1. 16/05/20151 Children & Young People’s Occupational Therapy H&F SENCo Forum Gross and fine motor skills: Easy Solutions to common problems Sheena Lorusso 07958 467884 Sh Sh Team Lead Children & Young People’s Occupational Therapy

2. Central London Community Healthcare NHS Foundation Trust CLCH aim “To provide the best healthcare for people in their homes and communities” CYPOT is provided over 3 boroughs – HF KC W as a community service Urgent complex needs children and non complex children with health and or educational needs Children are seen through direct referral – non- complex needs and the CCDS for complex needs Non-complex needs assessment clinics Complex needs Multi Disciplinary Assessments and urgent direct assessment 12 week package of intervention Groups and 1-1 direct intervention Training 1-1 and group to parents, schools and learning support assistants other professional groups Discharge Consolidation Re- referral 16/05/20152

3. Safeguarding CYPOT services are involved with some of the most vulnerable groups of children – 5% of children in borough fall under complex needs and we are involved with children at all thresholds of complex and non-complex needs It is essential we provide accurate information to support co ordination of services around this group of children Please inform us if the child we are to work with has any safeguarding concerns so that we can support the child and family most effectively sharing and coordinating services as recommended by best practice from recent local and national Serious Case Reviews Liaison and advice with safeguarding as well as health visiting and school nursing alongside GP’s and paediatricians and recommended through the Care and Quality Commission and Laming Report 16/05/20153

4. 4 Outline X Understanding: What could be the problem? X Tips X But first……..ACTIVITY

5. 16/05/20155 Building Blocks of Development Praxis Postural Stability Awareness of two sides the body Ocular Motor Skills Academic Learning Behaviour Daily Living Activities Emotional Control Auditory Visual Olfactory Oral Tactile Vestibular Proprioception Visual Motor Integration Visual Perception Auditory Language Skills Attention Body Scheme Reflexes Postural Stability Awareness of two sides the body Ocular Motor Skills Auditory Visual Olfactory Oral Tactile Vestibular Proprioception

6. Starting with the building blocks OT’s assess to find out what affects our ability to function – to do what we need to do or want to do in the occupations of –Work –Rest –Play Treatment approaches Functional difficulties Specific activities- gross and fine motor skills 16/05/20156

7. 7 Sensory Integration Sensory processing is the ability to organize the info from senses (hearing, vision, touch, movement, body position, smell and taste). Affects our ability to function – to do what we need to do or want to do The right level of alertness and focus for different tasks. For example driving vs TV Children with difficulties staying in a calm, alert state. “wild” or be constantly “on the go”.

8. 16/05/20158 Sensory Integration : TIPS Which of the 7 senses? Hypersensitive/ sensory seeking? Trial weighted vests, movement breaks, ear defenders, soft music in walkman, chewing/crunchy snacks, trampoline etc …… consult OT to assess

9. 16/05/20159 Gross Motor Motor planning Body awareness: Head, shoulders, knees and toes: d b / 0

10. 16/05/201510 Gross Motor Shoulder stability Core stability/ tummy muscles Proprioception

11. 16/05/201511 Muscle Tone “It is the tension within muscles that allows them to be ready for movement.” Usually our muscle tone is neither too tight nor too loose, it is just right, therefore we don’t have to use much effort to move our bodies or keep ourselves upright.

12. 16/05/201512 Chair supports thighs Feet flat on floor or footrest Knees at 90 o Head is upright Ideal Posture Table at elbow height Pelvis in neutral 90 degree RULE

13. 16/05/201513 Midline Crossing Midline - A line between the eyes, separating the body into left and right sides. Midline crossing – the ability to use one side or part of the body (hand, foot or eye) in the space of the other side or part. Problems with: Using cutlery, scissors, reading, handwriting and copying from the board.

14. 16/05/201514 Bilateral Integration ‘The ability to use both sides of the body together in a smooth, simultaneous, and coordinated manner.’ If a child has problems crossing the midline, coordinating the two sides together will be problematic.

15. 16/05/201515 Gross motor Tips Gross motor play!!! Activities such as jumping, therapy ball games, animal walks Movement Breaks Improve tummy muscles / shoulder stability Different positions: Work in lying if possible.

16. 16/05/201516 Gross motor Tips Posture pack, desk wedge, move’n’sit, box.

17. 16/05/201517 Fine Motor Skill Development Isolating finger movements Pincer grip In-hand manipulation ? Joint laxity?

18. 16/05/201518 Fine Motor Skills Tips Funky finger groups? IDEAS

19. 16/05/201519 Visual perception 20:20 vision, but cant find Wally?! Visual motor integration

20. 16/05/201520 Visual perception Tips Eye test?!.. Handouts Distractions, position from board www.eyecanlearn.com

21. 16/05/201521 Handwriting Skills Used: Gross-Motor Skills Fine Motor Skills Visual Perception Visual-Motor Integration Sensory Issues Cognitive e.g. Memory Environmental Behavioural Problems Seen in… Slouched Posture at the table Poor Pencil Grip Paper Position and stabilisation Line use, spacing, size and speed Hand Tires easily Reversing letters/numbers (age) Pressure through the pencil Legibility (mum only?)

22. 16/05/201522 Handwriting Pre-requisite Shapes: Pre-requisite Patterns:

23. 16/05/201523 Efficient Pencil Grasps

24. 16/05/201524 Inefficient Pencil Grasps 

25. 16/05/201525 Handwriting Tips Build on foundation skills: (see fine motor tips) Hand Strengthening – Putty, marbles or coin games. Paper Position: left and right handed Posture at the table ‘Feet flat, bottoms back, arms on table’ Poor Pencil Grips Pressure Through The Pencil – Strengthening and colouring on polystyrene, brass rubbings Spacing – 2 finger space, lollipop stick, stamper pens, stickers Line Use – double width of average middle letter, sky/grass/soil paper Legibility and speed – Pre-writing patterns on the blackboard Handwriting without tears

26. 16/05/201526 Handwriting Tips Touch typing: http://www.bbc.co.uk/schools/typing/ http://www.bbc.co.uk/schools/typing/ Neo Alpha smart- indestructible laptops- great for primary schools

27. 16/05/201527 Pencil Grips Types of pencil aid – ultra cross guard grip – handy writer – stubbie grip/stetro grip – wide but short pencils e.g. cut down hand hugger pencil. NB- When using pens, a gel ink pen is easier than a cartridge pen or ball point pen. Note:

28. 16/05/201528 Tools Alligator Easy Grip Ruler

29. 16/05/201529 SCISSORS Mini-Easy-Grip Scissors Easy-Grip Scissors Long Loop Easy-Grip Scissors Long Loop Scissors Self Opening Long Loop Scissors Pushdown Table Scissors Peta UK Telephone: 01245 231 118 www.peta-uk.com

30. 16/05/201530 Equipment Move ‘n Sit Posture pack

31. Referral Referral options – Service provision –Advice –Assessment Front page – General information –GP –Consent –Other professionals and safeguarding –Ethnicity and Cultural considerations –Additional needs for communication and literacy Reason for referral – Goal setting – engaging in your health care plan –Describing functional difficulties with mobility- gross and fine motor skills –Describing delays in daily living skills Children’s play and cognitive development compared to peers Sensory aspects of concern 16/05/201531

32. 16/05/201532 How to tell…. Observe and gather info e.g. PE Speak to child Speak to parents Compare to peers…. Average for age?

33. Current Referrals 16/05/201533

34. 16/05/201534 Question /Discussion of Specific Issues…