What's wrong with W-sitting?



W-sitting is when a child sits on their bottom with their knees bent and feet positioned outside of their hips. In this position child sits on his bottom and knees are bent, feet tucked under and legs are splayed out to side, what looks a “W”.



In this position child’s base of support (BOS) is wider and his centre of gravity (COG), is lower allowing for increased stability through the pelvis and trunk.
Children find this position convenient for play as they do not have to work on maintaining their balance while concentrating on the game or task in hand.



                     Why is W-sitting problematic for children?


While sitting in this position, children cannot achieve active trunk rotation, and cannot shift their weight over each side. Weight shifting and trunk balancing are important aspects for developing core strength and midline crossing skills (essential for handwriting and hand dominance).
Due to affected midline crossing development, bilateral coordination is also affected, the skill essential for doing two handed activities such as skipping, throwing, catching, kicking, buttoning, doing laces or ties.

                               Consequences of W-Sitting


•    Hips and leg muscles to be shortened and tight.

•    Back or pelvic pain

•    Pigeon toed walking or in-toeing (feet turned in while walking)

•    Flat foot

•    Difficulties performing two-handed activities (e.g., buttoning)

•    Poor hand preference or dominance (e.g., handwriting difficulties)

•    Lack of cross body movements (e.g., throwing, catching)

•    Limited trunk movements (e.g., copying from the whiteboard)

•    Likelihood of hip dislocation (if child has hip problems)


                             Strategies to prevent/improve W-sitting


PRONE SITTING
Children do W-sitting when core strength is an issue. Reduced core strength causes poor posture and over-compensation of other muscle groups.

The following strategies can be helpful minimising W-sitting posture: -

1.Encourage a child to sit in different ways, such as: -
•  Prone position (on stomach and forearms)

•    Criss-Cross Sitting (Crossed Leg Sitting)

•    Side Sitting (alternate sides)

•    Long Sitting (feet straight out front)


CRISS-CROSS SITTING
2.Ask the child to get up and bring something from next room such as cushion, favourite toy or game.

3.Remind the child to “fix their legs” whenever you see them sit in a W position.
SIDE SITTING

4.Alternate ways to sit such as a beanbag, low chair, pillow, to sit on, or suggest him to lie on his tummy.

5.Exercises such as stomach crunches, the plank can be beneficial in improving core strength.

6. Anticipate and catch it before the child tries to sit in W-sitting.

LONG SITTING
7.Offer the child a small chair or stool as an alternative to sitting on the floor.









We should expect young children to move in and out of positions when sitting on the floor - that is natural and the way kids stay alert and learn to manage their bodies in space. Just as one size does NOT fit all, one sitting position will never accommodate the sitting needs of all children. Young children learn best when their bodies are safely and comfortably positioned!



References:

American Journal of Occupational Therapy: http://ajot.aota.org/


The Pathways. Org: https://pathways.org/

Image source: Google images







Body awareness: Why is it so important?





Poor Body Awareness = Poor Motor Planning =Poor Gross & Fine Motor Skills

Body awareness is about understanding where our bodies are in space, as well as where and how we move them.
It is the internal awareness sense of the body, and its function is to make our body aware about, where it is, in relation to the environment.Body awareness is developed through proprioception sense and kinaesthesia. 
Moreover, it can be explained as knowledge of the boundaries of the body and its movements within space.For instance, it lets us know where is our right hand or left leg and what is the relationship between the two.
This develops since 9th -12th months in an embryo and completely develop by the time child is 5 years. Infants learn about their bodies and its relationship to surrounding on them during the normal course of development. Exploring, and manipulating objects is a process of developing body scheme. As they grow they learn about distances and sizes.


How does body awareness act on our body?

Our brain has body “maps” which carry information about every body part and its relationship to each other.

These maps support person to realise how his own body feels like when vision is blocked. Body awareness tells about the "doing sense" of the body without looking at different body parts. For example, scratching our back when it itches or wiping face when it has dirt on it. There are so many actions which are taken as for granted by us however our brain and body works phenomenally to process sensory information from the brain to various sensory systems. 

In above face wiping example, the brain sends messages to elbow so that specific muscles can contract and relax to bend elbow joint and hand can go up to face to clean the dirt. Related hand muscles also contract and relax.

We are able to put the lid on water bottle or pen without looking at it, control tap faucet while talking to someone, are some of the examples of body's "doing sense" while we are busy focusing on primary tasks. 

Our body's ability to change its posture unconsciously, when muscles of the particular group are fatigued in one position is a strong example body awareness.This process happens automatically while are sleeping or awake. 
Our proprioception receptors update these body “maps” (precepts) which helps the
brain in sending messages to needed body part for further actions. 

In children with the poor body awareness, the relationship between body actions and these “maps” do not work well. Due to poor functioning of body percept, the brain is not able to plan actions leading to poor motor planning. This is the reason children with Dyspraxia are disorganised, forgetful and clumsy. Their brain is not able to do motor planning causing them not being able to judge speed, weight rate, the direction of any object or task. 

Moreover, these maps also contain memories related to environment such as gravity. For example, while sitting on swing we know our upper body is on swing however legs are swinging. 

Another common example is while swimming whether our body is in deep or shallow water. In both the situations, body maps help the brain to plan the movements according to the state of the body.

Signs and Symptoms: 

1) Might bump into other people or stand in very close proximity to other people when interacting with them.

2) May have organisational difficulties in the classroom as well as home.

3) The concept of right and left, up-down, under-over, in-out is confusing for children to understand and learn therefore following directions is a difficult task.

4) For children with poor body awareness subjects like mathematics, physics are difficult to understand. Geometry, shapes, volumes, calculations are hard to understand.

5) Copying from the blackboard is a struggle for them due to midline crossing difficulties.

6) There may be difficulty while playing football or cricket. Judging distance and speed of ball can be an issue.

7) Body Awareness also interferes with learning since child’s brain is not able to do motor planning resulting in poor control over tasks. e.g. self-care. Usually, these children also have laterality and coordination difficulties. They can be ambidextrous.

Tips for improving Body Awareness

1) Visual Feedback: Learning new task is challenging for them, especially, gross motor skills such as jumping jacks, synchronised opposite sideways or same side jumping, or skipping. Most of the gross motor tasks require proprioceptive input, received through muscle and joint receptors, however, due to poor proprioceptive sensory processing, the child faces  difficulties in performing new dance steps, actions or exercises. These children should be given regular visual feedback through a mirror which can support them seeing what they are doing in order to learn and manipulate their body in the correct manner.Moreover, repetition of novel tasks is important.


2) Heavy Work Activites (Proprioceptive Input): Pushing and pulling heavy objects such as barrels, cart, large bean bags, pile of chairs or pushing another child on swing will provide muscles and joint receptors information about position of body parts (leg, arms, head and trunk) in space and in relationship with other objects.These activities provide deep pressure to muscles, joints, ligaments and key points (shoulder, pelvis and hips) to the tactile defensive child.Moreover, living movement break will support the child to concentrate better in studies such as sending him to the office to handover papers or asking him to distribute assignments in the classroom.


Hippotherapy: This therapy is used under the supervision of an occupational therapist. This process involves riding a horse with simultaneous involvement of a variety of therapeutic activities. Riding a horse provides various kinds of sensory information including, tactile, visual, proprioceptive and vestibular.Maintaining positions, staying alerted while riding, facilitates postural control and balance. This therapy helps in developing balance, core body strength (changing different positions, supine, prone, quadruped), as well as midline crossing, weight shifting and upper and lower body control. Resource


4) Obstacle courses: Make obstacle courses and ask the child to complete them in different positions (supine, prone, kneeling) while sitting on a scooter board.Engaging children into creating obstacle courses will support Dyspraxic children in developing ideation, planning and execution skills. Moreover, moving on the swing, through the tunnel, over the bench will help in developing spatial awareness concepts in relationship to the environment.


3) Animal Walks: Walking like a bear, the elephant, a duck or a seal will improve body sense.It will help in developing body's internal awareness. Additionally, animal walks provide proprioceptive-vestibular inputs activating sensory processing systems. Along with this, core body strengthening, balance, postural control of upper and lower body develops supporting the child to perform better in gross motor and fine motor skills.


5) Involve in home chores: Involving the child in kitchen activities such as asking him to give you different items needed will help to develop under-over, left-right concept. You may ask him to put the cake for baking in the lowermost shelf of the oven or put in dishes within the dishwasher. Doing work like car washing, vacuuming, cleaning, mopping will give proprioceptive feedback. Tasks like preparing to dine  (putting cutlery on the table, with correct position of utilities) will help in developing left, right, top, bottom concepts.


6) Target Games: Activities involving trunk rotation and both sides of the body should be incorporated such as throwing bean bags while picking from left and throwing them to the right side. Throwing them in hoops, buckets or bags can be done for proprioceptive input.Moreover, throwing balls, rings, darts at targets from various distances can be helpful to improve visual motor skills.Activities, like tossing balls and playing bat ball, will improve eye-hand coordination too.


7) Body Paint: Ask the child to paint his particular body parts such as right-hand or left-hand index finger. This can be a great fun activity for sensory seeking seekers and children with tactile discrimination difficulties. Drawing different shapes, letters and numbers on hand, leg and back will help in improving body awareness as well as self-concept.

8) Hiding Objects Games: Hide different objects in the room and ask the child to find them. Two things can be hidden together such as lock and key.Throwing balls ring darts, at the target. 


9) Confined Space: Children should be given small, organised spaces to work in as they feel secure and confident in confined spaces compared to large space areas.

10) Handwriting difficulties: This is a concern for children with poor body awareness. To know more, read the article.  






Why should we use Visual Support System?






Many children with ASD, ADHD, SPD respond positively to schedule charts, sign posters, and other visual strategies. This form of information presentation encourages them to communicate appropriately and helps to develop language and process information. Thus, it helps them to be more independent and self-confident to verbalise or make other understand their own feelings.


Visual strategies can be purposeful for expressing and understanding feelings and emotions, while going through transitions or changes, visiting a new place or meeting a new person.

A visual schedule is a representation of what is going to happen throughout the day or within a task or activity. It helps in carrying out life skills activities or task in hand in a planned manner and reduces high levels of anxiety 

It encourages structure and organisation in daily routine.

It can be in form of timetables, behavioural sheets, safety charts, activity sequencing for self-care skills (example-tooth brushing) or independent living skills (driving, sex education), emotion’s chart, social skills, instructions or reminders.

Marlene J. Cohen and Donna Sloan are authors of book Visual Supports for People with Autism: A Guide for Parents and Professionals (2007) which highlights the significance of visual support strategies for children and adults with autism.

Children with ASD often display anxious behaviours or act out when their routines change or they are in unfamiliar situations. Visual reminders can support them understand what to expect and what will happen next to reduce the anxiety. They help them to pay attention to details and understand situation visually in a better manner.

One of the main problems of people having ASD is social interaction, using language and repetitive behaviours. They have difficulties understanding instructions and display limited interests in activities. A visual support system helps in countless areas helping the child to work systematically and rationally.

Finally, some children with ASD are anxious or act out when their routines change or they are in unfamiliar situations. Visuals can help them understand what to expect and will happen next and also reduce anxiety. Visuals can help them pay attention to important details and help them cope with change.


Often ASD children get anxious due to changes in routine, classroom schedule, while meeting new people, and in unfamiliar situations. Visual support strategies can help them understand what to expect and when will it happen. Rather than getting panicked, agitated, angry, and anxious these children can look into the picture cards, or visual charts and follow the plan.



Moreover, parents’ teachers can easily communicate with them using visual reminders. This decreases frustration and may help decrease problem behaviours that result from difficulty communicating. Visuals can promote appropriate, positive ways to communicate.

The visual schedule breaks down the activity into multiple steps so that child can understand, plan and execute the task easily and complete the task (e.g. life-skill, such as brushing, shoe lace tying) successfully with reduced anxiety levels. According to Zigmond et. al (1999), anxiety caused by any reasons can aggravate sensory defensiveness in children with sensory modulation difficulties. Therefore, to minimise the sensory issues, caused due to raised levels of anxiety and stress visual reminders can be a helpful tool to a great extent.

Furthermore, anxiety resulting due to lack of information or fear of unfounded apprehension results in concentration difficulties, restlessness, hyperactivity, distractibility as well as learning abilities.

The manifestation of anxiety has been found to be associated with complex brain structure, known as limbic system and components of the reticular system.
It is better to have a portable schedule such as on a clipboard or a   binder or it can be fixed to a permanent place such as child’s bedroom or washroom wall or refrigerator. 

Fundamentally, the schedule should be visible to a child frequently and easily so that he can access it before or while performing planned task. Initially, verbal cues such as “check your schedule” can be prompted if a child gets baffled to perform any task.


Resources for Using Visual Supports: 

www.do2learn.com 
card.ufl.edu/content/visual.html
www.kidaccess.com/index.html 
Eckenrode, L., Fennell, P., & Hearsey, K. (2004). Tasks Galore for the Real World. Raleigh, NC: Tasks Galore. 


References:

Autism Speaks (www.autismspeaks.org/)

National Autistic Society (http://www.autism.org.uk/)

Bernard-Opitz, V, and Häußler, A. (2011) Visual support for children with autism spectrum disorders: materials for visual learners. Shawnee Mission, Kansas: AAPC Publishing  Bondy, A. and Frost, L. (2011).

A picture’s worth: PECS and other visual communication strategies in autism. 2nd ed. Bethesda, Maryland: Woodbine House  Cohen, M.J. and Sloan, D. L. (2008) Visual supports for people with autism: a guide for parents and professionals. Bethesda, Maryland: Woodbine House



Play Doh Hide and Seek



                                                          



This activity has been originally taken from one of the most popular and user-friendly guide, the Out of Sync Child Has Fun. I have done a couple of modifications according to own working experience. You may follow the book link to know more about Sensory Activities where there are a great number of fun and learning activities.

This is a fantastic activity especially for little ones however teens will also enjoy it. It improves motor planning, fine motor skills as well as bilateral coordination (ability to synchronise both right and left sides of the body, for example, making a sandwich or playing throwball). It improves tactile discrimination and proprioception skills. Moreover, it improves attention span and concentration on the given task, along with hand and intrinsic fingers strength. Feeling, recognising and understanding about physical characteristics of objects (size, shape, density, texture, and weight) is an integral part of tactile discrimination which can be difficult for our kids with sensory issues.

Our aim is to make their fingers ‘feel’ of different textures in a fun way and improve their learning about various objects even when they are not seeing them!
So let’s start!

Activity Requirements:
Play-Doh
Plastic or rubber toys (such as Lego, plastic apple, small sized ball)
Large and small buttons
Safety pin or hair pin
Different size coins
Rice or Lentil Box
Container for sorting- Cup or jewellery box

    




Procedure:
Pack the Play-Doh around the toy to make and sure that is not completely packed or covered. The child should be able to see the colour and shape of a toy which will work as the clue for him to recognise it easily. Once a toy is covered you may ask the child, “Do you know which toy is it?” or Can you find where the toy has gone?”



                         

Once the child is a master in above-mentioned activity we can switch to next level of effort. This time to increase the level of difficulty slightly, pack the toy thicker and leave a small portion unpacked to grade the activity to a next level. Once the toy is packed you may ask the child, to recognise the toy using his fingertips and visual sense.





Activity Gradation:
Time Framed: The activity can be more challenged by grading it according to time. You may ask the child to recognise the toy within a set time limit such as 60 seconds or two minutes. Time should be allotted depending on child’s abilities and needs. It is important to understand that activity should enhance his level of motivation to peruse and complete the given task successfully. 
Target should be achievable. He might lose interest in activity if he is unable to complete the task within the time frame. So make sure in his first attempt he is given enough time to keep up his self-esteem and self-confidence. 
Gradually, time can be reduced, say, from 3 minutes to 30 seconds.

Blindfold:
Once the toy is packed, leaving small portion as a clue, ask the child whether he would like to do this activity being blindfolded. If both child and parent think, it will be achievable, to recognise the toy, then go further and blindfold him. A child might take longer than usual time to recognise since his visual sense has been occluded. Parents should encourage him to use his fingertips sliding them around the edges and corners of the toy, so as to learn about shape and size of it. Help him to feel the toy where it is unpacked. This will help in improving tactile recognition and discrimination of object. On repeated practice of feeling different shapes, sizes, textures, density and weight (physical characteristics of objects) child’s touch discriminating abilities will improve to a maximal possible extent.



At this level, pack the toy completely and thicker to increase the level of challenge.
         Once the child has mastered, skill on different medium-sized toys, switch to fine motor objects. These objects can be:
             Different sized buttons
                      Safety or hair pins (make sure it does not injure him)
                            Different sized coins
                            Rubber
                            Small Lego pieces
                             Pen caps   







         Pack these objects fully. Now we can play treasure hunt. Hide the packed things in the box of rice or lentils. Initially, he can recognise and discriminate them without being time farmed or blindfolded. Later, on mastery of task gradation of activity will be great fun and challenge too!





Benefits:
Tactile Discrimination: Playing with different textures which have varying viscosities increase tactile perception, exploration and discriminatory sense as well as visualisation skill along with In-Hand-Manipulations skills which involve translation. Vast Tactile experience = Improvement in Tactile perception + discrimination 
2.    Visualisation Skills:
3.    Attention skills:
4.    Body Scheme:
5.    Speed, Accuracy and Precision:
6.    Fine Motor Skills:
7.    Self-Esteem:


Toilet Training and Autism Spectrum Disorder (ASD)



                                                   
   


Children with Autism Spectrum Disorder (ASD) often prefer structured routine in their life. It is important to understand child’s level of awareness, strengths and challenges before starting toilet training. Most of the times children with ASD or Developmental Delay have sensory issues and poor motor planning skills causing too much of difficulties while understanding and carrying out this essential and unavoidable life-skill task.

Parents are advised to carefully identify and understand the indicators or signs of “good time to start” toilet training of their child. Usually, children display different behavioural patterns such as being fidgety or distracted when they are wet. They may show gestures of discomfort. Sometimes children also express their concerns by pointing towards their nappies. This is a strong indicator that child has developed awareness about wee and poo.

Children with tactile defensiveness might display greater sensitivity towards wet or soiled nappies, however, those with tactile hyposensitivity might not have awareness of wetness, being soiled or when they started/finished weeing or pooing.

Developing a toileting routine can be an insurmountable problem which can cause a lot of frustration to both parents and the child. Changing routine from wearing diapers or nappies to using the potty or going to toilet is a challenge for every toddler or a very young person, however, small but consistent steps towards this ultimate goal can make child independent in toilet training. Due to lack of social motivation children with Autism may not demonstrate any interest or inclination to use the toilet. Moreover, sensory issues such as a sound of the flush, toilet lighting, or the sound of toilet extractor fan can cause anxiety among children.


Toilet training tips for toddlers or very

Infant development: Birth to 3 months



An infant’s physical development is the source of pride and happiness. Each step of developmental milestone, from rolling to sitting followed with standing to walking brings child one step nearer to his own physical and mental independence.  As the child grows he becomes much more alert and responsive. Apart from sleeping, crying, taking the feed and filling diapers, he begins to move his body smoothly.

For infants’ motor development, various activities are manifestations of early development. By end of one and a half months, the child develops better coordination especially in getting the hand to his mouth and recognising mother’s touch. During this time baby’s brain generate millions of neurones every day causing body’s development at the phenomenal rate. He receives information through all the senses which help him to learn and grow.

During this period, he moves his head side to side while lying on his stomach. And keeps his fists tight. He may flop head backwards if unsupported since head and neck control are not yet achieved milestones. He explores his hands and brings them to the mouth for sucking. He uses different sensory systems such as vision, touch (tactile), auditory to explore the environment around them.

Primary reflexes like sucking and rooting are present since birth which help a child in taking mothers feed. In simple terms, these reflexes are already programmed in child’s brain system and assist him in breastfeeding. They are usually present for -4 months and then disappear and gradually feeding becomes voluntary control.

More reflex (Arms open outward on being tilted backwards) is commonly seen among children of 0-3 months. This reaction to reflex means that child’s balance and movement sense are developing well. Moreover, being able to hold head up when lying on tummy tells about functioning of the vestibular system (the sensory system responsible for maintaining our relationship with gravity). This sense gives us information where our head and body are in space. Due to this sense, the baby is able to roll, sit, stand and walk well.



Emotional Security has major role every newborn's life since it establishes expressive protection, trust and acquaintance with mother or caregiver. After delivery, child’s first bodily contact with his mother or caretaker has great influence on child’s body system for rest of his life. After contact, the brain should interpret ate the sensations correctly and appropriately in order to form the first emotional attachment. Sometimes, it is also called as mother-infant bond. This bond is essential for the physical and mental development of the baby. This bonding later helps in developing body image and body awareness. It also provides a sense of himself as the physical body. 


Tactile (Touch)The sense of touch relates to Tactile System. We (children and adults) are nourished, calmed and attached to mother or caregivers (bonding) through touch. This is considered as the first language of communication. An infant and mother completely depend on touch until language, cognitive skills are matured and other developmental milestones are not achieved.

The tactile system starts developing since 5th week of pregnancy, supports child to influence recognise different types of touch sensations as he grows. It has very important on newborn for the rest of his life. 

Functionally, this system supports in two important aspects, sucking and establishing emotional security. It comforts baby in sucking, chewing and swallowing food. Children who have difficulties in sucking may face challenges in eating different textures of food later in their lives.


Vision (Seeing)At birth babies, may look at highly contrasting targets, however, their abilities develop much later to distinguish between two images. Their primary focus is on objects 8-10 inches from their face. During the first-month child’s eyes work in conjugation and vision improves rapidly. Infants begin to follow moving objects with their eyes and reach to things at around 3 months. Sometimes their eyes may appear to cross or wander but this is normal since eye coordination is still not well developed.


Auditory (Hearing)A month-old child startles to loud sounds and smiles when spoken to. He responds to mother’s voice and quiets if crying. By this time, he may make pleasurable sounds such as cooing. As the child progresses to 2-4 months, he starts moving eyes in direction of sounds and responds to changes in voice tone of known people. He starts expressing displeasure and excitement. He may coo in response to face to face contact.


Gustatory and Olfactory (Taste and Smell)Babies orients to a smell of their mothers breastfeed. They display preference for pleasant smells and displeasure for pungent smells such as spoiled food


Activities for Development of Senses:

  • ·   Baby’s tummy time is essential as it helps in colic movement and helps core muscles to strengthen.
  • ·        Rocking, swaying and baby helps to promote vestibular sense.
  • ·        Post-delivery skin-to-skin contact is important.
  • ·        Daily massage and sponge play important role in child’s growth and development
  • ·        Maintain hygiene
  • ·        Talk to baby softly and gently.
  • ·        Keep the environment clean, and quiet to support his sleeping well.