Development during early childhood is driven towards exploring and engaging in everyday activities in order to learn about the world. Children explore the world through their sensory systems (touch, movement, body awareness, hearing, seeing, smelling, etc). Once a child gains interest in an activity or toy, children then are asked to manipulate and further explore the object in order to learn more about how to utilize the item, toy, or object. Once these steps have been mastered, children are able to engage purposefully with an object or toy. An example of this can be when a 1-year-old child picks up two rings. First the child will explore it and manipulate it by touching it, moving it, visually inspecting it, and figure out what they may be able to do with the rings. Then the child may manipulate it further by banging it on a tabletop or banging the rings together at midline. Lastly, a child can engage in play with the rings in a purposeful manner, like bringing the rings together to make noise when listening to music. The skills needed for this process are highly driven by motor planning skills.

Motor planning is a large skill that includes our body’s ability to figure out what to do and how to do everyday activities. Difficulties with motor planning can lead to difficulties with learning and difficulties with mastering everyday activities.

Here are a few examples of motor planning tasks:
-Figuring out how to ride a bike
-Learning how to drive a car
-Learning how to walk, crawl, walk up/down stairs
-Learning how to use tools (i.e. scissors, crayons, etc) in a purposeful manner
-Learning how to kick a ball
-Figuring out how to use a spoon to feed oneself
-Learning how to write
-Learning how to organize day to day life

When a child has difficulty with motor planning, it can impact the child’s ability to learn how to interact with objects and activities in their world. In addition, difficulties with learning how to explore and engage with toys in novel ways can impact the child’s ability to learn in the school setting, play with peers, and function when changes or disruptions occur in their everyday activities. Here is an example of difficulties coming up with new ways to play with toys: If a child is having difficulty figuring out how to come up with new ways to play with their toys, they will prefer to play with their toys in the same way and have difficulty expanding on that. An example of this could be a child always pushing their cars or trains along a path on a table, and having difficulty taking that same toy and pushing it along a collection of pillows that create “hills”.

Here are just a few examples of what you may see if your child is having difficulties with motor planning skills:

-Difficulty figuring out a new way to play with a toy.
-Difficulties figuring out what to do with tools like scissors, spoons, forks, pencils, etc.
-Difficulty expanding on a play routine
-Difficulty coordinating the two sides of the body together to complete tasks like holding paper while coloring, stringing beads, riding a bike, playing catch and throw, etc.
-Difficulty with multi-step activities – obstacle courses, dressing, self feeding, etc.
-Difficulty learning how to complete prewriting shapes (vertical line, horizontal line, circle, square, triangle, oblique lines, etc) or difficulty learning how to form letters.

Here are a few questions to consider when looking at motor planning skills and determining whether difficulties with these skills are contributing to your child’s learning potential and development:

-Does your child have difficulty with expanding on their play routines?
-Does your child choose to play with the same toy in the same way?
-Does your child have difficulty dressing oneself?
-Does your child have difficulty feeding oneself without spilling a lot of the food?
-Can your child figure out how to assume simple yoga positions when you model it for them? (i.e. downward dog, child’s pose)
-Does your child have difficulty coordinating the two sides of their body to manipulate fasteners on their clothing, string beads, hold paper while cutting or coloring, etc.?
-Does your child have difficulty following multi step directions or multi step activities?
-Does your child seem to get lost while completing a task, and require modeling and verbal cues to help them figure out how to complete the task?
-Does your child get upset when they are asked to come up with new ways of playing with a toy?
-Does your child have difficulty with prewriting or handwriting skills?

These are only a few questions related to possible motor planning difficulties. If difficulties with motor planning are impacting daily life and your child’s ability to participate in age related activities to their fullest potential, an occupational therapy consultation or evaluation might be beneficial. Occupational therapy can assess a child’s individual motor skills, motor planning skills, and overall sensory processing capacity to assist with increase in functional independence.

Here are a few examples that an occupational therapist could utilize to assist you and your child with their motor planning:

-Completing an evaluation using the Sensory Integration and Praxis Test (SIPT), the gold standard for evaluating praxis (motor planning) related difficulties. This battery of 17 tests provides specific information in regards to sensory processing that directly impacts praxis skills. The test can be completed on children ages 4 through 8 years, 11 months.
-Determining what areas of sensory processing are delayed and impacting motor planning skills and focus intervention and home programming to increase those skills.
Determining adaptive techniques to assist with increased independence at home during motor tasks that are typically challenging for the child. An example could be to create a visual schedule or visual chart breaking a task down into simple steps with visual cues.

Dr. Neeha Patel is a licensed occupational therapist who offers a holistic approach to therapy, drawing from evidenced-based practice techniques, sensory integration theory, neurodevelopmental treatment, family-centered care, and a play-based approach. She is Sensory Integration and Praxis Tests (SIPT) certified, and has extensive experience helping children from birth to 16 years old with sensory processing delays, fine and visual motor delays, social skills, pre-writing and handwriting skills, as well as in their primary activities of daily life. She has worked with varying diagnoses including autism spectrum disorders, learning disabilities, developmental delays, developmental coordination disorder, cerebral palsy, disruptive behavior disorder, and down syndrome. Neeha has special interest and completed her doctoral work in the area of cultural sensitivity when working with children and their families. Neeha offers home, school, or community visits in Manhattan (Upper West Side, Midtown, Chelsea, Clinton, West Village, Soho, Tribeca, Union Square, Murray Hill, Gramercy Park, Upper East Side).

I am starting up my equine assisted psychotherapy program again in the coming months with small groups of 6-7 year olds based around feeling identification and empathy building. The sessions will include 15 minutes of grooming, a 30 minute therapeutic riding lesson, and a 30
minute office session on a separate day. The program will last 10 weeks: Riding will be on Monday afternoons at Kensington Stables and office sessions on either Wednesday or Thursday afternoons in Park Slope.

For those who are not aware, EAP is used to enhance office work with the use of horses. The therapeutic riding is excellent in helping with sensory integration, management of anxiety, and awareness of one’s body and feelings in the moment. This group will include those inherent aspects of therapeutic riding, but will have a specific focus on the feeling and empathy end. The riding is taught by an instructor from GALLOPnyc – www.gallopnyc.org – and the psychotherapeutic aspect is led by me, a licensed clinical social worker. If you are interested in the group for your child, please email me at susannah@brooklynlearning.com or call (718) 360-8531 to learn more.

Please note: Safety is of the highest priority – children must have adequate impulse control in order to be safe around the horses.

Susannah Gersten was born and raised in Brooklyn and specializes in working with young children and new parents. She obtained her undergraduate degree from Vassar College and her Master’s in Social Work from the Smith College School for Social Work. She has experience in mental health as well as community-based counseling services in Park Slope, making her invaluable in building relationships with the schools and other services in the area. In her private practice, Susannah offers play therapy with young children as well as behavior management, behavior plans and other techniques that involve both the child and their family. She also offers couples and family psychotherapy in order to help the parents and family address any underlying concerns in the family system. If parents desire, Susannah is happy to be in communication with guidance counselors, teachers and others at the child’s school. Outside of the office, She runs an equine assisted psychotherapy group with middle-school aged and younger children to address anxiety, shyness and depression. This group is especially indicated for children who have not responded to traditional therapy in the past. She has run this program for three years in conjunction with GallopNYC which works out of Kensington stables.

In the previous entry, we discussed three developing senses with which most parents are quite familiar (visual, auditory and tactile). Today, we’ll look at the two “hidden” senses most people never even think about, the vestibular sense and the proprioceptive sense. These senses can impact a child’s acquisition of many higher-level skills as they mature.

Vestibular System

Definition: This is a system located in the inner ear. It gives us our sense of spatial awareness, controls balance, and assists with movement. By providing information about the position and movement of the head in relation to gravity, the vestibular system lets us know the speed and direction of our movements. For example, if your body is falling to the side, the vestibular system registers the movement of the head and sends signals to activate the muscle groups we need to maintain balance.

Infants: You probably already know and have discovered the positive effects of the typical movements that babies enjoy: gentle, rhythmic rocking and swinging. This can be very organizing to a fussy baby. In addition to baby swings that can be used inside the home, infants often enjoy being pushed in a stroller, riding in a car (in a car seat), or being gently swung in a blanket with mom and dad holding the ends. Once head control is firming established, gentle bouncing on your lap, lifting the baby overhead, and slow, safe inversion (tilting baby upside down over your lap), can all help this sense mature. If your baby dislikes being laid down for diaper changes, try putting her down on her belly first (so that she feels more grounded) then turn her over to her back for the diaper or clothing change. Some babies may feel like they are “falling” and startle and cry with diaper changes if they are laid down too quickly.

Preschool: Kids in this age group are all about challenging their own vestibular systems! Provide lots of opportunities for your preschooler to explore playground equipment (swings, slides, merry-go-rounds), spinning toys (Sit and Spin, scooter boards), and rocking (rocking toys, glider chair). You’ve probably noticed that many children will also seek out this input themselves, through just plain rolling around or twirling in circles. To an adult whose vestibular system becomes less efficient with age, it can be hard to watch all that spinning…but know that it is good for their developing understanding of their body and how it moves. (Note: excessive self-stimulating such as spinning can indicate a sensory disorder).

School age: Many children at his age continue to crave intense vestibular input, and enjoy input such as amusement park rides, roller coasters, bike riding, skiing/snow boarding, and skate boarding. If your child wants to be “on the go” when it’s time to sit quietly (for example, mealtime, homework, or a long car trip), it can be helpful to provide some strong vestibular input prior to the upcoming stationary time. Swinging, bike riding, playing hopscotch, or using a slide can all provide the desired input, if you can get outside. In the home, you could provide a small trampoline (or allow jumping on the bed with an adult present), do jumping jacks, use a hippity hop, or have them use an exercise ball for bouncing. Some children have increased attention for seated work if they can get periodic movement during the task. Sitting on an exercise ball or using a movement cushion can help during this time. Here are examples of products that may be helpful:
Cushions: http://www.therapro.com/Air-Cushions-C4218.aspx
Ball chair: http://www.sensory-processing-disorder.com/exercise-ball-chair.html

Proprioceptive System

Definition: This sense can be simplified as “body awareness”. Receptors in our muscles, joints, and tendons send the brain information about the location of the limbs and overall body position. It also tells us how much force to use for a particular task. For example, even if your eyes were closed, you would know if I raised your hand over your head. You also know too much force to use to lift a full can of soda (but imagine what it feels like when the can you thought was full is actually empty!)

Infants: One of the main ways we give a baby early information about their body is through the ancient practice of swaddling. Yes, it is calming to a fussy baby and helps them sleep. Yes, it recreates the “womb space” and makes them feel safe. But, it is also providing their growing nervous system with valuable information and feedback about this little body that they are just getting used to. The tightness of swaddling is a type of deep pressure input to the body and limbs, that helps the brain learn about this new body of theirs, in a very calming, organizing way. Another way to provide this input (and also calm a baby) is a gently vibrating seat. Many are commercially available and include noise and lights to entertain as well. As your child ages, he/she might enjoy getting extra input from you in the form of massage or gentle “tapping” over the arms, legs, hands and feet. Try singing a song like “Head, Shoulders, Knees and Toes”, or rhyme like “This little piggy”…but expand both to include other body parts.

Preschool: Playground equipment where she can climb on, crawl under, or hang on will give great “heavy work” input to her body that helps develop this system. In the house, you can do wheelbarrow walking or play “tug-o-war” with a towel or blanket. Taking the cushions off the couch and setting up obstacle courses around the house where she needs to crawl over or through, then get up and jump over or balance on, then roll under and out, etc. Adjusting her body and her movement as she goes through the obstacle course will help her gain better control over muscles and the amount of force she needs to use. And it’s fun!

School age: Try games like Twister, or “Simon Says”, focusing on the concept of left and right, and having her cross the midline of the body (i.e., “Simon says put your right hand on your left ear”). Having your child do household chores, such as sweeping, carrying groceries, and washing the table or floor. Cooking is another great activity, since the mixing, stirring, rolling, and kneading are all “heavy work” for the hands.

The neurological process that interprets sensations from the body and its environment is called Sensory Integration. The brain’s ability to process sensory information makes it possible to use the body effectively within any given environment. The quick screening checklist below will help you assess your child’s sensory development.

If you answer “yes” to one or more of these questions, your child may be experiencing difficulties with sensory integration:

*Was your child unusually fussy, difficult to console, or easily startled as an infant?
*Is your child over-sensitive to stimulation? Does he/she over-react to touch, taste, sounds, or odors?
*Does your child strongly dislike baths, haircuts, or nail cutting (screaming, crying, “melting down”)?
*Does your child use too much force when handling objects, coloring, writing, or interacting with siblings or pets?
*Does your child seem to have weak muscles? Does she tire easily? Does she prefer to lean on people or slump in a chair?
*Was your baby slow to roll over, creep, sit, stand, or walk, or to achieve other motor milestones?
*Is your child clumsy? (Does she fall frequently, bump into furniture or people, and have trouble judging position of body in relation to surrounding space).
*Does your child have difficulty following instructions or sequencing the steps for an activity?
*Does your child avoid playground activities, physical education class, and/or sports?
*Does he/she not enjoy age-appropriate motor activities such as jumping, swinging, climbing, drawing, cutting, assembling puzzles, or writing?

Check out Kids Health website for further information on the development of senses, as well as other great information:

http://kidshealth.org/parent/growth/index.html#cat166

For further information on Sensory Integration and for children diagnosed (or suspected) of a Sensory Processing Disorder:

http://www.sensory-processing-disorder.com/index.html

http://www.spdfoundation.net/index.html

http://www.otawatertown.com/

If your child is experiencing difficulty with any of these areas of development, please contact your pediatrician and/or an Occupational Therapist to assess if there is an underlying problem. Children develop at their own pace, with a wide range of normal regarding skill acquisition. If he/she has difficulty in several areas of sensory development, it may indicate a Sensory Integration Dysfunction.

Lynn-Marie Herlihy is an Occupational Therapist in private practice in Park Slope, Brooklyn. She has over 12 years experience treating children from birth to school-age, with a variety of sensory and motor deficits, developmental delays, and learning issues. You can also visit her website at www.ParkSlopeOT.com.