THIRD

EDITION 1001
Pediatric
Treatment
Activities
Creative Ideas for Therapy Sessions

Ayelet H. Danto | Michelle Pruzansky

 AYELET H. DANTO, MS, OTR/L

MICHELLE PRUZANSKY, MS, OTR/L

 Vice President, Editorial: Jennifer Kilpatrick
Vice President, Marketing: Mary Sasso
SLACK Incorporated Acquisitions Editor: Brien Cummings
6900 Grove Road Director of Editorial Operations: Jennifer Cahill
Thorofare, NJ 08086 USA Cover: Tinhouse Design
856-848-1000 Fax: 856-848-6091
Project Editor: Erin O'Reilly Davis
www.slackbooks.com
© 2023 by SLACK Incorporated

Ayelet H. Danto and Michelle Pruzansky reported no financial or proprietary interest in the materials presented herein.

All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher, except for brief quota-
tions embodied in critical articles and reviews.

The procedures and practices described in this publication should be implemented in a manner consistent with the professional stan-
dards set for the circumstances that apply in each specific situation. Every effort has been made to confirm the accuracy of the infor-
mation presented and to correctly relate generally accepted practices. The authors, editors, and publisher cannot accept responsibility
for errors or exclusions or for the outcome of the material presented herein. There is no expressed or implied warranty of this book or
information imparted by it. Care has been taken to ensure that drug selection and dosages are in accordance with currently accepted/
recommended practice. Off-label uses of drugs may be discussed. Due to continuing research, changes in government policy and
regulations, and various effects of drug reactions and interactions, it is recommended that the reader carefully review all materials and
literature provided for each drug, especially those that are new or not frequently used. Some drugs or devices in this publication have
clearance for use in a restricted research setting by the Food and Drug and Administration or FDA. Each professional should determine
the FDA status of any drug or device prior to use in their practice.

Any review or mention of specific companies or products is not intended as an endorsement by the author or publisher.

SLACK Incorporated uses a review process to evaluate submitted material. Prior to publication, educators or clinicians provide impor-
tant feedback on the content that we publish. We welcome feedback on this work.

Library of Congress Cataloging-in-Publication Data

Names: Danto, Ayelet, author. | Pruzansky, Michelle, author.

Title: 1001 pediatric treatment activities : creative ideas for therapy
sessions / Ayelet H. Danto, Michelle Pruzansky.
Other titles: One thousand and one pediatric treatment activities
Description: Third edition. | Thorofare, NJ : SLACK Incorporated, [2023] |
Includes bibliographical references and index.
Identifiers: LCCN 2022030193 (print) | LCCN 2022030194 (ebook) | ISBN
9781630919924 (spiral bound) | ISBN 9781630919931 (epub) | ISBN
9781630919948 (PDF)
Subjects: MESH: Occupational Therapy--methods | Child | Psychomotor
Disorders--rehabilitation | Handbook | BISAC: MEDICAL / Allied Health
Services / Occupational Therapy
Classification: LCC RM735.3 (print) | LCC RM735.3 (ebook) | NLM WS 39 |
DDC 615.8/515--dc23/eng/20220803
LC record available at https://lccn.loc.gov/2022030193
LC ebook record available at https://lccn.loc.gov/2022030194

For permission to reprint material in another publication, contact SLACK Incorporated. Authorization to photocopy items for internal,
personal, or academic use is granted by SLACK Incorporated provided that the appropriate fee is paid directly to Copyright Clearance
Center. Prior to photocopying items, please contact the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA 01923 USA;
phone: 978-750-8400; website: www.copyright.com; email: [email protected]

Printed in the United States of America.

Last digit is print number: 10 9 8 7 6 5 4 3 2 1

 DEDICATION
In loving memory of my father, Azriel Golowa A”H, and my sister Dvora Golowa A”H.
The pride they had in me has served as an inspiration.
—Ayelet

In loving memory of my grandmother Ruth Naomi Weinstein A”H,

who always took pride in her grandchildren’s accomplishments.
—Michelle
 CONTENTS
Dedication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Important Warning and Disclaimer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii

Section I Sensory Integration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Chapter 1 Proprioceptive Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Chapter 2 Motor Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Chapter 3 Pressure Modulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Chapter 4 Bilateral Integration/Crossing Midline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Chapter 5 Vestibular System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Chapter 6 Tactile Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Chapter 7 Oral Motor Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45

Section II Visual System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49

Chapter 8 Visual Perception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Chapter 9 Visual Motor Integration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Chapter 10 Oculomotor Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63

Section III Dissociation Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71

Chapter 11 Body Dissociation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
Chapter 12 Finger Individuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

Section IV Hand Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83

Chapter 13 Open Webspace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
Chapter 14 Fine Motor Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89
Chapter 15 Pinch-Grasp Manipulation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95
Chapter 16 Hand Strengthening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99
Chapter 17 Handwriting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103

Section V Body Strengthening and Stabilizing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Chapter 18 Core-Strengthening Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Chapter 19 Balance Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
Chapter 20 Upper Arm Strengthening and Stabilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129

Section VI Cognitive and Higher-Level Skill Building . . . . . . . . . . . . . . . . . . . . . . .139

Chapter 21 Increasing Attention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141
Chapter 22 Executive Functioning and Organizational Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143

Section VII Social Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

Chapter 23 Increasing Social Interaction and Relatedness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147
Chapter 24 Group Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151
Chapter 25 Seasonally Themed Projects and Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159
viii Contents
Section VIII Improving Gait Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163
Chapter 26 Increasing the Arches of the Foot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165
Chapter 27 Decreasing External Rotation of the Hips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169
Chapter 28 Decreasing Internal Rotation of the Hips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175
Chapter 29 Addressing Toe-Walking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .181

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .187
Appendix A: Worksheets and Handouts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191
Appendix B: Therapeutic iPhone and Android Apps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255
Appendix C: Occupational Therapy Telehealth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .261
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .265
Brand Name Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .267
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .271
 ACKNOWLEDGMENTS
First, I thank God for giving us the opportunity, ability, and idea to write this book.
I thank my mother, Judith Golowa, and my in-laws, Dr. Joseph and Marilyn Danto, for all their support,
encouragement, and unconditional love.
To the best children a mother could want, Avraham Simcha, Moshe, Sara, Aharon, Nechama, and Racheli,
I love you more than you can know.
Finally, I thank my best friend and partner in everything, my husband, Nesanel, for his endless love, constant
support, and wisdom.
—Ayelet

I would like to thank my parents and in-laws, Brenda and Bill Wiener and Amy and Lawrence Pruzansky, for
always supporting me, believing in me, and being there for me. Your love and guidance have meant the world to
me. You are all wonderful parents and grandparents. I know I can count on you for anything in the world and am
lucky to have you all in my life.
I would like to thank my children, Samantha, Ally, and Nicole. Raising three beautiful daughters, you are a
constant source of love, joy, and pride.
Lastly, to my wonderful husband, Jason. You dedicate your life to your family and bring me smiles and happi-
ness. I love you.
—Michelle
 ABOUT THE AUTHORS
Ayelet H. Danto, MS, OTR/L, is an occupational therapist who has worked in various school settings with a
broad range of diagnoses. She currently works in the Passaic public school system. Ayelet received her bachelor’s
degree in psychology from Yeshiva University Stern College for Women and a master’s degree in occupational
therapy from Columbia University. She resides in Passaic, New Jersey, with her husband and children.

Michelle Pruzansky, MS, OTR/L, is a pediatric occupational therapist specializing in the treatment of children
with autism spectrum disorder. Michelle received her bachelor’s degree from Yeshiva University Stern College for
Women and her master’s degree in occupational therapy from Columbia University. Michelle currently lives in
New Milford, New Jersey, with her husband and children. She currently works in various school settings in New
Jersey.
 INTRODUCTION
As many pediatric therapists know, when working with children for extended periods of time in the same envi-
ronment, it is quite challenging to find and develop new and exciting treatment activities. In order to be effective,
therapists must not only treat specific impairments, but do so in a creative and resourceful manner that engages
children and maintains their attention and interest. It is for this reason that we developed this guidebook.

History
While working in a public school setting in a multidisciplinary team of therapists, we found ourselves using the
same activities over and over again. It became challenging for the therapists to constantly be coming up with fresh
ideas. To make matters worse, many children noticed that they were engaging in the same activities session after
session. Hearing “Didn’t we already play this game?” or “This again?” was not encouraging. In an effort to find
new ideas, we searched for different resources and books that could help with this problem. Although we were able
to find some resources that addressed a specific treatment area, we were not able to find any that comprehensively
covered the gamut of treatment areas that were typically addressed in a pediatric setting. So, we decided to take
action and do something about this problem.
We started by putting together a list of treatment areas that are typically addressed in pediatric therapy. We then
began to compile lists of different and exciting activities for each treatment area with the help of other therapists
from a variety of disciplines. Every day we would add new activities to our list. This small list began to evolve into
a binder full of activities. Soon enough, we started to realize that even the most creative and experienced therapist
can really benefit from new ideas. That is when we decided to put our efforts toward publishing this book.

Purpose
The purpose of this book is to enhance resources available to therapists. This book serves to add to our profes-
sion’s working knowledge and access to treatment activity ideas in a wide range of areas. It is meant to be a quick
and simple reference or handbook for any pediatric therapist looking for new ideas for a therapy session.

How to Use This Book

As this book is intended to be used as a quick reference, it is not meant to provide a detailed activity analysis
for the different topics addressed. The book was organized and written in a way that enables its user to quickly
open it and skim a chapter for new ideas. The activities were carefully organized and written in simple language
and with the intent of being as concise as possible.
While most activities can be explained in a short sentence, some activities require elaboration. Therefore, many
activities in this book are also accompanied by a photograph to help further illustrate the intent and setup of the
activity.

Contents and Organization

The information in this book is divided into eight sections, each with multiple chapters. Each chapter within a
given section provides the following information:
• An introduction
• A brief description explaining the treatment topic
• An explanation of why a particular skill is important
• A list of compensatory strategies that may be employed by the child who is deficient in the particular skill
• A list of treatment ideas and activities in which to engage, in order to work on the specific treatment goal
• Examples of commercial products that can be used to address the treatment goal
Generally, treatment activities were placed in the most suitable sections; however, many activities addressed
more than one goal at a time. For this reason, there were several activities that were listed in multiple sections.
xiv Introduction

Frame of Reference
Multiple frames of reference were used when compiling this book, including the biomechanical frame of refer-
ence and the sensory motor model (Giroux Bruce & Borg, 2002). The intent of this organization was to offer a wide
variety of easy-to-access activities to choose from in many different areas. However, the purpose of this book is not
intended to dictate the way treatment is given, but rather to provide therapists with the tools necessary to come up
with different treatment activities. It is up to the treating therapist to determine the appropriate frame of reference
to use with each individual child.

Who Should Use This Book

This book was written with the intent to be used primarily by pediatric occupational and physical therapists.
However, this book may also be useful for teachers, psychologists, or other pediatric educators.
Many activities provided in this book require skilled and experienced knowledge of working with children and
may be harmful or ineffective if used in the wrong way. Therefore, it is important that any layperson using this book
consult with a physical or occupational therapist before performing any of the suggested activities. It is also crucial
that any activities that are unclear be reviewed with a trained pediatric occupational or physical therapist.

Populations Intended for

This book was written to be used in a wide range of populations and pediatric settings. Specifically, these settings
include a pediatric clinic, school-based setting, hospital, and home-based therapy. When writing this book, a wide
variety of diagnoses and conditions were kept in mind including, but not limited to, children with fine motor and
gross motor delays, traumatic injuries, congenital abnormalities, perinatal injuries, attention deficit/hyperactivity
disorder, cerebral palsy, autism spectrum disorder, dyspraxia, global delays, learning disabilities, Down syndrome,
and other chromosomal disorders.

About Play
As mentioned earlier, particularly when working with children with disabilities, each child displays different
strengths and weaknesses and does not necessarily develop according to a defined schedule. However, it is helpful to
remember the different stages of play that children normally engage in at different points of development as a refer-
ence point. This can be of assistance in choosing age/developmentally appropriate play activities for a child from the
variety of play activities included in this book.
Nancy Takata developed play epochs under the leadership of Mary Reilly, the famous occupational therapist who
was instrumental in developing the occupational behavior frame of reference (Parham & Fazio, 1997).
Takata’s play epochs can be understood in the explanation below (ages identified are approximate; Takata, 1974):
• Sensorimotor (age 0 to 2 years): Solitary play (no peer interaction) involving motor and sensation, such as Peek-
a-Boo, “Patty Cake,” imitation of caregivers, container play, exploring objects, practicing new motor skills, and
simple problem solving.
• Symbolic and simple constructive (age 2 to 4 years): Beginning of make-believe and pretend play, shift from soli-
tary play to parallel play (playing side by side with peer with little or no interaction); building simple construc-
tions that represent another object or situation; practicing climbing and running.
• Dramatic, complex constructive, and pregame (age 4 to 7 years): More social participation; associative play (par-
ticipating in group with a shared activity), dramatic role-playing enacting daily experiences, social roles, fairy
tales, and myths; skill in activities requiring hand dexterity; daredevil activities involving strength and skill
outdoors; constructions are realistic and complex; verbal humor, creates rhymes.
• Game (age 7 to 12 years): Games with rules; fascination with rules; masters established rules and makes up new
ones; risk taking in games; concern with peer status; friendship groups are important; interest in sports and for-
mal groups; cooperative play (cooperates with peers in highly organized activity); interest in how things work,
nature, and crafts.
 Introduction xv
• Recreational (age 12 to 16 years): Formal peer group orientation, teamwork, cooperation, respect for rules, games
that challenge skills, competitive sports, service clubs; realistic constructive projects and complex manual skills.
Although this information is helpful, when choosing a play activity for a child, it is of the utmost importance to
keep in mind the preferences and desires of the particular child with whom you are working.

Final Things to Consider

• Grading: Grading an activity is the ability to modify an activity’s challenge level to suit the skill level of a child.
While some methods of gradation are provided within this book, it is left up to the treating therapist for the most
part to properly grade the activity to an appropriate level of challenge. Grading an activity must be done on an
individual basis, keeping the different components of the activity in mind, along with the different strengths and
weaknesses of the child.
• Repetition: Repetitive practice of a skill helps a child improve in an area and generalize the skill to other areas.
It is for this reason that multiple activities and ideas are provided for each treatment topic addressed.
• Fatigue: When supervising children engaged in different treatment activities, it is important to watch the child’s
level of fatigue. Pushing a child too hard can be unsafe and ineffective from a therapeutic standpoint. This is
especially true for many children with low muscle tone and other medical diagnoses.

What's New
The following items have been added to the third edition of 1001 Pediatric Treatment Activities: Creative Ideas for
Therapy Sessions:
• Dozens of new fun and engaging activities
• Full-color images and additional pictures throughout to support and help explain the various activities
• Current evidence based on today’s research added to each chapter introduction
• Chapter on handwriting and an appendix on teletherapy
• An up-to-date list of therapeutic apps

Conclusion
It has been both rewarding and hard work updating, editing, and expanding upon the third edition of this book. It
is our hope that our fellow clinicians benefit from the activities presented and make therapy more fun for the children
with whom they work. We urge readers to use caution and sound clinical reasoning when implementing the activi-
ties provided. We challenge clinicians to continuously employ innovative strategies and expand upon what we have
presented in this book. We wish all therapists the best of luck in their future endeavors!
 IMPORTANT WARNING AND DISCLAIMER
The authors of this book are not responsible for use or misuse of the treatment activities provided. All activities
provided should be closely supervised by a trained occupational or physical therapist or be performed under the
guidance of one. Before implementing any activities provided in this book, one must first check for any medical
contraindications. In addition, several activities involve the use of food; it is important to check for any food aller-
gies before using food in an activity.
It also is important to be aware of toys or objects that may pose a choking hazard to infants and small children.
The general rule is that the size of the toy should not fit through a toilet paper roll, but it is best to always consult a
pediatrician.
Moreover, before beginning treatment with any child, it is always important to become familiar with the child’s
background information, specifically that which is related to any medical conditions or diagnoses that may have
accompanying contraindications or sequelae that may adversely affect a child in a specific activity or exercise.
Finally, there are many activities throughout this book that involve the use of therapeutic handling techniques.
It is important that the therapist be skilled in proper handling techniques in order to safely and effectively imple-
ment the chosen activity. To become familiar with these handling techniques, the therapist should contact a trained
pediatric occupational or physical therapist familiar with the specific population of interest.
 I
Sensory Integration

Sensory integration is the ability of the brain and body to take in information through the senses and interpret it
meaningfully (Ayres, 2005). The seven senses include vision, touch, taste, smell, hearing, the vestibular sense (movement/
balance), and the proprioceptive sense (body awareness/deep pressure; Foster & Verny, 2007). Sensory integration dysfunc-
tion, sensory processing disorder, and sensory modulation disorder refer to children who demonstrate atypical responses
to sensory stimuli (Koziol et al., 2011).
The Interdisciplinary Counsel of Developmental and Learning Disorders has grouped sensory modulation disorder
into three categories: sensory overresponsivity, sensory underresponsivity, and sensory seeking/craving (Koziol et al.,
2011). Both hyposensitivity and hypersensitivity to sensory stimulation occur in approximately 5% of children within the
general population, while it is found in 40% to 80% of children with developmental disorders (Baranek, 2002). Another
manifestation of sensory integration disorder is when a child’s brain and body fails to interpret sensory information prop-
erly, causing the child to be clumsy and have difficulty learning new motor tasks (Ayres, 2005).

PROPRIOCEPTIVE ACTIVITIES
Proprioception is a sense that tells a person the location and orientation of their body and limbs during stationary and
movement activities (Ayres, 2005, p. 41). Difficulty processing proprioceptive input is especially common in children with
developmental disabilities (Blanche et al., 2012). Proprioception can be defined as the sum of neuronal inputs from the
joints, ligaments, muscles, tendons, and skin, that affects motor control and may also affect other components of sensory
regulation (Ayres, 1972). Deep pressure can also be a beneficial form of proprioceptive input and result in a calming
and organizing effect (Grandin, 1992). The use of proprioceptive input in the form of weighted equipment can also help
increase attention in children as well (Miller et al., 1999).
 1
Proprioceptive Activities

CLEANUP/SETUP ACTIVITIES Therapist massages child’s back and feet.

Vibrations: Therapist uses an Innergizer or another
vibrating machine and moves it along the child’s arms,
Child removes chairs from table and places them on legs, and back. (Figure 1-1; refer to user’s manual for
top of table during cleanup. safety precautions and contraindications.)
Child drags and rearranges small tables, desks, chairs, Brushing protocol: Refer to Wilbarger’s brushing pro-
and other small furniture in the room. tocol for instructions (Wilbarger & Wilbarger, 1991).
Child hangs up large mats or pulls them toward one Therapist brushes and provides joint compressions
side of the room. to child according to brushing protocol.
Older children can be taught to brush themselves
(joint compression will require another adult;
DEEP PRESSURE ACTIVITIES Figure 1-2).
Joint compressions: Refer to Wilbarger’s brushing pro-
Bear hugs: Therapist gives child a large hug, wrapping tocol for instructions (Wilbarger & Wilbarger, 1991).
their arms all the way around the child’s trunk and Lycra swing: The material in a Lycra swing surrounds
shoulder girdle, maintaining constant and firm pres- the child’s body and provides deep pressure. Different
sure. Lycra swing activities include the following:
Mummy-wrap game: Therapist wraps child tightly in a Therapist swings child in Lycra swing (Figure 1-3).
sheet, blanket, or towel. Therapist tucks the end of the
material in and has child walk across the room without Therapist plays Peek-a-Boo with child hidden in
letting the sheet/blanket/towel fall to the ground. swing.
Therapist ties two children together with Lycra mate- Child climbs up the swing and slides down—only
rial and has them walk across the room together. with long Lycra swing (Figure 1-4).

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 3-12).
© 2023 SLACK Incorporated.
4 Chapter 1

Figure 1-2.

Figure 1-1.

Figure 1-4.

Figure 1-3.
 Proprioceptive Activities 5

Figure 1-6.

Figure 1-5.

Figure 1-8.

Figure 1-7. Hot Dog and Sandwich games: Therapist pushes against
child with big pillows and has child pretend to be a hot
dog while the pillows are the buns. Therapist should
Body sock: Therapist places child in a body sock use careful judgment when pushing against child and
(Figure 1-5) and asks child to do the following: providing deep pressure.
Walk around the room. Ball-pit games
Play Simon Says. Child crashes into the ball pit.
Play “Patty Cake.” Child hides self underneath the balls; then the
Quadruped activities: Child goes into quadruped posi- therapist tries to find the child.
tion and does the following: Crab-walking: Child crab-walks across the room
Colors on a large piece of oak tag (Figure 1-6). (Figure 1-7).
Places pegs into a peg board on the floor or on a Wheelbarrow-walking: Child wheelbarrow-walks
slightly raised surface. across the room (Figure 1-8).
Assembles a puzzle. Child wheelbarrow-walks up ramp and then the thera-
pist gently pulls the child down the ramp by the legs
Maintains quadruped stance and counts to ten. carefully controlling the child.
6 Chapter 1

Figure 1-9. Figure 1-10.

Figure 1-12.

Figure 1-11.

Push-ups: Child performs different push-ups, including

Regular floor push-ups (Figure 1-9).
Half push-ups with knees touching floor (Figure
1-10).
Wall push-ups (Figure 1-11).
Couch push-ups: Child lies on a couch on belly,
hanging over the edge. Child places arms on the
floor and pushes off the floor keeping lower body
on the couch (Figure 1-12).
Chair push-ups: Child sits on a chair, grabs each
side of the chair with hands and pushes down with
hands in order to lift themself up slightly off the
chair. The child then lowers themself back down to
a seated position (Figure 1-13).

Figure 1-13.
 Proprioceptive Activities 7

Figure 1-14. Figure 1-15.

Chin-ups: Child pulls self up on chin-up bar (Figure Child wears ankle and wrist weights during an activity.
1-14). Therapist places a weighted lap pad on child during a
Controlled pillow fights: Child and therapist take seated activity.
turns pushing each other with large pillows. Specific Child wears a weighted vest.
rules and guidelines of this game should be made clear
in advance and the game should be terminated if the Child lies in prone position (on belly) and therapist
child becomes too rowdy or is not following the rules places a weighted blanket over child’s back.
(Figure 1-15). Child plays catch with a weighted ball.

ACTIVITIES UTILIZING HEAVY WORK ACTIVITIES

WEIGHTED EQUIPMENT Therapist places heavy objects on a scooter or in a
wheelbarrow, and the child pushes it around the room.
Although as yet there are no standardized guidelines, Therapist places several textbooks (approximately 5%
many recommend that therapists should use approximate- of child’s body weight) in child’s backpack, and the
ly 5% of the child’s total body weight when placing weights child carries the heavy objects across the room.
in weighted garments (Reichow et al., 2010; VandenBerg,
Therapist and child take turns giving “rides.” Therapist
2001).
sits on a chair with wheels and child gives a “ride.”
Therapist places weights in child’s shirt and pants Therapist and child then switch positions, and thera-
pockets. pist pulls child around the room.
8 Chapter 1

Figure 1-16. Figure 1-17.

Parachute games: Child sits in the center of a parachute Leaning Tower of Pisa game: Two children (or therapist
while another child pulls the parachute around with an and child) face each other and place hands palm-to-
adult assisting (Figure 1-16). palm. Therapist and child lean into each other and
Scooter activities hold this position for as long as possible, pretending
to be the Leaning Tower of Pisa (Figure 1-18). This
Child lies on belly on a scooter board and propels activity should be performed on a mat and closely
themself around the room using upper extremities. supervised.
Child lies on belly on a scooter board and pulls Modified wrestling: Therapist faces child. Therapist
themself up a ramp using upper extremities. and child lock hands and lean in toward each other.
Child lies on belly on a scooter board and holds The object of this game is to see who can keep their
onto a bungee cord or jump rope and gets pulled balance longer without falling backward or to the side.
by therapist. (An alternative method of this game This game should be closely supervised to make sure
would be to have child lie in prone position on the nobody gets hurt and should be only played with a
scooter board, tie a jump rope around a doorknob, child who will not become overly rowdy. This game
and have the child pull themself back and forth.) should be played on a soft mat.
Child and therapist make large Tic-Tac-Toe board “Row, Row, Row Your Boat” game: In this game, child
with masking tape on the floor. Child cuts out sits on the floor, facing either the therapist or another
circles and squares out of construction paper. Both child, each holding onto one end of a jump rope (posi-
then play Tic-Tac-Toe prone on scooters. tion I) or onto each other’s wrists (position II). As both
Therapist places Tic-Tac-Toe pieces on the other side sing the song, one person leans back as the other leans
of the room and has child use a scooter board to forward and then the opposite.
retrieve each piece at each turn. Position I (Figure 1-19).
Child sits on swing and holds onto one end of a Hula Position II (Figure 1-20).
Hoop. Therapist holds onto the other end and pulls Therapy ball activities
child back and forth on the swing (Figure 1-17).
Therapist rolls a very large therapy ball toward the
Squeeze a squeeze toy: Child squeezes a resistive ball, child quickly. Child must stop it and then push it
Koosh ball, or other sensory ball. back toward the therapist very hard and quickly.
Velcro toys: Child pulls apart different toys fastened Child pushes against a large therapy ball while
together by heavy-duty Velcro. another child or therapist gives resistance from the
Child pretends to be as strong as a superhero with spe- other side (Figure 1-21).
cial powers. Child then pushes against the walls and
pretends that the walls are moving.
 Proprioceptive Activities 9

Figure 1-19.

Figure 1-18.

Figure 1-21.

Figure 1-20.
Stapling: Child staples papers onto a bulletin board
Child pushes a large therapy ball through a Lycra with adult supervision or assists in stapling stacks of
tunnel. Make sure that the therapy ball is larger papers that need to be stapled together.
than the walls of the tunnel so that the child will Theraputty exercises
have to use resistance to push the ball through Child pinches, pulls, and squeezes Theraputty.
(Figures 1-22 and 1-23).
Child hides different objects in the putty and then
Child holds a medium-sized therapy ball in the air tries to find them as quickly as possible. (This activ-
with arms and legs while lying on back. Therapist ity can be made more exciting by using a timer to
tries to take the ball away and has child hold onto see how quickly the child can work and then see if
the ball as tightly as possible. the child can break their record or by letting them
Door opener: Child opens a large, heavy door and then keep a prize found in the putty.)
keeps it open while others walk through. Theraband exercises
Bubble Wrap Child places Theraband under both feet and pulls
Child pops bubbles on Bubble Wrap paper. up with both arms at each side (Figure 1-24).
Child jumps up and down on a sheet of large Bubble
Wrap paper.
10 Chapter 1

Figure 1-22. Figure 1-23.

Figure 1-24. Figure 1-25.

Child holds Theraband with both hands at chest Therapist ties Theraband around both front legs
level and pulls Theraband apart to each side (Figure of a chair and lets child kick back at Theraband as
1-25). needed in the therapy session or the classroom.
Child holds Theraband behind back and pulls out Child colors on a chalkboard or dry-erase board and
with both hands (Figure 1-26). then washes and dries the board, pushing very hard
Therapist ties Theraband to the side of a chair. Child onto the surface.
pulls and tugs at Theraband throughout therapy Tug-of-war (Figure 1-27).
session or during class as needed while performing Trapeze bar: Child hangs onto trapeze bar by holding
seated activities. on with hands or hanging upside down and hanging
from legs.
 Proprioceptive Activities 11

Figure 1-26. Figure 1-27.

CLIMBING ACTIVITIES
Child climbs up a ladder in the therapy room.
Child climbs up the wall with their legs: Place child
in a quadruped position with child’s feet next to the
wall. Have child walk feet slowly up the wall so that
the child’s body is in a 90-degree angle with the wall
(Figure 1-28).
Child swings across monkey bars on the playground
(Figure 1-29).
Child hangs on single monkey bar on the playground
(Figure 1-30).

JUMPING ACTIVITIES
Should be done under close supervision of a therapist.
Figure 1-28.
“Pop Goes the Weasel”: Child squats on the floor and
sings “Pop Goes the Weasel.” Every time the word
“pop” is sung, child should jump up. Relay races: Have child or group of children frog jump
from one end of the room to the other.
“Five Little Monkeys Jumping on a Bed”: Child squats
on the floor and sings “Five Little Monkeys Jumping Child jumps on a trampoline and then crashes into big
on a Bed.” The child should jump up and down dur- pillows.
ing this part of the song. Child should then crash into Child jumps up and down on either a mattress or large
a large pillow or bean bag at the point where the song pillows/bean bags.
says “one fell off and bumped his head.” Child jumps off of a high surface into a large bean-bag
pillow.
12 Chapter 1

Figure 1-29. Figure 1-30.

BAKING ACTIVITIES SPECIAL FOODS TO EAT

Knead dough: Therapist and child perform a baking Be aware of any allergies or special diets before giving a
activity that requires kneading dough (e.g., cookies, child any food. Additionally, rule out any feeding or swal-
pizza, bread). Child uses hands to knead the dough. lowing problems before using food in treatment.
Therapist uses a recipe that requires mixing of heavy Therapist provides child with crunchy/hard foods,
dough or another resistive substance and has child such as oat bars and crunchy cereal.
mix the batter with a baking utensil or handheld non-
electric mixer. Therapist provides child with chewy foods, including
bagels, gum, licorice, chewy bars, and peanut butter.
 2
Motor Planning
Motor planning refers to the process of preparation of Tic-tock-tire: Therapist hangs up a tire swing (a Hula
a movement that occurs during the reaction time prior to Hoop is okay, too) and swings it from side to side. A
onset of the movement (Wong et al., 2015). A child with bucket full of small items (bean bags, Koosh balls,
motor planning difficulties may appear clumsy and unco- etc.) is placed on the floor to the side of the child. The
ordinated. Difficulty with motor planning is often associ- child is asked to pick up one item at a time and throw
ated with decreased body awareness (Ayres, 1965). There it through the moving tire without letting it touch the
is an association between engaging in physical exercises tire.
involving complex motor planning tasks and a neurologi- To make this activity more challenging, ask child to
cal change in the motor pathways of the areas in the brain stand on a balance board while throwing the bean
controlling these movements (Jacini et al., 2009). There is a bags.
long history of occupational therapy being involved in the
treatment of motor coordination impairments (Wilson et To downgrade this activity, keep the tire still or
al., 2000). move it ever so slightly (Figure 2-2).
This activity can also be played in the form of catch,
with the child standing on one side of the tire and

MOTOR PLANNING the therapist on the other. The game is played with
a small ball while keeping the tire swaying from side

TREATMENT ACTIVITIES to side.

Body Positioning
Ball Activities Imitation of different body positions
Neck ball: Child holds a ball with neck and passes Child tries to imitate another child or therapist’s
it along to another child’s neck without using hands position.
(Figure 2-1).

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 13-19).
© 2023 SLACK Incorporated.
14 Chapter 2

Figure 2-1.

Figure 2-2.

Figure 2-3.

Child plays Simon Says, imitating different positions.

Child is shown photographs of people in different
positions and tries to place self in same position as
person in the photograph.
Imitation of different finger and hand positions:
Therapist faces child and positions own hands or fin-
gers in a specific position. Therapist holds the position
and asks child to try to create a mirror image of the
position. Figure 2-4.

Animal-walk: Therapist assigns child an animal and

then asks child to assume the different animal posi- Statue game: This activity can be played one to one or
tions. Child then walks across room in these posi- in a group. Therapist designates a leader and asks the
tions. Some examples include frog, kangaroo, snake, leader to pretend to be different statues. Child must
elephant, lion, bear, and rabbit (Figures 2-3 and 2-4). then try to imitate the different statues and positions.
 Motor Planning 15

Figure 2-5.

Body letter making: Therapist places children in groups

of two to four. Therapist asks each group to pick a let-
ter (A to Z) out of a hat. Therapist tells children in a
specific group to try to place their bodies in the correct
positions to make the letter on the floor. (This game
can also be played individually but will then work with
only some of the alphabet letters.)

Body Movement Games Figure 2-6.

Child points to and labels different body parts upon

request. This activity can be made more exciting if
played to a song, such as “Head, Shoulders, Knees, and
Toes” and “If You’re Happy and You Know It (touch
your nose, head, etc.).” (Singing these songs in front of
a mirror may help if child is having trouble touching
the correct body part.)
“Hokey Pokey”: Therapist sings the “Hokey Pokey”
song while helping child place the correct body part in
and out of the circle. (This game can also be helpful for
right/left orientation.)
Hopscotch: Therapist creates a hopscotch board on the
floor with masking tape (or sidewalk chalk outside).
Child plays hopscotch and concentrates, when jump-
ing, on opening, closing, and alternating feet onto
correct spaces.
Child climbs on top of a therapy ball and uses a tra-
peze bar to climb into a Lycra swing. To upgrade this
activity, tell the child which foot/arm to put in first
(Figure 2-5).
Elbow to knee: Child raises left knee and taps it with
right elbow, then repeats on opposite knee with other
hand (Figures 2-6 and 2-7).
Figure 2-7.
16 Chapter 2

Figure 2-8. Figure 2-9.

Child sings “The Itsy Bitsy Spider” along with thera-

pist. Child brings right index finger to the left thumb
and left index finger to the right thumb, then flips
fingers up in alternating fashion (Figures 2-8 and 2-9).
Child self-pumps on frog swing or on playground
swing.
Therapist holds up a series of Hula Hoops and child
crawls/walks through them without letting the hoops
touch their body. Child can also try and walk through
the tire swing without touching it (Figure 2-10).
Child spins a Hula Hoop around each wrist, starting
and stopping every few seconds on cue (Figure 2-11).
Child performs multistep obstacle courses, which can
include the following:
Climbing toys
Slides
Crash mats
Bean bags
Ball pits
Balance beam/balance board
Trampolines
Suspended equipment
Figure 2-10.
 Motor Planning 17

Figure 2-12.

Figure 2-11.

Child climbs on unfamiliar playground equipment

(Figures 2-12 through 2-15).
Therapist places toy a small distance from the child
(developmental age 7 to 12 months; Cottrell, 2004,
p. 19). While sitting on the floor, therapist then puts
out his or her leg as an obstacle for the child to crawl
over in order to get to the desired toy.
The therapist can also place other obstacles, such as
pillows or soft wedges, for the child to crawl over.

Activities With Eyes Closed

Child closes eyes, and therapist touches a specific body
part on the child, applying consistent pressure for 1 or
2 seconds and then removing hand. Child then opens Figure 2-13.
eyes and identifies the body part touched.
Therapist places a red dot on the wall at the child’s eye
level. Child moves index finger from nose to dot and
back three consecutive times. Child then tries to per-
form this activity with eyes closed.
18 Chapter 2

Figure 2-14. Figure 2-15.

Therapist draws a number/letter/shape with finger on

child’s back. Child tries to guess what was drawn. Rolling
This activity can also be played on child’s hands:
Child rolls on a mat and keeps body straight.
Have child close eyes and then therapist draws a
number/letter/shape on back of the child’s hand. Log-roll game: Child rolls on mat. When therapist says
Child then guesses what was drawn. stop, child must freeze and say if they are on back,
belly, or side.
This activity can be downgraded by giving child a
choice of two possible guesses of things that were
drawn.
Hide and seek: Therapist and child play together. (This
activity requires child to completely cover their entire
body, which helps to increase awareness to all the dif-
ferent parts of the body. This is because the child must
pay attention to body parts that are occluded from
vision.)
 Motor Planning 19

Running, Skipping, Jumping

Child performs a running jump through tire swing. (A
mat must be used, and the therapist should lower the
swing so that the child is able to jump through easily.)
Therapist teaches child how to skip and gallop.
Child practices jumping rope (Figure 2-16).

Commercially Available
Products
First Hand
Jenga
Skip It
Twister
Woggler

Figure 2-16.
 3
Pressure Modulation
Pressure modulation is the ability of the body and joints
to know the level of force to exert when completing a motor PRESSURE MODULATION
ACTIVITIES
task. Poor pressure modulation can occur in many areas,
from self-care to play activities. For example, a child with
decreased pressure modulation may be unable to push toys
together or pull them apart. Using too much or too little
force during writing tasks is a common problem faced by Sports
many children (Srivastava, 2016). Research has shown a
There are several sports that require precise pressure
relationship between high pressure or force on a writing
modulation in order to be played successfully. Some of
instrument associated with decreased legibility (Harris &
these include basketball, volleyball, miniature golf, ping-
Rarick, 1959). Inability to grade force may even have social
pong, and billiards/pool.
implications, as a child may unknowingly be overly aggres-
sive with their peers. Child throws a ball against the wall and catches it.
There are many activities and exercises that can help a (Upgrade this activity by having child stand on a bal-
child improve pressure modulation. Activities that combine ance beam when throwing the ball.)
discrimination of tactile, proprioceptive, and vestibular Child throws a ball to a Velcro bull’s-eye target
components can lead to smooth, graded, and coordinated (Figure 3-1).
movement (Miller et al., 2007). The exercises provided in Balloon volleyball: Child hits balloon toward therapist
this chapter require a child to grade their force in order to with either a racquet or hands. Child tries to keep bal-
be successful with that activity. When performing an activ- loon from touching the floor as long as possible.
ity requiring the use of graded force, a therapist can upgrade
the activity by placing a balance demand on the child in Horseshoe toss: Therapist places stakes or sticks onto
addition to the pressure modulation exercise itself. This the floor or in the ground outside. Therapist provides
will additionally challenge the child because this activity child with horseshoes and has child toss the horseshoes
requires more refined and precise pressure grading when onto the sticks.
placed on dynamic surfaces or during movement activities.

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 21-24).
© 2023 SLACK Incorporated.
22 Chapter 3

Figure 3-1.

Ring toss: Therapist places cones on floor and provides Figure 3-2.
child with rings or Hula Hoops. Child then tosses rings
onto cones.
Letter/shape shading: Therapist places cutout letters
Darts: Child shoots darts onto wall or a bull’s-eye. (The or other shapes from poster board and places them
child can stand further or closer to the wall in order to under the paper and asks child to shade the paper with
upgrade or downgrade the activity.) a pencil or crayon.
Skee-Ball: Child plays Skee-Ball if the equipment is Leaf shading: Therapist places leaves under a piece of
available or therapist can simulate a Skee-Ball setup. thin, white paper and asks child to lightly shade on top
of the paper with a pencil or crayons.
Craft Projects
Rainbow making: Therapist gives each child a black- Child draws the same picture three times with either
and-white rainbow. (See p. 192 of Appendix A for a crayon or a pencil. The first time the child should
sample template of project.) Child squeezes glue onto draw it as hard as possible, the second time as soft as
one line at a time and then sprinkles glitter on that line. possible, and the third time with a middle amount of
Child proceeds to glue the following line and sprinkle pressure. For smaller children who cannot understand
it with glitter of a different color. this task, ask them to just draw three lines (hard, soft,
and medium).
Puff paint: Child creates craft projects using puff paint.
Therapist reminds child that if too much pressure is
applied to the tube, too much paint may come out.
Child squeezes icing onto cookies in order to decorate
Tinfoil writing: Child writes name or makes a picture
them.
with toothpicks on a piece of tinfoil and tries not to rip
the foil.
Therapist places piece of paper on a soft surface (e.g., Recreational Children’s
cushioned chair, mouse pad) and provides child with
sharpened pencil (pencil tip must be very pointy). Games
Child then writes on paper or colors picture on paper
without poking hole through paper. Squeeze toys: Child squeezes a rocket launcher toy
toward a target on the floor (Figures 3-2 through 3-4).
Glitter-glue pens: Child squeezes pens to make a
picture. Pop Beads: Child pushes together and pulls apart Pop
Beads.
Child builds a tower with wooden blocks, trying not to
Coin shading: Child places a quarter or another coin allow the tower to fall.
under a piece of thin, white paper (not construction
paper). Therapist provides child with a pencil and child
lightly rubs pencil over the paper on top of the coin. A
light imprint of the coin should show up on the paper.
 Pressure Modulation 23

Figure 3-3.
Figure 3-4.

Dominoes: Child creates a long line of dominoes on a

flat surface and then tips the last domino to watch the Bowling pins: Child sets up bowling pins or other light
domino effect. It may be necessary to assist child in this objects flat on the floor or makes a tower with them.
task to make sure they do not accidentally knock over a Child then crashes into it or rolls a ball into it.
domino too early (Figures 3-5 through 3-7). Yo-yos: Therapist teaches child how to play with a
Card stacking: Child copies different card-stacking yo-yo.
houses from a model. (An easier version of this activity Keyboard typing: Child types different words or plays
is building houses or pyramids by stacking disposable different games on a computer keyboard.
plastic cups.) Lining up figurines: Child lines up small figurines gen-
Child builds multiple stacks of 10 to 15 pennies side tly, trying not to let them fall.
by side.
Mummy-wrapping game: Child wraps another child or
adult with toilet paper. Child must use only light pres-
sure in playing this game or else the toilet paper will
rip. (Try to use heavy-duty toilet paper for this project.)
24 Chapter 3

Figure 3-5. Figure 3-6.

Commercially Available
Products
Angry Birds Mega Smash
Barrel of Monkeys
Don’t Break the Ice
Don’t Spill the Beans
Jenga
Kerplunk
Konexi
Magformers
Magna-Tiles
Penguin Pile-Up
Pick Up Sticks
Rainbow Loom
Super Catch
Topple Chrome

Figure 3-7.
 4
Bilateral Integration/
Crossing Midline
Bilateral integration is the ability to coordinate both ties (e.g., dressing, putting on socks, turning the steering
sides of the body for a purposeful action. Deficits with wheel when driving a car, writing across a page, many play
bilateral integration can make simple, every day preschool activities; Van Hof et al., 2002).
activities challenging and frustrating (Dunbar, 1999). There To be able to cross midline, one needs adequate bilat-
are different components to bilateral integration. It includes eral integration skills. Many activities that involve crossing
performing an act with both sides of the body simultane- midline also require the use of both hands and sides of the
ously. This is called symmetrical bilateral integration (e.g., body simultaneously. One could say that bilateral integra-
rolling Play-Doh with a rolling pin, clapping hands). It also tion and crossing midline “go hand in hand.” It is for this
refers to using both sides of the body reciprocally, as in reason that crossing midline and bilateral integration
alternating movements (e.g., climbing stairs). Finally, bilat- activities were put into the same section.
eral integration includes using each side of the body for a In working with a child with poor bilateral integration
different action simultaneously. This is called asymmetrical skills, it is important to be aware of the ways in which
bilateral integration (e.g., stabilizing a paper with one hand children will compensate for this deficit. Although a child
while writing with the other, holding a jar with one hand may show a right-hand preference, this child will reach for
while unscrewing the cover with the other). objects on their left side with the left hand and transfer
Midline is a vertical line down the middle of one’s body. the object into the right hand in order to avoid crossing
Crossing midline means using a body part in the contra- midline.
lateral space (Cermak et al., 1980). An example of crossing In setting up a therapeutic activity, it can be helpful to
midline would be reaching for a puzzle piece with one’s remind the child to use their dominant hand to pick up
right hand when the piece is placed on the left side of one’s objects regardless of the location of the object (i.e., whether
body. The ability to cross the midline is related to how well the object is to the left or right of the child). This will help to
both sides of the body have become integrated and the abil- remind the child to cross midline. Many times a child will
ity to cross the midline is necessary in order for one hand to still avoid crossing midline by moving the direction of their
develop hand dominance (Cermak et al., 1980). trunk in order to face the object. It is important to help such
Bilateral integration and crossing midline support a a child stabilize the trunk when reaching, thereby forcing
child’s development of fine motor skills, academic skills, the child to cross midline.
and functional skills. It is needed for many everyday activi-
Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:
Creative Ideas for Therapy Sessions, Third Edition (pp. 25-33).
© 2023 SLACK Incorporated.
26 Chapter 4

Figure 4-1.

Figure 4-2.

Figure 4-3.

BILATERAL INTEGRATION/
CROSSING MIDLINE
TREATMENT ACTIVITIES
Figure 4-4.
Symmetrical Bilateral
Integration Child opens and closes plastic eggs (Figure 4-1).
Snow baller: Child uses a snow baller to pick toys off
LEGO pieces: Child plays with LEGO pieces, pushing the floor (Figures 4-2 and 4-3).
together pieces and pulling them apart. Upgrade this activity by placing the child on a bal-
Play-Doh: Child plays with Play-Doh, rolls it, flattens ance beam or on suspended equipment in using the
it, makes a ball with it, and uses Play-Doh toys and snow baller to pick up the toys.
accessories. (The therapist should encourage the child Dribbling games: Child dribbles a basketball in each
to use both hands during this activity.) hand at the same time (Figure 4-4).
Theraputty: Child pulls and pushes Theraputty. Rapper Snappers: Child pulls apart/pushes together
Child pushes together/pulls apart toys such as pegs or accordion plastics (Figures 4-5 and 4-6).
Pop Beads.
 Bilateral Integration/Crossing Midline 27

Figure 4-5. Figure 4-6.

Figure 4-7.
Figure 4-8.

Crossing Midline
In order to help a child become more aware of their midline
while practicing crossing midline activities, place painter’s
tape in a vertical line on the midline of the child’s trunk.

Children’s clapping games: Child 1 faces child 2. Both

children claps hands together then clap alternate hand
on opposite child (child 1’s right hand hits child 2’s
right hand) and then repeats with other hand. Some
games include the following:
“Miss Mary Mack”
“Patty Cake” (Figure 4-7)
Cheerleading games: Therapist gives child pom-poms
and has child watch therapist in order to imitate vari-
ous cheers. Cheers should include crossing midline and
using both arms together (Figures 4-8 and 4-9). Figure 4-9.
28 Chapter 4

Figure 4-10. Figure 4-11.

Stretching Child holds a basketball and moves it in a circle around

Child stands up and brings one hand to opposite stomach, back, and back to the front (Figure 4-10).
foot and switches. Repeat as tolerated. Child pretends to drive a car using a ball as the steering
Child sits in a chair and brings one elbow to the wheel. Therapist encourages child to cross hand over
opposite knee and then switches and repeats activity hand in turning the steering wheel (Figure 4-11).
as tolerated. Dancing Activities:
Figure eights Therapist puts on music with a marching beat.
Therapist tapes a large figure eight on floor. Child Child marches around room with right knee touch-
walks in a figure eight-style over tape. ing left elbow and left knee touching right elbow.
Child traces large, horizontal figure eights on a Child dances with scarves, making figure eights
piece of paper. with arms while waving the scarves.
Child traces large, horizontal figure eights on a Therapist places young child (developmental age of
chalkboard and continues going around the figure 3 to 9 months approximately) in supine position on
several times. play mat with hanging toys and encourages them to
swat/reach for toys on both sides (Figure 4-12).
Therapist places balance beam on floor. Child stands to
the left of the balance beam placed on the floor. Child Therapist places child in upright sitting position with
crosses outside leg (left leg) over balance beam onto the toys placed within reach on both sides and encourages
floor while walking forward. Child then crosses out- them to reach for toys on both sides (Figure 4-13).
side leg (right leg) over balance beam. Child continues
“criss-crossing” legs over balance beam until the end.
 Bilateral Integration/Crossing Midline 29

Figure 4-12. Figure 4-13.

Figure 4-15.
Figure 4-14.

Child plays game with other children where hands

Child sits backward on a chair in front of an oversized cross midline to clasp (Figure 4-15) and then sub-
paper taped to the wall or a whiteboard. (Sitting back- sequently reach up (Figure 4-16). Repeat multiple
ward prevents unwanted rotation during this activity.) times or play singing to a song.
Therapist draws a black dot on the far left side and on Child does push-ups facing another child. Children
the far right side of the paper with the child seated right cross midline to “slap 5” and then repeat with other
in the middle. (Make sure child can reach each dot hand (Figures 4-17 and 4-18).
with dominant hand.) Using different colored crayons
Child stands back to back with another child and
or markers, child draws a rainbow starting at the left
passes a ball from side to side (Figures 4-19 and
dot and ending at the right dot, using dominant hand
4-20).
(Figure 4-14; make sure child does not switch hands
being used in middle of the rainbow.)
30 Chapter 4

Figure 4-17.

Figure 4-16.

Figure 4-18.

Figure 4-19.

Reciprocal Hand Use

Child performs jumping jacks.
Bicycle sit-ups: Child lies on back and brings the right
elbow to the left knee while extending the right leg,
then switches and repeats as tolerated (Figure 4-21).
Climbing: Child climbs up a ladder or climbs up a
flight of stairs on their hands.
Double Dutch jump rope: Child tries to swing two
jump ropes at a time in the Double Dutch style.
Juggling: Therapist teaches child how to juggle two
or more balls (Figure 4-22). Juggling with scarves or
weighted bean bags may be a little easier than juggling
balls.

Figure 4-20.
 Bilateral Integration/Crossing Midline 31

Figure 4-21.

Figure 4-22.

Figure 4-23.

Asymmetrical Bilateral
Integration
Lacing beads: Child holds string in one hand and a
bead in the other. Child uses both hands to lace bead
onto string.
Child opens and closes jars.
Child screws and unscrews nuts and bolts.
Cutting activities: Child cuts strips of paper, shapes,
or diagrams. (See Appendix A, pp. 193-202, for sample
cutting activities.)
Paper ring project: Child cuts out multiple strips of Figure 4-24.
paper. Child glues the ends of one strip together to
make a ring. Child then loops the additional strips of
paper, one at a time, around the initial ring to add on Therapist gives child a sandwich cookie, for a snack, to
more rings. Child glues the ends together, and keeps break open in halves.
adding more rings to make a chain of paper rings Braiding: Child practices braiding on either hair, on
(Figure 4-23). dolls, or with pipe cleaners.
Lacing cards: Child uses lacing cards to lace a string in Caterpillar toy: Pull rings off/put rings on (Figure 4-24).
and out of the holes with one hand while stabilizing the Paper airplane making: Therapist teaches child how
lacing card with the other hand. (Lacing cards/boards to make paper airplanes. Therapist performs each step
can be created by laminating a small piece of construc- separately and slowly. After each step, therapist waits
tion paper and punching holes approximately 1 inch until child is caught up. Therapist assists child to make
apart around the perimeter of the laminated paper.) sure that the folding is performed accurately.
32 Chapter 4

Figure 4-26.

Table tapping: Therapist sits facing child and places

Figure 4-25. both of their hands and the child’s hands on the desk.
One person starts by tapping the desk once with one
hand. The four hands on the desk surface should try
and tap the desk, one hand at a time, in a clockwise
fashion. If someone taps twice in a row quickly, that
alternates the direction of the circle to counterclock-
wise (Figure 4-25).
Hoop jumping: Therapist places different colored
hoops on the floor (Figure 4-26). Child alternates step-
ping into each hoop with feet and calls out the color
of the hoop as the foot steps down into it. To upgrade
this activity, place pictures of different letters inside
the hoops and have child call out the letter in the hoop
(Figure 4-27). Place pictures of animals in the hoops
and have child call out name of animal (Figure 4-28).
Knitting activities (Figure 4-29).

Figure 4-27.
 Bilateral Integration/Crossing Midline 33

Figure 4-29.
Figure 4-28.

Commercially Available
Products
Etch A Sketch
KID K’NEX
Mr. Potato Head
Oreo Matchin’ Middles
Pop Beads
Smart Snacks Sorting Shapes Cupcakes
Twister
Velcro fruit
Zoom Ball
 5
Vestibular System
The vestibular system controls a person’s sense of move- observation of the child and watching for various signs and
ment, how one tolerates changes in movement, and the symptoms is crucial in order to implement the appropriate
sense of balance. There is an increase in the reporting of interventions (Rine & Wiener-Vacher, 2013).
vestibular deficits in children (Rine, 2009). The vestibular The following basic principles of the vestibular system
system is controlled by small receptors in the ears, which should be reviewed before any vestibular activities are
send messages to the brain in order to interpret movement undertaken:
(Ayres, 2005). Therefore changes in head position have a Speed of movement: Different children will respond
great impact on the vestibular system. Many children with differently to different speeds of movement. Although
sensory processing difficulties will have irregularities in fast movement may be more intense for some children,
their vestibular system. These children will be either over- slow movement can be just as powerful and intense
responsive or underresponsive to movement. depending on the child and how an activity is set up
Ayres (1979) discusses certain children who are overre- (Ayres, 2005, p. 42).
sponsive to movement as having “gravitational insecurity.”
Length of time: The longer a child is engaged in a ves-
These children will become stressed or even fear movement
tibular activity, the more intense the input will be.
or being placed in specific positions. Helping regulate the
vestibular system can provide a “gravitational security,” Having a child close their eyes increases the intensity of
which can help strengthen a child’s emotional well-being the movement provided.
(Schaft & Roley, 2006). Conversely, some children will Rotary movement (spinning) can be more intense,
seek increased vestibular input in a attempt to meet a high arousing, and stimulating.
threshold of response to sensory stimuli or to gain more
Linear movement (back and forth) may create a more
information from the environment (Dunn, 2001).
calming and organizing effect.
Research has shown that vestibular rehabilitation
including balance exercises and different head movements A child’s physical position will affect the intensity of
can be effective in improving functional motor skills and the input. Having a child sit upright is less intense than
independence in activities of daily living (Cohen, 1992). having a child lie on their back or side (Ayres, 2005,
Vestibular rehabilitation and exercises can also be an effec- p. 42).
tive tool at improving balance (Horak et al., 1992). Ongoing
Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:
Creative Ideas for Therapy Sessions, Third Edition (pp. 35-39).
© 2023 SLACK Incorporated.
36 Chapter 5

Figure 5-2.

Changing Head Positions

Figure 5-1.
Therapist slowly moves child’s head in different planes
of movement including to the side, backward, and
It is important to look for signs of nausea and dizziness forward.
when engaging in movement activities. If a child becomes Child bends down and looks under legs and waves
nauseous during an activity, stop immediately. It may also hello to therapist.
help to follow up with a proprioceptive activity in the form Child bends down and throws a ball between legs to
of deep pressure. This may help provide the child with a therapist (Figure 5-2).
grounded feeling and decrease the level of nausea. (It is
ideal to avoid having the child reach the point of nausea.)
Before selecting or implementing any movement activities, Slow, Controlled Movement
it is important to first review these ideas with an occupa- Therapist slowly rocks child in different planes on
tional therapist. rocker chair.
Child slowly walks up and down ramp.
Musical Chairs: Child walks around a set of chairs and,
ACTIVITIES TO STRENGTHEN when the music stops, the child has to sit down in one
of the chairs.
THE VESTIBULAR SYSTEM Balance beam activities
Child walks across a balance beam backward and

Swinging forward.
Child walks across with eyes closed.
Child sits/kneels/stands on different suspended equip- Balance board activities
ment and swings: Allow child to place feet on floor at
first, then attempt to swing child with feet off the floor. Child bends down to pick up toys off floor, then
throws toys into a container/basket (Figure 5-3).
Child swings on an outdoor hammock.
Child steps up onto balance board.
Child swings on a swing set swing (Figure 5-1).
Child makes a 360-degree turn in place while stand-
ing on balance board.
 Vestibular System 37

Figure 5-3. Figure 5-4.

Child slaps hands with therapist in different direc-

tional planes (Figure 5-4).
Child pops bubbles all around (Figure 5-5).
Child plays catch.
Child shoots basketballs.
Child slowly walks up and down a flight of stairs,
alternating feet when ascending or descending (instead
of a step-to-step pattern). Subsequently, child attempts
to do this without holding onto the railing (therapist
should guard child for safety).
Roly-poly game: Child lies on a mat and slowly rolls
from one end to the other. This can be made into a
game with a group of children. Designate one child as
the leader who determines in which direction to roll,
when to start, and when to stop. The object of the game
is to avoid bumping into anyone else on the mat.
Child goes inside a barrel. Therapist slowly rolls child
across the room.
Child sits on a swivel chair and is slowly spun around
in both directions. Note: spinning needs to be con-
trolled and monitored so as not to cause adverse effects.
The child should be spun no more than 10 times in
each direction at one spin/revolution per second.
Figure 5-5.
38 Chapter 5

Figure 5-6.

Figure 5-7.

Fast-Paced Input
Therapy ball
Therapist bounces child while the child is sitting
on the ball and then tips the child from side to side.
Therapist places child in prone position (on the
belly) on the ball and then tips the child forward and
to the sides (Figure 5-9).

Figure 5-8.
Hippity Hop: Child bounces across the room on a
Hippity Hop toy (Figure 5-10).
Child slides down slides of varying heights and turns.
Child climbs over big pillows and bolsters or any
uneven surface. Two children go on a seesaw, one at each end. The chil-
dren alternate between going up and down.
Child walks up onto a small, raised surface and then
slowly steps down (Figure 5-6). Alternatively, child can Child sits on a scooter while being carefully spun
jump down. around several times by therapist, as tolerated.

“Ring Around the Rosie”: Children hold hands with Trampoline games
therapist or other children and slowly move around in Child jumps on a trampoline and counts to 10.
a circle singing “Ring Around the Rosie.” Child runs in place on the trampoline.
Somersaults: Child performs somersaults on a mat on Child sits on the trampoline and tries to bounce up
the floor. and down by moving body to create momentum.
Child sits on Dizzy Disc with legs crossed and is spun Tag: Child plays tag or another fast-moving chasing
around or they can lie on belly on Dizzy Disc and use game.
hands to spin self around in circles (Figures 5-7 and
5-8). Note: The child should not be spun more than
10 times in each direction at the rate of one spin per
second.
 Vestibular System 39

Figure 5-9.

Figure 5-10.

Figure 5-11.

Jumping off surfaces of varying heights: Child holds

hands with therapist and jumps in the air off of the
floor. Child then jumps off a slightly higher surface. Figure 5-12.
Therapist should continue raising the height of the
surface slightly. If at any point the child is fearful, allow
Child sits on a swivel chair and is quickly spun around
child to hold both of the therapist’s hands or fingers.
in both directions.
Provide child with as minimal physical assistance as
possible. Chair rides: Child sits on a chair with wheels. Therapist
quickly pulls child around the room on chair.
Child quickly walks up and down a flight of stairs,
alternating feet (instead of step-to-step pattern). Child rocks back and forth on rocking playground toys
Subsequently, child attempts to do this without holding (Figure 5-11).
onto the railing. Therapist should closely and carefully Children bounce up and down on any outdoor slack
guard for safety. line or bungee rope (Figure 5-12).
 6
Tactile Sensitivity
Tactile sensitivity and tactile defensiveness are condi- and gradually introducing more noxious stimuli. This is
tions in which a child finds different types of touch aver- done to make sure that the child does not become overly
sive. Tactile defensiveness is characterized by a negative stressed.
response to tactile stimuli (Blakemore et al., 2006). It is
postulated that tactile sensitivity may be a result of a lack
of habituation in the neural pathways that typically occurs
after being exposed repeatedly to a sensory stimulus ACTIVITIES TO DECREASE
(Blakemore et al., 2006). A child with tactile sensitivity
usually has specific fibers, materials, and foods that are TACTILE SENSITIVITY
not tolerated (Ayres, 2005). One first must identify these
factors before working with the child. Individuals with
tactile sensitivity and other sensory defensiveness may be Deep Pressure
impacted socially, emotionally, and behaviorally (Pfeiffer
Lotion massage: Therapist massages child’s hands with
& Kinnealey, 2003). There is also an increase in “picky
lotion, applying firm and consistent pressure.
eaters” among tactilely defensive children (Nederkoorn
et al., 2015). Squishy toys: Child squeezes and releases toys with dif-
There are many exercises and activities that can help ferent squishy textures.
decrease tactile sensitivity. Some forms of massage have Wheelbarrow-walking: Child wheelbarrow-walks
been effective in decreasing tactile sensitivity in children across the room.
with autism spectrum disorder (Silva & Schalock, 2013).
While lying prone on a scooter board, child propels self
Vibration may also be an effective tool in the treatment
around the room using the palms of their hands.
of tactile sensitivity (Hochreiter et al., 1983). Firm touch
is preferred over light touch and can help suppress sen- Play-Doh: Child plays with Play-Doh, rolling it and
sitivity to light touch (Davich, 2005). In performing the squeezing it with both hands.
activities in this section, it is important to grade them Brushing protocol: Refer to Wilbarger’s brushing pro-
by presenting the child with the least noxious stimuli tocol (Wilbarger & Wilbarger, 1991).

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 41-43).
© 2023 SLACK Incorporated.
42 Chapter 6

Figure 6-2.

Figure 6-1.
Child crunches up pieces of corn flakes (or another
crunchy cereal) with their hands and sprinkles them
Becoming Comfortable With onto a piece of paper with glue to make a project.

an Outside Touch Creamy and Wet Textures

Graded exposure to textures: Child rubs fabrics of dif-
ferent textures and toys on back and front of the hand Shaving cream activity: Child spreads shaving cream
as tolerated. Child also attempts this activity with on an inflated balloon. Child then uses their index
eyes closed and tries to identify objects placed in their finger to spell their name in the shaving cream or make
hands without the assistance of vision. a smiley face.

Child strokes the back and front of their hand with a Finger paint: Child engages in many finger painting
feather. projects including making pictures, shapes, and spell-
ing words in the paint.
Vibrating massage: Child uses a vibrating toy or mas-
sager to massage both hands. Child massages both the Hand-tree project: Therapist places brown paint on
front and back of the hand as tolerated. child’s forearm and hand. Child presses hand onto a
white piece of paper. This will provide a tree trunk
Vibrating toothbrush: Child brushes teeth with a and branches. Therapist then places different colored
vibrating toothbrush. paint on child’s fingertips and has child press down on
Therapist plays “This Little Piggy” on the child’s fin- the tree branches to make leaves and fruit (Figures 6-3
gers (Figure 6-1). through 6-5).
Face painting: Therapist applies face paint to child’s Sticky glue project: Child uses colored or regular glue
face and cheeks. If child will not tolerate this, allow to squeeze on a piece of paper and then spreads it out
child to apply the face paint to own face directly. with index finger. Child can then place sequins or
Touching faces: Therapist uses fingers to touch differ- another craft material on top of the glue.
ent parts of child’s face and neck as tolerated. Child Marshmallow Fluff project: Child makes a
labels the body part touched. Marshmallow Fluff sandwich. Child spreads fluff on
a piece of bread or cracker with fingers. Allow child to
place some toppings onto the fluff (raisins, sprinkles,
Grainy Textures pretzels, chips, etc.).
Sandbox activities: Child plays in sandbox and makes Child spreads peanut butter on a plastic plate—enough
small castles with sand or finds hidden objects in sand. to cover the whole surface. Child then spreads choco-
Additionally, child can make different shapes and let- late pudding on top of the peanut butter. Child traces
ters in the sand. different letters on the plate. Allow child to lick finger
after each letter.
Child finds hidden objects in a rice or bean box (Figure
6-2). Be sure to first check for food allergies.
Sandpaper project: Child assists in smoothing rough
wood.
Be careful of splinters.
 Tactile Sensitivity 43

Figure 6-3. Figure 6-4.

Water play: Child plays with water in a sink, pouring

water from one container to another and then onto
their hands. Therapist should vary the temperature
of the water from warm to cool. Child should then
squeeze washcloths and sponges.
Be sure to supervise this activity to make sure that the
water temperature does not become dangerously hot.

Water hunt: Therapist blindfolds child and asks child

to pick out certain objects from the water.
Therapist must use sound judgment in selecting blindfold-
ing activity with a specific child and must carefully super-
vise any activity involving blindfolding.

Kneading activities: Child kneads bread or cookie

dough to make a baking project.
Figure 6-5.
Silly Putty: Child pulls Silly Putty and presses it onto
different surfaces.
Play-Doh: Child rolls and pinches Play-Doh.
Papier-mâché piñata: Child dips strips of newspaper
Commercially Available
into papier-mâché flour/water mixture and places
them on an inflated balloon. Child covers the entire
Products
surface except for a small opening at the top. The Playfoam
newspaper is allowed to harden for 1 day then a small Guidecraft 3D Feel & Find Game
opening is cut in the top. Finally the balloon is painted
Image Captor
and candy is placed inside.
Kinetic Sand
Juice making: Child squeezes oranges or grapes into a
cup to make fresh juice.
 7
Oral Motor Exercises
Oral motor exercises consist of activities that require
the use of the tongue, mouth, lips, and surrounding facial ORAL MOTOR EXERCISES
muscles. Many clinicians report seeing a correlation
between oral motor exercises and improved motoric abili-
ties and awareness (Muttiah et al., 2011). The purpose of Increasing Lip Closure and
oral motor exercises can be either to strengthen, stimulate,
or increase oral motor awareness. Oral motor exercises are Cheek Strength
most commonly utilized with children with childhood
Child blows bubbles on a bubble wand or bubble stick.
apraxia, low muscle tone, and oral defensiveness (Muttiah
et al., 2011). Various oral motor exercises and massages Child sticks a straw into a cup or bowl filled with water
can also be effective with helping children develop ade- and blows down to create bubbles.
quate oral motor strength and movement for feeding and Child plays with blower toys (Figure 7-1).
drinking (Kumin et al., 2001).
Child blows into whistles and kazoos.
These activities and exercises can be performed in
preparation for another activity or as an activity in itself. Therapist teaches child how to play a song on a record-
It is important to watch for signs of fatigue when a child er or asks child to make fun noises with the recorder.
is performing these exercises. If the child has feeding/ Child blows pom-poms or cotton balls across a table
swallowing difficulties, it is important to first check (Figure 7-2).
with a doctor or speech therapist before attempting these Therapist cuts out a paper fish and places it on a table.
activities. When working on oral motor issues, the treat- Child then blows it into a specific target (e.g., into a
ing therapist should check for the presence of a bite reflex. bucket with water).
It is also important to avoid placing small objects in the
mouth of a child who may have a tendency to eat nonfood Therapist tapes a small piece of paper or a feather to the
objects. end of a straw and asks the child to blow through the
straw (Figure 7-3).

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 45-48).
© 2023 SLACK Incorporated.
46 Chapter 7

Figure 7-1. Figure 7-2.

Exercises for Overall

Strengthening of Oral
Structures
Therapist should first check for any dental problems the
child may have or for issues with bite reflexes.

Jaw-strengthening exercises: Child bites down on

Popsicle stick while therapist pulls on it, or child places
a Popsicle stick horizontally in mouth and bites down
using teeth (Figures 7-4 and 7-5).
Lip-strengthening exercises: Therapist places a Popsicle
stick between child’s lips and has child hold this posi-
tion (Figure 7-6).
Tongue tug-of-war: Therapist wraps gauze around
child’s tongue and gently pulls it out of child’s mouth.
The child is asked to try to resist.
Cheek thrusts: Child pushes tongue into the side of the
mouth to make one cheek stick out. Therapist pushes
against the side of child’s cheek, trying to push against
the tongue.
Tongue push-ups: Child places a Cheerio, M&M’s, or a
Froot Loop on top of the tongue and pushes tongue up
Figure 7-3. against the palate for a couple seconds at a time, gradu-
ally increasing the amount of time the tongue can stay
pushed to the top of the mouth.
Sound Making Gum chewing: Therapist places gum on the child’s
back molars and asks child to practice biting up and
Therapist makes different sounds and noises and down, gradually increasing amount of times they
attempts to get child to imitate them. can bite down (Rosenfeld-Johnson, 2001, pp. 110-117
Therapist and child sing a song with many different [Review Rosenfeld-Johnson reference for sample gum-
sounds. For example, sing “Witch Doctor” (“Ooo eee ooo chewing protocol.]).
ah ah”) or “Old McDonald Had a Farm” (“Ee i ee i oh”) to
Child sucks liquids through a crazy straw. Therapist
practice making different sounds in a fun way.
should vary the thickness and texture of the liquids.
 Oral Motor Exercises 47

Figure 7-4. Figure 7-5.

Figure 7-6.

Therapist places jelly/Marshmallow Fluff/peanut but-

ter on the roof of child’s mouth and has child lick it off.
Therapist places jelly/Marshmallow Fluff/peanut but-
ter on the top lip and has child lick it off (Figure 7-7).
Therapist provides child with crunchy and sticky foods
to chew.
Child copies tongue movements and positions, includ-
ing up, down, side to side, and all around.
Child copies lip positions, including purse, pucker, Figure 7-7.
smile, frown, open, and close.
Tongue scavenger hunt: Therapist touches child’s lips Therapist places a small amount of ChapStick on the
and the skin around the mouth or any spot inside the child’s lips and has child try to spread the ChapStick
mouth with either a tongue depressor or a lollipop. onto the entire surface of the lips by closing their lips
Child then must point to the spot touched with the tip together and moving them back and forth, without
of the tongue. using the hands.
Fish face: Child tries to imitate a “fish face,” holds the
position for several seconds, and then relaxes the facial
muscles. Repeat as tolerated (Figure 7-8).
48 Chapter 7

Figure 7-8.

Figure 7-9.

Figure 7-11.

Therapist gently taps the skin with fingers around the

child’s mouth and has the child do the same.
Figure 7-10.
Child places Z-Vibe toy in mouth to gently stimulate
different parts of the mouth (lips, tongue, cheeks) with
Stimulating the Mouth vibration and rubbing.
Therapist stimulates different areas in and around the
Through Sensory Input mouth with a Nuk Brush (Figures 7-9 and 7-10).
Therapist massages different parts of child’s face and
Therapist provides compression with fingers to child’s surrounding area with lotion.
back molars. (Therapist should be wearing gloves.
Check first for latex allergies.) Plain facial and lip massage: Therapist gently massages
the skin around the child’s mouth and the lips as toler-
Therapist touches and massages different parts of ated.
child’s face with a warm and cold wet cloth.
ARK’s Grabbers/Chewy Tubes: Child bites down and
releases on chewy toy (Figure 7-11).
 II
Visual System

Many consider the visual system to be the most dominant and influential system in the human body (Schneck, 1996).
The body uses the visual system to obtain information about the environment. Dysfunction in the visual system can
negatively affect quality of life and decrease functional independence with activities of daily living (Markowitz, 2006).
This section focuses on three main components of the visual system: visual perception, visual motor integration, and
oculomotor movement.
 8
Visual Perception
Visual perception involves the process of receiving This chapter provides a variety of visual perceptual exer-
information from the environment and translating the cises that can help strengthen the visual perceptual system
input into meaning (Cooke et al., 2005). Visual perception through fun games and activities.
has seven main components: visual discrimination (the
ability to discriminate between two similar forms), visual
form constancy (the ability to recognize the same form
when it appears in a different way), visual figure/ground VISUAL PERCEPTUAL
(the ability to find a form when it is hidden among other
forms), visual closure (the ability to recognize a form when ACTIVITIES
the complete form is not visible), visual spatial relations
(the ability to determine the correct direction of forms),
visual memory (the ability to remember the details of a Visual Discrimination
single form), and visual sequential memory (the ability to
Child completes “What’s Missing/What’s Different
remember and recall a sequence of objects; Martin, 2006).
Pictures.” (See Appendix A, pp. 203-204, for sample
Impairments with visual perceptual skills may cause
pictures.)
difficulties processing, organizing, and interpreting visual
information the brain receives (Cooke et al., 2005). In one Therapist shows child a string of four differ-
survey of Australian occupational therapists regarding ent pictures and asks child to figure out which
which performance components they evaluate in children two pictures are exactly alike and circle them. (See
with learning disabilities, 100% of respondents indicated Appendix A, pp. 205-207, for sample pictures.)
visual perceptual skills (Wallen & Walker, 1995). Visual Dot marker game: Using different colored markers,
perceptual deficits can also impair reading and writing the therapist makes circles of various colors and sizes
tasks as well (Cooke et al., 2005). Visual perceptual skills on a page. Child should then be given dot mark-
are a commonly targeted area by pediatric occupational ers and be told to place the corresponding colored
therapists (Schneck, 1996). dot into each circle on the page (Figure 8-1). (See
Appendix A, p. 208, for sample dot marker handout.)

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 51-56).
© 2023 SLACK Incorporated.
52 Chapter 8

Figure 8-1. Figure 8-2.

Verbal descriptions: In learning how to write new let- Necklace making: Therapist provides child with
ters, therapist has child verbally describe the letter. This different colored beads and has child copy a pattern
may help the child remember the different attributes of with the beads.
a letter and be able to write and recognize it more easily.
Sorting games
Puzzle piece sorting: Child assists in sorting center
Visual Form Constancy
puzzle pieces from edge puzzle pieces. Ball-bouncing game
Child plays with color and shape sorters. Part I: Therapist places different random letters on
the wall and asks child to spell a word by throwing
Baseball or any sport card sorting: Child sorts play-
a ball against the letters, one at a time and in the
ers by team, league, etc.
correct order, to spell the word.
Deck of cards: Child sorts cards by suit, number, etc.
Part II: Child covers eyes while therapist flips the
Froot Loops sorting activity: Therapist places Froot letters on the wall so the letters are upside down,
Loops all over table and gives child five strings. sideways, or backward. Child opens eyes to look at
Child makes five different necklaces that are all one the letters and tries and spell the same word.
specific color.
Letter recognition: Therapist writes the letters of the
Copying patterns alphabet in different ways on multiple index cards or
Froot Loops necklaces: Therapist places different pieces of paper. For example therapist can write the
colored Froot Loops on a string to make a necklace. letter “A” in a big size, little size, uppercase, lowercase,
Child copies the pattern of colors on the original cursive, red, blue, and yellow. Therapist should do this
necklace. This activity can be upgraded or down- for several more letters, mix the letters up, and scatter
graded based on the complexity of the pattern and them on the floor. Child should then try and find all of
the number of colors used in making the necklace the different As hidden on the floor and subsequently
(i.e., use anywhere from two to six colors when cre- the other letters as well.
ating the original pattern). View Appendix A, pp. 209-210, for form constancy
Peg patterns: Child places pegs into a peg board in handout.
a specific order, copying a set pattern made by the
therapist (Figure 8-2).
 Visual Perception 53

Figure 8-3. Figure 8-4.

Visual Figure/Ground
Compensatory strategies to help a child with poor fig-
ure ground skills include the following:
Limit visual distractions by keeping a child’s work
area free of clutter.
Have child sit in the front of the classroom to limit
visual distractions.
When providing a written assignment for the child,
write as little on every page as possible. For example,
for a math homework assignment, write only one
math problem on each page.
Use bright, colorful borders around the paper the
child is writing on to give an additional visual cue. Figure 8-5.
Some children might find this distracting and may
benefit more from a dark black border around the
paper they are working on. Find the Letter: Child copies a word, sentence, or para-
graph onto a piece of paper. Therapist provides child
Hidden pictures: Child finds different hidden objects with a red pen or marker. Child then goes back to com-
in a picture. (See Appendix A, pp. 211-212, for sample position and looks for a specific letter. For example,
hidden picture handout.) choose the letter “R.” Have the child read over the writ-
Child completes word searches/word finds. ten work and circle all of the Rs on the page.
Finding objects in a competing background: Child
finds a specific toy either somewhere in the room or on
a messy shelf among other toys.
Visual Closure
Therapist places laminated letters all around floor and Puzzles: Child completes different puzzles.
has child jump over, hop over, or touch the letters of The easiest type of puzzle is a form puzzle
child’s name. (Figure 8-3).
I Spy: Therapist should look around the room and The next level of difficulty is a cut puzzle (Figure 8-4).
think of an object in the room. Therapist should give
The most challenging type of puzzle is an interlock-
clues about the object (e.g., size, color, specific fea-
ing puzzle (Figure 8-5).
tures). Child has to look around the room to find it.
Child is allowed to ask for hints and other clues.
54 Chapter 8

Figure 8-7.

Visual Spatial Relations

Child completes shape/size sorter worksheet (See
Appendix A, pp. 193-196, for handout.)
Puzzles: Child assists in turning the puzzle pieces in
the correct direction.
Shape matching: Therapist cuts out four items of same
shape or picture. Therapist places the shapes on the
table with one shape placed on the table above the other
three. The three shapes should all be facing a different
direction with only one of them placed in the same
Figure 8-6. direction as the shape on top of the others. Child then
identifies which shape matches the direction of the
shape on top (Figure 8-7).
Child completes interlocking puzzle with many small
pieces (Figure 8-6). LEGO matching: This game is the same as the shape
matching game (listed earlier), but played with LEGO
When putting a puzzle together, therapist asks child pieces. Therapist places four of the exact same LEGO
to identify an object in a specific puzzle piece without pieces on the table. One of the LEGO pieces should
looking at the completed puzzle picture. be in a row of its own on top of the other three. The
Incomplete puzzles: Therapist assists child in putting bottom three LEGO pieces should all face a different
together a puzzle, but hides several pieces of the puzzle. direction from each other, except one should face the
Therapist asks child to identify what is the picture in same direction as the LEGO piece on top. Child picks
the puzzle with only part of the puzzle completed. which LEGO piece is facing the same direction as the
Letter identification: Therapist writes parts of a letter one on top.
on a paper and asks child to identify which letter it is. Keyholes: Therapist draws a picture of a pretend key-
(See Appendix A, p. 213, for sample handout.) hole and picture of a pretend key. Therapist cuts out the
Word identification: Therapist writes parts of the key and asks child to turn the key in the correct direc-
different letters in a word to see if the child is able to tion needed to place the key into the hole.
identify the word. This activity can also be played by SET: Child plays the commercially available card game
covering the bottom quarter of a word with a piece of SET with another child in order to find shapes/pat-
of paper to see if the child can guess the word with terns with different orientations and colors (Figure 8-8).
only the top three-quarters of the word visible. (See Oops letter writing: Therapist deliberately writes a let-
Appendix A, p. 214, for sample handout.) ter on the board with an error (upside down, backward,
Picture identification: Therapist creates a picture and etc.). Child tries to verbally describe the error with
covers up part of it to see if child is able to identify the the letter.
item in the picture (See Appendix A, pp. 215-216, for
sample handout.)
 Visual Perception 55

Figure 8-8.

Be the teacher: Child copies a sentence or writes a

composition on a piece of lined paper. Provide the
child with a special felt-tipped marker or pen. Have
the child go back and edit the paper, circling every let-
ter that does not properly reach the line or letters that
erroneously go below the line. Give the child one point
for every correct circle and ask the child to try to reach Figure 8-9.
a set score.
A child who has difficulty writing neatly in a confined
space may be having difficulty with visual spatial rela-
tions. It may be helpful to use different types of paper
in order to help a child visualize the correct place on
the paper to write. Such papers include the following:
Graph paper: Child writes one letter per each slot on
the graph paper (Figures 8-9 and 8-10). Use smaller
or bigger boxed graph paper based on the child’s
handwriting level. The smaller the boxes, the more
difficult the handwriting activity is.
Raised line paper: This type of paper can help a
child feel a physical boundary when writing.
Visual clues: Therapist colors over the margin line
with a thick red marker to remind the child the
starting place to come back to when they finish Figure 8-10.
writing on a specific line. Therapist can also high-
light parts of the paper.
Additional visual cues: A child who has difficulty
organizing overall writing may require some other
visual cue aside from the margin line. It may be
helpful to place a sticker or a star in the upper left
corner of the page to remind the child where writing
starts. Handwriting Without Tears provides prefab-
ricated paper like this.
56 Chapter 8

Visual Memory Commercially Available

Memory games: These can be played with an actual
Memory game or can be self-made. Therapist places
Products
pairs of cards face down on the table. Child flips over Colorama
two cards each turn, trying to find a match. Connect Four
Froot Loops Memory game: Therapist shows the child Design and Drill Activity Center
a card with a sequence of colors written on it—for
example: red, orange, yellow, blue. The card is then Dominoes
removed and the child makes a Froot Loops necklace Doodle Dice Deluxe
with the correct order of colors. Fantacolor Junior
“Busy picture” books: Child looks at a page on a “busy I Spy
picture” book for a little while. The book is then closed
and the child tells the therapist as many details about Katamino
the page as possible. KID K’NEX
Lincoln Logs
Additional Visual Perceptual Oreo Matchin’ Middle
Pattern Blocks & Board
Resources Pattern Play
Test of Visual Perceptual Skills, Revised (TVPS-R). Perfection
The TVPS-R is meant to be used as an evaluation tool
Picture Perfect Design Tiles
to test a child’s visual perceptual skills. The TVPS-R
offers many examples of visual perception challenges. Rainbow Loom
A therapist can look at the items in this evaluation Rush Hour Jr.
in order to see various examples of visual perception
SET
challenges and create new ones based off these samples.
Smart Snacks Mix & Match Doughnut

Online Smart Snacks Sorting Shapes Cupcakes

Spot It
Visit the following website for additional visual percep-
Stare!
tual activities: http://edhelper.com/visual_skills.htm
Tetris
Tic-Tac-Toe
Where’s Waldo
 9
Visual Motor Integration
Visual motor integration (VMI) refers to the coordina- This chapter provides a variety of VMI activities. It is
tion of visual perception and the movement of the fingers important to remember that VMI activities call upon both
(Beery, 2004). Visual motor skills have been found to be perceptual and motor skills; one must keep this in mind
correlated with school readiness, school adjustment, and when determining an appropriate choice of activity to chal-
social-emotional well being (Bart et al., 2007). VMI skills lenge the child.
affect a child’s ability to cut with scissors, complete mazes,
stack blocks, and be successful in most sport activities.
Decreased visual motor skills can be related to clumsi-
ness in children as well (Parush et al., 1998). VMI is also a VISUAL MOTOR ACTIVITIES
required skill necessary for handwriting legibility (Daly et
al., 2003)
When working on visual motor skills, there are aspects Cutting and Gluing
of VMI that can pose difficulties for the child (i.e., the Cutting practice
motor component, the perceptual component, or both can
be equally troublesome). For example, a child who has diffi- Child snips a narrow sheet of paper (Figure 9-1).
culty completing mazes may struggle with moving a pencil Child cuts on straight lines.
through the maze within a confined space, but may easily Child cuts out shapes. (See Appendix A, pp. 193-196,
be able to see the correct path with their eyes. Conversely, for shape cutouts.)
another child may be able to guide a pencil through the
same maze with no problem, but have difficulty locating Child cuts out pictures.
the correct path visually. Therefore, in selecting visual Cutting textures: Child cuts out paper, cardboard,
motor exercises, it is important to identify which compo- straw, Play-Doh, and Silly Putty.
nent of VMI is difficult for the particular child. Child squeezes glue onto a line.

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 57-62).
© 2023 SLACK Incorporated.
58 Chapter 9

Figure 9-1.

Handwriting Skills Involving

Writing/Drawing
Child completes dot-to-dots. (See Appendix A, pp. 217-
221, for sample dot-to-dots.)
Child completes mazes. (See Appendix A, pp. 222-226,
for varying level mazes.)
Child traces between lines or along shapes or pictures. Figure 9-2.
(See Appendix A, pp. 197-202 and 227-233, for tracing
handouts.)
Handprint making: Child places nondominant hand Building
on a piece of paper and uses the dominant hand to
trace out the hand on the paper. Child builds a house with Popsicle sticks (Figure 9-2).
Child completes follow the arrow handout (see Create a box with Popsicle sticks: Therapist overlaps
Appendix A, p. 234, for sample handout). sticks on different layers and then has child copy the
template design (Figure 9-3).
Cage the animal: Therapist draws a picture of any ani-
mal inside a box. Therapist tells child that the animal Building/stacking: Child builds and stacks blocks and
will escape if bars are not drawn onto the animal’s cubes to make a tower.
cage. Child draws straight lines from the top of the cage Therapist creates a small design or tower with blocks or
to the bottom of the cage. cubes and has child try to replicate the design or tower.
Copying lines, prewriting strokes, and shapes: Child Marshmallow building: Therapist creates different
copies different simple shapes, letters, words, sentenc- geometrical designs using marshmallows with tooth-
es, or paragraphs onto a piece of paper. picks connecting the shape together. Child copies
Copying images: Child copies a series of different com- designs (Figure 9-4).
plex figures and drawings. Keep in mind appropriate
age expectations when having a child complete this
activity. A child should not be asked to copy a figure
that is developmentally too sophisticated. See the Beery
Developmental Test of Visual Motor Integration as a
resource for age appropriate expectations (Beery et al.,
2010).
Child uses stencils to make drawings and pictures.
 Visual Motor Integration 59

Figure 9-4.

Figure 9-3.

Figure 9-6.

Play-Doh letters: Child copies letters with Play-Doh

and then creates letters independently with Play-Doh
(without a model to look at).
Therapist gives out Popsicle sticks. Child makes shapes
and letters with Popsicle sticks.
Figure 9-5. Child makes letters with Wikki Stix (Figure 9-5).
Child copies designs and patterns with Wikki

Forming Letters, Shapes, and Stix (Figures 9-6 and 9-7; see sample handout in
Appendix A, p. 235, of designs child can copy with

Designs Wikki Stix.)

Therapist cuts out pieces of string or colored lanyard of
Pipe cleaner letters: Child copies models of letters with different lengths and places the pieces in random pat-
pipe cleaners and then creates letters independently terns, overlapping them. Child tries to place strings in
with a pipe cleaner (without a model to look at). the same design as in the template (Figure 9-8).
60 Chapter 9

Figure 9-7. Figure 9-8.

Figure 9-10.

Figure 9-9.

Geoboards: Child copies designs and shapes on a

geoboard (Figure 9-9).
Lacing boards: Child uses a lacing board and prac-
tices going around the lacing board with a whip
stitch (Figure 9-10) and then an over-under stitch Figure 9-11.
(Figure 9-11).
 Visual Motor Integration 61

Figure 9-12. Figure 9-13.

Ball Games
Dribbling activities
Child practices dribbling a basketball quickly and
slowly (Figure 9-12).
Child practices dribbling a ball with each hand
simultaneously (Figure 9-13).
HORSE: Child plays the basketball game HORSE with
another child or therapist. Child shoots a ball in a
basketball hoop. If the child misses the shot, it is the
therapist’s turn. If the child makes the shot, the thera-
pist must make the same shot. If the therapist misses,
they get a letter of the word “HORSE.” If the therapist
makes the shot, it is then the child’s turn again to shoot
a different shot, and so on. Whoever gets all letters and
spells HORSE loses the game.
Bowling: Therapist sets up bowling pins or soft blocks.
Child bowls with a small- or medium-sized ball and
tries to knock over as many pins/blocks as possible.
Juggling
Therapist teaches child how to juggle three or more
balls (Figure 9-14).

Figure 9-14.
62 Chapter 9

Figure 9-16.
Figure 9-15.

Child holds two balls, one ball in each hand. Child Online
throws right ball up and then passes ball from
left hand to right hand and catches the ball in the Visit www.eyecanlearn.com for additional visual motor
air with left hand. Repeat activity multiple times activities that can be played on a computer.
(Figure 9-15).
Tic-tock-tire: Therapist hangs up a suspended tire Commercially Available
swing (or a Hula Hoop) and swings it from side to side.
Therapist places a bucket full of small items (bean bags, Products
Koosh balls, etc.) on the floor to the side of the child.
Child picks up one item at a time and throws it through Angry Birds Mega Smash
the moving tire without letting the bean bags touch the Elefun
tire (Figure 9-16).
Frisbee
Jacks
Folding Activities Labyrinth
Origami: Therapist creates simple origami designs for
child to copy.
Paper airplanes: Therapist creates a paper airplane and
has child copy the steps, one step at a time.
Dinner napkin folding: Therapist teaches child simple
ways to fold dinner napkins. Different fun ideas can be
found online by searching for “easy napkin folding.”
 10
Oculomotor Exercises
The four major components of the oculomotor sys- treating therapist to provide gentle physical input to serve
tem include saccadic movements, smooth pursuits, con- as a reminder to keep the head still during the exercises.
vergence, and the vestibular system (Robinson, 1968). If the head moves when these exercises are performed, the
Although oculomotor movement can be a broad term that child will not be improving their oculomotor abilities to the
encompasses many different areas, this section focuses on optimal level.
a few specific components. These include tracking a slow- This chapter provides many oculomotor exercises.
moving object, moving the eyes quickly between two close Included is a group of exercises that call for visual scanning
objects, and moving the eyes from an object that is close to activities involving balance. These exercises are incorpo-
an object that is far away. rated into this chapter because a child exists in a dynamic
Decreased oculomotor movement may affect both aca- environment. Sensory information from both the visual
demic and functional skills. Different abilities of the visual and vestibular system share brain-way pathway connec-
system are highly correlated to a child’s success with read- tions and help produce motor output that affects body
ing skills and overall academic performance (Kavale, 1982). posture and balance (Jones et al., 2009). Children must
Functionally, a child may have difficulty playing sports and learn to scan on static surfaces as well as dynamic ones.
simply being able to watch moving objects in the environ- For example, a child might want to read a street sign while
ment. walking on a bumpy sidewalk, ascending a flight of stairs,
Children with poor visual scanning skills will often or stepping up onto a curb.
compensate for this deficit by moving their heads instead As the visual system has a strong connection to the
of using isolated eye movements when tracking something. system controlling movement, a therapist must watch for
This results in inefficient and ineffective visual scanning. signs of dizziness when performing oculomotor exercises
It is important with vision exercises to keep the head still and stop immediately if a child reports being either dizzy
(Axelsson et al., 2019). It may also be necessary for the or nauseous.

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 63-70).
© 2023 SLACK Incorporated.
64 Chapter 10

Figure 10-1. Figure 10-2.

Figure 10-3. Figure 10-4.

VISUAL SCANNING ACTIVITIES Visual tracking for lower-level child or young child
(to be determined by therapist): Place child in upright,
seated position or flat on back. Move a toy/object of
interest/shining light around child. Move the toy or
Basic Visual Tracking light in an arc from side to side, up and down, and in
To increase isolated eye movements instead of full head both diagonal planes.
movements, it might be helpful to lightly hold the child’s On back (Figures 10-1 through 10-3).
head still, forcing the child to move the eyes only and not Sitting upright (Figures 10-4 through 10-6).
the head.
Practicing saccades (i.e., the ability to quickly move
Visual tracking for the higher-level child: Therapist the eyes from one target to another): Therapist holds
holds an object in front of child’s face. Therapist up one object in each hand and asks child to look
instructs child to look at the moving object with only at each object alternately in a random pattern. For
their eyes and not to move the head. Therapist should example, therapist can hold a red marble and a blue
alternate moving the object slowly and quickly in all marble. Therapist then calls out “red, blue, red, blue,”
different planes. Therapist should try to pick some- etc. Therapist moves the two objects around/up/down,
thing visually attractive in order to help the child while child looks back and forth between them, keep-
maintain visual attention (e.g., finger puppet, toy with ing the head still (Figure 10-7). Therapist should
lights). alternate timing between verbal cues to decrease habit/
patterning.
 Oculomotor Exercises 65

Figure 10-5. Figure 10-6.

Flashlight tag: This game should be played in a dark

room. Therapist shines a light on the ceiling or some-
where else in the room. Child quickly locates this light
and shines a flashlight next to it.
“Where is it”: Therapist places a penny or small object
on the table in front of child. Therapist picks it up
with one hand and transfers it back and forth between
hands several times as the child watches. When the
therapist stops, child must guess which hand is holding
the penny.
Reading exercises
Child holds book in hand and reads out loud to
therapist.
Child reads book, keeping the index finger under
the word being read.
Child reads a row of letters placed on the board X
feet away (appropriate distance should be deter-
mined by treating therapist).
Child reads a list of sentences placed on the wall
X feet away (appropriate distance should be deter-
mined by treating therapist).
“Where is the queen”: Therapist places three playing
cards face up on the table. One of the cards should be
a queen. Therapist shows the child where the queen is
and then turns the cards face down. Therapist slowly Figure 10-7.
moves the cards around; then the child has to point to
the card that they believe is the queen card.
Bead mazes: Child pushes the beads from one side of Visual Scanning Activities
the bead maze to the other (Figure 10-8).
Yo-yo activities: Therapist has child watch yo-yo as it is Involving Balance
moved up and down and then swung gently from side
Balance beam scanning game: Child walks across a
to side. Therapist instructs child of appropriate age to
balance beam while reading across a row on a letter
attempt swinging yo-yo (this will be too difficult for
chart placed on the wall at the child’s front or side.
younger children).
To upgrade this activity, have child read down a col-
umn, read the first and last letters of a row, read every
66 Chapter 10

Figure 10-9.

Writing/Drawing
Matching cars games: Therapist takes a piece of paper
and on the far right side of the page makes a column
with different cars and on the far left side of the page
Figure 10-8. writes different numbers. Draw lines between the
cars and numbers and ask the child to use only their
eyes to see where each vehicle ended up. (See Appendix
other letter in a row, or read two letters at a time. This
A, pp. 238-240, for sample handouts.)
activity can be made simpler by placing a long strip of
masking tape on the floor and having the child walk Copying words and sentences: Child copies words or
across the masking tape instead of the balance beam sentences from a blackboard onto a paper placed on a
when reading the letters. If a child does not yet know table or desk in front of the child.
the names of the letters, an alternative picture/symbol Copying words and sentences: Child copies words or
chart can be used. (See Appendix A, pp. 236-237, for sentences out of a book placed on the table directly in
letter and symbol chart.) front of the child.
Slow movement tips: Child sits in a chair facing thera- Blowing bubbles: Child stands on floor or on a balance
pist. Therapist holds child’s head and maintains eye beam. Therapist blows bubbles all around child. Child
contact with child. Therapist slowly moves child’s head tries to pop as many bubbles as possible.
in different directions, including right, left, backward,
and forward.
Heel-toe rocking: Child maintains balance on heels. Throw/Catch and
They then rock back and forth between heels and toes,
holding each position for approximately 1 to 2 seconds. Ball Activities
Once child is able to perform this activity smoothly, Child throws a Hula Hoop in the air and catches it
therapist places a sentence on the wall that the child (Figure 10-9).
must read while rocking back and forth between heels
and toes. Hula Hoop toss: Child and therapist both hold a Hula
Hoop in their hands. When therapist calls out “go,”
they each throw their Hula Hoop and catch the other
person’s Hula Hoop simultaneously (Figure 10-10).
 Oculomotor Exercises 67

Figure 10-10.

ABC wall game: Therapist places the letters “A” through

“E” on the wall approximately half an inch apart in a
random order. The letters should be large enough so a
child can stand a few feet away from the wall and still
see them. Child throws a ball at letter “A” and catches
ball as it bounces off wall. Child then continues throw-
ing the ball in ABC order and catches it. Therapist can
Figure 10-11.
upgrade this activity by adding more letters or down-
grade the activity by placing only two or three letters
on the wall.
Wall spelling game: Therapist places scattered letters
Jumping
on the wall in a random order. Therapist calls out a let- Trampoline letter game: Therapist tapes different let-
ter and child throws a ball against the corresponding ters onto a trampoline. Therapist calls out one letter
letter and catches it. For older children, therapist calls at a time and child quickly finds the letter and jumps
out a word and child throws the ball at each letter in the onto it.
word (in the correct order).
Arrow map: Therapist places arrow map on the wall.
Child plays a sports game that requires a quick-moving (See Appendix A, p. 241, for sample chart.) Child reads
ball. Some of these activities include floor hockey, air the directions of the arrows out loud, walks in the
hockey, miniature golf, Ping-Pong, Frisbee, soccer, direction of the arrows, jumps in the direction of the
hitting a baseball in the air, tennis, etc. (Figure 10-11). arrows, or dances to a beat while moving in the direc-
Balloon air-bouncing: Child hits a balloon with either tion of the arrows.
a racquet or own hand. Child tries to keep the balloon
from falling to the floor.
Balloon volleyball: Child hits a balloon with either a
Strengthening Eye
racquet or own hand while playing a game of volleyball
with another person.
Convergence
Child bounces a small ball between a tennis racket and Therapist places a small sticker on the wall. Child does
the floor. wall push-ups while maintaining eye contact on the
sticker and has nose touch the sticker each time the
Child bounces a small ball on top of a tennis racket and body is brought in close to the wall (Figure 10-12).
keeps it in the air.
Suspended ball activities: Child hits a suspended ball
or tether ball with hand or any sort of rod. Upgrade
the activity by taping colored lines on a rod and have
child only hit the ball with a specific color. Further
upgrade this activity by performing it on a balance
board (Figure 10-13).
68 Chapter 10

Figure 10-12. Figure 10-13.

Child stands on the swing and picks up one piece at

a time to throw into the basketball hoop. Therapist
slowly swings the child back and forth; the child faces
the direction of the basketball hoop while playing this
game.
Child sits upright on platform swing or on rolling
scooter. Therapist pushes child toward a moving or
stationary ball and child must kick ball upon initial
contact (Figure 10-14).
Child lies flat on back on floor. Therapist rolls large
therapy ball toward child’s feet. Child must kick ball
when it comes near (Figures 10-15 and 10-16).
Figure 10-14. Child lies on stomach on floor. Therapist rolls large
therapy ball toward child. Child must push ball with
hands when it comes near (Figures 10-17 through
Child throws a small ball high up in the air and catches
10-19).
it. Upgrade this activity by performing it on a balance
board. Therapist or two children sit facing each other on floor
with both legs completely extended and touching each
Child throws a ball against the wall and catches it with-
other. Both children simultaneously turn feet in (posi-
out letting the ball drop on floor.
tion I; Figure 10-20) and then simultaneously turn feet
Swing basketball: Therapist places a small basketball out while slowly separating legs (position II; Figure
hoop next to a platform swing and places small bean 10-21). Therapist instructs child to maintain visual
bags or Koosh balls around the perimeter of the swing. attention with feet throughout the activity.
 Oculomotor Exercises 69

Figure 10-15. Figure 10-16.

Figure 10-17. Figure 10-18.

Two children lie prone, facing each other. They pass a

ball to each other (Figures 10-22 and 10-23).
Child goes into a tall kneel position. Therapist rolls
large therapy ball toward child. Child must push ball
away as it comes near.
Children face each other, each holding balls. Children
simultaneously throw ball at each other. Then repeat
(Figures 10-24 and 10-25).

Online
Figure 10-19.
Visit www.eyecanlearn.com for additional visual scan-
ning exercises.
Visit www.abcteach.com and follow links for mazes
and dot-to-dot handouts.
Commercially Available
Products
Lucky Ducks
Simon
Whac-A-Mole
Zoom Ball
70 Chapter 10

Figure 10-20. Figure 10-21.

Figure 10-22. Figure 10-23.

Figure 10-24.

Figure 10-25.
 III
Dissociation Activities

The term body dissociation refers to the use of individual parts of the body in isolation from the rest of the body. When
a child is unable to dissociate, their movements will appear stiff and clumsy. There are different forms of dissociation. In
the upcoming chapters of this section, body dissociation and finger individuation are discussed.
 11
Body Dissociation
Body dissociation refers to the ability to move one part with tight neck muscles will have difficulty dissociating
of the body without moving another part. For example, their head and neck from the rest of the body and may sub-
when rolling over, the child should be able to roll their body sequently present with difficulties in overall dissociation.
segmentally by dissociating the right and left extremities as
well as the extremities and the head. A child with poor body
dissociation will move stiffly—like a log—in one unit, as
opposed to rolling segmentally (Tecklin, 2008). BODY DISSOCIATION
Poor body dissociation may result in stiff, uncoordinat-
ed movement. This may also cause a child to use inefficient TREATMENT ACTIVITIES
movement patterns, requiring more energy expenditure
and taking more time. Additionally, postural control and
reaching for objects is highly dependent on being able to Whole Body Dissociation
segment and dissociate the different muscles of the trunk
Baseball: Therapist places a baseball or Wiffle Ball on
(Rachwani et al., 2015).
a tee. Child swings the bat to hit the ball off the tee.
There are three main components to body dissociation: Although this game can also be played without a tee,
the ability to move parts of the upper body and lower body it will be easier to work on dissociating the different
separately, the ability to move an extremity in isolation trunk muscles if the ball is hit off the tee in a slow,
from the body and from the other extremity, and the ability controlled fashion (as opposed to swinging at a ball in
to move the head and facial muscles in isolation from each the air).
other. This chapter provides activities to improve these
three components of body dissociation. Place child (developmentally 6 to 14 months; Cottrell,
This chapter also discusses exercises to work on torti- 2004, p. 19) on side and place a toy in front of child to
collis. Torticollis is characterized by a tilting or turning motivate them to roll over fully (Figure 11-1).
of the head to one side (Hervey-Jumper et al., 2011). These Twist child’s legs toward side to be rolled in order to
exercises are provided in the present chapter because a child give child a head start (Figure 11-2).

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 73-77).
© 2023 SLACK Incorporated.
74 Chapter 11

Figure 11-1. Figure 11-2.

Figure 11-3. Figure 11-4.

Rolling: Child slowly rolls on a mat segmentally (first Child faces large bolster and places one leg over bolster
head, then trunk, then legs)—not like a log. If child and other leg in kneeling position. Child reaches for
appears stiff while rolling, therapist can provide child objects on both sides and places them in the container
with verbal and physical cuing as needed. (Figures 11-3 and 11-4).
Fast running: Child runs across the room or outside. Mother holds child with one knee bent/hip flexed
Therapist can remind child to utilize an arm swing in front of mother’s stomach, other leg straight and
when running. relaxed behind mother’s back.
Frog jump activities: Child squats down on the floor
and frog jumps as far as possible. Child jumps to a bas-
ket and places Koosh balls or other toys in it to make
this activity more playful.
 Body Dissociation 75

Figure 11-5. Figure 11-6.

Dissociating Extremities
From the Body
Dry-wet game: Therapist wets different parts of child’s
body with water, alternating between wetting a part on
the child’s right side and left side (e.g., arms, fingers,
shoulders, knees). Therapist calls out a body part that
is wet (“wet hand”) and child must extend/raise only
the body part that is wet while keeping the dry body
part down.
Child moves both arms three to four times in a specific
direction (in and out, up and down, to the side, etc.).
Therapist then asks child to move only one side in that
same direction and motion. This game can also be
played with the lower extremities.
Position 1 (Figure 11-5), Position 2 (Figure 11-6),
Position 3 (Figure 11-7).
Child lies on floor or stands against the wall. Child lifts
one leg or arm at a time off the floor or wall while keep-
ing the other limb flush against the resting surface.
Figure 11-7.
Child stands still with both hands on hips and kicks a
moving ball.
Child shrugs one shoulder at a time. Child turns a jump rope with one hand (therapist
can tie a rope to a doorknob or hold the other end
Child lies on floor or outdoors in snow and makes of the rope) while keeping the rest of the body still
snow angels. Child then attempts to do this using only (Figure 11-8).
on one side at a time.
76 Chapter 11

Figure 11-8.

Figure 11-9.

Figure 11-10.

Coloring activity: To help a child use isolated wrist/

finger movements instead of whole arm movements in
coloring a large picture, therapist can divide a picture
into many smaller sections. If the child is able to follow
instructions and color in only one section at a time,
this will automatically cause the child to use more iso-
lated movements (Figure 11-9).
Figure 11-11.

Dissociating Head and Child moves one side of the facial muscles at a time to
Facial Muscles wink, close an eye, blow up one cheek, or move the lips.
Child then switches and makes the same movements
Child visually tracks a moving target while keeping the using only the muscles on the other side of the face
head still. (Figures 11-10 and 11-11).
Child shakes head “yes” and “no” without moving the
shoulders or any part of the trunk.
Child moves head all around in a circle, keeping the
rest of the body still.
 Body Dissociation 77

Figure 11-12. Figure 11-13.

Treating Torticollis
Massage child’s tight neck muscles with lotion.
Elongate and stretch child’s tight neck muscles
(Figures 11-12 and 11-13).
Do not perform any stretches on child without first being
taught how to properly handle and stretch child by either
a doctor or a trained occupational or physical therapist.
Repeat at each diaper change.

Have child face the nonpreferred side: Stimulate this by

either placing a toy on the nonpreferred side for child to
look at or having an adult play Peek-a-Boo on nonpre-
ferred side. Child can be sitting, lying on back, belly, or
on your lap (Figure 11-14). Figure 11-14.
Place stroller toys toward the nonpreferred side of the
child during walks.
Increase tummy time. See Chapter 20, “Upper Arm
When child is sleeping, turn child’s head to nonpre- Strengthening and Stabilization,” for ways to help
ferred side. increase child’s tolerance of tummy time.
Have child play in side-lying position. Therapist or parent holds baby on adult’s hip on the
side that forces the baby to turn head in direction that
causes a stretch to tight neck muscles.
 12
Finger Individuation
Finger individuation is the ability to move a single finger
in isolation from the other fingers. Being able to individuate FINGER INDIVIDUATION
TREATMENT ACTIVITIES
the digits is one of the hallmarks of human motor control
(Thielbar et al., 2014). Relatively independent finger move-
ments rely on the motor cortex and the corticospinal tract
(Lemon et al., 1986). The anatomy and structure of the
hand’s internal bones, muscles, tendons, and ligaments Playful Finger Games
allow for an unlimited combination of varied movements
(Benbow, 1997). Movements of the fingers occur over Child sings “Where Is Thumpkin?” while holding up
multiple joints causing coactivation of noninvolved joints the appropriate finger:
(Jones & Lederman, 2006). The accurate coordination of Where is Thumpkin, where is Thumpkin?
finger movements is also necessary in order to approximate Chorus:
the size, shape, and use of an object before making contact Here I am, here I am.
with it (Raghavan et al., 2007). Some children are unable How are you today sir?
to move an individual finger in isolation from the other Very well I thank you.
fingers and, therefore, cannot master the level of precision Run away, run away.
needed for fine motor activities.
Follow with “pointer,” “tall man,” “ring man,” and
This chapter provides activities that require isolated “pinky.”
finger use and can help promote improved hand and finger
function. Therapist and child play “This Little Piggy”: In play-
ing this game, child sticks out one finger at a time
(Figure 12-1).
Counting: Child counts out loud with fingers, one
number at a time. Child counts forward to 10 and then
backward.

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 79-82).
© 2023 SLACK Incorporated.
80 Chapter 12

Figure 12-1.

Therapist places finger puppets on child’s fingers.

Child then acts out a story.
Thumb wars.
This game should be played only between therapist and
child, not between two children, to make sure that no one
gets hurt.

Therapist teaches child basic sign language signs and

how to sign the alphabet in sign language.
Figure 12-2.

Computer and Keyboard Therapist places finger crayons on each of child’s

Activities fingers. Therapist tells child to make a line, but only
with a specific color. Therapist then asks child to
Child plays computer games that involve pushing spe- make a line by using two colors together at the same
cific buttons with specific fingers. time.
Child plays computer games that require use of a Child peels stickers off of a sticker sheet and places the
mouse: Many children have difficulty using a mouse stickers on a piece of paper.
because they are unable to push down with their index Child colors in or traces gradually smaller shapes.
fingers in isolation and instead push down with both
fingers together. Bead games: Therapist places a small bead between the
child’s index finger and thumb. Child rolls the bead
Typing: Using the keyboard keys, child writes words back and forth and from side to side. Child then trans-
and sentences or a story. fers bead between the next finger and thumb and per-
Child plays a song on a piano or keyboard. If this is forms the same activity. Child continues to the pinky
too challenging, child can copy/imitate hitting specific and then works back toward the thumb.
notes on the piano. Play-Doh/Theraputty: Child pushes one finger at a
time down into the putty.
Crafts and Coloring Child strings beads to make a necklace.
Child crumples small pieces of tissue paper with one
Finger crayons
hand, using only the fingertips to crumple the paper.
Therapist places a different finger crayon on each
Child writes letters in small graph paper boxes
of child’s fingers. Child colors a picture with finger
(Figures 12-2 and 12-3).
crayons.
 Finger Individuation 81

Figure 12-3.

Finger Exercises and

Positions
Child touches each finger to the thumb one at a time
(Figure 12-4).
Child imitates different hand and finger positions.
Finger writing: Child pretends that their fingertip is a
pencil and writes a word on a piece of paper using only Figure 12-4.
the fingertip. Therapist may need to gently stabilize
child’s hand so that only the finger and the fingertips
move to write the letters. (This activity may be difficult
for some children and some may resist using fine finger
Using the Thumb and
movements. The supervising therapist should use only
gentle guidance in assisting any child in this activity.)
Index Finger Together
Child carries multiple items in each hand. Child uses Child picks up small pellet-sized objects.
the fingers to wrap around each item (around a loop, Page turning: Child turns the pages of a storybook, one
bag strap, Hula Hoop, pen, or anything that can be page at a time.
gripped with just the fingers). Therapist calls out one Card dealing: Child deals out a deck of cards using
item, and child must release that item without drop- only one hand at a time, thereby forcing the child to
ping other items in their hand. An alternative way to isolate thumb movements in dealing out the cards.
play this game is with paper. Child holds colored strips
of construction paper between each finger. Therapist Child twirls a pen around the fingers.
calls out a color, and child must drop the specific color Spin a top: Child practices spinning a top on a tabletop,
without releasing any other color (Figures 12-5 and floor, or other hard surface.
12-6).
Child pushes a finger popping toy using one finger at a
time and alternates fingers (Figure 12-7).
82 Chapter 12

Figure 12-5.
Figure 12-6.

Figure 12-8.

Therapist teaches child some notes or chords on

any instrument with buttons or holes to press or
cover, including recorder, horn instruments, and brass
instruments.

Commercially Available
Figure 12-7.

Playing Musical Instruments Product

Therapist teaches child some notes or chords on any Etch A Sketch
instrument with strings, including guitar, violin, and
cello (Figure 12-8).
 IV
Hand Skills

Hand skills are needed for everyday functioning with gross motor tasks as well as tasks involving fine precision. This
section includes activities that can assist in improving functional hand use by focusing on the necessary prerequisites
needed. It also focuses on placing the hand and fingers in the correct position when engaged in a fine motor activity and
playing games with very small objects that require precision. Finally, it focuses on strengthening the small muscles of the
hand as well as practicing skills that involve those muscles, such as grasping a sock to pull it on, coloring with a crayon, or
engaging in craft activities. It is important to understand typical development of various hand and other fine motor skills
in order to select appropriate treatment activities and when establishing goals (Exner, 1997).
 13
Open Webspace
An open webspace (Figure 13-1) is the space between
the thumb and the index finger that appears when grasp-
ing an object; the index finger is in proper opposition with
the thumb. When the webspace is closed (i.e., when using a
lateral pencil grasp) there is an associated increase in whole
arm movement and upper back muscle activation (Farris
et al., 2019). Consequently, there is a resulting decrease
in dynamic finger movements. Pencil grasps using a lat-
eral grasp where a closed webspace is typically present, will
negatively affect handwriting, especially in boys (Farris et
al., 2019).
This chapter provides two types of activities. First, there
are activities that promote moving the fingers to the tip
of the thumb, promoting opposition and thereby opening
the webspace. The second type of activity involves wrap-
ping the child’s hands around different objects, naturally Figure 13-1.
creating an open webspace. The activities provided in this
chapter are intended to help a child promote the finger and
hand stability needed for precision and fine motor skills.

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 85-88).
© 2023 SLACK Incorporated.
86 Chapter 13

Figure 13-2.

ACTIVITIES TO
OPEN THE WEBSPACE
Exercises
Child touches each finger to the thumb, going forward,
backward, and then on both hands simultaneously.
Making “Os”: Child practices forming the letter “O” Figure 13-3.
with the webspace.
Stretching exercises: Therapist gently massages and Child slides pencil or marker up and down tips of fin-
then stretches the webspace open for the child. gers with only one hand (i.e., child “walks” fingers up
Finger Twister: Therapist creates a mini Twister board and down the pencil).
and has child play Twister with the fingers.
Child places hand on table and then makes wide circles
with thumb. Repeat circles 20 times. Therapist may
Special Equipment
need to stabilize digits two to five if child is unable to Child uses different pencil grippers in writing or col-
keep hand still. oring to help keep the webspace open during activities
Finger Painting “Os”: Therapist places finger paint on with a writing utensil.
child’s thumb. Child draws “Os” with thumb while
keeping other fingers flat on the paper.
Wrapping the Hands Around
Child picks up small pellet-sized beads while keeping
hand in shape of an “O” and then releases them into Round Objects
container.
Wrap hand around the following:
Child holds mini marshmallow between index finger
and thumb while fingers are positioned around marsh- Small balls (Figure 13-2).
mallow in shape of an “O.” Child holds marshmal- Handles on a bike (Figure 13-3).
low gently so as to not crush it and slowly counts to
Rungs on a ladder in the playground.
10 while maintaining position.
 Open Webspace 87

Figure 13-4.

Rungs on the monkey bars in a playground Figure 13-5.

(Figure 13-4).
Around trampoline handlebars (Figure 13-5).
Around jump rope handles (Figure 13-6).
Use a roller to flatten dough.
Hold onto ropes while on platform swing.
Hold onto trapeze bar (Figure 13-7).
Sit on seesaw and hold onto handlebars.
Child holds pencil with proper grasp while therapist
encourages an open webspace (Figure 13-8).

Figure 13-6.
88 Chapter 13

Figure 13-8.

Figure 13-7.
 14
Fine Motor Skills
Acquiring fine motor skills is a critical component of
child development. These skills allow children to partici- FINE MOTOR ACTIVITIES
pate in valued occupations including activities of daily liv-
ing, learning, and playing (Marr et al., 2003). There is also
a strong relationship between in-hand manipulation skills Theraputty/Play-Doh
and handwriting proficiency (Cornhill & Case-Smith,
Child makes little balls out of Theraputty or Play-Doh
1996). Children who struggle with fine motor skills risk
by rolling small pieces between the fingertips. Child
falling behind in school, becoming dependent on others,
then picks up pieces with tongs and places them into a
and getting teased in school. (Losse et al., 1991; Piek et
nearby container.
al., 2006). There is also research to indicate that occupa-
tional therapy intervention dealing with fine motor skills Child finds the letters of their name on letter beads.
is effective in preschool and lower elementary school. Child then hides those specific letter beads in
(Bazyk et al., 2009). Theraputty or Play-Doh and subsequently finds them.
The present chapter provides activities that will help to
strengthen fine motor skills by engaging a child in games
and activities with small parts and pieces. The purpose
Writing/Coloring
of the suggested activities is to improve overall manual Finger crayons: Child colors and makes a picture with
dexterity. The activities provided require a child to use finger crayons placed on specific fingers (Figures 14-1
in-hand manipulation, pincer grasp, and other manipula- and 14-2).
tive skills.
Toothpicks activity: Therapist traces child’s name
lightly on a piece of Styrofoam board with a pencil
or pen. Child places toothpicks, one at a time, into
Styrofoam along the traced letters of name to poke
holes (Figure 14-3). Child then colors over the letters
(Figure 14-4).

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 89-94).
© 2023 SLACK Incorporated.
90 Chapter 14

Figure 14-1. Figure 14-2.

Figure 14-3.

Beading and Lacing

Activities
Pop Beads
Child pushes and connects small Pop Beads togeth- Figure 14-4.
er, then pulls them apart one at a time (Figures 14-5
and 14-6).
Lacing beads: Child strings beads on a thin piece of
Child pushes and connects large Pop Beads togeth- string. (If this is too challenging, this activity can
er, then pulls them apart one at a time (Figures 14-7 be downgraded by stringing the beads onto a pipe
and 14-8). cleaner.)
Food art: Child strings macaroni to make a necklace, Bead rolling: Therapist places a small bead between
bracelet, or another design. child’s index finger and thumb. Child rolls the bead
Froot Loops necklace: Child strings Froot Loops on back and forth, from side to side, and then in circles.
a long, thin piece of licorice (this activity can also be Child then tries to transfer bead between the next fin-
performed with Cheerios). ger and thumb and perform the same activity. Child
continues to the pinky and works back toward the
thumb.
 Fine Motor Skills 91

Figure 14-5. Figure 14-6.

Figure 14-7. Figure 14-8.

Lacing art and sewing kits: Therapist teaches child dif- Pop-up books: Therapist reads child a pop-up book.
ferent sewing stitches (whip stitch/over-under stitch) Child lifts tabs off the page with their fingertips.
with a needle and thread. (Make sure the needle is not Child peels an orange or grapefruit and is then allowed
too sharp and that this activity is performed only with to eat it.
a child having appropriate safety awareness.)
Cookie cutters: Child pushes cookie cutter into dough
and then peels out cookie shape by pulling away excess
Peeling With the Fingertips dough.

Child peels strips of masking tape off a tape roll. Child

makes shapes, letters, or a picture with the strips. (This Manipulating Small Objects
activity is often more fun for a child when colored
masking tape is used.) Grasp-release activities (developmental age 7 to
9 months)
Child peels stickers off of a sticker sheet and places
them on a piece of paper. Therapist places toy fish in a small toy fishbowl and
has child take all of the fish out of fishbowl and
Button Candy: Therapist gives child a reward of Button then put them back in one at a time. (The Ocean
Candy and asks child to peel the candy off the sheet of Wonders Musical Fishbowl plays music to reinforce
paper (Figure 14-9). putting in and taking out the fish, which may make
Turning pages: Therapist reads child a book. Child this activity more reinforcing to the child.)
turns the pages with fingertips.
92 Chapter 14

Figure 14-9.

Figure 14-10.

Penny picture handouts: Child picks up one penny at

a time and places the pennies onto the circular marks
on the penny flipping handout to make a design. (See
Appendix A, pp. 242-244, for sample penny handouts.)
Child breaks pistachio shells off and gets to eat the nut
inside.
Be sure to check for nut allergy.

Cutting Activities
Therapist draws lines, shapes, or pictures of animals on
Figure 14-11.
a piece of paper. Child practices cutting along the lines
to cut out the picture. If this is too challenging, thera-
Therapist takes a simple bucket and several toys pist can hold a 1-inch strip of paper and allow child to
that the child enjoys playing with. Therapist places make snips in the paper. (See Appendix A, pp. 197-202,
toys in the bucket. The child removes the toys one for sample cutting activity pages.)
at a time and then places them back in the bucket.
Repeat several times.
Child attaches paper clips in a chain.
Keys
Nuts and bolts: Child screws together nuts and bolts of Lock and key: Therapist provides child with different
different sizes. keys. Child unlocks different doors or locked boxes.
Therapist scatters several pennies/coins on table. Child Child adds keys onto a key chain ring. (The larger the
picks up three coins, one at a time. Child places each key chain ring, the easier the activity.)
coin, one at a time, back into a piggy bank (to upgrade
this activity to work on in-hand manipulation and
translation, increase the number of pennies the child Games
must pick up at one time). Therapist demonstrates “cause and effect” toy where the
Penny flipping: Therapist places 10 pennies on the child has to press/pull/push a knob or button to make a
table in a line. Child turns each penny over, one at a character pop up (developmental age of 6 to 9 months).
time. Dominoes: Child creates a long line of dominoes on a
Penny design making: Child creates different pictures flat surface and then tips the last domino to watch the
and designs using pennies. “domino effect.” It may be necessary to help child with
this task to make sure that no dominoes are accidentally
knocked over too early (Figures 14-10 through 14-12).
 Fine Motor Skills 93

Figure 14-13.

Figure 14-12.

Figure 14-15.

Figure 14-14. Buckling and unbuckling belt buckles

Zipping and unzipping zippers
Card flipping: Therapist plays a card game or a game Snapping and unsnapping snaps
of Memory in which child must flip cards over on the
table. (Do not let the child drag the card to the edge Hooking overall latches and unhooking
of the table to flip it or else they will not be using the Don’t drop the clothes: Therapist places many skirts
small muscles in the fingers for the card-flipping task.) or pants on a skirt hanger. Child tries to hold hanger
Travel-sized games: Child plays travel-sized games up in the air and remove one article of clothing from
with small pieces (some examples include Checkers, the hanger without letting the others fall to the floor
Chess, and Connect Four). (Figure 14-13).
Folding activities: Therapist teaches child how to fold

Dressing and Grooming clothing neatly in a pile (Figure 14-14).

Makeup application: Therapist teaches older children
Doll dressing: Child plays with small dolls, dressing how to apply makeup.
and undressing them. Nail polish: Therapist and child practice polishing fin-
Dressing skills and manipulating fasteners. Child can gernails or toenails (Figure 14-15).
engage in the following:
Tying and untying shoelaces
Buttoning and unbuttoning a shirt
94 Chapter 14

Commercially Available Don’t Spill the Beans

Hi Ho Cherry-O
Products Lite Brite
ADL books Mancala
Bead art Mastermind
The Cheerios Play Book Melissa & Doug Basic Skills Board
Connect Four Melissa & Doug Latches Puzzle
Cootie Perler Beads
Tinkertoys
 15
Pinch-Grasp Manipulation
A pincer grasp involves gripping an item between the Child uses tongs, chopsticks, or tweezers to pick up
thumb and index finger and typically emerges at 9 months small objects. Suggested objects to pick up include
of age (Gerber et al., 2010). Adequate pinch-grasp strength marshmallows, Styrofoam, nuts, beads, and pom-poms
is required for many activities of daily living, including (note: the closer to the tip the child holds the tong, the
eating and playing. Many children with various disabilities easier the activity becomes).
will demonstrate decreased pincer grasp strength (Häger- Child places toothpicks deep into resistive Theraputty
Ross & RÖsblad, 2002). The present chapter discusses ways to make a picture of a smiley face, a flower, a circle, etc.
to work on strengthening the pinch-grasp. Child then removes each toothpick one at a time.
Tissue paper projects: Child cuts up small strips of tis-
sue paper. Child crumples each piece of tissue paper
PINCH-GRASP MANIPULATION and then glues it to a paper to make a picture or create
a letter of their name (Figure 15-3).

Pincer Activities Tissue paper butterfly: Child crumbles small pieces of

cut-up tissue paper in each hand, holding hands in the
Child colors with small broken pieces of crayons air when crumbling and not against body. Child places
(Figure 15-1). This automatically places child’s fingers pieces on a butterfly to decorate (Figure 15-4).
in correct pincer position for coloring and prewriting Stringing beads: Child laces beads to make a necklace.
activities. To downgrade this activity, the child can string beads
Child colors with adapted pencil grips and graspers onto a pipe cleaner instead of a string.
placed on writing utensil (Figure 15-2). Bead rolling: Therapist scatters beads on the table.
Child picks up small, pellet-sized items (e.g., beads, Child picks up a bead one at a time and squeezes it
small cubes, rice). between the index finger and thumb and holds for
3 seconds. Child then rolls bead back and forth, side to
Child picks up pennies to place into piggy bank. side, and then transfers it into a cup.

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 95-98).
© 2023 SLACK Incorporated.
96 Chapter 15

Figure 15-1. Figure 15-2.

Figure 15-4.

Stamps: Child picks up different stamps with small

handles and stamps a paper or their own skin.
Stickers: Therapist draws a picture of a smiley face or
something else the child likes. Child puts very small
stickers on the lines of the drawing and on the eyes,
nose, mouth, etc.
Figure 15-3.
Child squeezes toothpick between thumb and index
finger and sticks toothpick into various small marsh-
Play-Doh rolling: Child rolls pellet-sized balls of Play- mallows or pieces of fruit and eats them.
Doh between the thumb and pointer finger, then
squeezes them one by one using a pinch-grasp.
Small knobbed puzzles: Child holds the small knob on Pincer Strengthening
the puzzle piece to complete the puzzle (Figure 15-5). Child uses a reacher to pick up items off the floor and
Magna Doodle boards: Child holds the small tips places them into a bucket (Figure 15-8).
of the Magna Doodle pieces to color a picture Child completes clothespin activities.
(Figures 15-6 and 15-7).
Child places clothespins on string to make a
Wind-up toys: Child winds up different wind-up toys necklace.
and watches them go.
 Pinch-Grasp Manipulation 97

Figure 15-5.

Figure 15-6.

Figure 15-7.

Therapist writes letters on clothespins and has child Figure 15-8.

form words with clothespins (Figures 15-9 and
15-10).
Bubble Wrap: Child pinches individual bubbles on
Spray water bottles: Child helps water plants or washes
Bubble Wrap between thumb and index finger.
off the chalkboard with a spray water bottle.
Sponge activities
Water guns: Therapist fills a water gun with water
and creates a bull’s-eye to be placed on the wall. Child Child squeezes small sponges for sponge painting.
stands a few feet away from the target and squirts the Child wets small sponges and erases letters on a
water at the bull’s-eye. chalkboard (Figure 15-11).
Gluing activities: Child squeezes a glue bottle with the
thumb and index fingers.
98 Chapter 15

Figure 15-9. Figure 15-10.

Digi-Piggy Digital Piggy Bank

Digital Coin Bank
Gator Grabber Tweezers
Hungry Dog/Monkey/Bunny Motor Skills Game
Hungry Hungry Hippos
Jolly Octopus
Mr. Mouth
Operation
Peg Domino
Figure 15-11. Plastic Jumping Frog Toys
Rock Em’ Sock Em’ Robots

Commercially Available Scatterpillar Scramble

Squiggly Worms
Products Super Sorting Pie
Ants in the Pants Tiddlywinks
Barbecue Party Wok 'N Roll
Bed Bugs
Design and Drill Activity Center
 16
Hand Strengthening
Adequate fine motor skills (as mentioned in previous
chapters) are only part of what is needed for functional HAND-STRENGTHENING
ACTIVITIES
hand use. Sufficient grip strength is necessary for inde-
pendence with various activities of daily living (Häger‐
Ross & RÖsblad, 2002). Grip strength may significantly
influence a child’s performance in various activities of
daily living. Increased grip strength has also been shown Push and Pull
to correlate with improved pencil control and improved
handwriting in typically developing children (Alaniz et al., LEGO pieces: Child pushes LEGO pieces together
2015). Increasing the strength of the hand can also help a tightly and then pulls them apart.
child better control fine motor movements (Huffman & Pop Beads
Fortenberry, 2011). Therapist holds chain of Pop Beads and allows child
Measurements of grip strength are often used in treat- to pull beads off the other end.
ment planning (Häger‐Ross & RÖsblad, 2002). This chapter
Child pushes together Pop Beads and then pulls
not only provides activities to increase hand strength but
apart one bead at a time.
also focuses on endurance as an equally important principle.
Rapper Snappers: Therapist crunches up a Rapper
Snapper toy and holds one end while child grasps
the other end. Therapist encourages the child to pull
one way while the therapist pulls the other way (the
noise that this toy makes when being stretched is very
reinforcing).

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 99-102).
© 2023 SLACK Incorporated.
100 Chapter 16

Figure 16-1. Figure 16-2.

Squeezing and Pinching Using resistive grippers: Child performs hand-

strengthening exercises on a hand gripper (Figures
Tennis ball smiley face: To create this, the therapist or 16-3 and 16-4). Add rubber bands to increase resistance
child draws a smiley face on a tennis ball and then an as needed.
adult uses scissors or a knife to cut a 1-inch slit in the Puff paint: Child squeezes puff paint onto a paper, a
tennis ball over the mouth. Child then squeezes the fabric, or another craft surface of choice to draw a pic-
sides of the tennis ball to place in small beads. After ture or make a design.
child completes placing the beads in ball, the child can Squeezing glue: Child squeezes glue out of a container
make the tennis ball have a stomach ache and “throw onto a line. (Be sure to use glue out of a container and
up” all the beads (Figures 16-1 and 16-2). (The larger not a glue stick.) This can be incorporated into any glu-
the slit on the tennis ball, the easier the activity.) ing and pasting craft activity of choice.
Theraputty exercises Child fills a squeeze toy with water and shoots it.
Child pinches, pulls, and squeezes Theraputty. Pustefix Bubble Bear: Child maintains a continuous
Child hides different objects in putty and then finds squeeze on the bottle to keep the wand up out of the
them as quickly as possible. (This activity can be bottle and blows bubbles (Figure 16-5).
made more exciting by using a timer to see how
quickly child can work and then see if child can
break their record.) Increasing Endurance
Play-Doh Hand puppets: Child performs a play with different
Child rolls and squeezes Play-Doh. hand puppets.
Child creates different objects, including a ball, Coloring: Child colors in large pictures in coloring
square, and triangle, with the Play-Doh. books.
Knead dough: Child helps prepare dough for a baking Snapping fingers: Therapist teaches child how to snap
activity and kneads dough until it is smooth. fingers together; they then snap along together to a
song.
Squeeze toys: Child squeezes a stress ball, Koosh ball,
or another sensory ball. Hand exercises: Child opens and closes hand and fin-
gers to the beat of a song.
 Hand Strengthening 101

Figure 16-3.

Cutting Activities
Simple cutting: Therapist draws lines, shapes, or ani-
mals on a piece of paper. Child practices cutting
along the lines to cut out the picture. (See Appendix A,
Figure 16-4.
pp. 197-202, for sample cutting handouts.)
Snipping paper: Therapist holds a 1-inch strip of paper
and allows the child to make snips in the paper (for
lower-level children).
Child performs resistive cutting activities
Child cuts strong Theraputty.
Child cuts thick paper.
Child cuts several papers at once.
Craft scissors: Child uses craft scissors to cut paper
(craft scissors are more difficult to cut with than regu-
lar scissors).

Figure 16-5.
102 Chapter 16

Figure 16-7.

Child pops bubbles on Bubble Wrap, grabbing bubbles

with whole fist.
Child presses down on pop-up toys (Figure 16-7).

Commercially Available
Products
Figure 16-6. Bug-Out-Bob
Mr. Potato Head
Smart Snacks Sorting Shapes Cupcakes
Pressing
Stapling: Child helps to staple booklets of paper
together.
Hole punching: Therapist draws a line or a shape onto
a piece of paper. Child punches holes along the line
so that the picture is hole-punched out of the paper
(Figure 16-6).
 17
Handwriting
Handwriting concerns are a primary impetus for an “fall letters” (g, j, p, q, y) are provided in this chapter to
occupational therapy referral in the school-based setting enable practice of targeted handwriting skills and letters
(Reisman, 1991). There is a notable increase in the number of focus.
of children being referred for school-based occupational Please refer to Chapter 15 for activities to strengthen the
therapy due to handwriting deficits (Oliver, 1990). Some pincer grasp which also can affect proper pencil grasp.
studies have shown that 10% to 20% of elementary school
students have difficulty with handwriting (Alston & Taylor,
1987). Additionally, there is a significant amount of time
dedicated to paper and pencil writing tasks within the
classroom (Diekema et al., 1998).
HANDWRITING GAMES
Handwriting interventions can yield significant Rainbow tracing: Child writes the same letter over
improvements in various components of overall penman- original template on paper in various colors of the
ship skills and legibility (Case-Smith, 2001). In this chapter, rainbow in order to continually form the same letter.
various techniques will be introduced in order to promote
proper position of the fingers and wrist during writing and Sandpaper writing: Child writes or traces words on
proper pencil grasp. regular paper with sandpaper placed underneath the
Wrist extension is crucial during writing in order to paper to provide proprioceptive input during writing
allow for distal finger movements. In order for the wrist to activity.
be in an optimal position, wrist flexors and extensors must Cardboard tracing: Therapist pokes holes in cardboard
work antagonistically and allow proper cocontraction to in the shape of a specific letter. Child then traces over
provide control of the wrist (Benbow, 1997). Various verti- the bumps to form letter (Figures 17-1 and 17-2).
cal surface writing activities are provided in this chapter as Child writes letters with small or broken crayons. This
this helps facilitate wrist extension. will prevent fisting of writing utensil.
Lastly, various pangrams (sentences containing all 26
Child uses vibrating pen to trace or write letters.
letters of the alphabet) and sentences including multiple

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 103-108).
© 2023 SLACK Incorporated.
104 Chapter 17

Figure 17-1.

Figure 17-2.
Therapist and child take turns tracing various letters
in each other’s palm without looking. Child then has

ACTIVITIES TO PROMOTE
to guess the letter that was traced.
Air tracing: Child writes letter in the air with extended
index finger.
Foot writing: Child dips toe or foot in paint and then
DISTAL FINGER MOVEMENTS
writes a letter on a large paper placed on the floor.
Child colors in small quarter-inch circles of various
Sandbox writing: Child writes or traces letters in a colors, matching color to the circle (Figures 17-3 and
sandbox. 17-4).
Window writing: Child uses special washable window Child makes a tiny “x” inside small circles all over
markers to write letters or words on windows. paper (Figures 17-5 and 17-6).
Play-Doh writing Child traces small circles in designated area (Figure
Child writes letters on flattened piece of Play-Doh. 17-7).
Child forms letters out of skinny rolled pieces of Child traces circle inside paper protector placed on
Play-Doh. construction paper (Figure 17-8).
Child traces small lines of varying patterns inside
small box on a paper (Figure 17-9).
 Handwriting 105

Figure 17-3. Figure 17-4.

Figure 17-5. Figure 17-6.

106 Chapter 17

Figure 17-7. Figure 17-8.

ACTIVITIES TO
PROMOTE WRIST EXTENSION
Have child practice writing with the HandiWriter
Handwriting Tool (Figure 17-10).
Writing on vertical surfaces
Child writes on slant board.
Therapist places clip board on large binder to simu-
late slant board for writing.
Therapist tapes piece of paper to the wall and child
writes on paper.
Child writes on whiteboard or chalkboard on the
wall.
Child writes on a Magna Doodle placed on vertical
surface.
Child traces over letters with wet sponge or paper
towel.

Figure 17-9.
 Handwriting 107

PENCIL GRIPS
Different types of pencil grips address a variety of under-
lying pencil grasp deficits. Below is a list of various pencil
grips that can be purchased:

DMFLY Pencil Grip

Crossover Grip
Writing Claw
Stetro Pencil Grip
Geddes Kushy Pencil Grip
Pencil Grip Jumbo
Bumpy Grip
Soft Cushion Pencil Grip
Foam Grip
Triangle Pencil Grip

PANGRAMS
The following is a list of pangrams compiled from
various websites (Wikipedia, 2020; The Word Play Website,
2020; Your Dictionary, 2020):
Figure 17-10.
The quick brown fox jumps over the lazy dog.
Jived fox nymph grabs quick waltz.
The jay, pig, fox, zebra, and my wolves quack!
Glib jocks quiz nymph to vex dwarf.
Sympathizing would fix Quaker objectives.
Sphinx of black quartz, judge my vow.
A wizard’s job is to vex chumps quickly in fog.
How vexingly quick daft zebras jump!
Watch “Jeopardy!”, Alex Trebeck’s fun TV quiz game.
The five boxing wizards jump quickly.
By Jove, my quick study of lexicography won a prize!
Pack my box with five dozen liquor jugs.
Waxy and quivering, jocks fumble the pizza.
We promptly judged antique ivory buckles for the next
prize. The following is a list of sentences with fall letters (g, j,
p, q, y):
How razorback jumping frogs can level six piqued These sentences include letters that fall below the line and
gymnasts. are intended to help work on horizontal alignment aware-
Sixty zippers were quickly picked from the woven jute ness.
bag.
The girl picked a green gummy and jelly bean.
Crazy Fredrick bought many very exquisite opal jewels.
The gift wrap paper was pink and purple.
Jump by vow of quick, lazy strength in Oxford.
The quick piggy played in the muddy pig pen.
Quick zephyrs blow, vexing daft Jim.
The queen quickly picked a pretty quilt.
Waltz, nymph, for quick jigs vex bud.
The girl is quietly jumping by herself.
Jackdaws love my big sphinx of quartz.
I lost my key in the gooey plaster.
Two driven jocks help fax my big quiz.
108 Chapter 17
Why are you going to be by yourself? I’m painting a picture of a penguin gobbling apples
Peter Piper picked a peck of pickled peppers. and pizza.

In gym class the girls were galloping quickly. The pampered girl is polishing her nails while wearing
pajamas.
He gives her a shiny penny today.
The baby is petting my pet puppy.
I hope you have a happy and joyous birthday.
The soapy sponge dripped on the floor and needs to be
The young boy keeps hopping, skipping and playing. mopped up.
I suggest you pick apart the wrapping paper before We jingled bells, did a jiggy dance, and jumped all
opening the packaged present. night long.
I’m going on a quick jog with grandma in the pretty I prepared yummy popcorn for the party.
park.
The baby green giant playfully punched and wiggled
The jester spilled juice on the queen’s quilt. around.
The funny hippo splashed in the muddy pond. We must pick green peas as a healthy and yummy
The jaguar and puma leaped across the jungle at night. snack.
The pony hopped and galloped on the foggy day. It is quite peculiar to pick a purple poncho in the pour-
The baby girl plays with her piggy, froggy, and puppy ing rain.
toys.
She prepped for her quiz every night.
 V
Body Strengthening and
Stabilizing

Postural control and stability create the base of support for the rest of the body. There is a significant correlation
between decreased core strength and difficulties with dynamic balance (Salar et al., 2014).
This section addresses the various components of body strength and stability. The topics discussed include core-
strengthening activities, balance activities, and activities to help improve shoulder and arm stability.
 18
Core-Strengthening Activities
The term core musculature refers to the transverse
abdominis, internal obliques, pelvic floor, and multifidus CORE-STRENGTHENING
ACTIVITIES
muscles (Jeffreys, 2002). Decreased core strength can cause
postural insecurity. Ayres (1979) associates postural insecu-
rity with decreased postural mechanisms. Decreased core
strength can also result in deficits in fine motor control as
well (Shumway-Cook & Woollacott, 1995). Core strength Abdominal Exercises
should be one of the first areas addressed in dealing with
any fine or gross motor deficit. In this chapter, various Modified sit-up: Place child on back on the floor or soft
core-strengthening exercises are provided to help establish surface. Pull child’s hands gently at the same time and
a strong foundation on which to build further skills. let child use abdominal muscles to pull self to upright,
seated position (developmental age of 4 to 6 months;
It is important that when performing activities with
Figure 18-1)
infants, small children, and developmentally delayed chil-
dren, the therapist should be skilled in proper handling “Row, Row, Row Your Boat” game: In this game, child
techniques in order to safely and effectively implement the sits on the floor, facing either therapist or another
chosen activity. To become familiar with these handling child, each holding onto one end of a jump rope (posi-
techniques, the therapist should contact a trained pediatric tion I) or onto each other’s wrists (position II). As both
occupational or physical therapist familiar with the specific sing the song, one person leans back as the other leans
population of interest. forward and then the opposite.
Position I (Figure 18-2).
Position II (Figure 18-3).
Sit-ups and crunches: Child performs sit-ups and
crunches on the floor. Therapist performs the same
exercises with child to help keep child motivated
(developmental age of 6 years and up).

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 111-120).
© 2023 SLACK Incorporated.
112 Chapter 18

Figure 18-2.

Figure 18-1.

Figure 18-3. Figure 18-4.

Child takes ball between child’s ankles and passes ball

back to the therapist in same way. This can also be
played with two children (Figures 18-6 through 18-8).
Backward flip: Child lies on back on therapy ball. Child
places arms on floor for support behind self. Child then
flips body over (Figure 18-9).

Figure 18-5. Whole-Body Stabilization

Sitting exercises (developmental age of 6 to 8 months)
Feet kick: Child lies supine (on back) on a mat with feet
in the air. Therapist throws a large therapy ball toward Therapist places the child on lap with the child
child’s feet. Child kicks ball upward and back toward facing therapist. Therapist holds child’s hands and
therapist (Figure 18-4). engages child while also lifting up one of child’s
knees and then the other, shifting child’s weight
Leg lifts: Child lies flat on floor and raises and lowers from side to side.
legs off the floor (developmental age of 6 years and up).
Weight shifting: Therapist places child in sitting
Bicycle sit-ups: Child lies on back and brings the right position on floor, providing minimal support.
elbow to the left knee, while extending the right leg. Therapist gently tilts child off balance to each side
Then switches and repeats as tolerated (developmental (one at a time) and then forward and backward.
age of 6 years and up; Figure 18-5). Therapist should try to tilt child only slightly so that
Therapist lies on floor opposite child with therapist’s child is able to regain balance and an upright, seated
feet touching child’s feet. Therapist places a small ball position independently when possible.
between therapist’s ankles and passes the ball to child.
 Core-Strengthening Activities 113

Figure 18-6. Figure 18-7.

Figure 18-8.

Therapist places child in sitting position for play

and interaction with Boppy pillow around child for
support (Figure 18-10).
Therapist places Hip Helpers (www.hiphelpers.com)
on child to provide extra support while sitting. Hip
Helpers prevent the child from “W” sitting (or sit-
ting with legs spread wide apart, forming a wide
base of support), thus “forcing” child to activate
their trunk muscles while sitting. Figure 18-9.

Therapist places child in sitting position on floor,

providing minimal support as needed. Therapist Therapist can place the toys on all sides of child so
allows child to stay in this position as tolerated that child is required to reach in different directions
while engaging in playful activities (Figure 18-11). to acquire the toys.
While child is sitting, therapist holds a favorite toy, Standing exercises (developmental age of 3 to 4 months;
such as a rattle, just above child’s head and encour- Cottrell, 2004, p. 20): Have child practice standing with
ages child to reach for the toy. Therapist should limited support. Hold child under armpits (Figure
have several different toys on hand so this can be 18-12) or by the hands (Figure 18-13), providing mini-
repeated several times in a row. mal support as needed. Place child’s feet on a steady
surface. Have child practice standing for several sec-
onds at a time as tolerated.
114 Chapter 18

Figure 18-10. Figure 18-11.

Figure 18-12. Figure 18-13.

Kneeling activities: Child performs activities while Child slowly walks up a ramp. Therapist makes sure
kneeling on the floor (Figures 18-14 and 18-15). While child is standing upright and not using the hands or
there are many games that can be played in this posi- head to help climb.
tion, some ideas include coloring activities, completing Dizzy Disc: Child spins on the disc without falling off
puzzles, playing catch, playing a card game on a low (Figure 18-16).
stool, and rolling a ring across the floor (do not allow
child to lean body against surface to support self when
in unstable positions).
 Core-Strengthening Activities 115

Figure 18-14. Figure 18-15.

Child sits on a bolster or peanut ball and reaches for far

items placed on both sides. Child then throws the items
into a basket (Figure 18-17).
Couch push-ups: Child lies prone (on the belly) on a
couch, perpendicular to the length of the couch, with
the upper body off the couch and hands on the floor
and then performs push-ups (Figure 18-18). Child can
also play a game or do a puzzle in this position.
Step-ups: Child steps up and down from an object
approximately a foot off of the floor. Therapist reminds
child to place both arms out to the side when stepping
onto and off of the surface to prevent them from com-
pensating by using arm muscles (Figure 18-19).
Hippity Hop toy: Child bounces across room on a
Hippity Hop toy (Figure 18-20; this toy can also be
used as part of a relay race).

Figure 18-16.
116 Chapter 18

Figure 18-18.

Figure 18-17.

Figure 18-20.

Figure 18-19.
 Core-Strengthening Activities 117

Figure 18-21.

Crab-walking: Child crab-walks across the room and

picks up different objects along the way (Figure 18-21).
Bridge making: Child lies on back on the floor. Therapist
helps child make a bridge. Child then attempts to make
a bridge independently (Figures 18-22* and 18-23*;
child can also make a bridge over a therapy ball.)
Limbo: Child walks under a stick in the game of limbo.
Therapist should make sure that child leans backward
in walking under the stick and not forward or else child Figure 18-22.
will not be using abdominal muscles.
Pogo stick jumping: Child jumps across room on a
pogo stick.

Suspended Equipment
Activities
Therapist must make sure that a mat or soft surface is
placed under all suspended equipment while in use.

Therapist wraps child’s legs around a T-swing. Child

goes upside down and then tries to pull self up
(Figure 18-24*).
Log swing
Child straddles log swing and goes back and forth
Figure 18-23.
on moving swing without falling off.
Child hangs upside-down on swing and holds on for
a set count. Child then performs this activity several
more times trying to beat own record for time held
on (Figure 18-25*; This activity can be made more
challenging by reaching for items on floor while
hanging upside down).

*Increased caution should be taken with these activities, especially with children with lax ligaments or any medical conditions that may make them
susceptible to dislocations or where head inversions are contraindicated.
118 Chapter 18

Figure 18-24. Figure 18-25.

Tire swing: Child straddles tire. Therapist makes sure

child is not leaning forward or backward, rather sitting
upright so that the back and belly are not touching the
tire. Therapist swings tire back and forth and side to
side. Child holds on as long as possible (Figure 18-26).
Child hangs upside down on a trapeze bar and pulls
self up (Figure 18-27*).
Lycra swing: Child climbs up a long Lycra swing to the
top and then slides down.

Therapy Ball Activities

Child holds therapy ball against wall only with body
(no hands). Child plants feet on floor and creates a
bouncing momentum against the ball.
Child holds a large therapy ball against the wall only
with body and then slightly moves ball back and forth
along the wall using their chest and stomach without
using hands (Figure 18-28).
Therapist places child in sitting position on therapy
ball. While holding onto child, therapist rolls ball for-
ward and backward and from side to side while engag-
ing the child.

Figure 18-26.

*Increased caution should be taken with these activities, especially with children with lax ligaments or any medical conditions that may make them
susceptible to dislocations or where head inversions are contraindicated.
 Core-Strengthening Activities 119

Figure 18-28.

Figure 18-27.

Figure 18-30.

Figure 18-29.

Child lies on back on the floor and holds therapy ball

with both feet and hands. Therapist tries to gently pry
ball away from child while child tries to hold onto ball
(Figure 18-29).
Puzzle–ball sit-ups: Therapist scatters puzzle pieces
around a therapy ball. Child sits on therapy ball and
reaches for puzzle pieces placed behind or on the side
of the ball. Child then performs a sit-up to put the piece
into the puzzle frame (Figures 18-30 and 18-31).
Figure 18-31.
120 Chapter 18

Figure 18-32. Figure 18-33.

Climbing
Climbing up furniture: Therapist brings child near a
chair, couch, or small table. Therapist places a desired
toy on the surface and encourages/assists child, as
minimally as possible, to transition from either sitting
or quadruped to standing while holding onto couch or
chair to reach for toy (Figures 18-32 and 18-33).
Ladder climbing: Child climbs up a ladder, net, or rope
in the therapy area or outside on playground (Figure
18-34).
Rock wall games
Child climbs up wall.
Child climbs up rock wall, using only one rock of a
specific color.
Therapist scatters rings on the top and along rock
wall. Child climbs across rock wall, picks up rings,
and throws them into a basket.

Figure 18-34.
 19
Balance Activities
Balance is required for smooth and coordinated move- Specifically, the balance activities included in this chap-
ment. There is a correlation between decreased balance and ter are those that require the child to be on one foot or to
adverse effects on fine motor skills (Burnett et al., 2011). maintain balance on unstable surfaces. A child lives in a
Some children will have a postural disorder that affects dynamic environment. For example, they will need to learn
balance and may include poor righting and equilibrium to walk on uneven sidewalks, up and down curbs, and over
reactions, poor weight shifting and difficulty with trunk bumps on a grassy surface. A child who is able to maintain
rotation (Miller et al., 2007). balance only on stable and static surfaces would face serious
There is various literature on the efficacy of balance difficulties in real world situations. Activities to strengthen
training programs and treatments geared at improving protective reactions are included as well. Protective reac-
standing and dynamic balance (Shumway‐Cook et al., tions occur in the frontward and backward as well as in
2003). Balance training interventions have also shown the lateral plane of movement. A protective reaction occurs
improvements in postural control with people with autism when one is falling and “catches” oneself by stretching out
spectrum disorder (Cheldavi et al., 2014). Specifically, pos- one’s arms in the direction of the fall. These reactions also
tural control can be strengthened through balance training occur in forward, backward, and lateral directions (Case-
activities (Granacher et al., 2010). Engaging in core strength Smith, 2001).
exercises is another way to improve balance (Granacher et
al., 2013).

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 121-127).
© 2023 SLACK Incorporated.
122 Chapter 19

Figure 19-1.

Figure 19-2.

Tapping cones with one foot: Child stands on one foot.

Therapist places numbered (or colored) cones on floor
approximately a foot away from child. Therapist calls
out a number (or color) and child taps corresponding
Figure 19-3. cone while maintaining balance (Figure 19-2).
Hopping activities

BALANCE ACTIVITIES Child hops into rings placed on floor and freezes
(Figure 19-3).
Child hops over bumpy balance board sections
All activities in this chapter must be done with close adult
(Figure 19-4).
supervision, especially with children who have poor bal-
ance skills. Child hops in place.
Therapist places laminated letters all around the
floor. Child hops over the letters of child’s name.
One-Foot Activities Therapist places a rope on floor and tapes it down
Child maintains balance on one foot for X seconds and on both ends. Child hops over the rope and back
then alternates to other for X seconds. (Amount of time (Figure 19-5).
should be determined by treating therapist.) Therapist places a rope on floor and tapes it down
Child stands on one foot with other foot resting on a on both ends. Starting from one end of the rope,
ball. Therapist stabilizes the ball if needed. To make child hops over the rope, alternating landing on
activity more challenging, child performs an activity each side of the rope, making their way along the
while on one foot—for example, while playing catch, length of the rope while hopping, until they reach
clapping hands, etc. (Figure 19-1). the other end.
 Balance Activities 123

Figure 19-4. Figure 19-5.

Figure 19-6.

Balance on it: Therapist calls out a body part. Child

balances on that body part. Some examples include
right foot, left foot, both knees, one knee, both
hands, etc. (Figure 19-6).
Figure 19-7.
Human maze: Children lock arms to create a human
obstacle course. Another child will have to balance and
climb over the human maze (Figure 19-7). Child pops bubbles in air (Figure 19-10).
Child passes ball under leg to another child. Other Child reaches across midline for items in the air
child receives ball and repeats activity to pass ball back (Figure 19-11).
(Figures 19-8 and 19-9).
Child plays basketball (Figure 19-12).
Child throws a ball against a wall and catches it
Standing/Walking on (Figure 19-13).

Unstable Surfaces Child places bean bag on head and balances it while
on balance board.
Balance-board activities Balance beam activities
Child steps on/off balance board. Child walks across balance beam.
Child turns around in a 360-degree circle. Child picks up items from the floor and throws
Child plays catch with therapist. them into target (Figure 19-14).
124 Chapter 19

Figure 19-8. Figure 19-9.

Figure 19-10. Figure 19-11.

 Balance Activities 125

Figure 19-12. Figure 19-13.

Figure 19-14.
Figure 19-15.

Child walks across balance beam while holding an

object in both hands. This activity can be downgraded by allowing child’s
Child plays catch on balance beam. toes to slide slightly forward and make contact with
the floor (as opposed to being completely grounded
Child stands still, maintaining standing balance. on the air disc).
Inflatable air disc: Child maintains balance with both Woggler: Child walks across the room on a Woggler
feet placed on inflatable disc. (Figure 19-15).
126 Chapter 19

Figure 19-16.

Figure 19-17.

Figure 19-18.

Stepping stones: Child walks onto a specific colored or

numbered stone (Figure 19-16).
Child walks on beanbags or other uneven surfaces
(Figure 19-17).
Therapist places a therapy ball under a mat/ramp.
Child walks up the mat/ramp (Figure 19-18).
Therapist places therapy ball under mat. Child “surfs”
by balancing on moving mat and standing in one place
(Figure 19-19).
Therapist places log swing on floor. Child walks across
it without falling off. (Therapist may need to stabilize
swing on the floor so it does not move around too
much when the child is walking across it.)
Curb-walking: Child walks outside along the sidewalk
Figure 19-19.
curb.
 Balance Activities 127

Figure 19-20.

Walking on straight line: Child walks along a straight

piece of long tape placed on the floor.
Stair climbing
Therapist must guard child while performing these activi-
ties and be done with close supervision. Figure 19-21.
Child walks up and down stairs without using
railing.
Child walks backward up stairs and then down Alternative Forms of Exercise
again. Karate
Pilates
Yoga (Figures 19-20 and 19-21)
 20
Upper Arm Strengthening
and Stabilization
Upper arm strength and stability are essential to the
functional use of the hands. It is a long-standing belief UPPER ARM STRENGTHENING
AND STABILIZATION
among physical and occupational therapists that proximal
control is a prerequisite for distal arm functioning (Tudor,
1981). Children with poor upper arm strength and stabil-
ity frequently have difficulty performing tasks with their
hands. Proximal stability of the shoulder and surrounding Bearing Weight Through the
musculature is necessary for distal arm control and proper
use of the hand (Benbow, 1995). Hands
This chapter provides a variety of activities to help
Place child in prone weight-bearing position so that
strengthen and stabilize the arm and shoulder area. Weight-
child bears weight through forearms or hands.
bearing activities can often provide stability to the shoulder
joint. This chapter also includes activities that can be per- Lie on floor next to child, slightly higher than eye level.
formed on a vertical surface, which can result in improved Alternatively, place child in prone position on a bed
use of the thumb (Benbow, 1995). surface to make it easier for adult to be at child’s eye
level (Figure 20-1).
Place child on Boppy pillow or elevated surface in order
to improve tolerance toward being in a prone position
(developmental age 4 to 6 months; Figure 20-2).
Increase supervised “tummy time” activities for young
children (developmental age 4 to 6 months).
Therapist lies at slight angle on floor, couch, or bed
and places child on stomach/chest area in prone
position (Figure 20-3).

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 129-138).
© 2023 SLACK Incorporated.
130 Chapter 20

Figure 20-1. Figure 20-2.

Figure 20-3. Figure 20-4.

Place a thin soft blanket on floor and place a toy in

front of child on belly (Figure 20-4).
Place child on stomach in front of a mirror.
Place child on stomach over therapist’s lap
(Figure 20-5).
Hold child horizontally in air, weight bearing on
adult’s forearm (Figure 20-6).
Place child in quadruped position
Have child maintain stationary position.
Have child reach for items from this position
(Figure 20-7).
Have child go through crawling movements from
this position with the therapist facilitating the
Figure 20-5.
movement.
 Upper Arm Strengthening and Stabilization 131

Figure 20-7.
Figure 20-6.

Figure 20-8.

Child lies in prone position (on the belly) on a platform

swing or a net swing a few inches off floor. Child leans
over the edge so the chest is not on the swing, but rath-
er off the edge. Therapist spreads out objects all around
and under the swing. Child walks on hands to objects,
picks them up, and throws them into a container, or
Figure 20-9.
performs another task with them (Figure 20-8).
Child lies prone (on belly) on a scooter board. Child
holds onto a bungee cord or jump rope while being Wheelbarrow walking
pulled by therapist. Child maintains a stationary wheelbarrow position.
Child lies prone on a scooter board and propels self Child reaches for toys in this position.
around the room in order to reach and pick up objects.
Child walks on hands with legs being held up in the
For example, child picks up scattered bean bags or
air (Figure 20-11). This activity can be graded by
Koosh balls all over the floor and then places them
the distance walked and where the therapist places
into a bucket.
support when holding the child’s legs. It is most
Child walks feet up the wall while weight bearing physically challenging for the child when being held
through the hands on a mat (Figure 20-9). around the ankles. The closer to the hip the support
Crab-walking: Child walks in a supine (on back) posi- is provided, the easier the activity for the child.
tion on hands and feet making sure that no other parts Wheelbarrow-walking races (Figure 20-12).
of the body are touching the floor (Figure 20-10).
132 Chapter 20

Figure 20-10. Figure 20-11.

Figure 20-12. Figure 20-13.

Wall push-ups (Figure 20-15).

Couch push-ups: Child lies on a couch on belly,
hanging over the edge. Child places arms on the
floor and pushes off the floor keeping lower body
on the couch (Figure 20-16).
Chair push-ups: Child sits on a chair, grabs each
side of the chair with hands, locks elbows, pushes
down, all while keeping bottom seated on chair
(Figure 20-17).
Child leans over the edge of a solid stable surface, so
that the chest is not supported by the surface. Therapist
spreads puzzle pieces around the floor within arm’s
Figure 20-14. length. Child reaches for pieces and completes the
puzzle (Figure 20-18).

Push-ups: Child performs different push-ups. Child is placed prone on therapy ball while bearing
weight through the arms. Child performs push-ups in
Regular floor push-ups (Figure 20-13). this position (Figures 20-19 and 20-20).
Half push-ups with knees touching floor
(Figure 20-14).
 Upper Arm Strengthening and Stabilization 133

Figure 20-16.

Figure 20-15.

Figure 20-18.

Figure 20-17.
134 Chapter 20

Figure 20-19. Figure 20-20.

Figure 20-21.

Bubble Wrap popping: Therapist places sheet of Bubble

Wrap on floor in a line. Child takes rolling truck or car
and places it on top of Bubble Wrap paper and presses
down on rolling truck as it is rolled over the line of
Bubble Wrap (Figure 20-21).
Figure 20-22.

Using Vertical Surfaces Child completes writing sheets on a slantboard.

The following activities work best on shoulder stabilization
Child colors piece of paper taped onto the wall.
when the arm is in a position at and above shoulder level
(Child can color, paint, or write on this surface.)
(90 degrees of shoulder flexion).
Child cleans off the chalkboard with an eraser or wet
Vertical surface writing paper towel.
Child colors on an easel. Child pushes pegs into a peg board on vertical surface
Child writes on a chalkboard. (Figure 20-22).
Child traces letters on a whiteboard. Child places magnets on a vertical surface.
 Upper Arm Strengthening and Stabilization 135

Figure 20-24.

Figure 20-23.

Figure 20-26.

Child swings a jump rope.

Child holds arms up in the air for X number of sec-
onds. (Amount of time should be determined by treat-
ing therapist.)
Child plays a game with magnetic fishing rods. Child
uses the rod to lift up the fish when magnets connect
(Figure 20-23).
Child builds a tower with blocks.
Figure 20-25.
Child lies prone on a platform swing. Child uses a
reacher to pick up scattered beanbags/toys and places
them into a bucket (Figure 20-24). To upgrade or
Stabilizing the Shoulder downgrade this activity, therapist can put the bucket at
different heights and distances away from child.
Against Gravity Child lies prone on floor and faces another child or
The following activities provided work best on shoulder therapist lying on belly. Both children pass ball by
stabilization when the arm is in a position at and above rolling it on the floor back and forth between them
shoulder level (90 degrees of shoulder flexion). (Figures 20-25 and 20-26).
136 Chapter 20

Figure 20-28.

Figure 20-27.

Figure 20-29. Figure 20-30.

Resistive Activities Child places a mid-sized therapy ball between hands

with arms straight out in front of body and walks
Child sits in a storage bin or barrel and pulls self out by across the room holding the ball (Figure 20-30). Use a
climbing a rope that is being pulled tightly by therapist smaller ball if this is too challenging.
(Figure 20-27). Child climbs up a ladder.
Child pulls apart Rapper Snappers or Therabands with Child swings on a trapeze bar.
arms straight out in front (Figures 20-28 and 20-29).
 Upper Arm Strengthening and Stabilization 137

Figure 20-31. Figure 20-32.

Child swings across monkey bars in the playground

(Figure 20-31).
Child hangs on monkey bar in place (Figure 20-32).
Theraband exercises
Child holds Theraband out in front of the body with
both hands, pulls apart, holds, and repeats as toler-
ated (Figure 20-33).
Child places Theraband behind the back with the
Theraband wrapped around so child can grab it
with each hand on both sides. Child straightens
arms out to the side and holds. Repeat as tolerated
(Figure 20-34).
Hula Hoop pulling: Therapist places child on a swing
or a scooter while child holds onto a Hula Hoop.
Therapist holds onto the other end of the hoop and
pulls child around.

Figure 20-33.
138 Chapter 20

Figure 20-35.

Figure 20-34.

Figure 20-37.

Commercially Available
Products
Don’t Spill the Beans
Figure 20-36. Fantacolor Junior
Jenga
Tug-of-war: This game can be played between child Lite Brite
and therapist or between two children. This game Magnet Express
should be closely supervised for safety concerns
Melissa & Doug Magnetic Puzzles
(Figure 20-35).
Zoom Ball
Lifting weights: In a standing position, child holds
weight in each hand at shoulder height with flexed
elbows (Figure 20-36). Child fully extends arms and
maintains shoulder flexion at 90 degrees (Figure
20-37). Repeat a certain number of times (number
of repetitions should be determined by treating
therapist).
 VI
Cognitive and Higher-Level
Skill Building

Cognitive skills and executive functioning are critical for complex child behavior (Biederman et al., 2004). Studies of
various diseases show the significance of executive functioning and how deficits in executive functioning will result in
large functional impairments (Chen et al., 1998).
Included in this section are activities that will help to improve overall organizational skills related to cognition and
executive functioning. As described by Zeigler-Dendy (2002), components of executive functioning that affect school per-
formance include the following:
Working memory and recall (holding facts in mind while manipulating information, accessing facts stored in long-
term memory).
Activation, arousal, and effort (getting started, paying attention, finishing work).
Controlling emotions (ability to tolerate frustration, thinking before acting or speaking).
Internalizing language (using “self-talk” to control one’s behavior and direct future actions).
Taking an issue apart, analyzing the pieces, and reconstituting and organizing it into new ideas (complex problem
solving).
This section addresses specific areas of cognition and higher-level skill building, including increasing attention and
improving organizational skills.
 21
Increasing Attention
Being able to maintain attention is a prerequisite to Other helpful strategies for increasing attention include
engagement and completion of any activity (Ben-Yishay the following:
et al., 1987). This chapter discusses three main types of The therapist should prepare the treatment area before
attention: visual attention, sustained attention, and shifted/ treating a child to avoid having to stop an activity to
divided attention. Sustained attention is the ability to obtain needed toys or materials.
maintain attention on a specific point for a considerable
It may be helpful to work and play in a tent/tunnel or
length of time. Shifted/divided attention refers to the abil-
cubicle to avoid outside distractions.
ity to move attention from one task to another. Many chil-
dren, especially those with developmental disabilities will When working with a higher-level child, try working
demonstrate difficulties with sustained attention to a task or playing with music in background. This can help
(Cardona et al., 2000). When a child is unable to attend or to strengthen the child’s ability to tune out extraneous
focus, this will often cause difficulties with learning and background noise and focus on the demands at hand.
peer interaction (DeGangi, 1994). This should be done only with a child who has already
The types of activities suggested in this chapter are mastered the skill of being able to focus in a quiet,
those that require continued engagement for a successful distraction-free environment.
outcome. Most activities and games provided require both Perform fast-paced activities to help the child stay
forms of attention. A therapist working on these skills may focused.
downgrade the task by focusing on only one form of atten- Computer-based learning games and activities are
tion at a time. It is at the discretion of the treating therapist commonly used to help increase attention as they pro-
to upgrade any activity as needed. vide continuous and immediate feedback (Cardona et
al., 2000).

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 141-142).
© 2023 SLACK Incorporated.
142 Chapter 21

ACTIVITIES TO Freeze dancing: Child dances to music. When music

stops, child freezes in place.

INCREASE ATTENTION Red Light, Green Light, 1, 2, 3: Therapist stands next

to the wall with back facing the child. Therapist says
“red light, green light, 1, 2, 3” and then turns to face
Visual Attention the child. Child runs to touch therapist but stops once
therapist turns around. If therapist catches child run-
Therapist plays Peek-a-Boo with child. ning, child must return to the wall and start again.
Child bounces on a therapy ball or sits on an air disc Child jumps into ball pit. Therapist instructs the child
while playing a game. to throw balls into a basket in specific order, differenti-
ating the balls by color. For example, therapist instructs
Child visually tracks an object in different planes child to throw “red, blue, red, yellow” in that specific
(choose an object that is desirable to the child). order.
Bingo: Child plays Bingo in group or with therapist.
Higher-Level Attention (This game can be played with Bingo cards with num-
bers, shapes, or pictures in order to upgrade or down-
Building grade level of difficulty).
Card games: Therapist and child play card games
Copy a pattern: Child laces beads in a pattern of colors
together. Examples include gin, go fish, and war.
or shapes.
Memory: Child and therapist play Memory game
Child colors lines on a paper in a specific pattern. Child
together.
repeats the pattern out loud in a sing-song way as a
memory tool. I Spy: Therapist plays I Spy with child in a small room
(this will force the child to pay attention and look for
ABC wall game: Therapist places the letters A through
details around the room.)
E on the wall approximately half-an-inch apart in a
random order. The letters should be large enough so a Arrow Game: Therapist hides something in the room
child can stand a few feet away from the wall and still or inside the building. Therapist tapes arrows (created
see them. Child throws a ball at letter “A” and catches out of masking tape) on the floor leading to the hidden
it; they continue throwing the ball at the next letter and toy. Child follows arrows and peels each arrow off of
catch it. (Upgrade this activity by adding more letters the floor as they pass it.
or downgrade the activity by only placing two to three
letters on the wall.)
Child repeats a series of numbers, letters, or colors.
Commercially Available
Board games: Therapist plays board game with child. Products
Child attempts to remember when their turn is, with-
out verbal prompting from therapist. Clue Junior
Child engages in different arts and crafts projects. Cranium Hullabaloo
Child sings parts of a song while performing an Hyper Dash
activity. Simon
Child sings a complete song for therapist. Stare!
 22
Executive Functioning and
Organizational Skills
Executive functioning refers to a neurocognitive process
that includes planning, organizing, and decision mak- ORGANIZATIONAL
SKILLS ACTIVITIES
ing (Welsh & Pennington, 1988). In children, difficulties
with organizational skills are most commonly seen in the
school-based setting (Langberg et al., 2008). Some problems
that will manifest themselves due to poor organization
skills include forgetting homework assignments, losing Following Set Directions
school work, difficulty planning for long-term projects,
difficulty studying for exams, and trouble keeping class Single-step direction following: Therapist creates a
materials organized (DuPaul & Stoner, 2014). Various score sheet for child and gives them a sticker upon
interventions aimed at improving organizational skills have completing each direction correctly. (See Appendix A,
shown significant improvements in the areas of homework, p. 245, for sample sticker score card.) Single-step direc-
time management, and planning for events in the future. tions can focus on commands with prepositional use.
Activities geared at improving organizational strategies are Examples include “Place the penny IN the box,” “Stand
important to employ by themselves or coupled along with ON TOP OF the paper,” “Walk AROUND the chair,”
other evidence-based interventions (Langberg et al., 2008). and “Climb THROUGH the tunnel.”
This chapter provides various activities that may be Multiple-step direction-following: Child follows a
upgraded or downgraded based on the child’s functional three-step direction. For example, “Run to the door,
level and abilities. Demands placed on the child should be skip to the basketball hoop, and shoot three baskets.”
just slightly above the child’s current ability, which research Therapist grades direction’s level of difficulty based on
shows to be the optimal level for a child to learn. This level child’s ability.
is called “the zone of proximal development,” a concept Child completes color-by-number/color-by-letter
developed by Russian psychologist Lev Vygotsky. This type handouts. (See Appendix A, pp. 246-251, for sample
of learning style enables a child to learn with assistance handouts.)
from someone who is more skilled and ultimately leads the
Child copies block or building designs.
child to achieve independence in the skill (Vygotsky, 1986).

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 143-144).
© 2023 SLACK Incorporated.
144 Chapter 22

Figure 22-2.

Strategizing
Sudoku: This game requires strategy and concentra-
tion. Visit www.websudoku.com to print out very
simple forms of the Sudoku puzzles.
Scavenger hunt: Therapist creates a list of items child
must find in the room. Child checks off each item
once it is found. (See Appendix A, p. 252, for sample
scavenger hunt.)
Figure 22-1.
Multiple-step obstacle course: Child completes a series
of tasks in an obstacle course. Some examples include
Child follows patterns with beads, pegs, or Froot Loops climbing through the tunnel, over the barrel, under the
(Figures 22-1 and 22-2). bean bag and jumping into the hoop, walking around
Getting dressed: Therapist instructs the child to put the cones, hopping over the blocks, etc.
on several articles of clothing in a specific order. For Letter find obstacle course: Therapist tells child a letter.
example, first socks, then shoes, then hat, then jacket, Child completes an obstacle course and at the end of
etc. the course finds the letter hidden among other letters
Setting the table: Child follows either verbal or visual hanging on the wall.
directions/instructions to set a table for mealtime.
Following a recipe
Commercially Available
Child completes a simple cooking project from a
ready-to-bake mix. Products
Child follows a more difficult recipe from a cook-
Battleship
book, with assistance and supervision from the
therapist as needed. Connect Four
Memory
Othello
Scrabble
 VII
Social Skills

The complex social skills needed for a well-adjusted interaction with other children are among the most important
skills a child must acquire. Deficits in social skills play a significant role in the development of many emotional and
behavioral disorders of childhood and adolescence (Combs & Slaby, 1977). Additionally, children with poor social skills
are more likely to develop adjustment problems as adults (Cowen et al., 1973). A child with poor social skills may find it
challenging to participate in classroom activities, play a game with peers, or maintain eye contact when speaking with a
friend (Williamson & Dorman, 2002).
Social skills training is directed at helping a child increase the ability to perform crucial social behaviors that are impor-
tant in achieving success in social situations (Combs & Slaby, 1977). Social skill training will typically focus on teaching a
child to engage in various interactions, interpersonal games, and social activities (Michelson et al., 2013).
This section will provide activities that promote social interactions and provide different games, group projects, group
activities, and seasonal-based games and projects, all geared at improving social skills.
It is important to note that many of the activities provided work on multiple components of social competence, and it
is at the discretion of the treating therapist to determine the primary area to work on with the child.
 23
Increasing Social Interaction
and Relatedness
In the school-based setting, a child will be faced with cess in an activity. These activities should first be attempted
infinite social interactions including those at play time, with the child interacting with an adult. As the child comes
recess, and collaborative academic work in the classroom closer to mastering an activity, they should then attempt the
(Schmidt et al., 2019). Appropriate social interactions activity with another child.
enable a child to make friends and create relationships with
peers. Social interactions also help teach children how to
behave in a socially appropriate manner.
There are different components to appropriate social INCREASING SOCIAL
interactions and being related. Maintaining eye contact
is one important part of being able to interact and relate INTERACTION AND
with one’s peers. Maintaining eye contact is often difficult,
especially for children with an autism spectrum disorder RELATEDNESS WITH
(Carbone et al., 2013).
In addition to maintaining eye contact, there are also
many other components of social competence that can be
CHILD AND PEERS
addressed while performing activities from this chapter.
Some of these include reading facial expressions, under- Back-and-Forth Games
standing nonverbal social cues, maintaining appropri-
ate personal space, modulating voice volume, having the Roly poly: Therapist and child roll ball back and forth
ability to take turns, negotiating, and solving problems between them while sitting on floor with legs spread
(Williamson & Dorman, 2002). apart (Figure 23-1).
Although there are an infinite number of games and Wonder ball/pass-the-ball-around game: Therapist
activities that can be played to help work on increasing a and child pass ball back and forth between them while
child’s social skills, this chapter provides a sample of these singing the wonder ball song. The song is sung as fol-
sorts of activities. Many will require pairing children up lows: “The wonder ball goes around and around, to
and call for interdependence on the child’s partner for suc- pass it quickly you are bound, if you’re the one to hold

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 147-149).
© 2023 SLACK Incorporated.
148 Chapter 23

Figure 23-1.

Figure 23-2.
it last, you will owe …” When ball stops, child and
therapist perform an action together (e.g., touch their
heads, clap hands). Freeze dance
Ball games: Child sits in a chair or stands in a barrel Musical Chairs
(in order to stay stationary) and plays toss/catch games
Red Light, Green Light 1, 2, 3
with therapist (Figure 23-2).
Card games: Gin, War, Go Fish

Interdependence Games Board games: Therapist chooses any board game that
requires two or more players (eg, Checkers, Candy
Peek-a-Boo games: Child hides behind a pillow, under Land, Guess Who?).
a small blanket, or in a tunnel and plays Peek-a-Boo Four Corners: In this game, one person is designated
with therapist. the counter. All four corners of the room are numbered
Scooter-board games corners one through four. The counter stands in the
middle of the room and counts to 10, while covering
Child sits on a scooter holding onto a rope. Therapist their eyes. While the counter is counting, the other
pulls child on scooter by pulling the rope. children can run around the room and pick one of
Two children sit on separate scooters. Therapist ties the corners to stand in. The counter then calls out a
rope around the handle of two scooters. The chil- number between one and four, referring to one of the
dren hold hands while being pulled. corners with their eyes still closed and then opens their
Several children lie prone on scooter boards. eyes. All of the children who are standing in the corner
Children make a train by holding onto the child’s called out are “out.” Counter repeats counting until
ankles in front of them. Therapist pulls rope tied only one child is left. The last child left wins and gets
onto the first scooter board. to be the counter in the next round.

Chasing games: Child and therapist play tag and other

chasing games together. Sensory Activities With
Group Games Movement, Touch, and Song
“Ring Around the Rosie”
In the following games, it is important to determine the
appropriate level of involvement of the therapist, whether “This Little Piggy …” (Figure 23-3)
it be directly playing, supervising, or facilitating. “Patty Cake,” “Miss Mary Mack” (Figure 23-4)
Hide and Seek “Hot Potato” (Figures 23-5 and 23-6)
Simon Says “Itsy Bitsy Spider”: Therapist sings song with child
while trying to make eye contact.
Follow the Leader
“Hokey Pokey”
 Increasing Social Interaction and Relatedness 149

Figure 23-3. Figure 23-4.

Figure 23-5. Figure 23-6.

“If You’re Happy and You Know It”: Therapist sings Copy games: Child watches therapist and:
this song with child. Child finishes each phrase and Imitates different facial expressions.
acts it out with therapist (e.g., “If you’re happy and you
know it … touch your nose”). Imitates a beating pattern on a drum.
Therapist places child on swing and says “go” and Imitates different funny body postures.
“stop” when starting and stopping movement. Therapist Facial cues: Therapist makes different faces at child.
attempts to have child say these words in order to direct Child tells therapist what emotion is being displayed
therapist to move swing. Therapist can also try to have (anger, sadness, happiness, surprise, etc.). Child then
the child count “1, 2, 3” to direct therapist to swing the tries to imitate a specific emotion.
swing.
Therapist places child on a therapy ball. Therapist
bounces child on the ball while focusing on eye contact
Commercially Available
and increasing vocalizations and other sounds.
Therapist provides linear vestibular movement on a plat-
Products
form swing while maintaining eye contact with child. Guess Who?
Twister
Making Eye Contact
Therapist plays games with child in front of a mir-
ror and makes eye contact through the mirror (e.g.,
therapist and child sing “Head, Shoulders, Knees, and
Toes”).
 24
Group Activities
Group activities are a great way to help build social Funny passing game: Children sit in a circle and try to
skills and friendship among children of all ages. Fun and pass a small ball without using their hands. They can
exciting games and projects that can be played with two pass it by grabbing it with their elbows or feet, knock-
or more children are provided in this chapter. The treat- ing it with their heads, or any other safe and creative
ing therapist can choose to have the listed activities played way.
between several children or between therapist and child. Neck ball: Children pass a small ball from one child to
Some children with more severe social deficits will require the next without using their hands, passing it only with
an adult to prompt and guide them during many of these their necks (Figure 24-3).
social activities.
In planning a group, it is important to understand the
population one is working with and to know any specific Color-Themed Groups
child’s needs in advance. This is to make sure that there
will be enough adult supervision and assistance. A group’s Color “Hokey Pokey”: Therapist cuts out strips of tis-
success often depends on adult supervision and assistance. sue paper and gives children different colored strips.
Children then sing the “Hokey Pokey” song: “Put your
red hand in,” etc. After this is done with tissue paper,

GROUP ACTIVITY THEMES

it can also be done with small balls or different colored
bean bags.
Therapist covers a flashlight with different pieces of
Funny Ball Games colored Cellophane wrap. Therapist turns out the lights
and shines each color on the ceiling, then asks each
Over/under game: Children line up and pass a small child to find one item in the given color. Children bring
ball between them. The first child passes it backward their items into the middle of the circle.
over their head, and the next child passes it backward
between their legs. Once the last child gets the ball, all
the children turn and face the opposite direction and
play again (Figures 24-1 and 24-2).
Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:
Creative Ideas for Therapy Sessions, Third Edition (pp. 151-158).
© 2023 SLACK Incorporated.
152 Chapter 24

Figure 24-1. Figure 24-2.

Building a colored tower: Children pick a color out of

a hat and then add the corresponding colored block to
a tower. Children see how tall they can make the tower
before it falls.
Child picks a color out of a hat and then hops/jumps/
wheelbarrow-walks to something matching the same
color across room.

Letter-Themed Groups
Therapist places several index cards with letters on
Figure 24-3. a wall, orienting the cards in different directions
(some cards will be upright, upside down, sideways,
Color hunt: Children close their eyes and pick a piece diagonal, etc.). Therapist chooses a random word.
of colored construction paper out of a bag filled with Child throws a ball against the wall onto the first let-
small pieces of construction paper in various colors. ter of the word and then catches it as it bounces back.
Each child tries to find something of that color in the Child continues to throw the ball against the wall onto
room. the second and then remaining letters of the word and
then catches it.
“If You’re Wearing …”: Play a Simon Says style game
(e.g., “If you’re wearing red, stand up. If you’re wearing Letter-themed obstacle course: Child picks a letter out
blue, clap your hands.”). of a hat and looks at it, but therapist holds onto it. Child
then completes the obstacle course. At the end of the
Color-association game: Therapist places index cards obstacle course, several letters should be hanging on a
with fruit, animals, clothing, etc., of various colors on wall either in the same case or in a different case (upper
a board in front of the children. Children take turns or lower). Child identifies the chosen letter on the wall
sorting these cards into the correct color categories. and then tapes it on top of the matching letter on the
I Spy: Children play the I Spy game using colors as wall (Figure 24-4).
clues. For example, therapist says, “I spy something red Each child builds the letters of their name out of pegs.
that is on the top shelf of the bookcase.” Children then Therapist mixes all the assembled letters together and
try to guess that object. spreads them out on the floor. Each child individually
walks to find the letters of their name and then spells it
out on a table (Figures 24-5 and 24-6).
 Group Activities 153

Figure 24-4. Figure 24-5.

Figure 24-6.

Number-Themed Groups Figure 24-7.

Children go outside and collect small leaves or flowers.
They are given a page showing a picture of an empty
tree or flower, onto which they then glue the leaves or
flower petals. Children count up the number of leaves/
petals on the tree or flower and write that number on
the tree trunk/flower stem (Figures 24-7 and 24-8).
Number chart: Children are given the number chart
(see Appendix A, p. 253) and then asked to glue the
corresponding number of sequins or foam pieces onto
the row (Figures 24-9 and 24-10).

Figure 24-8.
154 Chapter 24

Figure 24-9.
Figure 24-10.

Figure 24-11.

Figure 24-12.

Shapes Groups
Shape instructions: Therapist provides each child with
Therapist places different shapes all over the floor
a shape handout (see shape instruction handout in
around the room. Therapist gives the children gross
Appendix A, p. 254). Children follow the key at the bot-
motor instructions regarding the shapes. For example,
tom of the page. Instructions include make dots in the
therapist may say, “Jump over the squares, hop over the
circles, make vertical lines in the triangles, and make
triangles, march around the rectangles,” etc.
horizontal lines in the squares.
Therapist places items of various shapes into a bag
Shape collage: Therapist makes large circles, squares,
(square book, triangle puzzle piece, ball, etc.). Children
rectangles, and any other shape all over a piece of paper
stick their hands into the bag and use stereognosis (i.e.,
and then gives out craft foam pieces. Children glue
the ability to identify objects based on touch without
the corresponding shapes into the large shapes on the
the assistance of vision) to determine what shape they
paper (Figure 24-12). An alternative activity would be
are touching.
to have the children just draw smaller shapes into the
Children make shapes out of a jump rope (Figure 24-11). large ones (Figure 24-13).
Children try to make shapes with their fingers. They Children create pictures solely out of cutout shapes
then lie on the floor and position their bodies to make (e.g., of a person, house, ice cream cone; Figure 24-14).
specific shapes. With an instant print camera or digital
camera, therapist takes a picture of the children once
they are in the correct position.
 Group Activities 155

Figure 24-14.

Figure 24-13.

Teamwork Games
Relay races: Examples include three-legged race, potato
sack race, placing a spoon in mouth with an egg or
ping-pong ball on the spoon, transferring water from
one bucket to another, frog jumping, backward walk-
ing, twirling, etc.
Clothing race: Therapist places different articles of
oversized clothing on one side of the room. Children
must race to the other side of the room and get dressed
in the large T-shirt, shorts, and socks as quickly as pos-
sible (Figures 24-15 and 24-16).
Scavenger hunt: Children play the game together as a
group in a circle. Child gets a turn to find one item on
the list and bring it back into the circle. Alternatively,
small groups can be formed and the children can play
in teams against one another. (See Appendix A, p. 252,
for a sample scavenger hunt.)

Figure 24-15.
156 Chapter 24

Figure 24-17.

in the circle to answer this question. For example, if

the category picked is favorite colors, child must ask
someone in the circle, “What is your favorite color?”
and then be able to tell the group the answer. For each
correct question and answer, both children are given a
small sticker to place on the sticker chart.
Mummy wrap: Children pair up in teams of two
or more people. One child is designated to be the
Figure 24-16. “mummy.” The mummy must stand still while other
children in group wrap toilet paper around them.
Human puppet game: Therapist pairs up children.
Therapist places large pieces of paper on floor. One
child from each pair lies on paper. Other child traces
out the body outline. Children then switch. After this is
completed, children cut out their puppets (with thera-
pist assistance if needed), draw or glue on body parts,
and decorate them (Figures 24-17 and 24-18).
Children make hand puppets out of brown paper bags.
Children glue on googly eyes, color in the mouth, and
put on feathers for hair. Children sing songs and talk to
each other using their puppets (Figure 24-19).
“Bridge-body-connect”
Several children perform a bridge with their backs
(therapist assistance may be required). Remaining
children crawl under all of the other children’s
Figure 24-18. bridges (Figure 24-20).
Therapist then pairs up the children in groups

Building Social Skills of two. Children lie on their backs on the floor
with their feet touching their partner’s feet. Both
children raise their legs off of the floor and press
Get to know you game: Children are given an empty
their feet against the partner’s feet (Figure 24-21).
sticker chart (see Appendix A, p. 245, for the sticker
Remaining children crawl under the bridge.
chart). Each child picks a category card with a question
on it at random out of a bag. Child then asks one friend
 Group Activities 157

Figure 24-20.

Figure 24-19.

Children then face each other and hold hands.

Children raise their hands so other children can
climb under. (Think of other fun and creative ways
to connect the children’s bodies and make more
bridges.) Figure 24-21.

Telephone: Children sit in a circle. One child or thera-

pist whispers a word or sentence into the next child’s
ear. That child whispers what they heard to the next Groups to Work on Attention
child. Finally, the last child says what they heard out
loud, and the original person says whether or not that and Organization
was correct.
Random association groups: Children match pictures
Cookie making: Therapist takes cookies and has chil- or words to something associated with them (e.g., sum-
dren spread icing on them with their fingers. Children mer/hot, dog/bone, bed/pillow, raindrop/umbrella).
then decorate their cookies with sprinkles, small pret-
Association groups based on seasons and holidays.
zel pieces, raisins, etc. Each child makes two cookies,
Therapist creates cards with association pictures/
one for themself and one for a friend.
words. Children play matching and sorting games
“Ring Around the Rosie” with cards.
Rolling game: Children all lie on their backs on a mat Memory: Children play Memory games in a group.
next to each other. They sing the song, “There were
Bingo: Children play Bingo together. Children can use
[insert number] children in a bed and the little one said
numbers, shapes, or pictures in Bingo. Therapist can
roll over.” Children continuously roll without touching
create Bingo sheets with a few items on the page or
the next child while singing the song; they freeze once
many in order to upgrade or downgrade the level of
they reach the edge of the mat. Children then continue
difficulty.
rolling the other way.
158 Chapter 24

Figure 24-23.

Sensory Groups
Sensory baseball: Child comes up to bat either on a tee
Figure 24-22. or be thrown a slow pitch. Child hits the ball and runs
around the bases. Each base should be a sensory activ-
ity. For example, first base could be a trampoline that
you have to jump on 10 times. Second base could be a
large bean bag that the child crashes into. Third base
could be a wedge that child must crawl up and jump
off, etc.
Oral motor group
Therapist places a pom-pom on the table. Children
blow the pom-pom back and forth between them
without letting the pom-pom fall off the table
(Figure 24-22).
Children can also each be given whistles and take
turns blowing them. After this, the therapist can
hold an empty paper towel roll and sing a song
through it (using it as a microphone). Therapist
should only start the song, and the children should
Figure 24-24. pass around the “microphone” and take turns say-
ing the specific verse in the song.
Pin the tail on the donkey: Children can play this game
with eyes open, closed, spinning, and no spinning.
Parachute games: Children walk holding onto para-
chute handles, run underneath parachute when it is
raised, sit on the middle of parachute, and be pulled by
therapists (Figure 24-23).
Parachute popcorn game: Children crumple large
strips of tissue paper and throw them into the middle
of the parachute. Once all the colors are in the middle,
children swing the parachute up and down and watch
the “popcorn.” They try to keep the popcorn from fall-
ing off the sides for as long as possible (Figure 24-24).
 25
Seasonally Themed Projects
and Activities
The different seasons offer times for learning and fun. Therapist must use sound judgment in selecting a blind-
This chapter provides various activities and projects that fold activity with a specific child and must carefully super-
can be completed during the different seasons. When vise any activity involving blindfolding.
selecting a project or activity, it is important to keep in
mind the child’s abilities and the specific skills that need to Apple bowling: Place pictures of apples on bowling
be strengthened. pins. Have the children roll a ball and try to knock
over the pins (if bowling pins are not available, small
Because many teachers and therapists work with a vari-
cones can be used).
ety of children from different backgrounds, it is important
to keep in mind cultural and religious sensitivities before Fall Bingo: Create a fall Bingo sheet. Categories
selecting a project or activity. can include apples, pumpkins, acorns, leaves, pine
cones, and trees with fall-colored leaves. Have chil-
dren play Bingo in a group.

FALL ACTIVITIES Fall Memory: Create small cards with fall-themed

pictures. Make two of each. Mix the cards together
and place them facedown on the table. Then have
Games the children play fall Memory. (Sample categories
Pin the stem on the pumpkin: Draw a very large are included in the fall Bingo activity.)
pumpkin without a stem on a piece of oak tag or Turkey hunt: Make photocopies of a picture of a
paper. Cut a stem out of green construction paper. turkey. Hide the turkeys around the room and ask
Place adhesive on the back of the stem. Blindfold the the children to find the hidden turkeys. After one
children and have them take turns trying to place round, split the children into two groups. Have one
the stem on the correct spot on the pumpkin (same group of children hide the turkeys and then allow
rules as with pin the tail on the donkey). the other group to search for them (then switch
hider and finder groups.)

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 159-162).
© 2023 SLACK Incorporated.
160 Chapter 25
Fall gross motor activity: Create two sets of match- Fruit turkeys: Place an orange or an apple sideways
ing fall cards (sample categories provided in the fall on the table. Place four toothpicks on the top of the
Bingo activity). Spread the two piles on opposite fruit and one toothpick into the side of the fruit.
sides of the room. Instruct a child to pick a specific (The toothpicks will serve as feathers and the head.)
card from the first pile and then have the child go the Stick four raisins into each toothpick on the turkey’s
other pile while following a gross motor instruction back and one grape on the turkey’s head. Then place
(e.g., hop, jump, skip, gallop, wheelbarrow-walk, one mini marshmallow on the top of each of the
crab-walk, scooter, backward walk, frog-jump). four toothpicks on the turkey’s back.
Leaves hunt: Go outside and search for different Thankful turkey project: Ask the children to glue
types of leaves. colorful tissue paper onto the back of a paper plate,
Visit the website http://www.dltk-holidays.com. which will serve as the turkey’s back. Give each
From it you can automatically create Bingo sheets, child four pieces of construction paper that have
Memory cards, and other holiday-themed games. been cut into the shapes of turkey feathers. Ask the
children to write one thing that they are thankful
Projects for on each feather. Then glue the feathers onto the
Cut out and color pumpkin shapes, then hide plate. Place googly eyes and draw on a nose.
them around the room and have a pumpkin hunt Book of thanks: Ask the children to create a book of
where the children must find their friends’ hidden thanks by writing a different word or sentence on
pumpkins. each page about something they are thankful for.
Tissue paper corn project: Create a corn template Then let the children illustrate their book of thanks.
and ask children to cut it out. Have long pieces of To bind the pages of the book together, punch holes
green tissue paper and small pieces of yellow tissue on the edges of the paper and then tie string or
paper. Ask children to glue on the long green pieces yarn through them (the book can also be stapled
for the husk, then take one yellow piece of tissue together).
paper in each hand and crumple them up. Glue Hand trees: Therapist paints child’s arm and hand
the yellow tissue paper pieces in the middle for the with brown and green paint, respectively. Child
kernels. Continue crumpling and gluing until the presses down on paper to form the trunk and leaves
entire template is covered with tissue paper. of the tree. Child dips fingertips into paint of the
Scarecrow project: Give each child five pieces of a different fall colors. Child then makes dots on paper
scarecrow that have to be put together in the correct to finger-paint leaves all over the tree.
order. Each child should be given a cutout pumpkin Leaf shading: Collect leaves from the ground out-
head, straw body, pants, shoes, and straw hat (the doors. Place the leaves under a piece of white paper.
body parts can also be photocopied and cut out by With a crayon, color lightly on the paper over the
the children themselves). leaf. The shape of a leaf will then appear on the
Acorn maracas: Ask children to collect acorns from paper.
outside. Color and decorate two paper plates. Staple
the plates together with the tops of the plates facing
each other. Do not staple all the way around so that
there is some space left with a hole to put in the WINTER ACTIVITIES
acorns. Give each child acorns and have them put
the acorns inside the holes. Then staple the plates all Games
the way so there is no space for the acorns to fall out. Visit the website http://www.dltk-holidays.com.
The children can play with and shake their maracas There you can automatically create Bingo sheets,
to the beat of a tune. Memory cards, and other holiday-themed games.
Pumpkin decorating: Provide small pumpkins and Bundle up the bear: To work on dressing skills, have
allow the children to decorate them with markers, a child dress a stuffed animal with winter clothes,
paint, sequins, feathers, etc. using infant’s clothing. It can be made into a game
Hand turkeys: Trace each child’s hand on brown of “we pass the bear around” and, each time the bear
construction paper to make a turkey. Glue feathers stops, another article of clothing is added.
onto the fingertips and a googly eye onto the thumb. Indoor sledding: Have child sit on a scooter-board
while holding onto a jump rope with two hands; an
adult or another child can pull the rope to propel the
child around the room.
 Seasonally Themed Projects and Activities 161
Winter Bingo: Create a winter Bingo sheet. Sample
categories can include snowman, sled, jacket, ice-
skating, skiing etc. Then have children play Bingo
in a group.
Winter Memory: Create small cards with winter-
themed pictures. Make two of each. Mix the cards
up and place them facedown on the table. Then have
the children play winter Memory. (Sample catego-
ries are included in the winter Bingo activity.)
Projects
Snowman: Make a snowman using three small
white paper plates. Cut out an orange triangle for
the mouth, glue on buttons for the eyes, and use
crumpled tissue paper balls to form the mouth.
Staple on brown pipe cleaners for the arms.
Snowflake projects: Fold a white paper in half sev-
eral times, then snip different shapes with scissors.
Unfold the paper to see the snowflake. It can be
decorated with glitter for a sparkle effect.
Handprint evergreen tree with snow: Therapist
paints green finger paint on child’s hands. Child
makes multiple upside-down handprints on a large
Figure 25-1.
paper in the shape of an evergreen tree (triangle). If
necessary, a triangular border can be drawn on the
paper for the child prior to the painting. Therapist Projects
then makes a mixture of half glue/half shaving
cream. Child paints mixture on tree to get a puffy Pop-up ground hog on a Popsicle stick: Print out
“snow” effect when dry. picture of groundhogs. Have the children color
them and glue them to Popsicle sticks to make pup-
Create calendars: Have children draw pictures asso- pets. For each puppet, cut out two squares of brown
ciated with each month of the year. Print out cal- paper and staple them together on opposite sides
endar pages for the 12 months of the year. Place a (leaving the top and bottom open). Put the puppet
picture above each month and staple the calendar into the “pocket underground” and then make it
together. pop up.
Make bunnies: Create a blank template of a rabbit
on a piece of construction paper. Ask the children to
SPRING ACTIVITIES place small pieces of Styrofoam or crumpled white
and pink tissue paper on the bunny. Then make
the mouth and whiskers with black pipe cleaners
Games
(Figure 25-1).
Children go into potato sacks and pop up and down
Bunny hats: Cut out hats with bunny ears and place
out of the potato sacks, pretending to be flowers
on the children’s heads. Then tell the children to
blooming. They then have a potato sack race.
hop around the room like bunnies.
Flowers Memory game: Create flower Memory
Tissue paper flowers: Cut four to six pieces of tissue
cards by coloring matches of different sorts of flow-
paper into 8- by 10-inch pieces. Place the pieces on
ers on the cards. Then have the children play a game
top of each other and fold them like an accordion.
of Memory.
Tie the center of the folded tissue paper with a green
Visit the website http://www.dltk-holidays.com. pipe cleaner. Then slowly unravel each layer one at a
There you can automatically create Bingo sheets, time, creating the flower’s petals.
Memory cards, and other holiday-themed games.
162 Chapter 25

Figure 25-3.
Figure 25-2.

SUMMER ACTIVITIES
Games
Summer Bingo: Create a summer Bingo sheet.
Sample categories can include American flags, bar-
becues, hot dogs, hamburgers, ketchup, grills, fire-
works, beach, sun, swimming, suntan lotion, ice
cream, etc. Then have children play Bingo in a
group.
Summer Memory: Create small cards with summer-
themed pictures. Make two of each. Mix the cards
together and place them facedown on the table.
Then, have the children play summer Memory.
(Sample categories are included in the summer
Figure 25-4. Bingo activity.)
Projects
Flower vases: Children paint and decorate empty American flags: Draw an American flag template
water bottles or seltzer bottles with sequins. They on white paper. Cut out red strips and glue them to
can also wrap yarn or string of various colors every other stripe. Cut out a blue square for the cor-
around bottles. ner and use either small star stickers or silver glitter
Paper plate picture frames: Ask the children to for the stars (Figure 25-3).
bring in pictures of themselves with their mothers. Watercolor fireworks: Provide each child with dif-
Each child then cuts a hole in the center of his or ferent colored paint in cups. Have the children
her plate slightly smaller than the picture. It may be squeeze the paint from the cup into a medicine dis-
helpful to trace a line for the children and start the penser and then create droplets on a white piece of
first cut so that the child does not rip the paper. Ask paper. Next, have the children blow through a straw
the children to decorate the plates with glitter, stick- onto the paint droplets to create fireworks.
ers, sequins, or other craft materials. Last, have an Glitter fireworks: Have children glue shooting lines
adult staple the pictures onto the plates from behind onto a black piece of construction paper and then
(Figure 25-2). sprinkle glitter onto the lines (Figure 25-4).
American flag safety pin: Place small red, white, and
blue beads onto the safety pin in the pattern of the
American flag.
 VIII
Improving Gait Patterns

Most children begin walking around 1 year of age with a wide base of support, a “foot-flat to foot-flat” pattern, and
straight knees. By approximately the age of 3.5 years, children develop more mature gait patterns (Jacobs, 2010). However,
.

some children will develop difficulties establishing mature gait because of various physical problems. Some problems
include flat feet, increased internal rotation of the hips, increased external rotation of the hips, and/or toe-walking. A
trained therapist can perform an assessment to determine if these issues are normal variants of development or require
further evaluation and treatment (Jacobs, 2010).
In the upcoming chapters of this section, activities will be provided that address flat feet, increased internal rotation of
the hips, increased external rotation of the hips, and/or toe-walking.
 26
Increasing the
Arches of the Foot
Flat feet can result from combined foot and ankle defor-
mities. In addition to heel misalignment, a decreased arch INCREASING ARCHES
OF THE FOOT
is present as well (Kwon & Myerson, 2010). Approximately
4% of children at the age of 10 years have flat feet (Bertani et
al., 1999), which can sometimes be due to decreased muscle
strength (Andreasen et al., 2013). However, a flat foot can
have other causes as well. Flat feet in children are often asso- Activities Involving Balance
ciated with pain, poor motor skills, altered gait patterns, and
discomfort (Müller et al., 2012). Therefore, children with flat Child stands barefoot on air disc and:
feet will have difficulty engaging in various sports and other Maintains stationary balance.
age-appropriate activities because of this condition. Catches ball.
In this chapter, various activities are provided—including
Moves slightly from side to side.
stretching, strengthening, and sensory activities—to help
increase the arches of the foot. Stands in place and moves feet from pronated to
supinated position.
Child stands on one foot while resting other foot on
the ball positioned on the floor. Child tries to maintain
balance while singing the ABCs. (Upon completion,
the position should be reversed, with opposite foot on
ball.)

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 165-168).
© 2023 SLACK Incorporated.
166 Chapter 26

Figure 26-2.

Child stands with one foot on bolster and one foot

on floor. Child reaches to pick up nearby objects off
floor on outside of the foot child is balancing on.
Therapist places bolster on incline against wall.
Child walks up bolster slowly (Figure 26-1).

Curling the Feet and Toes

Around Objects
Figure 26-1. Child picks up small Koosh balls around feet using
only toes to pick them up. Child places them into
nearby container with toes.
Child stands on foam surface or soft pillows focusing
on curving foot over surface.
Child sits on floor with one foot placed on ball on
floor and plays game with therapist or another child
(Figure 26-2).
Barefoot child rolls arches of foot over a tennis ball
(Figure 26-3).

Foot Exercises and Stretches

Theraband activities
Child sits in long sitting position. Therapist wraps
Theraband around feet of child, mostly under the
Figure 26-3.
toes.
Child pushes Theraband forward with toes and
Bolster activities holds for 5 seconds. Repeat 10 times (Figure 26-4).
Child stands with one foot on bolster and one foot Therapist places a sticker on wall at height of child’s
on floor and maintains balance. nose. Child stands at arm’s length from a wall with
Child stands with one foot on bolster and one foot palms flat against the wall. Child slowly bends elbows
on floor and plays catch with therapist. to lean toward the wall trying to touch nose to sticker
while keeping hips, knees, and back straight and heels
flat on floor (Figure 26-5).
 Increasing the Arches of the Foot 167

Figure 26-4.

Figure 26-5.

Figure 26-6.

Barefoot movement: Child walks or runs barefoot

across room several times.
Achilles tendon stretching exercises
Child pushes against wall with one leg in front of
other and back leg straight (Figure 26-6).
Child places one foot on curb and one foot on
ground and bends down to touch curb (Figure 26-7).
Foot/toe curling exercises
Child sits in long sitting position. They then plantar
flex ankle and hold position for 5 seconds. Child
then curls toes and holds position for 5 seconds.
Repeat 10 times.
Child sits in long sitting position. They then curl
just toes for 5 seconds and hold position. Repeat 10
times.
Child stands barefoot on a flat surface and tries to
touch each toe to the floor one at a time. Therapist
says “This Little Piggy” rhyme for each correspond-
ing toe that child presses down.
Figure 26-7.
168 Chapter 26

Textured Surfaces Under the Child stands in place and then rocks onto the side of
the foot and holds position. They then rest feet flat
Foot on floor and repeat.
Child stands in sand and plays catch with therapist.
Sandbox activities Therapist tries to throw ball slightly off center to
Child walks back and forth across sandbox. child so that child can focus on balance while stand-
ing in sand.
Child walks on sand and presses feet firmly into the
sand, focusing on arch of foot. Rice box activities
Child stands on sand and curls foot on sand, mak- Child stands barefoot in rice box and curls foot in
ing marks in sand. rice.
Child stands in place and then rocks onto toes, Child sits by edge of rice box and picks up small
freezes in place, and then rocks onto heels and items with toes inside rice box.
freezes in place. Repeat 10 times.
 27
Decreasing External Rotation of
the Hips
Young children learning to walk will demonstrate grad- This chapter provides various strengthening and stretch-
ual and progressively improved gait patterns between the ing exercises. One of its main focuses is to enable the child
ages of 1 and 3 years. By age 3 years, the amount of exter- to perform activities with tibial advancement over a fixed
nal rotation present in gait will be significantly decreased foot facing forward. The treating therapist should ensure
(Effgen, 2005). However, some children will continue to proper musculoskeletal alignment in performing all of
present with externally rotated hips, walking with a toe-out these activities in order to achieve the desired effect.
gait. External rotation of the hips can be caused by weak
muscles or other musculoskeletal problems (Cibulka et al.,
2010). Before treating children with externally rotated hips
(or a toe-out gait), it is important to determine whether the DECREASING EXTERNAL
problem stems from the hips or whether it is secondary to
tibial torsion or torsion of the foot. It is also important to ROTATION OF THE HIPS
determine whether the amount of external rotation is part
of normal development or an issue to be concerned about. To promote tibial advancement over a fixed foot, have
Externally rotated hips may affect balance and can make child do activities to target tibial progression over the foot.
it difficult for a child to run, play, and engage in many age-
appropriate activities. Asymmetry in hip rotation (where
external rotation is greater than internal rotation or vice
Dynamic Strengthening
versa) is also associated with numerous musculoskeletal
problems (Cibulka et al., 2010). Children who remain in hip
Activities
external rotation for prolonged lengths of time will develop Side-walking (developmental age of 12 to 15 months):
overstretched internal hip rotators and shortened or con- Therapist brings child near a couch or another long
tracted external rotators. surface. Therapist places various toys along couch and
has child side step to gather toys and place them into
container. Therapist keeps child’s hips and feet aligned
throughout if needed (Figures 27-1 and 27-2).

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 169-174).
© 2023 SLACK Incorporated.
170 Chapter 27

Figure 27-2.

Squatting activity (developmental age of 12 to

15 months): Therapist has child stand next to pile
of toys on floor. Child squats to pick up one toy at a
time and place it into a container on a higher surface
(Figure 27-3).
Stair activities (Therapist must ensure proper align-
ment of hips during activity.)
Child steps up single step forward.
Child steps up single step to the side.
Figure 27-1. Child steps down single step backward.
Tandem-walking activities
Child walks on a taped line across the floor.
Child walks across balance beam.
Child walks along curb outside.
Seated scooter activities
Child sits on rolling scooter and propels scooter
forward using feet only.
Child sits on rolling scooter and propels scooter
with feet while picking up scattered objects around
room (Figure 27-4).
Jumping activities (Therapist helps child focus on foot
placement during jumping activities; verbal and gentle
physical cues may be needed.)
Child jumps up and down off the ground.
Child jumps over small object placed on the floor.
Child jumps with ball squeezed between knees.
Wall slide: Child sits with hips at 90 degrees and back
against wall. Child slides up and down wall (Figures
27-5 and 27-6).

Figure 27-3.
 Decreasing External Rotation of the Hips 171

Figure 27-4.
Figure 27-5.

Knee kicking
Child drops medium-sized ball onto their knee and
kicks it forward (Figure 27-7).
Child drops therapy ball onto their knee and kicks it
forward (Figure 27-8).
Therapist slowly drops medium-sized ball over
child’s lower extremity. Child bounces ball off knee
(Figure 27-9).
Heel-walking: Child walks across room on heels.

Stationary Strengthening
Activities
Single-limb stance activities
Child balances on one foot.
Child stands with one foot on medium-sized ball
and other foot aligned flat on floor.
Dynadisc activities
Child stands on Dynadisc and maintains balance
for X number of seconds (amount of time should be
determined by treating therapist; Figure 27-10).
Child catches ball on Dynadisc.
Figure 27-6.
172 Chapter 27

Figure 27-8.

Figure 27-7.

Figure 27-9.

Figure 27-10.
 Decreasing External Rotation of the Hips 173

Figure 27-11. Figure 27-12.

Figure 27-13.

Activities in long sit with small or medium sized ball

placed between the ankles.
Do not use a large ball or you may increase external rota-
tion.

Child squeezes and releases ball 10 times

(Figure 27-11).
Child squeezes ball and plays catch with therapist
or another child with a different ball (Figure 27-12).
Child places squeaky ball between ankles and
squeezes toy to make it squeak and make noise.
Child squeezes ball between ankles with straight
legs slightly raised in air (Figure 27-13).
Half-kneel activities Figure 27-14.

Child maintains half-kneel position on the floor

(Figure 27-14). Child moves from half-kneel to tall-kneel position
Child pushes/pulls Theraband or rope in this posi- (Figure 27-17).
tion (Figure 27-15). Child reaches for objects all around and crossing
Child moves from half-kneel position to stand midline (Figure 27-18).
(Figure 27-16).
174 Chapter 27

Figure 27-15.

Figure 27-16.

Figure 27-17. Figure 27-18.

 28
Decreasing Internal Rotation of
the Hips
Increased internal rotation of the hips is commonly
found in children with spastic cerebral palsy (Wren et al., DECREASING INTERNAL
ROTATION OF THE HIPS
2005). However, increased internal rotation can also be
the result of weak external rotators (Cibulka et al., 2010)
or other orthopedic conditions. Children who remain in
internal rotation for prolonged lengths of time will develop
overstretched external rotators and shortened or contracted Positioning and Stretching
internal rotators. These children will thus have difficulty
walking, running, engaging in sports, and other gross Activities
motor activities. As stated in the introduction to Chapter
27, it is important to determine where the level of twist or Tailor-sitting activities
torsion of the leg is and rule out tibial torsion or torsion of Child tailor sits on floor.
the foot. Child sits in tailor-sitting position and plays catch
This chapter provides various stretching and strength- with therapist.
ening activities designed to decrease internal rotation of
Child sits in tailor-sitting position and reaches for
the hips and strengthen the external rotators of the hips.
items on both sides (Figures 28-1 and 28-2).
It is important for the treating therapist to focus on proper
postural, hip, and foot alignment during these activities in Tailor stretching
order to achieve the desired goal. Butterfly stretch: Child sits with back against wall
and soles of feet touching. Child holds onto ankles
and gently moves knees up and down, flapping
them like butterflies.

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 175-179).
© 2023 SLACK Incorporated.
176 Chapter 28

Figure 28-1. Figure 28-2.

Figure 28-4.

Duck-walking: Therapist instructs child to turn feet

out and walk across room with feet turned out and
quack like a duck.
Therapist tapes cutout footprints onto floor with foot-
prints externally rotated. Child walks along path,
Figure 28-3. aligning feet to the footprints.
Child stands with feet in neutral or externally rotated
position and does the following:
Tailor press: Child sits with back against wall and
soles of feet touching. Child holds onto ankles Jumps in the air 10 times.
and gently presses down on knees with elbows Jumps to pull Post-It Notes off the wall.
(Figure 28-3).
Jumps over cones in obstacle course.
Partner tailor stretch: Children sit back to back.
Ballet poses
Child 1 sits with soles of feet touching, hold-
ing ankles. Child 2 leans back into child 1 with Therapist teaches child first position (Figure 28-5).
appropriate pressure to stretch. Therapist supervises Therapist teaches child second position (Figure
(Figure 28-4). 28-6).
Therapist teaches child third position (Figure 28-7).
 Decreasing Internal Rotation of the Hips 177

Figure 28-6.

Figure 28-5.

Figure 28-7.
178 Chapter 28

Figure 28-9.
Figure 28-8.

Strengthening Activities
Climbing activities
Child climbs up rope ladder.
Child climbs up bars on playground equipment or
ladder.
Child climbs up rock wall.
Therapist places bolster on incline against wall. Child
walks up bolster slowly (Figure 28-8).
Squatting activities
Isolated squats: Child performs set number of
squats, maintaining proper hip alignment.
Child reaches down to pick object up off floor and
place in a higher container.
Child leans against wall with hips in neutral and
slowly lowers self through squat (Figures 28-9 and
28-10).

Figure 28-10.
 Decreasing Internal Rotation of the Hips 179

Figure 28-11. Figure 28-12.

Child leans against wall with hips externally rotated Roller skating activities
and slowly lowers self through squat (Figure 28-11). Child skates in straight line across floor.
Child sits on peanut-shaped therapy ball and com- Child takes steps in roller skates.
pletes squats.
Child moves right foot in clockwise circles on floor.
Child then moves left foot in counterclockwise
Activities to Promote Having circles on floor.
Therapist places small pieces of fabric or carpet squares
the Feet in a Neutral or on floor and child skates on them.

Externally Rotated Position

Prone scooter activities
Child propels self on scooter using only legs.
Child weaves through different cones in obstacle
course while prone on scooter (Figure 28-12).
 29
Addressing Toe-Walking
Toe-walking is a condition where children walk on the
balls of their feet. It is sometimes seen in small children ADDRESSING TOE-WALKING
learning to walk; however, they will usually have a typical
heel-to-toe gait by 3 years old (Jacobs, 2010).
Toe-walking can be the symptom of neurological influ- Activities Promoting Flat
ences, a result of trauma, or may have no known cause (i.e.,
idiopathic toe-walking; Williams et al., 2013). When chil- Foot Placement
dren walk on their toes, it can cause pain in surrounding Heavy pushing: Child pushes heavy cart or object
contracted muscles (Solan et al., 2010) and affect their abil- across floor.
ity to fully engage in age-appropriate activities (Engström
& Tedroff, 2012). Child pushes walking toys across room (Figure 29-1).
Various treatment techniques have been developed Stepping activities
to address toe-walking with varying degrees of success Child stands on a raised surface or crate and slowly
(Williams et al., 2013). It is important for the therapist to lowers one leg at a time to the ground (opposite leg
first identify the cause if possible. Once this is done, they will get stretched; Figure 29-2).
can then select the appropriate course of treatment.
Child stands in front of crate and raises one leg up
This chapter provides various stretching, strengthening,
onto crate backward to step onto crate. Raised leg
and sensory activities that help limit toe-walking in young
will get stretched (Figure 29-3).
children. In addition to these activities, various techniques
developed by other medical professionals are sometimes Child descends flight of stairs, alternating feet if
employed, including serial casting, orthotics, and the use possible.
of medical injections of botulinum toxin (Williams et al., Child ascends flight of stairs backward with close
2013). A trained physical or occupational therapist can help supervision.
determine the proper course of treatment in treating a child
who toe-walks as well as the need for other services.

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 181-186).
© 2023 SLACK Incorporated.
182 Chapter 29

Figure 29-2.

Therapist places hands on child’s shoulder giving input

for child to keep toes flat on ground. Child walks across
room, with therapist maintaining gentle physical input
down and onto child’s shoulders (Figure 29-4).
Standing on unstable surfaces
Figure 29-1. Child stands on large pillow barefoot and reaches
one at a time for multiple items scattered around the
pillow on floor.
Child stands on Dynadisc with bare feet and bal-
ances for several seconds.
Child walks across large bean bags placed on floor.
Child stands on balance board while completing
puzzle placed on floor in front of balance board.
Roller skating activities
Child skates in straight line across floor.
Child skates backward while holding therapists
hands, focusing on pressing feet into floor.
Child takes steps in roller skates.
Scooter activities
Child sits on scooter and pulls self forward across
room, focusing on pulling self with heels.

Figure 29-3.
 Addressing Toe-Walking 183

Figure 29-4. Figure 29-5.

Child sits on scooter and pushes self backward Child steps firmly on stepping stones and presses them
across room, focusing on keeping feet flat on floor into floor.
when pushing. Child steps backward up a ramp.
Activities with riding toys (Figures 29-5 and 29-6) Child walks forward up a ramp.
Child sits on riding toy and pulls self forward across Child walks on treadmill on increased incline with
room, focusing on pulling self with heels. direct therapist supervision.
Child sits on riding toy and pushes self backward Child frog-hops across room.
across room, focusing on keeping feet flat on floor
when pushing. Child bear-walks across room.

Child sits on top of large plush toy and uses feet to pull
self around room (Figure 29-7).
184 Chapter 29

Figure 29-7.

Figure 29-9.
Figure 29-6.

Child places one foot on curb and one foot on floor and
bends down to touch curb (Figure 29-10).
(These should always be followed by meaningful
activities.)

Sensory Activities Providing

Input to Bottoms of Feet
Child walks barefoot along floor on various textures,
concentrating on keeping feet flat.
Child stands in rice box.
Child walks across sand box.
Figure 29-8.
Child jumps barefoot on trampoline.
Child walks across mushy bean bags placed on floor.
Stretching Exercises Child walks across room with ankle weights.
Child walks while wearing weighted vest or with
Child lies on back and therapist moves child’s feet in
weighted blanket on shoulders.
bicycle position (Figure 29-8).
Child wears high-top sneakers and walks across room.
Child pushes against wall with one leg in front of the
other and back leg straight (Figure 29-9).
 Addressing Toe-Walking 185

Figure 29-11.

Figure 29-10.

Figure 29-13.

Yoga Positions
Downward dog (Figure 29-11)
Warrior position (Figure 29-12)
Triangle pose (Figure 29-13)
Forward fold (Figure 29-14)
Forward fold with a partner (Figure 29-15)

Figure 29-12.
186 Chapter 29

Figure 29-14. Figure 29-15.

 References

Alaniz, M. L., Galit, E., Necesito, C. I., & Rosario, E. R. (2015). Benbow, M. (1995). Principles and practices of teaching handwriting.
Hand strength, handwriting, and functional skills in children In A. Henderson & C. Pehoski (Eds.), Hand function in the child:
with autism. American Journal of Occupational Therapy, 69(4), Foundations for remediation (pp. 255-281). Mosby-Year Book.
6904220030p1-6904220030p9. Benbow, M. (1997). A neurokinesthetic approach to hand function and
Alston, J., & Taylor, J. (1987). Handwriting: Theory, research, and practice. handwriting. Advanced Rehabilitation Institutes.
Nichols. Ben-Yishay, Y., Piasetsky, E. B., & Rattok, J. (1987). A systematic method
Andreasen, J., Mølgaard, C. M., Christensen, M., Kaalundb, S., Lundbye- for ameliorating disorders in basic attention. In M. J. Meier, A. L.
Christensen, S., Simonsen, O., & Voigte, M. (2013). Exercise therapy Benton, & L. Diller (Eds.), Neuropsychological rehabilitation (pp. 165-
and custom-made insoles are effective in patients with excessive 181). The Guilford Press.
pronation and chronic foot pain—a randomized controlled trial. The Bertani, A., Cappello, A., Benedetti, M. G., Simoncini, L., & Catani, F.
Foot, 23, 22-28. (1999). Flat foot functional evaluation using pattern recognition of
Axelsson, I., Holmblad, A., & Johansson, J. (2019). Restoring visual capac- ground reaction data. Clinical Biomechanics, 14(7), 484-493.
ity after stroke using an intense office‐based vision therapy program: Biederman, J., Monuteaux, M. C., Doyle, A. E., Seidman, L. J., Wilens, T.
Three case reports. Clinical Case Reports, 7(4), 707-713. E., Ferrero, F., & Faraone, S. V. (2004). Impact of executive function
Ayres, A. J. (1965). Patterns of perceptual-motor dysfunction in children: deficits and attention-deficit/hyperactivity disorder (ADHD) on
A factor analytic study. Perceptual and Motor Skills, 20, 355-368. academic outcomes in children. Journal of Consulting and Clinical
Ayres, A. J. (1972). Sensory integration and learning disorders. Western Psychology, 72(5), 757-766.
Psychological Services. Blakemore, S. J., Tavassoli, T., Calò, S., Thomas, R. M., Catmur, C., Frith,
Ayres, A. J. (1979). Sensory integration and the child. Western Psychological U., & Haggard, P. (2006). Tactile sensitivity in Asperger syndrome.
Services. Brain and Cognition, 61(1), 5-13.
Ayres, A. J. (2005). Sensory integration and the child. Understanding hid- Blanche, E. I., Reinoso, G., Chang, M. C., & Bodison, S. (2012).
den sensory challenges. Western Psychological Service. Proprioceptive processing difficulties among children with autism
Baranek, G. T. (2002). Efficacy of sensory and motor interventions spectrum disorders and developmental disabilities. American
for children with autism. Journal of Autism and Developmental Journal of Occupational Therapy, 66(5), 621-624.
Disorders, 32(5), 397-422. Burnett, R., Cornett, N., Rekart, G., Donahoe-Fillmore, B., Brahler, C. J.,
Bart, O., Hajami, D., & Bar-Haim, Y. (2007). Predicting school adjustment Aebker, S., & Kreill, M. (2011). Investigating the associations between
from motor abilities in kindergarten. Infant and Child Development, core strength, postural control and fine motor performance in chil-
16(6), 597-615. https://psycnet.apa.org/doi/10.1002/icd.514 dren. Journal of Student Physical Therapy Research, 4(2), 40-47.
Bazyk, S., Michaud, P., Goodman, G., Papp, P., Hawkins, E., & Welch, Carbone, V. J., O’Brien, L., Sweeney-Kerwin, E. J., & Albert, K. M. (2013).
M. A. (2009). Integrating occupational therapy services in a kin- Teaching eye contact to children with autism: A conceptual analysis
dergarten curriculum: A look at the outcomes. American Journal of and single case study. Education and Treatment of Children, 36(2),
Occupational Therapy, 63(2), 160-171. 139-159.
Beery, K. E. (2004). The Beery-Buktenica developmental test of visual- Cardona, M. D. P., Martinez, A. L., & Hinojosa, J. (2000). Effectiveness
motor integration (5th ed.). NCS Pearson, Inc. of using a computer to improve attention to visual analysis activities
Beery, K. E., Buktenica, N. A., & Beery, N. A. (2010). The Beery-Buktenica of five preschool children with disabilities. Occupational Therapy
developmental test of visual-motor integration (6th ed.). Pearson. International, 7(1), 42-56.
Case-Smith, J. (2001). Occupational therapy for children. Mosby, Inc.

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 187-190).
© 2023 SLACK Incorporated.
188 References
Cermak, S. A., Quintero, E. J., & Cohen, P. M. (1980). Developmental age Foster, S. M., & Verny, T. R. (2007). The development of sensory sys-
trends in crossing the body midline in normal children. American tems during the prenatal period. Journal of Prenatal & Perinatal
Journal of Occupational Therapy, 34(5), 313-319. Psychology & Health, 21(3), 271-280.
Cheldavi, H., Shakerian, S., Boshehri, S. N. S., & Zarghami, M. (2014). Gerber, R. J., Wilks, T., & Erdie-Lalena, C. (2010). Developmental mile-
The effects of balance training intervention on postural control of stones: Motor development. Pediatrics in Review, 31(7), 267-277.
children with autism spectrum disorder: Role of sensory informa- Giroux Bruce, M. A., & Borg, B. (2002). Psychosocial frames of reference.
tion. Research in Autism Spectrum Disorders, 8(1), 8-14. SLACK Incorporated.
Chen, S. T., Sultzer, D. L., Hinkin, C. H., Mahler, M. E., & Cummings, J. Granacher, U., Gollhofer, A., Hortobágyi, T., Kressig, R. W., & Muehlbauer,
L. (1998). Executive dysfunction in Alzheimer’s disease: Association T. (2013). The importance of trunk muscle strength for balance,
with neuropsychiatric symptoms and functional impairment. The functional performance, and fall prevention in seniors: A systematic
Journal of Neuropsychiatry and Clinical Neurosciences, 10(4), 426- review. Sports Medicine, 43(7), 627-641.
432. Granacher, U., Gollhofer, A., & Kriemler, S. (2010). Effects of balance
Cibulka, M. T., Strube, M. J., Meier, D., Selsor, M., Wheatley, C., Wilson, training on postural sway, leg extensor strength, and jumping height
N. G., & Irrgang, J. J. (2010). Symmetrical and asymmetrical hip in adolescents. Research Quarterly for Exercise and Sport, 81(3),
rotation and its relationship to hip rotator muscle strength. Clinical 245-251.
Biomechanics, 25(1), 56-62. Grandin, T. (1992). Calming effects of deep touch pressure in patients
Cohen, H. (1992). Vestibular rehabilitation reduces functional disability. with autistic disorder, college students, and animals. Journal of Child
Otolaryngology—Head and Neck Surgery, 107(5), 638-643. and Adolescent Psychopharmacology, 2(1), 63-72.
Combs, M. L., & Slaby, D. A. (1977). Social-skills training with children. Häger‐Ross, C., & Rösblad, B. (2002). Norms for grip strength in children
In B. B. Lahey & A. E. Kazdin (Eds.), Advances in clinical child psy- aged 4–16 years. Acta Paediatrica, 91(6), 617-625.
chology (pp. 161-201). Springer. Harris, T. L., & Rarick, G. L. (1959). The relationship between handwrit-
Cooke, D. M., McKenna, K., & Fleming, J. (2005). Development of a stan- ing pressure and legibility of handwriting in children and adoles-
dardized occupational therapy screening tool for visual perception in cents. The Journal of Experimental Education, 28(1), 65-84.
adults. Scandinavian Journal of Occupational Therapy, 12(2), 59-71. Hervey-Jumper, S. L., Justice, D., Vanaman, M. M., Nelson, V. S., & Yang,
Cornhill, H., & Case-Smith, J. (1996). Factors that relate to good and L. J. S. (2011). Torticollis associated with neonatal brachial plexus
poor handwriting. American Journal of Occupational Therapy, 50, palsy. Pediatric Neurology, 45(5), 305-310.
732-739. Hochreiter, N. W., Jewell, M. J., Barber, L., & Browne, P. (1983). Effect
Cottrell, R. P. F. (2004). National occupational therapy certification exam of vibration on tactile sensitivity. Physical Therapy, 63(6), 934-937.
review & study guide. International Education Resources. Horak, F. B., Jones-Rycewicz, C., Black, F. O., & Shumway-Cook, A.
Cowen, E. L., Pederson, A., Babigian, H., Isso, L. D., & Trost, M. A. (1973). (1992). Effects of vestibular rehabilitation on dizziness and imbal-
Long-term follow-up of early detected vulnerable children. Journal of ance. Otolaryngology–Head and Neck Surgery, 106(2), 175-180.
Consulting and Clinical Psychology, 41(3), 438-446. Huffman, J. M., & Fortenberry, C. (2011). Developing fine motor skills.
Daly, C. J., Kelley, G. T., & Krauss, A. (2003). Relationship between visual- Young Children, 66(5), 100-103.
motor integration and handwriting skills of children in kindergar- Jacini, W. F., Cannonieri, G. C., Fernandes, P. T., Bonilha, L., Cendes, F.,
ten: A modified replication study. American Journal of Occupational & Li, L. M. (2009). Can exercise shape your brain? Cortical differ-
Therapy, 57(4), 459-462. ences associated with judo practice. Journal of Science and Medicine
Davich, J. A. (2005). A comparison of interventions for children with in Sport, 12(6), 688-690.
tactile defensiveness [Master’s thesis, University of Wisconsin- Jacobs, B. (2010). Toe walking, flat feet and bow legs, in-toeing and out-
Stout]. MINDS@UW. https://minds.wisconsin.edu/bitstream/ toeing. Paediatrics and Child Health, 20, 221-224.
handle/1793/41587/2005davichj.pdf?sequence=1&isAllowed=y Jeffreys, I. (2002). Developing a progressive core stability program.
DeGangi, G. A. (1994). Documenting sensorimotor progress: a pediatric Strength & Conditioning Journal, 24(5), 65-66.
therapist’s guide. Therapy Skill Builders. Jones, L. A., & Lederman, S. J. (2006). Human hand function (1st ed.).
Diekema, S. M., Deitz, J., & Amundson, S. J. (1998). Test–retest reliabil- Oxford University Press.
ity of the Evaluation Tool of Children’s Handwriting-Manuscript. Jones, S. M., Jones, T. A., Mills, K. N., & Gaines, G. C. (2009). Anatomical
American Journal of Occupational Therapy, 52(4), 248-255. and physiological considerations in vestibular dysfunction and com-
Dunbar, S. B. (1999). A child’s occupational performance: Considerations pensation. Seminars in Hearing, 30(4), 231-241.
of sensory processing and family context. American Journal of Kavale, K. (1982). Meta-analysis of the relationship between visual
Occupational Therapy, 53(2), 231-235. perceptual skills and reading achievement. Journal of Learning
Dunn, W. (2001). The 2001 Eleanor Clarke Slagle Lecture. The sensations Disabilities, 15(1), 42-51.
of everyday life: Empirical, theoretical, and pragmatic consider- Koziol, L. F., Budding, D. E., & Chidekel, D. (2011). Sensory integration,
ations. American Journal of Occupational Therapy, 55(6), 608-620. sensory processing, and sensory modulation disorders: Putative
DuPaul, G. J., & Stoner, G. (2014). ADHD in the schools: Assessment and functional neuroanatomic underpinnings. The Cerebellum, 10(4),
intervention strategies. Guilford Publications. 770-792.
Effgen, K. (2005). Child development and appraisal. In K. Effgen (Ed.), Kumin, L., Von Hagel, K. C., & Bahr, D. C. (2001). An effective oral motor
Meeting the physical therapy needs of children (pp. 74-75). F. A. Davis intervention protocol for infants and toddlers with low muscle tone.
Company. Infant Toddler Intervention, 11(3/4), 181-200.
Engström, P., & Tedroff, K. (2012). The prevalence and course of idiopath- Kwon, J. Y., & Myerson, M. S. (2010). Management of the flexible foot
ic toe-walking in 5-year-old children. Pediatrics, 130(2), 279-284. in the child: A focus on the use of osteotomies for corrections. The
Exner, C. E. (1997). Clinical interpretation of “In-hand manipulation Pediatric Foot and Ankle, 15(2), 309-322.
in young children: Translation movements.” American Journal of Langberg, J. M., Epstein, J. N., & Graham, A. J. (2008). Organizational-
Occupational Therapy, 51(9), 729-732. skills interventions in the treatment of ADHD. Expert Review of
Farris, K., Fehrenbacher, R., Hayes, E., McEvoy, R., Smith, A., & Neurotherapeutics, 8(10), 1549-1561.
McCulloch, R. (2019). The relationship between muscle activation Lemon, R. N., Mantel, G. W., & Muir, R. B. (1986). Corticospinal facilita-
and handwriting quality with different grip styles. International tion of hand muscles during voluntary movement in the conscious
Journal of Exercise Science: Conference Proceedings, 8(7), 57. monkey. The Journal of Physiology, 381(1), 497-527.
 References 189
Losse, A., Henderson, S. E., Elliman, D., Hall, D., Knight, E., & Jongmans, Salar, S., Daneshmandi, H., Karimizadeh Ardakani, M., & Nazari Sharif,
M. (1991). Clumsiness in children‐do they grow out of it? A 10‐year H. (2014). The relationship of core strength with static and dynamic
follow‐up study. Developmental Medicine & Child Neurology, 33(1), balance in children with autism. Annals of Applied Sport Science,
55-68. 2(4), 33-42.
Markowitz, M. (2006). Occupational therapy interventions in low vision Schaft, R., & Roley, S. (2006). Sensory integration: Applying clinical rea-
rehabilitation. Canadian Journal of Ophthalmology, 41(3), 340-347. soning to practice with diverse population (pp. 52, 74-80).
Marr, D., Cermak, S., Cohn, E. S., & Henderson, A. (2003). Fine motor Schmidt, A., Dirk, J., & Schmiedek, F. (2019). The importance of peer
activities in Head Start and kindergarten classrooms. American relatedness at school for affective well‐being in children: Between‐
Journal of Occupational Therapy, 57(5), 550-557. and within‐person associations. Social Development, 28(4), 873-892.
Martin, N. A. (2006). Test of visual perceptual skills—non motor (3rd ed.). Schneck, C. M. (1996). Visual perception. Occupational Therapy for
Academic Therapy Publications. Children (6th ed., pp. 373-403). Mosby, Inc.
Michelson, L., Sugai, D. P., Wood, R. P., & Kazdin, A. E. (2013). Social Shumway‐Cook, A., Hutchinson, S., Kartin, D., Price, R., & Woollacott,
skills assessment and training with children: An empirically based M. (2003). Effect of balance training on recovery of stability in
handbook. Springer Science & Business Media. children with cerebral palsy. Developmental Medicine & Child
Miller, A., Moncayo, Z., Treadwell, D., & Olson, L. (1999, April).Children Neurology, 45(9), 591-602.
with autism using weighted vests: Two single-subject studies [Paper Shumway-Cook, A., & Woollacott, M. H. (1995). Motor control: Theory
presentation]. The American Occupational Therapy Association and practical applications. Williams & Wilkins.
Annual Conference and Exposition, Indianapolis, Indiana. Silva, L., & Schalock, M. (2013). Treatment of tactile impairment in young
Miller, L. J., Anzalone, M. E., Lane, S. J., Cermak, S. A., & Osten, E. T. children with autism: Results with qigong massage. International
(2007). Concept evolution in sensory integration: A proposed nosol- Journal of Therapeutic Massage & Bodywork, 6(4), 12-20.
ogy for diagnosis. American Journal of Occupational Therapy, 61(2), Solan, M. C., Kohls-Gatzoulis, J., & Stephens, M. M. (2010). Idiopathic toe
135-140. walking and contractures of the triceps surae. The Pediatric Foot and
Müller, S., Carlsohn, A., Müller, J., Heiner, B., & Mayer, F. (2012). Static Ankle, 15(2), 297-307.
and dynamic foot characteristics in children aged 1–13 years: a cross- Srivastava, A. (2016). Sensory integration strategies for handwrit-
sectional study. Gait & Posture, 35, 389-394. ing among autistic children. Academic Journal of Pediatrics &
Muttiah, N., Georges, K., & Brackenbury, T. (2011). Clinical and research Neonatology, 2(1), 1-4.
perspectives on nonspeech oral motor treatments and evidence- Takata, N. (1974). Play as a prescription. In M. Reilly (Ed.), Play as explor-
based practice. American Journal of Speech-Language Pathology, atory learning (pp. 209-246). Sage Publications.
20(1), 47-59. Tecklin, J. S. (2008). Pediatric physical therapy (4th ed.). Lippincott
Nederkoorn, C., Jansen, A., & Havermans, R. C. (2015). Feel your food. Williams & Wilkins.
The influence of tactile sensitivity on picky eating in children. Thielbar, K. O., Lord, T. J., Fischer, H. C., Lazzaro, E. C., Barth, K. C.,
Appetite, 84, 7-10. Stoykov, M. E., & Kamper, D. G. (2014). Training finger individu-
Oliver, C. E. (1990). A sensorimotor program for improving writing ation with a mechatronic-virtual reality system leads to improved
readiness skills in elementary-age children. American Journal of fine motor control post-stroke. Journal of Neuroengineering and
Occupational Therapy, 44, 111-116. Rehabilitation, 11(1), 171.
Parham, D. L., & Fazio, L. S. (1997). Play in occupational therapy for Tudor, M. (1981). Child development. McGraw-Hill.
children. Mosby, Inc. VandenBerg, N. L. (2001). The use of a weighted vest to increase on-task
Parush, S., Yochman, A., Cohen, D., & Gershon, E. (1998). Relation of behavior in children with attention difficulties. American Journal of
visual perception and visual-motor integration for clumsy children. Occupational Therapy, 55, 621-628.
Perceptual and Motor Skills, 86(1), 291-295. Van Hof, P., Van der Kamp, J., & Savelsbergh, G. J. P. (2002). The relation
Pfeiffer, B., & Kinnealey, M. (2003). Treatment of sensory defensiveness in of unimanual and bimanual reaching to crossing the midline. Child
adults. Occupational Therapy International, 10(3), 175-184. Development, 73, 1353-1362.
Piek, J. P., Baynam, G. B., & Barrett, N. C. (2006). The relationship Vygotsky, L. (1986). Thought and language. (Rev. ed.). Massachusetts
between fine and gross motor ability, self-perceptions and self-worth Institute of Technology.
in children and adolescents. Human Movement Science, 25(1), 65-75. Wallen, M., & Walker, R. (1995). Occupational therapy practice with
Rachwani, J., Santamaria, V., Saavedra, S. L., & Woollacott, M. H. (2015). children with perceptual motor dysfunction: Findings of a literature
The development of trunk control and its relation to reaching in review and survey. Australian Occupational Therapy Journal, 42,
infancy: A longitudinal study. Frontiers in Human Neuroscience, 9, 15-25.
94. Welsh, M. C., & Pennington, B. F. (1988). Assessing frontal lobe
Raghavan, P., Krakauer, J., Santello, M., & Gordon, A. (2007). Relationship functioning in children: Views from developmental psychology.
between finger individuation and shaping the fingers to object con- Developmental Neuropsychology, 4(3), 199-230.
tours. American Journal of Physical Medicine & Rehabilitation, 86(4), Wikipedia. (2020). Pangram. https://en.wikipedia.org/wiki/
327. Pangram#cite_note-2
Reichow, B., Barton, E., Neely Sewell, J., Good, L., & Wolery, M. Wilbarger, P., & Wilbarger, J. (1991). Sensory defensiveness in children
(2010). Effects of weighted vests on the engagement of children aged 2–12: An intervention guide for parents and other caretakers.
with developmental delays and autism. Focus on Autism and Other Avanti Educational Programs.
Developmental Disabilities, 25(1), 3-11. Wilson, B. N., Kaplan, B. J., Crawford, S. G., Campbell, A., & Dewey, D.
Reisman, J. E. (1991). Poor handwriting: Who is referred? American (2000). Reliability and validity of a parent questionnaire on child-
Journal of Occupational Therapy, 45,849-852. hood motor skills. American Journal of Occupational Therapy, 54(5),
Rine, R. M. (2009). Growing evidence for balance and vestibular prob- 484-493.
lems in children. Audiological Medicine, 7(3), 138-142. Williams, C. M., Michalitsis, J., Murphy, A., Rawicki, B., & Haines, T. P.
Rine, R. M., & Wiener-Vacher, S. (2013). Evaluation and treatment of ves- (2013). Do external stimuli impact the gait of children with idiopath-
tibular dysfunction in children. NeuroRehabilitation, 32(3), 507-518. ic toe walking? A study protocol for a within-subject randomised
Robinson, D. A. (1968). The oculomotor control system: A review. control trial. Journal of Foot and Ankle Research, 3(3), e002389.
Proceedings of the IEEE, 56(6), 1032-1049. Williamson, G. G., & Dorman, W. J. (2002). Promoting social competence.
Rosenfeld-Johnson, S. (2001). Oral-motor exercises for speech clarity. Hammill Institute on Disabilities.
Innovative Therapists International.
190 References
Wong, A. L., Haith, A. M., & Krakauer, J. W. (2015). Motor planning. The Your Dictionary. (2020). Examples of pangrams. https://examples.your-
Neuroscientist, 21(4), 385-398. dictionary.com/reference/examples/examples-of-pangrams.html
The Word Play Website. (2020). Some well-known pangrams. http://www. Zeigler-Dendy, C. A. (2002, February). Five components of executive
fun-with-words.com/pang_example.html function and a bird’s-eye view of life with ADD and ADHD: Advice
Wren, T. A. L., Rethlefsen, S., & Kay, R. M. (2005). Prevalence of spe- from young survivors. CHADD Attention Magazine. https://chadd.
cific gait abnormalities in children with cerebral palsy. Journal of org/attention-magazine/attention-magazine-february-2002/
Pediatric Orthopaedics, 25, 79-83.
 A
Worksheets and Handouts

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 191-254).
© 2023 SLACK Incorporated.
192 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 193

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
194 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 195

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
196 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 197

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
198 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 199

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
200 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 201

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
202 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 203

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
204 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 205

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
206 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 207

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
208 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 209

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
210 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 211

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
212 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 213

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
214 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 215

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
216 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 217

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
218 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 219

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
220 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 221

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
222 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 223

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
224 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 225

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
226 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 227

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
228 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 229

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
230 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 231

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
232 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 233

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
234 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 235

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
236 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 237

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
238 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 239

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
240 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 241

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
242 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 243

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
244 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 245

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
246 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 247

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
248 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 249

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
250 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 251

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
252 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 Worksheets and Handouts 253

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
254 Appendix A

© SLACK Incorporated, 2023. From Danto, A. H., & Pruzansky, M. (2023). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions,
Third Edition. SLACK Incorporated.
 B
Therapeutic iPhone and
Android Apps
To learn proper pencil grip, it is recommended to use a stylus, such as the Dano AppCrayon Stylus for Kids, with many
of these apps, especially when working on handwriting skills.

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 255-260).
© 2023 SLACK Incorporated.
256 Appendix B
Therapeutic iPhone and Android Apps 257
258 Appendix B
Therapeutic iPhone and Android Apps 259
260 Appendix B
 C
Occupational Therapy
Telehealth
GAMES AND ACTIVITIES FOR Digital coloring pages: Therapist shares screen of
online coloring pages with child and child can color.

TELEHEALTH
(Can work on visual skills as well by having the child
only color specific objects found in the picture.)
Connect Four: Using an online Connect Four game
Telehealth supplies scavenger hunt: Child looks around therapist and child play Connect Four.
house for supplies (e.g., paper, crayons, scissors, glue,
Tic-Tac-Toe: Therapist shares screen with child and
pencils) to keep in a box (can use a shoe box) for tele-
plays online Tic-Tac-Toe game.
health occupational therapy sessions.
Sequencing activities: Therapist finds online sequenc-
Freeze dance: Using Zoom or other platform therapist
ing games and shares screen with child. (Some websites
plays music. Child dances whenever the music is play-
with sequencing games include https://www.turtledi-
ing. When the music is shut off, child freezes until the
ary.com/, https://www.education.com/, https://www.
music starts again.
roomrecess.com/)
Simon Says
Crossword puzzles: Therapist finds or creates puzzles
Therapist shares a YouTube video (e.g., “lets play online with crossword puzzle creator. Therapist sends
Simon Says”) with the child. child the link and has the child share their screen with
Therapist plays traditional Simon Says using various the therapist. Child completes the puzzle and then
gross motor, fine motor, and stretching activities as writes sentences with the words found.
the instructions that “Simon” is giving. Therapist Create your own word search: Therapist shares link
and child can switch off being Simon. with child and child shares screen with therapist.
Picture schedule: Using clip art photos, therapist and (There are websites that assist with this such as www.
child create a visual schedule for different sequenced thewordsearch.com and many others.)
activities such as toothbrushing, morning routine,
recipes, or the schedule for the telehealth occupational
therapy session.

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (pp. 261-264).
© 2023 SLACK Incorporated.
262 Appendix C
Animal shape craft: Child cuts out various shapes and https://mathsisfun.com/
glues together to form different animals. www.crafty- https://www.digipuzzle.net/
beecreations.com sells templates for this. Or create
your own templates. https://www.roomrecess.com/

“What’s Different” pictures: Therapist shares screen www.abcya.com

with child with two similar pictures. Child finds the Handwriting sheets, printables, and crafts
differences in two pictures on the screen. (Some web- https://firstpallette.com/
sites that have spot the difference games are https://
www.hellokids.com/ and https://www.spotthediffer- https://craftybeecreations.com/
ence.com/) https://www.education.com/
Mazes: Therapist shares screen of online maze games https://edhelper.com/
with child and child completes the maze. (Some web- https://kidzone.ws/
sites that include mazes are https://toytheater.com/ and
https://www.happyclicks.net/) www.k5learning.com

Book scavenger hunt: Child looks at a picture book and Educational/therapeutic games
finds different objects in the book as directed by the https://papergames.io/
therapist (e.g., find a bicycle, a dog, something funny, https://playtictactoe.org/
clouds).
https://www.hellokids.com/
Jamboards in Google Classroom: Therapist creates
Jamboard and shares with the child to play games, https://www.roomrecess.com/
color, or practice handwriting. (Jamboard is Google https://toytheater.com/
Classroom’s interactive digital whiteboard; google https://www.wordgametime.com/
“Jamboard for further instructions and sample tem-
plates.) https://www.happyclicks.net/

“What’s Silly” pictures: (Google “what’s silly pictures” https://www.primarygames.com/

for many examples). Therapist shares screen. https://shinylearning.co.uk/
Child works on finding hidden objects in the pic-
ture.
Therapist uses silly picture as a writing prompt in
order to practice handwriting with child.
YOUTUBE VIDEOS
Movement
Shukla, P. (2011, June 17). Stand Up, Sit Down
WEBSITES Children’s Song [Video]. YouTube. https://www.you-
tube.com/watch?v=t9WAGkQUUL0
Typing The Kiboomers. (2015, March 25). Freeze
https://www.broderbund.com/mavis-beacon-teach- Dance, Freeze Song, Freeze Dance For Kids
es-typing-anniversary-edition [Video]. YouTube. https://www.youtube.com/
watch?v=2UcZWXvgMZE
https://www.typingclub.com/
Rocking Dan Teaching Man. (2017, April 14). Do
https://play.typeracer.com/ The Bear Walk (Gross Motor/Balance/Coordination/
https://www.kidztype.com/ Self Regulation/Brain Break) [Video]. YouTube.
Visual skills https://www.youtube.com/watch?v=KG3AO6lJ4BQ

https://eyecanlearn.com/ The Learning Station-Kids Songs and Nursery

Rhymes. (2014, May 18). Shake Your Sillies Out,
www.thewordsearch.com Brain Breaks Songs for Kids, Kids Action Songs
https://www.spotthedifference.com/ [Video]. YouTube. https://www.youtube.com/
https://www.highlightskids.com/ watch?v=NwT5oX_mqS0

https://matchthememory.com/
 Occupational Therapy Telehealth 263
incogneato72. (2011, October 11). Bop ‘Til You The Learning Station. (2019, April 26). Hokey Pokey
Drop [Video]. YouTube. https://www.youtube.com/ (Original Version). Kids Dance Song. Brain Breaks
watch?v=3dXoiCMyyu4 By The Learning Station [Video]. YouTube. https://
Mitchell, D. (2018, August 21). Yoga Yoga Slide www.youtube.com/watch?v=NhZI-ghmyrU
[Video]. YouTube. https://www.youtube.com/ Hartmann, J. (2016, April 28). Clapping Machine
watch?v=bkhBtXah6N4 Is a Great Brain Breaks Song Engaging Kids With
Mitchell, D. (2018, August 21). Yoga Every Little Clapping Patterns [Video]. YouTube. https://www.
Cell [Video]. YouTube. https://www.youtube.com/ youtube.com/watch?v=9sS0OeABaFs
watch?v=MPhgiyjNlUs Shukla, P. (2019, August 14). Simon Says For Children
The PE Shed. (2020, March 22). Teddy Bear (Official Video) By Miss Patty [Video]. YouTube.
Challenges—PE Home Learning Activities https://www.youtube.com/watch?v=OkO8DaPIyXo
[Video]. YouTube. https://www.youtube.com/ Hartmann, J. (2019, March 29). Jack Hartmann
watch?v=whPptTaKMtA Says. Following Directions Song for Kids. Brain
The Kiboomers. (2016, September 15). Walking Breaks [Video]. YouTube. https://www.youtube.
Walking Hop Hop Hop Song, Walking Walking, com/watch?v=OhRQSOMRk_A
Walking Song [Video]. YouTube. https://www.you- Koo Koo Kanga Roo. (2013, December 2). Koo
tube.com/watch?v=r6cJB7k6eEk Koo Kanga Roo—Dinosaur Stomp (Dance-A-Long)
Cocomelon Nursery Rhymes. (2017, October [Video]. YouTube. https://www.youtube.com/
3). Head Shoulders Knees & Toes (Baby Version) watch?v=Imhi98dHa5w
[Video]. YouTube. https://www.youtube.com/ Little Sports. (2019, October 3). 9 Min Exercise
watch?v=QA48wTGbU7A For Kids-Home Workout [Video]. YouTube. https://
ChuChu TV Nursery Rhymes & Kids Songs. (2014, www.youtube.com/watch?v=oc4QS2USKmk
April 4). Head Shoulders Knees Toes—Exercise Song Miss Renee OT. (2020, October 12). “Mr. Bones”
for Kids [Video]. YouTube. https://www.youtube. Body Awareness Online Learning Activity
com/watch?v=h4eueDYPTIg [Video]. YouTube. https://www.youtube.com/
Cocomelon Nursery Rhymes. (2018, May 24). The watch?v=BccyyePMqsM
Wheels On The Bus [Video]. YouTube. https://www. The Learning Station. (2013, January 9). The
youtube.com/watch?v=e_04ZrNroTo More We Get Together—Kids Songs—Children’s
Little Baby Bum. (2015, June 3). If You’re Happy & Songs—Nursery Rhyme—By The Learning Station
You Know It [Video]. YouTube. https://www.you- [Video]. YouTube. https://www.youtube.com/
tube.com/watch?v=vN_cgoVvsBI watch?v=lldmkrJXQ-E

Sesame Street. (2021, March 10). Sesame Street: If Emotions

You’re Happy Know It Lyric Video [Video]. https:// Miss Molly. (2018, March 28). The Feelings Song
www.youtube.com/watch?v=LDP08F3op80 [Video]. YouTube. https://www.youtube.com/
Hartmann, J. (2017, December 15). Exercise, Rhyme watch?v=-J7HcVLsCrY
And Freeze, Rhyming Words for Kids, Exercise KidsTV123. (2013, August 27). The Feelings Song
Song [Video]. YouTube. https://www.youtube.com/ [Video]. YouTube. https://www.youtube.com/
watch?v=cSPmGPIyykU watch?v=UsISd1AMNYU
Hartmann, J. (2020, September 1). Crossover, Brain Learning Time Fun. (2016, February 3). Learn
Breaks, Crossing the Midline [Video]. YouTube. Feelings And Emotions For Kids (Learning Videos for
https://www.youtube.com/watch?v=RRlY1vWLS0o Toddlers) [Video]. YouTube. https://www.youtube.
The Learning Station. (2018, April 6). Brain Break. com/watch?v=37w9JjUWN30
Exercise Song For Kids. Fitness Songs Kids. Move Dressing
With Me [Video]. YouTube. https://www.youtube. Flannery Brothers. (2012, January 19). Dip N’ Flip
com/watch?v=JoF_d5sgGgc Jacket Song [Video]. YouTube. https://www.youtube.
Hartmann, J. (2019, January 16). Move It And Freeze com/watch?v=NpCNf4oTxg4
Extended. Brain Breaks [Video]. YouTube. https:// WonderGrove Kids. (2014, July 8). You Can Dress
www.youtube.com/watch?v=Nqg5zY0MOfI Yourself S3 E10 [Video]. YouTube. https://www.you-
tube.com/watch?v=iugZbbUvAmI
264 Appendix C
Fine Motor Strengthening OT Closet. (2020, November 22). Brain Gym Warm
The OT Toolbox. (2016, August 30). Finger Aerobics Up With Emoji And Metronome. Fine Motor Exercise
[Video]. YouTube. https://www.youtube.com/ For Fingers, Hands. Handwriting [Video]. YouTube.
watch?v=3VpARNgbb8c https://www.youtube.com/watch?v=Iatni_Jk9ks

HooplaKidz—Official Nursery Rhymes Channel. 123ABCtv. (2016, April 2). How To Write Letters
(2014, March 7). Where Is Thumbkin. Nursery A-Z—Learning To Write The Alphabet For Kids—
Rhyme. HooplaKidz [Video]. YouTube. https://www. Uppercase And Lowercase Letters [Video]. YouTube.
youtube.com/watch?v=bRNDu3O2VQY https://www.youtube.com/watch?v=vsue4unC7YQ

Early Years Emily. (2020, April 4). “I Like To” Kiddos World TV. (2021, April 13). How To Write
Playdough Action Song [Video]. YouTube. https:// Letters For Children - Teaching Writing ABC For
www.youtube.com/watch?v=BOLR3pQt8zg Preschool - Alphabet For Kids [Video]. YouTube.
https://www.youtube.com/watch?v=C7oebqj3PCY
GriffinOT. (2019, June 9). Crocodile Snap Pencil
Grasp Childrens Song [Video]. YouTube. https:// Hartmann, J. (2021, September 13). Let’s Learn The
www.youtube.com/watch?v=N6kPcQSSsEY Letter A [Video]. YouTube. https://www.youtube.
com/watch?v=t2MfGBsnyZM (insert the letter you
Miss Sprinkle. (2019, October 15). Playdough want to learn for individual letter video)
Finger Exercises To Twinkle Twinkle Little Star
[Video]. YouTube. https://www.youtube.com/ Mindfulness and Attention
watch?v=1JaF0mjG4e8 GoStrengthsOnline. (2012, March 30). Teaching
HeidiSongs. (2015, July 30). The Scissors Song. Music Mindfulness to Children at Home and in Schools
for Classroom Management [Video]. YouTube. [Video]. YouTube. https://www.youtube.com/
https://www.youtube.com/watch?v=-Qwi0l29ppY watch?v=iBpEYa74w2Y

Twinkle Little Songs—Nursery Rhymes. (2020, Fablefy-The Whole Child. (2017, April 11). 3 Minutes
January 31). Itsy Bitsy Spider Song for Kids. Body Scan And Meditation—Mindfulness for Kids
Incy Wincy Spider Nursery Rhyme (BIG CITY!) and Adults [Video]. YouTube. https://www.youtube.
[Video]. YouTube. https://www.youtube.com/ com/watch?v=ihwcw_ofuME
watch?v=dTHv15w09pY Meditation Channel. (2016, February 13). Breath
Writing Meditation For Kids. Mindfulness for Kids
[Video]. YouTube. https://www.youtube.com/
Bailey, M. (2020, January 26). Where Do You Start watch?v=CvF9AEe-ozc
Your Letters [Video]. YouTube. https://www.you-
tube.com/watch?v=j6eLk7fDLCM Cosmic Kids Yoga. (2016, October 3). The Listening
Game. Cosmic Kids Zen Den—Mindfulness for
OT Closet. (2020, October 4). Handwriting Warmups Kids [Video]. YouTube. https://www.youtube.com/
With Pencil. Beginner Hand And Finger Exercises watch?v=uUIGKhG_Vq8
For Kids [Video]. YouTube. https://www.youtube.
com/watch?v=gMpq7ql9fAw
 Glossary

Bilateral integration: The ability to use the right and left Pinch grasp: Grasping a small object between the pads of
side of the body together to perform an activity. the thumb and index finger.
Body awareness: A person’s sense of where their body and Pressure modulation: The ability of the body to know how
limbs are in relation to the environment and each other. hard or soft to grade pressure when interacting with
Compensatory strategies: Strategies employed that help a objects in the environment.
person compensate for decreased strength or weak skills Prone: The position of lying on the stomach.
(e.g., wearing Velcro shoes when a child cannot tie laces). Proprioception: The system that controls a person’s aware-
Crossing midline: The ability to reach across the body ness of where the body’s limbs are in relation to the
with one hand for an object on the opposite side (e.g., environment and each other.
reaching with the right hand for an object placed on the Quadruped: The position of being on “all fours” (on hands
left side). and knees) on the floor.
Dissociation: The ability to move different parts of the Sensory integration: The body’s ability to take information
body in isolation from the rest of the body. from the environment, process it through the different
Finger individuation: The ability to use each finger in iso- senses, and produce an appropriate response.
lation from the other fingers. Supine: The position of lying on the back.
Grading: The ability to make an activity more challenging Tactile system: The system that controls the body’s sense
(upgrade) or less challenging (downgrade) by modifying of touch.
a task or demand. Vestibular system: The system that controls the body’s
Input: Providing sensory feedback. sense of movement.
Motor planning: The ability to control and navigate the
body and limbs in a coordinated fashion in response
to the environment and during unfamiliar and new
actions.

Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:

Creative Ideas for Therapy Sessions, Third Edition (p. 265).
© 2023 SLACK Incorporated.
 Brand Name Products
The brand name products mentioned in 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions, Third
Edition, are listed below, along with their manufacturer information. None of the owners of the trademarks of these prod-
ucts have endorsed the use of these products in the manner described in this book.

Angry Birds Mega Smash (Angry Birds) Dano AppCrayon Stylus for Kids (AppCrayon)
Ants in the Pants (Hasbro, Inc.) Design and Drill Activity Center (Educational Insights)
ARK’s Grabbers/Chewy Tubes (ARK Therapeutic Digi-Piggy Digital Piggy Bank (Gift Depot)
Services, Inc.) Digital Coin Bank (Royal Sovereign)
Barbecue Party (Goliath Games) Dizzy Disc (Sportime)
Barrel of Monkeys (Hasbro, Inc.) DMFLY Pencil Grip (DMFLY)
Battleship (Hasbro, Inc.) Don’t Break the Ice (Hasbro, Inc.)
Bed Bugs (Hasbro, Inc.) Don’t Spill the Beans (Hasbro, Inc.)
Boppy pillow (The Boppy Company) Doodle Dice Deluxe (Jax Games)
Bubble Wrap (Sealed Air Corporation) Dynadisc (Exertools, Inc.)
Bug-Out-Bob (Toysmith) Elefun (Hasbro, Inc.)
Bumpy Grip (The Pencil Grip Inc.) Etch A Sketch (Spin Master)
Button Candy (Necco) Fantacolor Junior (Quercetti)
Candy Land (Hasbro, Inc.) First Hand (R&R Games)
Cellophane (Innovia Films Ltd) Frisbee (WHAM-O)
ChapStick (GlaxoSmithKline) Froot Loops (Kellogg Company)
Cheerios (General Mills, Inc.) Gator Grabber Tweezers (Learning Resources)
The Cheerios Play Book (General Mills, Inc.; Lee Wade) 3D Feel & Find Game (Guidecraft)
Clue Junior (Hasbro, Inc.) Foam Grip (The Pencil Grip Inc.)
Colorama (Manfrotto) Geddes Kushy Pencil Grip (Raymond Geddes and
Connect Four (Hasbro, Inc.) Company)
Cootie (Hasbro, Inc.) Guess Who? (Hasbro, Inc.)
Cranium Hullabaloo (Hasbro, Inc.) HandiWriter Handwriting Tool (Handithings LLC)
Crossover Grip (The Pencil Grip Inc.) Handwriting Without Tears (Jan Z. Olsen)
Danto, A. H., & Pruzansky, M. 1001 Pediatric Treatment Activities:
Creative Ideas for Therapy Sessions, Third Edition (pp. 267-269).
© 2023 SLACK Incorporated.
268 Brand Name Products
Hi Ho Cherry-O (Hasbro, Inc.) Nuk Brush (Gerber)
Hip Helpers (Hip Helpers, Inc.) Ocean Wonders Musical Fishbowl (Fisher-Price)
Hippity Hop (Gymnic) Operation (Hasbro, Inc.)
Hula Hoop (WHAM-O) Oreo Matchin’ Middles (Fisher-Price)
Hungry Dog/Monkey/Bunny Motor Skills Game Othello (Mattel, Inc.)
(Lakeshore Learning Materials) Pattern Blocks & Board (Melissa & Doug, LLC)
Hungry Hungry Hippos (Hasbro, Inc.) Pattern Play (Small World)
Hyper Dash (Wild Planet) Peg Domino (Sammons Preston)
iPad (Apple, Inc.) Pencil Grip Jumbo (The Pencil Grip Inc.)
iPhone (Apple, Inc.) Penguin Pile-Up (Ravensburger)
I Spy (Briarpatch, Inc.) Perfection (Hasbro, Inc.)
Image Captor (Westminster Inc.) Perler Beads (IG Design Group)
Innergizer (Soleeze Innergizer) Pick Up Sticks (Commando LLC)
Jenga (Hasbro, Inc.) Picture Perfect Design Tiles (Educational Insights)
Jolly Octopus (Ravensburger) Plastic Jumping Frog Toys (U.S. Toy Company)
Katamino (Gigamic) Play-Doh (Hasbro, Inc.)
Kerplunk (Mattel, Inc.) Playfoam (Educational Insights)
KID K’NEX (K’NEX Brands, L.P.) Pop Beads (Cousin Corporation of America)
Kinetic Sand (Spin Master) Popsicle (Unilever)
Konexi (Wonder Forge) Post-It Notes (3M)
Koosh balls (OddzOn Products) Pustefix Bubble Bear (Pustefix)
LEGO pieces (The LEGO Group) Rainbow Loom (Rainbow Loom)
Lincoln Logs (Hasbro, Inc.) Rapper Snapper (Ellis Enterprises)
Lite Brite (Hasbro, Inc.) Rock Em’ Sock Em’ Robots (Mattel, Inc.)
Lucky Ducks (Hasbro, Inc.) Rush Hour Jr. (ThinkFun Inc.)
Lycra (Lycra) Scatterpillar Scramble (Hasbro, Inc.)
M&M’s (Mars, Incorporated) Scrabble (Hasbro, Inc.)
Magformers (The Magformers Inc.) SET (Set Enterprises, Inc.)
Magna Doodle (The Ohio Art Company) Silly Putty (Crayola, LLC)
Magna-Tiles (Magna-Tiles) Simon (Hasbro, Inc.)
Magnet Express (Anatex Enterprises) Skee-Ball (Skee-Ball, Inc.)
Mancala (California Dreams) Skip It (Hasbro, Inc.)
Marshmallow Fluff (Durkee Mower Company) Smart Snacks Mix & Match Doughnut (Learning
Mastermind (Pressman Toy Corporation) Resources, Inc.)
Melissa & Doug Basic Skills Board (Melissa & Doug, Smart Snacks Sorting Shapes Cupcakes (Learning
LLC) Resources, Inc.)
Melissa & Doug Latches Puzzle (Melissa & Doug, LLC) Soft Cushion Pencil Grip (Charles Leonard Inc.)
Melissa & Doug Magnetic Puzzles (Melissa & Doug, Spot It (Blue Orange)
LLC) Squiggly Worms (Pressman Toy)
Memory (Hasbro, Inc.) Stare! (Game Development Group)
Mr. Mouth (Hasbro, Inc.) Stetro Pencil Grip (Rose Moon Inc.)
Mr. Potato Head (Hasbro, Inc.)
 Brand Name Products 269
Styrofoam (The Dow Chemical Company) Twister (Hasbro, Inc.)
Sudoku (Nikoli Co, Ltd) Velcro (Velcro U.S.A.)
Super Catch (U.S. Games) Where’s Waldo? (Martin Handford)
Super Sorting Pie (Learning Resources) Whac-A-Mole (Hasbro, Inc.)
Tetris (Tetris Holding LLC) Wiffle Ball (The Wiffle Ball Inc.)
Theraband (Theraband) Wikki Stix (Omnicor, Inc.)
Theraputty (GF Health Products) Woggler (Elrey Enterprises)
Tiddlywinks (House of Marbles) Wok ‘N Roll (International Playthings)
Tinkertoys (Hasbro, Inc.) Writing Claw (The Pencil Grip Inc.)
Topple Chrome (Pressman Toy Corporation) Zoom Ball (Goliath)
Triangle Pencil Grip (The Pencil Grip Inc.) Z-Vibe (ARK Therapeutic Services, Inc.)