Wednesday, October 26, 2016

Postural Control, Gross Motor Development and Mealtime


When you think of children and mealtime, the first things that come to mind may be related to the hand and mouth – ie the ability to use a spoon or fork, bringing food to mouth and getting food inside the mouth.  What you may not realize is that the child’s postural control and gross motor skills greatly influence the ability to function independently during mealtime.  The hips affect the lips!


Alignment of the mouth and jaw for feeding is interconnected to head and trunk stability.  As babies develop their gross motor skills, they become developmentally ready to try solid foods.  This is usually around 6 months of age when the baby is able to: sit with support in an upright position (either on the lap or in a suitable high chair), roll over, rotate trunk and head voluntarily and bring hands and toys to mouth for exploration.

As children begin to increase their mobility, they learn to position themselves independently during mealtimes in a variety of settings including on the floor, small tables and chairs or at the dining room table.  At around 17-19 months, children can back into a small chair or slide sideways onto the chair to sit to eat at a small table.  Around 18-21 months, children can climb forward onto an adult chair, turn around and sit.  At around 37 – 46 months, children eat most foods without significant mess.  Regardless of where they are seated, children need to have the postural control to remain upright and stable while eating not only to control oral motor skills but to prevent choking.



In order to achieve proper alignment of the head during mealtimes, the baby or child needs to be stable at the pelvis, trunk and head.  Children with neurotypical development may be able to compensate with regards to oral motor skills if there is misalignment in the trunk.  Children with disabilities, may exhibit significant difficulties with oral motor skills if there is a lack of postural control.

Starting at the pelvis, the hips should be stable, symmetrical and around a 90 degree angle.  This stable pelvis will allow the child to maintain a more upright posture.  Foot support can help to increase pelvic stability, therefore in the older child, the feet should be positioned on the floor or a foot stool.  The sitting posture should be approximately 90 degrees at the hips, 90 degrees at the knees and ankles.

The trunk should also be symmetrical allowing the child to sit up straight during mealtime.  For children with significant disabilities, adaptive seating may be necessary to achieve a stable pelvis and trunk.

Having a stable pelvis and trunk allows for proper head position for mealtime.  Research indicates that a child’s head position influences the swallow during feeding and reduces the risk of aspiration.  The recommended head posture for safe swallow is a “chin tuck.” The head is positioned upright, in midline, with slight neck flexion, so that the chin is directed slightly downward and inward.  For children with significant physical disabilities, a caregiver may have to facilitate the position for safe swallowing.


Here are 5 gross motor activities to work on improving postural control to encourage pelvis, trunk and head stability for mealtime-

  1. Play in prone.  Play any games while lying on your stomach, hands under shoulders, propped up on your elbows.  This position helps to facilitate postural control and a chin tuck especially if game pieces, books, puzzles, etc are placed on the floor.
  2. Small weight shifts while sitting on an exercise ball.  When you move back and forth or side to side on a therapy ball, very slowly and in control you are activating your pelvic and trunk muscles to keep your body stable.
  3. Animal walks or yoga poses.  Try different animal walks or yoga poses that require activation of the trunk and hip muscles.  For example, cat/camel pose, crab walking, bear walking, etc.
  4.  Swinging.  Maintaining your balance while pumping a swing requires a significant amount of postural control.  Challenge the child’s postural responses by occasionally stopping and starting the swing.  The child will have to activate their postural muscles to maintain upright.
  5. Add kneeling, squatting or sit to stand transfers to any activity.  When you perform those actions you activate the hip and trunk muscles. Position toys so a child has to squat down to pick something up.  Put toys a low table or bench and the child can kneel to play.  Use vertical surfaces (ie whiteboard on a wall, magnetic wall, etc) so child has to sit to stand to complete the activity. Play Strong includes 40+ playful activities that encourage muscle strengthening in children.

Functional Skills for Kids - 12 month series by OTs and PTs

This post is part of the Functional Skills for Kids series is on mealtime. This series is a 12-month long series written by occupational and physical therapy bloggers on the development of 12 functional skills for children. Stop by to see what the other occupational therapists and physical therapists in the Functional Skills for Kids series have written on mealtime.

When Can Kids Feed Themselves? (and other mealtime milestones) | Mama OT

Fine Motor Skills For Mealtimes  | Therapy Fun Zone

Postural Control, Gross Motor Development and Mealtime  |Your Therapy Source

Attention, Behavior, and Meal Time Problems | Sugar Aunts

4 Ways to Modify Meal Times for Fussy Eaters  | Your Kids OT

Mealtime Skills, Rituals & Play – Nurturing a Love for Food | Kids Play Space

15 Tips for Picky Eaters | The Inspired Treehouse

Positioning, Motor Skills, and Table Manners: What the Connection? | Miss Jaime OT

Visual Perceptual Skills Needed for Independent Feeding | Growing Hands-On Kids


Furano et al and Parks, S (2014). HELP® Checklist 0-3 Birth to Three Years. VORT Corporation.

Redstone, F., & West, J. F. (2004). The importance of postural control for feeding. Pediatric nursing, 30(2), 97.

Royal Children’s Hospital Melbourne. Physical, Sensory and Oral Motor Development. Retrieved from the web on 10/25/16 at

Teaford, P et al (2010). HELP® Checklist 3-6 Checklist. VORT Corporation.


The post Postural Control, Gross Motor Development and Mealtime appeared first on Your Therapy Source.

Tuesday, October 25, 2016

Frankly…I Love to Exercise


Frankenstein sensory motor activity

Print out this free Frankenstein activity to create.  Cut out the pieces to the Frankenstein and attach with brads to create your very own exercising Frank.  Kids can move the joints on the Frankenstein and try to copy the movements.  Work with a partner – one child moves the joints and the other child copies Frank.

DOWNLOAD Frankly…I Love to Exercise for free.

Need more Halloween activities?  Check out all of these resources to encourage sensory motor development with a Halloween theme.

Brain Breaks for Halloween

Brain Breaks for Halloween – Download includes 30 Halloween themed Brain Breaks, 5 brain break spinners, Roll Some Halloween Brain Breaks and Calm Down poem.

Halloween Poses - Postural and Strengthening Exercises with a Halloween Theme

Halloween Poses – includes 12 full size pages with one Halloween pose and directions per page, 3 pages of the 12 poses in smaller sizes, 20 games ideas to use with the poses and BOO! game cards and directions.

Print and Create Fine Motor Projects – Halloween

Print and Create Fine Motor Projects Halloween – includes 10 fine motor projects with a Halloween theme.The 10 projects included are the following:
Halloween Clothes Pin
I Can Draw Halloween
Chinese Pumpkin Lantern
Wacky Pumpkin Game
Paper Skeleton
Clothes Pin Critters
Pumpkin Patch
Step By Step Cat
Witch Mask
Spooky Door Hanger


The post Frankly…I Love to Exercise appeared first on Your Therapy Source.

Monday, October 24, 2016

5 Ways to Increase Peer Interactions for Children with Disabilities


Therapists are frequently asked for suggestions on improving inclusive classrooms settings whether it be for accessibility, play, social or peer interactions.  Here are 5 evidence based tips to increase peer interactions during playtime for children with disabilities:

  1. Toys should be limited and well chosen.  Children will play longer when allowed to choose their playthings.  Social play such as pretend play, creativity or cooperative play helps to increase social interactions.
  2. Group children with disabilities with peers who demonstrate appropriate social skills.
  3. Keep adult child interaction to a minimum.
  4. The target behaviors should be play and joint attention.
  5. Play area should be relatively small.

Reference: Papacek, A. M., Chai, Z., & Green, K. B. (2015). Play and Social Interaction Strategies for Young Children With Autism Spectrum Disorder in Inclusive Preschool Settings. Young Exceptional Children, 1096250615576802.

Play - Move - Develop

Play Move Develop includes 100 reproducible games and activity ideas to encourage motor skill development and learning in children.  FIND OUT MORE INFORMATION.

The post 5 Ways to Increase Peer Interactions for Children with Disabilities appeared first on Your Therapy Source.

Thursday, October 20, 2016

Visual Motor and Discrimination Activity – Hedgehogs


Here is a cute, visual motor and visual discrimination freebie with hedgehogs.  Just print, grab some crayons and start looking for matching hedgehogs.


DOWNLOAD the visual motor and visual discrimination freebie here.

This is from the Visual Discrimination Seek and Find download which includes 8 full color boards with cards and 12 black and white boards to color. Look for objects that are pictured on the tablet screen. Match up the cards or color in the matching picture according to the key. This activity encourages visual discrimination, visual closure and visual motor skills. Kids will love the tablet theme! Just print and play.



You can create the boards with cards.  They range in difficulty from easier to more difficult.


Create busy bags to make the activities easy to travel with from school to school.


Find out more information about the Visual Discrimination Seek and Find download.

visual discrimination seek and find Your Therapy Source

The post Visual Motor and Discrimination Activity – Hedgehogs appeared first on Your Therapy Source.

Tuesday, October 18, 2016

Link Between Visual Motor, Object Manipulation Skills, Executive Function and Social Behavior

Link Between Visual Motor, Object Manipulation Skills, Executive Function and Social Behavior

Research Quarterly for Exercise and Sport published research on 92, three to five year old children to establish a link between early visual-motor integration skills and executive function and a link between early object manipulation skills and social behaviors in the classroom during the preschool years.  Each participant was evaluated for visual-motor integration skills, object manipulation skills, executive function, and social behaviors in the fall and spring of the preschool year.  The results indicated the following:

  1. children who had better visual-motor integration skills in the fall had better executive function scores in the spring of the preschool year after controlling for age, gender, Head Start status, and site location, but not after controlling for children’s baseline levels of executive function.
  2. children who demonstrated better object manipulation skills in the fall showed significantly stronger social behavior in their classrooms (as rated by teachers) in the spring, including more self-control, more cooperation, and less externalizing/hyperactivity after controlling for social behavior in the fall and other covariates.

The researchers concluded that children’s visual-motor integration and object manipulation skills in the fall have modest to moderate relations with executive function and social behaviors later in the preschool year.

Reference:  MacDonald, M., Lipscomb, S., McClelland, M. M., Duncan, R., Becker, D., Anderson, K., & Kile, M. (2016). Relations of Preschoolers’ Visual-Motor and Object Manipulation Skills With Executive Function and Social Behavior. Research Quarterly for Exercise and Sport, 1-12.

Teaching Catching, Throwing and Kicking Skills

Teaching Catching, Throwing and Kicking Skills is loaded with information to help children learn object manipulation skills. It is in PDF format and in Word (therefore you can edit the pages).  This packet includes the age progression of each skill, visual picture cards with step by step directions, tips on teaching the skills, letter home to parents regarding teaching the skills, different ways to practice the skill and data collection to track progress. The activities are reproducible to use over and over again with all the children that you teach.  FIND OUT MORE INFORMATION.

The post Link Between Visual Motor, Object Manipulation Skills, Executive Function and Social Behavior appeared first on Your Therapy Source.

Monday, October 17, 2016

Tactile Function in Children with Cerebral Palsy


As pediatric therapists, assessment and treatment of children with cerebral palsy frequently focuses on motor impairments although, children with unilateral cerebral palsy (hemiplegia) are also likely to have sensory impairment.  Research indicates that tactile registration for children with hemiplegia is consistently worse with their impaired hand than their unimpaired hand.  Both hands of children with hemiplegia performed worse than either hand when compared to typically developing children. Forty percent of children with hemiplegia had tactile registration and perception deficits, 37% had perception deficits only and 23% had no tactile deficit. The larger the tactile registration deficit, the poorer the performance on all tactile perceptual tests.  The researchers concluded that tactile dysfunction may contribute to functional impairment and is a possible target for intervention (Auld, 2012).

Here are a few suggestions to encourage tactile registration and perception during therapeutic play activities:

  1. Provide different textured toys during playtime.  For example, verbalize and discuss differences between soft/hard, bumpy/smooth, fluffy/scratchy, etc.  If the toys are just smooth plastic, then try and add a sensory component to the toy.
  2. Add weight to toys to increase input.  For example, try stacking boxes with weights in them (ie 1 lb. bag of beans).
  3. Add to texture during arts and crafts time.  For example, add sand to fingerpaints or use shaving cream.
  4. Focus specifically on tactile perception and registration.  For example, the child can close their eyes and rely only on their sense of touch to identify objects.  They will not be able to use their sense of vision to determine what the object is and how to hold it.
  5. Add tactile input to weight bearing activities.  For example, when a child is working on weight bearing with an open hand, try performing that skill on different surfaces such as bubble wrap (bumpy), sand paper (rough), dry towel (scratchy), yoga mat (smooth) or cold (gel ice pack).  For the bare feet, try walking or balance with on different tactile surfaces such as grass, sand or dirt.


Auld, ML et al. (2012). Tactile function in children with unilateral cerebral palsy compared to typically developing children. Disability & Rehabilitation, 2012, 1–7, Early Online. DOI: 10.3109/09638288.2011.650314

Teaching Motor Skills to Children with Cerebral Palsy and Similar Movement Disorders - A

Teaching Motor Skills to Children with Cerebral Palsy and Similar Movement Disorders – A Guide for Parents and Professionals – The ELECTRONIC version of Teaching Motor Skills is a must have reference for all therapists who work with children with cerebral palsy. Whether you are a beginner or experienced therapist you will find the information concise, informative and very helpful to carry out everyday functional tasks including stretching with children with cerebral palsy. The book provides activity suggestions throughout the developmental sequence such as head control, tummy time, sitting, transitions, walking and beyond. There is also great information that reviews additional interventions for children with cerebral palsy such as bracing, surgical and medical management.  Find out more.

The post Tactile Function in Children with Cerebral Palsy appeared first on Your Therapy Source.

Friday, October 14, 2016

Halloween Mini Book

Halloween Mini Book from Your Therapy Source

Check out this adorable Halloween Mini Book that you can print, cut and fold.  I happen to love small things so this fits the bill.  I also happen to love Halloween activities.  So fun to create!

You can download this free template to practice scissor skills and folding.  Send home the mini book for the child to write some small notes or draw some pictures.  Just print in grayscale if you want it black and white.  It still comes out really cute!

DOWNLOAD the Halloween Mini Book and step by step directions for free!

Need more Halloween activities?  Check out Halloween Visual Perceptual Puzzles, Print and Create Halloween Fine Motor Projects, Multisensory Handwriting Activities for Halloween,  My Halloween Handwriting Book, Halloween Brain Breaks and Halloween Poses.

Check out Cut and Fold for more scissor and folding skills practice.

The post Halloween Mini Book appeared first on Your Therapy Source.

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