Upper Extremity Casting

Serial Casting

Wrist Sprains


Occupational Therapy

Occupational Therapy involves assessment and intervention for the following services: adaptive equipment, developing coordination, feeding, fine motor, gross motor, handwriting, performing activities for daily living, playing and socializing, self care, and sensory integration.

Fine Motor Skills

Skills related to the small muscles of the body, particularly those of the hands. Children need adequate dexterity, strength, and coordination to manage a variety of objects in their daily routines such as writing utensils, eating utensils, and scissors.


Sensory Integration

The organization of sensory input for use. This may include perception of the body or the environment, adaptive response, or learning process. Through sensory integration, many parts of the central nervous system work together so that a child can interact with the environment safely and effectively.


Visual Perception

This is the process responsible for the reception and cognition of visual stimuli. Visual perception allows a child to make accurate judgments of the size, configuration, and spatial relationships of objects.


Visual Motor Skills

These skills are the integration of visual perception and fine and gross motor skills. Children who have difficulties with visual motor skills will often have trouble learning how to print or write.


Therapeutic Listening

This is a highly individualized method of auditory intervention using electonically altered compact discs in protocols specifically tailored by sensory integrative professionals to match the child’s needs. Therapeutic listening combined with sensory integration tends to speed up the emergence of organized behavior, self-regulation, postural control, social skills, communication, and much more. The Therapeutic Listening Program is used under the guidance of a certified therapist, who performs an evaluation to determine eligibility. This program includes two 30 minute listening sessions per day for two weeks for each music CD. The number of weeks needed to complete the program depends on the severity or complexity of behaviors and concerns.


Interactive Metronome

The Interactive Metronome (IM) is a brain-based rehabilitation assessment and training program developed to directly improve the processing abilities that affect attention, motor planning, and sequencing. This in turn, strengthens motor skills, including mobility and gross motor function, and many fundamental cognitive capacities such as planning, organizing, and language.

The IM program provides a structured, goal-oriented training process that challenges the patient to precisely match a computer generated beat. Participants are instructed to synchronize various hand and foot exercises to a reference tone heard through headphones. The patient attempts to match the rhythmic beat with repetitive motor actions such as tapping his/her toes on a floor sensor mat or hand clapping while wearing an IM glove with palm trigger.

A patented audio or audio and visual guidance system provides immediate feedback. The difference between the patient’s performance and the computer generated beat is measured in milliseconds. The score provided indicates timing accuracy.

Motor planning and sequencing problems have been linked to a variety of developmental, behavioral, and learning challenges. More than a decade of clinical research on IM demonstrates gains in motor planning and sequencing lead to improvements in:

  • Attention and Concentration
  • Language Processing
  • Behavior (Aggression and Impulsivity)
  • Motor Control and Coordination
  • Academic Performance

Individuals with motor planning and sequencing problems, speech and language delays, motor and sensory disorders, learning deficits, and various cognitive and physical difficulties may benefit for the IM program. Adult and pediatric patients who have benefited from IM include those with:

  • Sensory Integration Disorder
  • Asperger Syndrome
  • Autism Spectrum Disorder
  • Cerebral Palsy

ADHD Study. A double-blind, placebo-controlled study of 9 to 12 year-old boys diagnosed with ADHD found those who completed the IM program showed significant patterns of improvement in attention, coordination, control of aggression/impulsivity, reading and language processing. This study was published in the American Journal of Occupational Therapy, March 2001.

A comparison of IM-trained special education students to a control group found the IM-trained group improved significantly in both motor control and motor coordination as measured by independent assessments compared to the control group. Parents of the IM-trained group also reported marked improvement in their children’s ability to attend to tasks, read, write and general behavior.

(Stemmer, P.M. (1996) “Improving Student Motor Integration by Use of an Interactive Metronome” presented at the 1996 Annual Meeting of the American Educational Association in Chicago, IL.)

A correlation study of 585 children in a public school district found significant correlations between IM score and academic performance in reading, mathematics, language, science, social studies, and study skills. This suggests that timing and rhythmicity play a foundational role in the cognitive processes underlying performance in these academic areas. The results were published by the High/Scope Foundation, a prestigious, non-profit educational research institution.

Sensory Integration

What is Sensory Integration?

Every day, we receive a great deal of information from our senses. We use this information to organize our behavior and successfully interact in the world. Our senses give us information about the physical status of our body and the environment around us. Think of the senses – sight, hearing, touch, taste and smell. Yet, there are many other sensations which are just as essential to survival. Our nervous system also detects changes in movement and gravity. These sensory systems include: 1) balance and movement (our vestibular sense); the knowledge or the position of one’s head in relation to gravity and movement which is used to come down a slide, or ride a playground swing without falling off, and 2) muscle and joint sense (proprioception); the internal awareness of the position of one’s joints and muscles in space which allows you to life a spoon to your mouth without spilling your soup.

Our brains must organize this information so that we may function in everyday situations such as the classroom, at home, on the playground, and during social interactions. When one recalls all of the sensory modalities, it is truly amazing that one brain can organize input from all senses simultaneously, and still come up with a response to the demands of the environment. The complex nature of the interaction is reflected in the following example: “Johnny, please put your coat on.”

  1. Focusing your attention on the person speaking and hearing what they say.
  2. Screening out other incoming information going on around you.
  3. Seeing the coat and adequately making a plan for how to begin.
  4. Seeing the armhole openings and sensing muscle and joint position (which allows you to know where your arms are and where to put your arms in relation to the coat sleeves).
  5. With your sensitive touch awareness, you feel that the coat is on your body correctly.
  6. Adequate motor planning, touch awareness and fine motor skills to enable you to zip or button your coat.

We could continue with this breakdown, but the point is that the central nervous system is constantly focusing screening, sorting and responding to sensory information both from the external environment and from internal receptors in order to perform purposeful activity. Imagine the amount of SENSORY INTEGRATION needed to sit in a chair, pay attention in an active classroom, copy an assignment or read a book!

Sensory Integrative Disorders

Handwriting Without Tears

What happens if one or more of our senses are not being interpreted properly? A child with vague or hazy feedback about his sense of touch, body position, or movement and gravity is in a world totally foreign to ours. Imagine yourself in a world where something as basic and reliable as the pull of gravity or other children’s touch upon you is perceived as something unreliable, inconsistent, or threatening. The child would not feel the usual security, safety and fun that other children experience.

Occupational therapists with training in sensory integration provide therapeutic activities to facilitate child-directed treatment sessions. The child with sensory integrative dysfunction may participate in play activities but he does not play in a manner that is integrating or organized. The child needs an environment with suspended equipment especially designed to meet his needs. The therapist designs an environment to enable the child to interact more effectively. Following diagnosis of the child’s sensory system, the therapist encourages and assists the child in choosing activities that provide the appropriate amount of sensory input.
The therapist tries carefully to balance structure and freedom in a way that leads to constructive exploration. This balance is not easily achieved. Free play does not inevitably, in itself, further sensory integration. If it did, many children with dysfunction would have solved their own problems. But too much structure does not allow growth either. With this balance of structure and freedom, the therapist helps the child to develop both his neural organization and his inner direction. The child is given as much control over therapy as he can handle, as long as his activity is therapeutic. The therapist controls the environment, while the child controls his own actions. Self-confidence, or an improved attitude about one’s self, is often the first change parents notice in their children after they have started therapy. The child becomes more in command of his life because he develops better control of his body as his nervous systems functions better.

Adapted by: Janet McLaughlin, OTS and Karyn Russell, OTS
A. Jean Ayres (1979) and Ginger Grass, OTS, Cincinnati Public Schools
Revised February 1992 by Linda Palmstrom M.S., OTR/L

Jan Olsen, the Author of Handwriting Without Tears, has been an Occupational Therapist for 28 years. She developed the program when her own son was having trouble with handwriting in the first grade. Taking a developmental approach, she kept what worked, threw away what didn’t, and created Handwriting Without Tears. She spent many years working with children who had difficulty with handwriting. Since that time, Handwriting Without Tears has been adopted into the public school systems of 9 states.

The Purpose of Handwriting Without Tears
To teach children handwriting techniques that will make handwriting an automatic and natural skill. Children who know how to write, want to write!
It is a fun method of teaching handwriting that truly takes away the tears!
Children of all abilities are successful with handwriting when using Handwriting Without Tears.

Problems with Handwriting

Why are children having so much trouble with handwriting?

Children are expected to write but are not taught how to write.
Some educators believe that the computer keyboard can become a permanent alternative to handwriting. Many teachers say, “As long as I can read it….”, or “They will eventually just pick it up”. BUT…. Without a good foundation, a child will not achieve speed and neatness together, in handwriting. The writing may be OK until the child is expected to write with speed. When the quantity increases, problems with neatness and precision will develop.

The Handwriting Without Tears Program

  • Handwriting Without Tears techniques are taught like piano lessons where the child builds on what has been mastered.
  • The program is divided into three sections: readiness (pre-writing activities), printing, and cursive writing.
  • All techniques are developmentally based and diagonal lines ( the most difficult) are taught last. Letters are taught in groups of similar strokes.
  • Multi-sensory teaching techniques are used.
  • The children learn to use posture and balance, control and movement, perception and memory, and coordination correctly, to develop good handwriting habits from the very beginning.
  • Teacher demonstration – child imitation throughout the entire program.
  • Techniques used prevent and correct reversals.