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Lewis is a 5-year old child who has recently joined pre-school. According to his parents he is very active, energetic and friendly boy who likes running in ground, spinning, jumping, watching Doctor Who and talking to everyone. After working with Lewis for a week, his class teacher discovered some unique habits, characteristics and behaviours of him which were as follows:
- While sitting in his chair or writing he slouches without him knowing about it. Likes wandering in the classroom and “always on a go”. He cannot sit for more than 10-12 minutes in his place.
- Doesn’t like playing with Lego or construction toys.
- Easily distracted by background sounds or outside noise (e.g., bird chirping or vehicle passing by)
- Gets confused with letters and numbers while reading and writing
- He is right handed but often uses left hand to write.
- While writing he goes out of space without realising it.
When these observations were discussed with school OT, she strongly recommended him for Sensory Integration assessment as all above stated features were part of sensory difficulties which were interfering in his handwriting, self-care, fine motor skills and day to day activities.
According to Case-smith (1992), children began to draw and scribble on paper as soon as they are able to grasp a writing tool. The development of writing process in early years includes scribbling, drawing lines and circles.
During 7-8 years they learn to use the different functional tool such as
knife and fork, scissors, pencils, zippers, buttons, brooms. They learn to plan and sequence actions which are the important part of motor planning.
However, for an atypically growing child these opportunities and playful scenarios are sensory challenges. They may experience stress in the case in the course of the day to day tasks related to fine motor, gross motor and handwriting skills.
Proprioception Sense Issues:
- May lack judgement about the amount of pressure needed to exert on paper.
- May drop things in hand and look weak.
- May erase so hard which may cause holes in sheet due to poor modulation issues.
- May use the least pressure while writing on paper due to which writing is illegible
- May get tired easily or tend to slump over the desk.
- May avoid extended hours of sitting and writing
- May complain about pain in his hand, arm and neck if writing for prolonged hours.
- May have the poor grip on pencil due to poor modulation.
Proprioception Sense Strategies:
hand and wrist muscles and providing resistive exercises.
Plastic Bendable Pencils :used for children who likes chewing pencil tops for oral stimulation.
Pencil Grips and paper alterations:
Vestibular Sense Issues:This sense is called as vestibular sense. Our relationship to parents can be called secondary when explaining importance and relation to gravity in our lives. Due to this sense essential skills such as bilateral integration, eye-hand coordination and balance are accomplished during child’s growth and development.Usually, children with poor vestibular sense have poor bilateral integration.
- The child may have difficulties in coordinating both the sides of the body that are left and right side confusion will be prominent.
- May get easily confused with instructions or directions that are why they easily forget classroom routes.
- May have difficulties in dancing, playing the drum, eating with knife and fork as hands and feet may not work in coordination.
- Maybe ambidextrous or have poor hand preference.
- May have trouble with maths.
- May have disorganised desk, room, and surroundings
Vestibular Sense and Bilateral Coordination Strategies & activities:
Visual-Auditory Processing Issues:
- May have difficulties in forming or staying in line when drawing,
- May have difficulties in cutting along the lines or glueing properly.
- May have difficulties in placing cut-outs in the correct place in crafts project.
- May be sensitive and easily distracted to noise, visual stimuli or background sounds.
- May look confused often.
- May loose page while reading writing, copying
Auditory-Visual Sense Strategies:
Tactile Sense Issues:
- May dislike being touched or approached from behind.
- May dislike getting hands messy in finger paint, glue and shaving form.
- May seem distressed when having nail cutting or toe nail cutting.
- May chew pencil, shirt collar, hair or rubber while writing or reading in the classroom or home.
- Maybe sensory seeker and have the tendency to touch everyone and everything.
Tactile Sense Strategies:
Inform child before touching him.
Try plastic bendable pencils for chewing purpose and oral stimulation.