Wednesday, April 27, 2011

Visual-Spatial Relationships

Perceiving Visual-Spatial Relationships is the ability to perceive the position of two or more objects in relation to each other and in relation to your own self. For example, a child walking through a classroom must know where he is positioned in relation to the furniture and his classmates. Children with problems in this area may have challenges with maneuvering through space, with ball skills, and with writing and spacing between words and letters. These students also have difficulty with concepts such as “up”, “down”, “left” and “right”. 

Here are some activities to address difficulties with visual-spatial relationships:
-Make an activity sheet of identical shapes, forms, letters, etc. with one of them positioned differently. Have the child point to the one that is oriented in a different direction.
-Do the same as above, but use actual objects. For example, line up for paper clips on the table with one slightly rotated and ask, “which one is in a different position?”
-Climbing through a homemade obstacle course of pillows, blankets, etc.
-Parquetry blocks, tangrams, and pegboard design sets (found at Amazon and school supply stores). Have the child reproduce shapes or forms from an example.
-Equilibrio Game
-Jig saw puzzles
-Have the child draw a person with all parts of the body, or assemble a person out of cut out body parts.
-Drawing maps of home, school, etc. Trace the way from one room to another.
-Gross motor activities of running, hopping, jumping, skipping around obstacles.
-Throwing objects at a target (bean bags, balls)
-Simon Says, Hokey Pokey games

Monday, April 25, 2011

Visual Perceptual Skills

Visual Perception refers the brain’s ability to make sense of what the eyes see. This is not the same as the term visual acuities, which means how clearly a person sees (for example “20/20 vision”). A person can have 20/20 vision and still have problems with visual perceptual processing. Good visual perceptual skills are needed for reading, writing, cutting, drawing, completing math problems, as well as many other skills. A child who has problems with perceptual processing might have difficulties working puzzles, copying block designs, or discriminating shapes, pictures or letters.

Seven of the terms that are traditionally included as
“sub-areas” under the term visual perception are listed below. In upcoming posts, I will define these terms and provide activity suggestions to address weaknesses in these specific perceptual “sub-areas”. It is important to note that visual perceptual deficits cannot be remediated with practice. These activities are designed to help children compensate for visual perceptual deficits and assist them to capitalize on their visual perceptual strengths.

Sub-Areas - (According to the Non-Motor Test of Visual Perceptual Skills, 3rd Edition)

-Visual Discrimination
-Visual Memory
-Visual-Spatial Relationships
-Visual Form Constancy
-Visual Sequential-Memory
-Visual Figure Ground
-Visual Closure

If you suspect that a child has visual perceptual processing problems, you may want to request an evaluation by a professional, such as a psychologist or occupational therapist. There are several assessments available that can determine a child's perceptual strengths and weaknesses such as:
The Non-Motor Test of Visual Perceptual Skills, 4th Edition
Motor Free Visual Perception Test, 4th Edition
Beery Test of Visual Perception (a sub-test of the Beery Test of Visual Motor Integration)

For information about therapeutic Visual Perceptual Activities and Products-
Click HERE!

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Saturday, April 23, 2011

Handwriting Warm-Up Exercises

These are some great warm-up exercises that prime the arms and hands for writing activities. They can be used in the classroom or at home to prep the hands for homework.

-Chair sit-ups- while seated, have the kids place their hands on either side of their hips and raise their bottoms up off of their chairs.
-Press down hard on desktop with both hands
-Briskly rub hands together
-Place the fingertips together and do finger “push-ups”
-Pass around a weighted ball
-Wall push ups- Place both hands on the wall with both feet about a foot from the wall and lean into the wall bending both elbows and then push back out
-Stretch thick rubberbands between fingers and thumb
-Push the palms together, then fold fingers around each other and try to pull them apart
-Clap hands in a rhythm and have the students imitate

Have fun! :) 
Photo Credit: Patrisyu @

Saturday, April 16, 2011

Correcting Letter Reversals

Letter reversals are common for preschoolers and kindergarteners, but by the age of seven, reversals should only be occasional. Common letter reversals include b/d, n/u, p/q and m/w. Letter and word reversals that occur with writing are one of the symptoms of dyslexia, but this does not necessarily mean that every child who reverses letters has dyslexia. If a student is reversing letters and words on a consistent basis past seven years of age, or well into the third grade, parents may want to consider an evaluation by a professional to check for dyslexia or some other learning disability. Whether or not a child has been formally diagnosed with a learning disability, there are remedial strategies and activities that can help students practice the process of forming letters with proper directionality.

To address directionality, the first concepts that need to be understood are the directions of “right” and “left”. A good reminder for this concept is to have the child wear a watch or bracelet on the left hand. Another cue is to show the child that on the Left hand, you can make an "L" with your pointer finger and your thumb… L for Left, and on the right hand, the L is backwards. In the classroom, you can work on right and left throughout the day. When asking questions that require a hand to be raised, ask the children to raise the right or left hand. For example, who knows the answer to number five? Raise your right hand. 
Rhyming techniques are also a good strategy. Just do a Google search on “rhymes for teaching left and right.” There are some great suggestions and cute rhymes that can serve as a reminder for remembering the right/left concepts.

Here are some more suggestions for addressing letter reversals.
Make worksheets with rows of lower case letters. Start with letters that are easily distinguished and progress to those which are often reversed or seen upside-down.
Tell the child to circle to letter that is “different”. After the exercise, ask the child questions such as “how is that letter different than the other?”

b b d b b

m n m m m

p p p q q

Then you can have the child make his own set of practice sheets. This is a great way to “feel” the differences in how the letters are formed. Use the suggestions on my previous post about kinesthetic handwriting instruction to work on the teaching the formation of commonly reversed letters.

There is also a great article on the Pediastaff website that addresses letter reversals…check it out @
There are also two activity workbooks that I frequently use with students who reverse letters or words. They are both available on Amazon, and I highly recommend them. Correcting Reversals and Correcting Word Reversals by Penny Groves. Just click here and scroll to the bottom of the page and you'll see the workbooks, then click on each book for more information or to purchase them! :)

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Tuesday, April 12, 2011

Kinesthetic Handwriting Instruction

     The best way to teach handwriting is to use a kinesthetic approach, which means to actually feel physical movement as it is being carried out. Many students don’t write letters using motor memories…they actually draw the letters while watching how they are forming the letters as they write them. This is not efficient and can really slow the process of writing down.
The best way to learn kinesthetically is to simultaneously visualize and verbalize a movement pattern as the action as it is taking place. Here is an example of how to carry out kinesthetic instruction for letter or number formation. Have the child stand up or sit down in a chair with an upright “tall posture”. The teacher or parent should draw a model of the letter on a chalkboard or white board. Designate the starting point and verbalize the instruction for the letter stroke as it is made. For example, if you are making a lower case b, say, “draw a long line down, and then go around to the right to make a circle”.
After the child observes the demonstration, she should trace over the letter on the chalkboard with eyes open, then with the eyes closed while verbalizing the details of the letter formation at the same time (just as the instructor did). After tracing the letter several times, the child should then practice forming the stroke by “writing it in the air” with a pointer finger, moving the whole arm from the shoulder. The instructor should check to be sure that the motor pattern for the letter is correct before having the child write the letter on paper.
The child can then attempt to write some letters on paper while verbalizing the details of the letter formation again. There should be no erasing, just practice. Kinesthetic reinforcement should focus on the “feel” of the movement patterns so as the child is practicing forming the letter, ask her “how does it feel to form the letter?” When the student can write the letter well, have her try with the eyes closed. Finally, after a row of letters has been completed, the child should evaluate her own work by circling the letters that she feels were formed most accurately. This is a wonderful way to teach handwriting and parents and teachers should try this approach because kinesthetic motor learning is much more efficient than “drawing” letters!           

Saturday, April 9, 2011

Positioning for Handwriting

     Many problems that students have with writing can be addressed with adaptive devices, positioning, or desk adjustments. In this post, I’m going to share some information about proper positioning for handwriting.
     A correct sitting posture is important when it comes to handwriting. The height of chair, desk, or writing surface can seriously affect a child’s ability to write. The following sitting posture is recommended:

-Hips should be snug against the back of the chair, knees bent at 90 degrees, feet flat on the floor, with the feet contacting the floor for comfort and weight shifting. Make sure that when seated, the child has at 1 to 2 inch space between the front of the chair and the back of the child’s knees. The top of the desk should allow for the arms to rest comfortably on the desktop surface, with the desktop approximately 2-inches above the child’s flexed elbow when seated.

A poorly fitted desk or poor sitting posture may cause the child to use compensatory movements. If the chair is too high, the student may need to wrap his legs around the chair or lean forward on the desktop. This position provides support for the arms and limits extraneous arm movements. A chair or desk that is too small can cause a student to slump or hang his head, or sit on his feet. It is important to consider all of these factors when selecting desks for students. 
Reference: Handout from Pediatric Therapy East, Memphis, TN.

Thursday, April 7, 2011

The First Strokes Handwriting Program

     One of my favorite multisensory programs for teaching handwriting is the “First Strokes Program”. It was designed by an occupational therapist, Jan McCleskey, MA, OTR. The workbooks are for pre-K through 3rd grade students and I use them with my students on a daily basis. They are great! 
     This program separates the letters of the alphabet into categories based on the first part of the letter stroke. For example, i, r, n, and m are all in a group together because they all begin with a “short line down”. 
    There is a colorful storybook that teaches the concepts of drawing and grouping the letters using a colorful, fun and entertaining story about "Billy the Seal". The print program has a computer tutorial that is absolutely wonderful (This CD is only compatible with a PC format).
     If you have a child that already knows the basic formation of the letters, but has a problem with general legibility, there is a workbook called “Cool! One Hour to Legibility” that addresses the most common handwriting errors. It is full of activities and samples and can be used with students who are second grade and above.
     My favorite thing about “First Strokes is that it doesn’t require any special adaptive paper; therefore, students can immediately generalize to regular Zaner -Bloser paper. This is a big benefit! For more information about this program and the products, check out their website @
     Please note: if your child has severe visual motor or visual processing issues, these programs may not be appropriate and you’ll want to consult with an occupational therapist before selecting a program.

Monday, April 4, 2011

Functional Pencil Grasps

One of the most common problems occupational therapists in the school are consulted about is improper pencil grasp. The most efficient way to hold a pencil is the dynamic tripod grasp; however, many other patterns are commonly seen in children, and these grasps do not necessarily require intervention or modification. Here are some examples of functional grasps:


Several studies have found no statistically significant differences in legibility and speed among these types of pencil grasps. However, if a child has an awkward grasp, and complains that her hand tires or hurts, you may want to consider an adaptive pencil, or pencil grip. I really like the "Twist-n-Write" pencils and the Grotto pencil grip. They can be purchased at Amazon. These pencils and pencil grips promote a nice grasp and do a nice job keeping the fingers and thumb in place, thus encouraging a more functional grasp. You also want to encourage wrist extension during writing, and you can do this by having the child write on a slanted surface such as a 3-ring binder or slant board.

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References (Including Photos of Pencil Grasps):
       Koziatek, S. M., & Powell, N. J. (2003). Pencil grips, legibility, and speed of fourth-graders’ writing in cursive. American Journal of Occupational Therapy, 57, 284–288.

Friday, April 1, 2011

Cutting with Scissors

Cutting is another activity that promotes hand separation. The tong activities in my last post are great for working on pre-cutting skills. When cutting with scissors, a child should sit back away from a table so that the forearms are not resting on a surface. The thumb should be turned upward inside the loop and the middle finger should be inside the other loop. The index finger should be outside the loop serving as a “guide”. (You can put a sticker on the child’s thumb and tell him that he should always be able to see the sticker while cutting). The wrist should always be held straight and not flexed or hooked.

Begin with activities such as snipping straws or short strips of index card. It is a good idea to begin with card stock or other sturdy paper like old file folders, fine grade sandpaper, or construction paper so that it doesn’t “flop” around as the child attempts to cut. You can also have a child cut from dot-to-dot using stickers or stamps for variety, then progress to cutting vertical lines, then shapes.

This is the developmental progression that is typically seen with scissor skills:

The child shows an interest in cutting
-Child is able to hold the scissors correctly
-Opens and closes scissors
-Snips paper
-Cuts paper in half
-Cuts straight lines
-Cuts out shapes with curves
-Cuts out squares
-Cuts out complex shapes

If the child cuts with his arms held high or doesn’t seem to be holding the scissors correctly, have him her lay on his stomach for cutting. This provides stability through the elbows and shoulders.