness of where our bodies are in space. Awareness of timing and where our bodies are in space are essential for motor planning and praxis skills. The signals are transported from the ear and processed through the nervous system, creating integration with additional systems that influence coordination of movement, attention, sleep/wake cycles, bowel/bladder control, emotional regulation, and feeding. It was an excellent course that explained the anatomy and use of this exciting tool. I am looking forward to incorporating it into my personal practice and educating parents on the possible benefits of this program.

For more information on Therpeutic Listening, visit Vital Links

Picky eating is a common concern reported by parents. Picky eating can also be a serious issue when a child's diet is highly limited due to oral sensitivity.

Some signs of oral sensitivities can include:
- gagging easily when food or utensils are in or near the mouth
- avoiding food smells or tastes that are a typical part of other children's diets
- eating foods of one or few tastes/ temperatures/ textures 
- being considered a "picky eater"

If you are concerned about your child's diet, nutrition and eating, consider a formal evaluation with an occupational therapist, a speech therapist and/or a dietitian at Child and Family Development.  Members of our pediatric therapy team have special training and expertise.

While most children enjoy playground activities, like swings, slides, and merry go rounds for limited periods of time. Some children just can't seem to get enough of it. Playground activities, which provide "vestibular input", including head movements through space, are beneficial to the vestibular system and a natural part of childhood development. As mentioned in my previous blog, avoidance of these activities can be a sign of sensory challenges. In addition, seeking out to much vestibular input, can interfere with functioning on a daily basis.

The following are signs of vestibular seeking behaviors:
- seeking out so much movement that it interferes with daily routines (like moving in a seat or fidgeting)
- rocking in a chair, at a desk, or on the floor
- rocking without being aware of the behavior, like while watching television
- seeking out all kids of movement activities, including moving toys, playground equipment, or merry-go-rounds
- spinning self or twirling self frequently throughout the day
- enjoys feeling dizzy or doesn't become dizzy like expected

If your child displays excessive needs for movement, as well as other sensory sensitivities or seeking behaviors, it may be beneficial to pursue an occupational therapy evaluation. If you are based in or near the Charlotte area, an Occupational Therapist at Child and Family Development can help!

The iPad and other technology is making a huge impression on our children. Angry birds seems to be of particular interest with the kids at the South Charlotte office!

I recently purchased an iPAD and I am exploring the use of apps in treatment sessions. I am very interested in how to make handwriting fun. One of my current staples for letter formation is "Letter School". It's produced by Boreaal and their website is http://letterschool.com. I copied this image from their website to share with you.

Letter school offers uppercase and lowercase letters and numbers. It includes Handwriting Without Tears® (HWT), D'Nealian and Zaner-Bloser style handwriting. I love that it offers HWT style letters which is what we often in occupational therapy interventions. It also provides consistent formation which is very important for kids who have a hard time with handwriting. The app requires proper sequencing of formation and progresses in independence with each letter.

On the first attempt, children are simply required to locate the starting points and the app shows them where the lines should be formed. The second attempt requires the child to complete the tracing, and reinforces the formation with visuals of trains, lights, or lawn mowers to name a few. On the third attempt, the child is required to form the letter without any visual cues. Once the child has mastered all of the letters, there is a second level with new visuals to provide practice.

I love this app because it is fun and accomplishes education on basic letter formation, while allowing the child to show off what they have learned!

Children with visual processing difficulties can sometimes be difficult to identify because the subtle characteristics that typically go unnoticed.

Signs of visual defensiveness can include: 
- preferring or happy to be in the dark
- avoiding or showing discomfort in response to bright lights (asking to turn of the lights often during the day or hiding from sunlight are two examples)
- squinting or covering eyes to protect them from bright lights
- having a hard time putting together age-appropriate puzzles
- frustration with finding objects in a messy room or cluttered drawer
- continues to be bothered by bright lights when everyone else has already adapted to the light

One challenge with visual defensiveness is that children can easily become overwhelmed by too much input in everyday environments. This can lead to challenges with functioning, behavior, and emotional responses since the child's sensory system is unprepared to process the visual input in our typical environments. If you are concerned that your child may have difficulty with sensory processing, contact an Occupational Therapist at Child and Family Development. We help families through the process of identifying and treating children with sensory processing challenges.

For most kids, the playground is a fun place that provides all kinds of movement including swinging, spinning, hanging up-side-down, going down the slide, and hanging on monkey bars. (There are often tactile benefits too of playing in sand!) The kind of movement that playgrounds provide is what occupational therapists would identify as "vestibular input", which is the motion or change of head position. Most kids highly enjoy vestibular activities, but if a child avoids these or similar activities, there may be an indication of sensory processing challenges.

The following are signs of over-reactions to vestibular input:
- intolerant or fearful of unexpected movement
- avoids or is distressed by movement activities
- displays anxiety, fear, or distress when feet are off the ground (swinging, monkey bars, etc.)
- dislikes or avoids playground equipment or moving toys 
- hesitant with stairs or curbs
- tends to be tense and rigid
- doesn't like activities where head is upside down 
- doesn't like riding in a car
- becomes disoriented after bending over a table or a sink

Avoidance of vestibular input can be a sign that there is a larger underlying sensory challenge. The vestibular system is one of the foundational sensory areas, and dysfunction can often lead to challenges in other areas of sensory processing. If you are concerned about your child's sensory functioning and are looking for an Occupational Therapist in Charlotte, contact Child and Family Development. We would love to help you and your family learn about sensory integration.