The information on Occupational Therapy was generously
provided by Geela Spira of Har Nof.
Dovid is seven years old. He is a good boy and tries his best
in cheder. But he is sensitive to touching certain
objects and doesn't like how some things feel against his
skin. Clothing can irritate him, especially his white cotton
tzitzis. In fact, his loose falling payos also
bother him so he doesn't want to wear tzitzis or have
long payos. Other clothing irritates him as well but
his parents are confused and upset. They worry about his
yiras Shomyaim and what the neighbors might think.
They do not know that this issue is a physical one and not an
emotional one. If they can help their son cope with his
sensitivity while he is young, he has a better chance of
becoming a well-rounded Jew.
We want our children to be successful adults. So we help the
best we can by example and guidance. When this is not enough,
we take him/her to a specialist who can balance the child's
deficiencies. Occupational Therapy (OT) is one of these
areas. OT deals with life skill training. The goal is to help
the person function as a whole and learn how to help himself.
If a child doesn't like the feel of a hair cut or his
tzitzis, he needs help with sensory issues. If a child
cannot manage to jump rope at school and has poor gross motor
skills or cannot adjust to the demands of the classroom, we
might call on an OT. The OT gives the child experience in
areas to help with daily performance and stress management
and techniques to meet the expectations of the environment
and his age.
Two major OT issues are motor skills and the sensory
systems.
MOTOR SKILLS
A MOTORICAL REACTION is our physical response to the physical
world and what we think is going on around us.
A child may be clumsy and not coordinated at jumping rope.
She feels left out of the circle of friends when they jump
rope. Dance steps may be dyslexic for her. Her poor motor
coordination may show itself in other, not obviously related,
areas. Her desk or room may be messy. Her pencil tips break
too often from undue pressure. She gets one-third of her
homework done.
Unless she has super high self-confidence, these disabilities
may increase her lack of self-esteem. And yet she is sweet
good girl. Her undetected problem may stem from poor body
coordination. Sometimes emotional and behavior issues in
friendship are from inflexibility. Social play for kids are
heavily motor based between the ages of three to twelve. It
is a disadvantage for a child not to jump rope easily, both
socially and scholastically. Poor body coordination may
reflect low mental or other coordination as well (but not
always).
Muscle strength and development supports a child in more than
one way. For instance, when the back, neck and head are held
up properly, the child is more attentive and sits in a
relaxed upright self-confident position. Poor muscle tone can
lead to poor sitting in school, to poor school and notebook
work, cutting and pasting and unfortunately, a poor self-
image and with maladaptive skill and bad behavior. We are
then left to build up or rebuild emotional behavior as well
as the physical basis for the problem.
Physical activity prepares the physical and thinking body for
school tasks. How the body holds itself together is a base
for thinking and cognition. Movement is health and if it is
stuck, it hurts. Organs have mobility. Kids are programmed to
move. They find their own ways.
The OT prepares a child for schoolwork by making the child
physically ready to learn. How a child is tuned to rhythm,
timing and space in his physical movement and activity is an
indication of his success in schoolwork. A child needs
physical space to get concepts of physical space. This is why
recess is important. A severly handicapped child is limited
in knowledge because experiences are a huge part of learning.
Of course, there are many children who are gifted cerebrally
and need less physical movement than the average child.
MOTOR PROBLEMS AND LOW MUSCLE TONE (LMT)
LMT is the basis for all other motor difficulties. Examples
include:
* Sitting slouched over
* Week eye muscles for reading and copying
* Off balance -- falling down, knocking into walls or
inefficient body or hand movements
* Fixation -- extremeties are too close to trunk -- too tired
and not enough mobility -- loses attention. Needs help with
neck muscles to hold head up to pay attention. Copying in
school is tiring and difficult
* Lack of coordination (efficient use of muscles)
* Weak hands for writing, hands that get tired or sloppy or
switching hands with confused dominance. (Small intrinsic
muscles of hand for handwriting do not develop till age five
and a half or six, so teach writing skills after age five.
Don't give fine pencil work too early.)
* A locked pencil grip using forearm muscles instead of
finger muscles which can result in pain or arthritis after
twenty years
CLUES TO CHECK FOR
* Does child adapt to meet his needs, surroundings and
expectations of his environment and society?
* Is s/he eager to play in a naturally experimental way with
physical variety?
* Does he have a natural experimental behavior in a variety
of games?
* Is the child eager to play outside?
* Can he stand on a swing, lift legs? Does head go first,
then tilt back? How is he on the slide? Is he flexible?
* How does he approach writing? Does he enjoy writing? Does
he run away from it? Does child review and experiment with
variety?
* Does he have pains in his hand?
PARENTS CAN ENCOURAGE
* Strengthen shoulder girdle: Work on vertical surface at
level of shoulders and eyes, not too high and not too low.
* Use a chalk blackboard. This has more resistance than dry
erase boards.
* Focus binocular. Get eyes to work together.
* Have child hang his own school/art work on wall above
shoulder level.
* Do repetitive motions. Rocking a baby. Hugging an older
child while rocking from side to side. Get on your hands and
knees to give a ride to a small child. Encourage "on all
fours" relay games or simply call an exercise break and do a
series of exercises including rocking and stretching on hands
and knees.
* Include perceptual skills such as throwing a ball at a
specific distance.
SENSORY SYSTEMS
The sensory systems use information from the senses in order
to receive congitive-mental input. Feeling and touching are
sensory issues. Sensory feeling takes in information for
processing. A natural state of sensory arousal equals a vast
range of alertness that opens windows of learning for the
child.
Sensations include: Touch / Personal Space / Noise (sound
frequency) / Visual (sunglasses in the summer) / Smell /
Gravity (insecurity for babies)
Yossi is a coordinated young man. He has leadership potential
but can't sit still in class. He is unaware that he blurts
out answers and touches things and other people. Dovie sucks
on his kipa and has trouble calming himself down after
recess. He can't match the appropriate energy level to the
next situation. Transitions are difficult for him.
Shuli doesn't like wet or gooey art projects or when her
mother touches her too lightly. Children such as these may be
weak in some areas of learning as well if they have sensory
issues.
Two major categories of reaction to sensory input that need
assistance are:
1. Hypo -- under the norm with decreased reaction to
sensation.
2. Hyper -- over the norm. Can be mild to normal.
Even a mild digression is alright, so long as it doesn't
interfere with functioning in life. An OT will design a home
program that helps release the calming chemistry of
neurotransmitters. An OT may check for hormonal/metabolic
problems, the immune system (allergies) and various stress
pathways. The body makes neuro connections and pathways from
physical and mental action. The neurotransmitters in the
brain release chemicals that remove pain, deal with fears
(defense pathways) and the sympathetic nervous system. The
goal is for the child to regulate and adjust his own chemical
and time-release functions.
SENSORY DEFENSIVE
A child with high needs may be sensory defensive. He may
react out of proportion to everyday sensations. These usually
are physiological-based problems and are not emotional.
* A boy who is uncomfortable with tzitzis and
payos. His unknowing parents may label him as
uncooperative or less religious.
* A child who doesn't like art classes because of gooey or
wet textures.
* A child who is edgy and has outbursts because of not up-to-
par pathways to the emotional brain connection.
* Instances of an overload or drop in adrenaline wires a
child to a survival response creating unacceptable
behavior.
* Troubles with changes in routine. The child needs to know
ahead of time in order to adjust slowly.
* He uses loud/fast music to drown out other problems.
HOW TO GO FROM ONE STATE TO ANOTHER
(CALM TO NORMAL TO ALERT)
Provide a variety of sensory experiences spaced throughout
the day to keep release of body chemical in mid-range. A
variety of activities and appropriate foods release a variety
of neurotransmitters. Change the pattern of what the child is
doing. After the body is in mid-arousal for one to three
months, it begins to understand what it feels like and begins
to take over.
* Deep breathing / meditation calming techniques
* Short quick movements / carousel amusement park rides to
wake up the senses
* Long and repetitive movement to calm
* Firm massage touch affects the deep skin receptors
* Wrap in blanket with massage
* Moving-swinging-rocking -- bike rides -- trampoline
jumps
* Resistant work: Lifting weights / putting away cans /
pulling weeds
* Nuts or seeds to chew at Shabbos table during Divrei
Torah
* Soft music
* Aromatherapy
* Foods:
Calming: mushy, bland comfort foods, ice cream, chocolate
Alerting: crunchy (chew a carrot, eat popcorn), signal
channel strong flavors -- fireballs, pineapple juice and hot-
spicy
* Remove allergenic foods
HOW TO CHANGE THE ENGINE SPEED IN SCHOOL
Working in coordination with the administration and staffs is
essential. Unobtrusive toys and gadgets help a fidgety child
or one that needs to wake up. Make sure they are age
appropriate.
* Key chain with something on it such as a textured fuzzy
object
* Pencil case from thick fake fur
* Chain necklace / textured bracelet
* Rubber eraser that stretches (kneaded rubber eraser)
* Rubber tubing on pencil tip
* Pencils that light up
* Rubber tubing for feet on chair or floor
* Bottle of colored water and glitter with floating beads
* Chew gum (quietly)
* Colored beads on shoelaces
* Rocking chairs
* Velcro under the desk
* Rubber pom poms
* Hand squeezer or squeeze bags (double balloon filled with
flour or sand)
The window of learning and active focus is our goal. An
occupational therapist may provide the glasses a child needs
when he can't see clearly into his window.
Geela Spiro may be reached at 02-6511-467 for Occupational
Therapy.
Devora Piha is offering private consultations or group
classes for teachers, pre-school teachers and parents on
"Teaching Art to Children, with Confidence;" concepts
projects and class plans to teachers and gannanot.
Also "Printing and Drawing" for women and children with
special needs and chuggim for children (Bais Yaakov)
for mothers and children together.
02-9920501 in Ramat Beit Shemesh.
