Children’s Therapy Services - Occupational Therapy

Palm pushes

• Place palms of hands together, elbow raised and pointed outwards with fingers pointed upwards (praying position), keeping elbows up, push palms together. Repeat 5 times.

Chair push-ups

• Sit on the chair
• Place both hands on the sides of the chair
• With straight arms, push up until bottom and feet are in the air
• Hold for a few seconds
• Repeat 5 times

Wall push-ups

• Stand with hands on wall with arms straight
• Bend arms to allow body to lean towards the wall, touch nose on the wall
• Push on the wall to straighten arms back to starting position
• Repeat 5 times

Animal walks

Bunny

• Squat low on heels and place the hands palm-down on the floor
• Move the hands forward, and then bring the feet forward between the hands with a little jump

Crab

• Squat, reach backward with the arms, and put both hands flat on the floor
• Rise up until the head, neck and body are in a straight line, then walk or run in this position

Pushing and pulling activities

• Try games such as wheelbarrows or tug of war
• Encourage your child to sit opposite you in high kneeling, put your palms out onto a gym ball and try to push the gym ball towards each other

• Include 'heavy work' at school, such opening heavy doors, carrying piles of books, moving chairs around, pushing trolley of laptops/ lunch boxes, cleaning the whiteboard

Targeting games

• Aim a ball or a bean bag at targets placed above eye level on a wall

Other activities

• Active play such as hanging from hands on climbing frames or monkey bars
• Arm wrestling
• Holding bucket with both hands and catching beanbags
• Practice precise pouring by pouring fluids from a jug into a cup without spilling any. Encourage the child to fill the jug as full as possible to see how strong they are. Pour coloured water into small containers. Try to make them as full as possible without spilling
• Lying on stomach, roll ball towards child who then pushes it back (elbows and hands not touching floor)
• Lying on stomach on bench, encourage child to move themselves forwards along the bench only using arms to push back
• Doing drawings and paintings at shoulder height e.g. working at an easel or paper blue tacked onto the wall, or doing a chalk or paint mural. Draw large circles or figures of 8 on the paper/easel. Child stretches as far up as they can and to the side, keeping their body still at midline
• Adult to suspend a ball with arms straight in front of you. Encourage your child to hold a stick in both hands and gently tap the ball. Gentle tapping requires more control than just hitting the ball, and so develops stronger joints
• With a partner, each hold one end of a rope and swing the rope around, making circular movement with arm
• Carry a small ball, marble or stone on a long handled wooden spoon, held at arm's length. Start by holding the spoon near the bowl of the spoon and progress to holding it at the end of the handle. Increase the weight of the ball gradually and the distance the child walks while carrying it

• Lying on tummy, keeping legs straight, throw and catch balls with both arms off the floor. Repeat 5 times.

• Bridging: lying on back with knees bent up and feet flat on the floor. Encourage your child to lift his/her bottom up without it swaying. Keep a small gap between knees. Repeat 5 times.

• In the bridging position, but with one leg straight and close to the floor encourage your child to lift his/her bottom up, hold in position and then lower. Repeat 5 times.

• On all fours, bend the arms at the elbows to touch the floor with nose and return to the all fours position. Repeat 5 times.

• On all fours, place a box in front of your child. Hold a beanbag/rolled up sock in front of your child and ask him/her to reach for it with one hand and place it in the box. Repeat with the other hand. Repeat 5 times.

• On all fours, stretch one arm out in front, off the floor, with the opposite leg stretched out behind. Hold each side for 10 seconds.

• In half-kneeling position, practice reaching to touch someone's hand to each side and above their head.
• Practice throwing and catching balls. Progress to holding the ball above their head. See how long he/she can maintain the correct position with their eyes shut. Progress this to upright kneeling.

• Wheelbarrows: practice walking on hands with both feet lifted, either with a partner holding their feet or on a gym ball. It is important that hands are flat and pointing directly in front and that the pelvis does not sway from side to side or rise. If this happens then hold closer to the body. Create a team game where they race to pick up items in front of them. Using one hand to pick up will increase difficulty of task.

• Crab walking - Ensure hands are underneath shoulders and fingers point towards feet.

• Air chair Assume a sitting position with back against a wall and hold it for as long as possible. Alternatively, using a gym ball, roll down into a sitting position and hold.

• Sit on a gym ball and maintain balance. Once this is achieved, start to throw and catch a balloon or large ball with your child.
• Lay back on the ball, engage core muscles and reach out to ball held above.

• Lying on back and curl up like a ball. Cross arms at chest, bend knees to chest and lift head up to curl up, hold and time.
• Whilst holding this position, gently pull the child's head and knees apart while they try and stop you by staying in curled up position.

• Pushing against resistance. With a partner, place feet to feet and push. Alternatively, with a partner, place hands on either side of a gym ball, and push against each other.

Pegboard patterns

• Give the young person a peg upside down. Ask them to take the peg and turn it the correct way using only their fingertips and place it in the pegboard
• Place the peg in the palm of their hand and encourage the young person to move it to their fingertips without using their other hand to assist
• Place 2 different coloured pegs in their hand. Ask them to choose a colour and move that peg to their fingertips as above, then to move the other coloured peg to their fingertips. Once they are able to do this, they could try with using 3 different coloured pegs or time themselves to see how quickly they can do it
• See how many pegs the young person can collect in their hand, one at a time, without dropping them. Begin with 3 and increase number. Try with the other hand as well

Buttons / beads/ marbles

• See how many buttons, beads, marbles, pegs (or any other small object) the young person can pick up in one hand, and then drop, one at a time, into a container without letting the others drop
• See how many they can pick up and hold in their hand in 30 seconds
• Ask the young person to categorise and sort into colour, shape, size, weight, etc. for example, can you find 3 big blue ones using your right hand?
• Roll a marble up and down the wall using only thumb, index and middle fingers

Money games

• Sort change into piles or containers
• Post objects (coins, counters, etc.) into a money box (margarine container with a slit or hole cut into the top). Give the young person a coin in their palm and ask them to post the coin by moving it up into their fingertips, (without using the other hand to assist) and holding it between the tip of their index finger and thumb. How many coins can they hold in their hand before bringing them to their fingertips, ONE AT A TIME, and posting it in the box without dropping any of them? See if they can increase the number of coins they can hold and manipulate in one hand

Spinning games

• Hold a coin between thumb and index finger or thumb, index and middle finger and spin it. See how long it spins. Have competitions to see whose coin spins the longest
• Spin spinning tops. Same as above

Play dough / therapy putty

• Basket of eggs: Make the basket by rolling a ball of playdough[EO1] or thera putty and pressing a thumb halfway down into the middle of the ball. Pinch around the edges using tip of index finger and thumb to form the basket. Make the eggs by pulling off small pieces of playdoh and rolling them into small balls using thumb and fingertips (one hand at a time)
• Hide marbles, pegs or small beads in playdough or theraputty and ask the young person to find them and dig them out. Ask them to hide objects also

Threading

• Begin with threading larger beads and when they are able, thread smaller beads. Make a necklace/ bracelet alternating between 2 or 3 beads and a knot
• Thread macaroni
• Thread cut-up straws
• Thread polo mints

Knots

• Learn how to make simple knots such as reef knots

Scrunching paper

• Tear up pieces of paper and scrunch them into balls using only one hand, ensuring the young person does not use their other hand, chest or table to help (although they may need to do this initially)
• Use the paper balls to make collages or to play finger football (i.e. flicking the ball between 2 objects using only the thumb and index finger)

Paper clips

• Connect paper clips together to make a chain
• See how many paper clips your child can string together in 3 minutes
• Ask the young person to copy a sequence of coloured paper clips made by someone else

Construction toys

• Using Lego, connect-a-straw and Popoids to make different objects
• Sort construction toys by collecting the pieces in the hand and placing them in piles. Join them together, pull them apart, etc.

Baking

• Make scones or biscuits without a mixer, using thumbs and fingers to mix the butter and flour etc.
• Decorate biscuits or cup cakes by using ready made icing tubes, sprinkling hundreds and thousands, chocolate sprinkles, silver balls, etc.
• Make models out of marzipan

Other activities

• Play with travel sized games or board games with small pieces such as Ludo, snakes and ladders, Connect 4, Chinese chequers, tiddly winks
• Play with other games like Jenga, Pick Up Sticks, and Operation. Use a stopwatch to time how quickly and accurately your child can complete these games and then see if they can improve their speed
• Make things using model kits any kind of kit which has small pieces to manipulate, for example constructing an aeroplane, car, dolls house, etc.
• Walk fingers up and down the shaft of a pencil
• Ask your child to hold a pencil in between their index and middle finger and use their thumb to turn or rotate the pencil

Multi-sensory experiences

Providing children with multi-sensory experiences can help to improve their learning. You can use a range of materials that stimulate each of your child's senses for pre-writing activities, for example:

Sight

• Try writing on aluminium foil, construction paper of different colours, different kinds of paper, standard paper or colouring books
• Use special colouring books in which the colour appears when children paint with water
• Use different colours of chalk, markers, crayons, pens, pencils, and paints (including finger paints and watercolours)

Touch

• Try writing on sandpaper with different crayons, paint brushes or chalk
• Draw around sandpaper or wooden stencils
• Trace with a finger around a shape made of wool or a craft stick
• Try drawing in sand or mud
• Use lotions, gelatin, oatmeal, cornflour or whipped cream to finger-paint

Smell

• Try drawing with scented markers
• Add a few drops of bubble bath or scented oil to finger-paint
• Use scented lotions for finger painting

Hearing

• Use a musical toothbrush to paint
• Attach bells to the end of a paintbrush

Taste

• Try finger painting in whipping cream on a flat pan of jelly
• Try drawing on a frosted cake to decorate it
• Draw with cheese spread on crackers or bread

Movement activities

Movement activities can help to support your child's learning, especially movement that uses large muscles and gross motor co-ordination.

• Ask your child to walk on straight, curved, and diagonal lines made from a board, tape or string. Your child can walk with or without shoes
• Your child can help position the line by putting a beanbag, ball or toy at the beginning and end points
• Your child can walk, run, crawl or roll from the beginning to the end points
• Ask your child to walk on shapes drawn in sand

Pre-writing shapes

These multi-sensory activities can support with learning and practising pre-writing shapes.

• Draw in sand and ask your child to copy your shapes using his or her index finger or a long stick
• Use water and paintbrushes to paint lines and shapes on the pavement for your child to copy
• Give your child a stencil cut out of cardboard, felt, sandpaper or cloth glued to a board. Ask them to feel the shape with their eyes closed, then ask them to draw inside the stencil with crayons, markers or finger paints. Remove the cardboard so they can see what they have done. With the stencil removed, ask them to follow the mark with a finger, then ask them to try to repeat the shape without the stencil
• Make a shape on cardboard using wool, sandpaper or flat sticks. Ask your child to feel the shape with one or both hands, then ask them to use finger paints or crayons to repeat the shape
• Stick stars on a piece of paper at the beginning, end or corners of a shape.  Ask your child to draw from star to star to make the shape, then ask them to draw the shape without the stars
• Attach crepe-paper streamers to the end of a paper-towel roll to make a magic wand. Stand next to or facing your child. Alternate holding the wand with one hand or both hands. Wave the wand in the air in a vertical, horizontal, or circular direction, or draw shapes or letters. Ask your child to copy the movement
• Stick paper to a wall or use an easel so you can talk to your child through the movements made to form letters - for example, round, up and down to draw the letter 'a'
• Use a wobble pen

These exercises can be helpful before handwriting or in short breaks during longer pieces of work.

The exercises are in a sequence that includes all the main muscle groups used in handwriting. All of the sequence should be completed for best results.

1. Get into a good sitting position, sitting upright with the feet flat on the floor

2. Hold on to each side of the chair and push up through straight arms

3. Shrug shoulders - right, left then both

4. Hold arms out in front with one in a fist. Open that fist while making the other hand into a fist at the same time, repeat several times

5. Stretch both arms up above the head, stretch out to the sides and then cross them in front of you. Hold each position for ten seconds

6. Interlock fingers and circle thumbs around each other, clockwise then anti-clockwise

7. Interlock fingers and lift both index fingers up and down. Repeat this with little fingers

8. Hold hands pointing upwards in front of you, with both elbows pointing out to the side. Press palms against each other and hold for a few seconds

9. Make loops with the thumb and each finger in turn

10. Press all fingertips and thumbs together

11. Walk the index and middle fingers up and down the surface of a table

12. Hold a pen and rotate it using the thumb, index and middle finger. Change direction

13. Hold a pen at the top and walk the thumb, index and middle fingers down to the tip

14. Push the cap off and on whilst holding it in the same hand

Controlling tools with open and close hand movements

• Use tweezers or kitchen tongs to pick up and place objects (for example, cotton wool balls, bean bags) encouraging accuracy. This can be done as a timed exercise or as a relay
• Use clothes pegs to pick up small objects (for example, paper balls, pencils). This too can be done as a timed game
• Use a hole punch to punch holes in paper
• Staple paper with a hand-held stapler
• Squeeze plastic household bottles or washing up bottles to get the trigger-like action
• Tear paper (from top to bottom). Try using different thickness of paper or card
• Squeeze toy syringes or turkey basters and use them to transfer water between containers

Using two sides of the hand for different functions

• Try any of the above controlling tools activities while your child holds a cotton wool ball between the pads of their ring and middle finger and the palm of their hand
• Progress to doing any of the above activities while the child holds the pads of their ring and middle finger against the palm of their hand
• Make a circle by touching the pads of the index and middle fingers to the pad of the thumb, whilst holding the last two fingers against the palm. Then pick up and release objects between the thumb and first two fingers

Stages of scissor control

1. Holding scissors correctly
2. Mastering opening and closing of scissors
3. Short random snips
4. Cutting forward
5. Cutting along a straight line
6. Cutting along straight shapes (for example, rectangles, triangles)
7. Cutting along curved lines

• Be sure that your child has the correct scissors (for example, left or right-handed, ordinary or adapted) and that they are holding them correctly
• Snip rolls of playdough or plasticine
• Remember that card is initially easier to cut than paper
• Begin by snipping a variety of easy-to-cut textured items (for example, straws, pieces of string, corrugated cardboard strips, aluminium foil, fabric, cardboard or paper). Gradually increase the width of the strips of paper or card (for example, one inch, two inches, and four inches)
• Cut straight lines across a page. Try cutting within straight parallel lines of different widths
• Randomly stick small stickers on a piece of paper. Cut from sticker to sticker. The more stickers on the page the more complex the task becomes
  
• Cut a piece of sandpaper using a wavy line. Now separate the pieces so that a gap is formed, and glue the sandpaper in place on a piece of paper. Now try and cut along the wavy line using the sandpaper as a guide
  
• Cutting between boundaries - these can be made using two pieces of string or strips of card, or be drawn with a thick pen. As cutting improves, reduce the width between lines
• Cut along lines marked on a page. Begin with thick lines and gradually reduce the width
  
• Punch a hole at the top and bottom of a sheet of paper and draw a broken line between each hole (or a solid line if a broken line is too difficult). Cut from one hole to the other turning the paper with the other hand to change direction while cutting
• Stick curved strips of thick cardboard on a piece of paper to use as a cutting guide. Cut around the card letting it guide the scissors
  
• Draw or stick a picture of a house or another simple picture onto a piece of paper or card. Encourage your child to cut around the picture slowly and accurately, turning the paper with their other hand to change direction while cutting
• As cutting control improves, progress to cutting shapes with straight edges, corners, and curved lines
  
• Punch a series of holes into stiff paper, in the shape of a curve. Cut along the curve using the holes to guide the scissors
  
• Try using different thicknesses and textures of paper and fabrics
• Draw a circle in the centre of a piece of paper or card and then draw curved and straight lines from the circle to create a sun. Cut out each segment one at a time to finish with just the circle left
• Try more complex shapes, including paper snowflakes and people chains
• Cut pictures from magazines to make collages, jigsaws or a scrapbook collection
• Cut two circles out of corrugated cardboard. Place a piece of paper in between. Cut out circles using the cardboard to guide the scissors
  

Please note that the products and organisations listed here are provided for illustrative purposes only. NHFT and the Children's Occupational Therapy Service have no affiliation with any of the companies mentioned and alternative suppliers are widely available.

Easi-grip scissors

These are very lightweight and have a continuous loop plastic handle. They are operated by squeezing gently using the thumb and fingers, or fingers and palm of the hand. The scissors automatically reopen when the pressure is released and a blade guard is supplied for safety when the scissors are not in use. A plastic stand is also available to convert Easi-grips from hand held to tabletop scissors.

Long-loop Easi-grip scissors

These have the features of the standard Easi-grip scissors but have the added advantage of greater control through placing the fingers through the long loop. Alternatively for those with very limited movement, fingers can be placed over the long loop. Blade guard provided.

Dual-control training scissors

These have double loops on each handle, allowing a teacher and child to simultaneously complete the cutting action. The child uses the loops furthest from the blade, while the teacher uses the other loops to assist with necessary control, force or guidance.

Long loop scissors

These have been designed so that the strength of the whole hand can be used for the cutting action, allowing superb control.

Self-opening scissors

These look like conventional style scissors, but they have been fitted with a spring so that the scissor automatically reopens after pressure is released. Blade guard supplied.

Push-down table top scissors

These have two 'T' shaped pads and are operated either by depressing the handle with the scissors in a stable position, or by 'scooting' it across the table. Blade guard supplied.

Mounted table top scissors

These offer superb stability as the scissor is fixed to a wooden base, which has non-slip pads. The scissor is operated by depressing the large 'T' shaped handle, the spring will automatically reopen the scissor after the cutting action has been completed.

In the classroom there are a number of ways we can help left-handers complete the tasks expected of them. Try these left-handed writing tips and tricks to help your lefty use and hold a pencil when writing in the home or classroom so they can write at a functional level.

• Left-handers should sit on the left-hand side of the table if they are sharing a table or on the left side at the end of the row. This ensures there is no elbow bumping if they are sharing table space with a right-handed person
• Students who are left handed should be encouraged to tilt their page to the right when they are drawing or writing. The page can be tilted at 30-40 degrees clockwise. This allows them to have a clearer view of their work and prevents some of the smudging that typically happens when a lefty moves their hand across the page
• Encouraging a left-handed person to hold their pencil slightly further up the shaft of their pen or pencil will also help them to see their work and prevent smudging. A pencil grip or elastic band wrapped around their pencil can provide a guide of where to place their fingers when they start developing their pencil grip
• Working on an sloped surface can also be helpful for left-handers. Slant boards prevent the flexed or hooked wrist that typically develops in left-handers. Slant boards are widely available to buy, otherwise a lever arch file can be used to create an elevated surface
• Writing direction can be challenging for left-handers as it's natural for them to want to work from right to left. Place stickers in the top left-hand corner of the page as a reminder to work from right to left
• When copying words, numbers, letters or pictures, ensure that the model or example is on the right side of the page. This prevents the left-hander from covering the work that they need to copy with their left hand
• Finger spaces are difficult for a left-hander when they develop their writing skills. Using an ice-lolly stick or strip of paper to mark out finger spaces can be helpful in the early stages of writing
• Other products that may make a left-hander's life easier are left-handed pencil sharpeners and a left-handed computer mouse

Using scissors can be another difficult task for left-handed students. Try some of these tips to teach lefties to use scissors functionally.

• Left-handed scissors are essential for left-handed learners. The leading blade of left-handed scissors is on the opposite side to that of right-handed scissors, making it much easier for the left-handed person to line up the blade and the line they are cutting out
• Left-handers should be encouraged to cut to the left and in a clockwise direction. This helps them to comfortably feed the page with their right hand and ensures they can see the line they are cutting throughout the task

• Left-handed products for left-handed people
• Ergonomic rollerball pen
• Easi-grip scissors

Please note that the products and organisations listed above are provided for illustrative purposes only. NHFT and the Children's Occupational Therapy Service have no affiliation with any of the companies mentioned and alternative suppliers are widely available.