I graduated from the University of Malta in 2009 and I have a post-graduate degree in Sensory Integration with the University of Ulster. I have been working as an Occupational Therapist in the paediatric field for the past 11 years and currently work in private practice. I have worked in a variety of settings such as schools, outpatient clinics, neonatal intensive care, inpatient care and private clinics from which I have gained my professional expertise. My current professional role involves the assessment and treatment of children who experience developmental delays and sensory processing difficulties.

Reach out on +356 99872936 or email on wonderkidsmalta@gmail.com

The post Occupational Therapy and Sensory Integration in Malta by Ema Bartolo appeared first on Occupational Therapy Malta.

Some of the most common immature pencil grip include:

• Fist or Palmar grip over the age of 5 years
• Lateral pencil grasp (Securing pencil by pressing thumb against index finger. No web space)
• Thumb tuck (Thumb is tucked  under index finger with no web space)
• Thumb wrap (Thumb is wrapped around the pencil and fingers)
• Bent wrist position
• Lack of wrist stability on desk 
• Pencil shaft pointing away from the hand 
• Switching between grasps for a child older than 5 years
• Holding pencil with fingers on pencil shaft (Spreading all fingers along the pencil shaft and controls the pencil with their little finger
• Holding pencil too tightly or too loose
• Holds pencil too far up or too close to the tip

When to correct an inefficient pencil grip

Correcting an immature grip can be quite challenging and can have an impact on the child’s writing skills. We need to be very cautious as to when this is done. It is hard to change the grip in older children especially when writing patterns have also been established. One should consider to change a grip if:

• It causes discomfort and the hand hurts when writing
• The child is lacking behind in his writing tasks
• If the grip makes writing inefficient.

Modifications and Strategies to Compensate for an immature pencil grasp

As discussed in the blog ‘Tips to promote a Functional Pencil Grip’, in the case of younger children the focus should be on promoting the development of hand skills prior to applying any other modifications. 

• Carry out handwriting warm ups prior to writing

These activities will assist your child getting their hand and finger muscles ready for writing. Handwriting warm up exercises should support: shoulder stability, wrist strength, thumb and hand and finger strength, hand and finger dexterity. Activities to strengthen the core and shoulder muscles include; Wheelbarrow walk, animal walks, tug of war, climbing, playing on all fours, pulling activities and crawling. The following clip illustrates some handwriting warm up exercises which you can practice at home.

• Rubber Band Method

In order to help your child correctly position the pencil, you can use this method.  Place one rubber band on the wrist, while the other is looped over the pencil. This will help to pull the pencil back. 

• Writing on a sloping surface

Your child’s wrist position can have an impact on his endurance while writing. If this happens try using a slanted desk or slant board or vertical surface. 

• Use shorter or thicker pencils.

Children who have a weak grasp tend to hold the writing tool using a fisted grip. They would benefit from smaller, shorter pencils or crayons to promote a good grasp. 

• Promote the use of 3 fingers

In order to encourage your child to hold the pencil between the thumb, index and middle finger, you can prompt your child to hold a small pom pom or coin with the last two digits. This will assist your child to hold the pencil with the tripod grip while the other fingers will be closed and supporting the pom pom.

• Sticker or rubber band on pencil shaft

If your child has difficulty to position his fingers correctly along the pencil shaft, you need to use a visual cue to act as a reminder. Use a sticker or rubber band to assist your child with finger positioning on the pencil.

• Pencil grips

The use of pencil grips should be considered as a last resort. They can be helpful for some children however for others they result in an added distraction. Additionally, some children might take time to adjust to them making writing tasks even harder. The type of grip to be used should be recommended by your occupational therapist.

A word of Advice….

If you are in any way concerned about your child’s pencil grip, and need help to understand better your child’s developmental level or functionality pencil grip development, you need to consider an occupational therapy assessment . This will help figure out whether your child is compensating for other weak skills, or whether your child has missed out on some developmental stage along the way.

At WonderKids paediatric centre Malta we can help you out.

The post Common Pencil Grip Problems appeared first on Occupational Therapy Malta.

Occupational therapists are often approached by professionals and parents with concerns related to their child’s pencil grip development. This concern is a very common concern, mostly because it can have impact on the child’s participation in writing and drawing tasks. Some of the most common concerns are related to:

• The development of pencil grip in preschoolers.
• The correction of a child’s pencil grip once they have already established a grasp. 
• The correction of a child’s grip once they have started writing.

The assessment of a child’s pencil grip development is considered to be important as it can indicate various aspects of their overall development. It can also indicate their performance in other skills in the scholastic environment. 

What is the best pencil grip?

There is a general perception that the “dynamic tripod” grasp is the best and most suitable grip for a child.  This type of grasp involves holding the pencil against the middle finger, thumb and index finger. 

The current research indicates that there are variations to this and other grips have been found to be almost equally efficient. An efficient and functional pencil grip needs to enable the child to:

• Have an open web space (space between the thumb and index finger)
• Control the pencil by moving only the fingers rather than the whole hand 
• Participate in writing tasks without getting tired
• Participation in writing tasks with good writing quality 

There are mixed opinions as to what age a child matures their pencil grip. The key point is to keep in mind that the development of pencil grip has its stages of development. As a general rule this developmental process starts to mature at Kindergarten age. This is when your child starts to experiment with colours and other writing tools which in turn will further promote the development of the pencil grip.

At this stage you should demonstrate the proper finger position to your child, however, you should allow for the developmental progression to take its course. This means that you need to encourage your child to experiment with various writing tools, carry out fine motor activities and avoid the use of pencil grips in Kindergarten. Remember children are still learning how to adjust and correct their grip.

Immature Grip

An immature or inefficient pencil grip does not allow a child to use efficiently finger movements. In this case movements during writing can be static and come from the wrist or whole arm. Children who experience an immature or inefficient pencil grip need more than just practicing with crayons or pencil in order to develop a better pencil grip. Activities to target the underlying skills need to be carried out. 

Activities to Promote efficient pencil grip

• Strengthen the core and shoulder muscles

Your child needs adequate core stability, alignment and posture in order to efficiently use fine motor skills. This will provide a stable base for the development of an efficient pencil grip. Activities to strengthen the core and shoulder muscles include; Wheelbarrow walk, animal walks, tug of war, climbing, playing on all fours, pulling activities and crawling.

• Practice Fine Motor Activities rather than Pencil and Paper activities

Fine motor skills involve movements using the small muscles of the hands and wrist. They are complex motor movements which are based on the refinement and stability of gross motor movements. Fine motor development includes: grasping, finger isolation, development of the arches of the hand, use of the hand, manipulating small objects and bilateral skills.  To promote fine motor development you need to carry out fun activities that require the manipulation of tactile media and exploration with hand muscles. Pen and paper activities on their own will not promote fine motor development. 

An interesting activity involves painting with just one finger at a time. This will promote finger isolation. Encourage your child to use their pointer finger to paint with red, their middle finger to paint with blue, their ring finger to paint with yellow, and their little finger to paint with green.  For more fine motor activities read ‘Handwriting Readiness: Is my child ready to write?‘.

• Bilateral activities 

In addition to fine motor activities you need to practice activities that require your child to use both hands together. This is an important skill to achieve as many of our daily tasks involve actions that require the use of both sides of our body. For example during writing tasks your child would need to be able to write with one hand and manipulate the pencil while holding the paper steady with the opposite hand. 

• Hand Strengthening Exercises

Hand strengthening activities will help your child to improve adequate muscle tone, develop arches of the hands and improve endurance. These activities should be carried out in conjunction to the above mentioned core and shoulder activities. Therapeutic putty or play dough is an important medium to be used for such skill. You can also use items such as clothes pegs, water pipettes, large tweezers. Refer to ‘Handwriting Readiness: Is my child ready to write?’ for ideas.

A word of Advice….

If your child experiences challenges with pencil grip development you will need to consider an assessment by an Occupational Therapist. Your child might need a professional more in-depth assessment of his muscles tone, postural skills and motor coordination.

At WonderKids paediatric centre Malta we can help you out. 

The post Tips to promote a Functional Pencil Grip appeared first on Occupational Therapy Malta.

Your child’s ability to eat, chew, swallow food, drink from a straw, lick an ice-cream or blow out his birthday cake candles are all considered oral motor skills. These start to develop in the womb and are matured early in childhood at around the age of 4. Throughout this time your child’s neurological system will be busy learning how to develop muscle strength and coordination in preparation for eating, drinking and speaking.

Your child is not born with the knowledge of chewing, blowing or licking and these skills are learnt through the experiences that he is offered during childhood. This learning curve is supported by many other skills and milestones such as the integration of primitive reflexes, adequate postural skills, muscle coordination and bilateral use of hands and tongue. Should all of these processes work in sync, you will expect that your child attempts drinking from a straw at around 1 year of age.

When your child learns to drink from a straw he develops an important internal suck/swallow/breath mechanism. This mechanism is an important aspect for the refinement other feeding and speech skills.

Here are some tips to help you teach your child to drink from a straw:

Have the necessary equipment and set

Before starting the training make sure to have all the necessary equipment. This will allow you to present the right equipment as per your child’s needs and make the task more successful.

Preferably start with a thin and short straws as this will help liquid to reach the mouth faster and with less effort.  

In addition to the straw width it is also important to consider the type of cup to be used. There are cups or bottles which can be bought off the shelf that will make this learning process easier. The use of soft cups and bottles  can facilitate the beverage to flow in the straw by gently pressing onto the cup or the bottle. If you are going to use these cups be very careful when pressing the beverage into your child’s mouth and make sure liquid is reaching the mouth in a slow motion. There are also other bottles such as the Bear Bottle Kit or the CIP-KUP by Ark therapies. These have a special valve that keeps the beverage at the top of the straw so the child does not need to put a lot of effort to sip up the drink.  

Avoid using sippy cups

Ideally when you decide to transition from the baby bottle you consider going to a straw instead of a sippy cup. The use of a sippy cup will  promote the same sucking action as the baby bottle. This will decrease the development of other motor patterns required to drink from a straw and a cup.

Use their favourite beverage for learning.

Using your child favourite beverage will provide a sense of familiarity and motivate them to try this new piece of equipment.

Dip and tip method.

This method will help your child understand that the straw contains the beverage. It can be very frustrating for a thirsty kiddo to figure out how to use a straw when he doesn’t have the know how. To try out this method you need to dip a straw into your child’s favourite beverage, then place your finger tip on the end of the straw and lift out of the cup. With your finger still on the end, put the end of the straw into your child’s mouth. Ideally you put the straw on the tongue tip and then prompt your child to take a sip. Release the straw so the liquid flows into your child’s mouth. 

Make sure to give short sips.

Whether you are using the dip and tip method or any other method it is very important to give your child short sips. You also need to give your child time to swallow and adjust to the new sensation. Remember they are still in the LEARNING phase. It is also important to keep in mind that straw drinking can cause children to swallow quickly which may make them cough and choke on the beverage. 

Prevent the straw from going far in the mouth.

The straw should be positioned in a way so the beverage reaches the front of the mouth. Ideally only the tip of the straw is in the mouth.  Your child is still learning the coordinated suck/swallow/breath action so this is very important to avoid aspiration.

Test the length of straw that is in you child’s mouth by doing the following; While the straw is in your child’s mouth, pinch the straw at the lips. Remove the straw from the mouth, and note how much of the straw was inside the mouth.

Supervise all the time.

Keep in mind that your child is still learning to adjust to coordinate the suck/swallow/breath mechanism. So it is important to provide constant supervision during feeding and drinking tasks. 

Teach your child to close their lips around the straw

This should be done once your child feels the liquid flowing in their mouth. You can use a Lip Blok ®  to promote better lip closure. This will also help with proper positioning of the tongue and prevent the straw from going too far into the mouth. If your child is good at imitating facial expressions you can model the action. Make sure to use exaggerated and slow facial expressions.

A word of Advice….

If your child experiences challenges with learning this task or any other mouth actions you will need to consider an assessment by an Occupational Therapist and Speech and Language Pathologist. Your child might need a professional more in-depth assessment of his oral motor milestones, postural skills, reflex integration.

At WonderKids paediatric centre Malta we can help you out.

The post Teaching my child to drink from a Straw appeared first on Occupational Therapy Malta.

Many children begin to draw and scribble on paper shortly after they are able to grasp a colour. By the time they are about four years, most children will have established hand dominance and show more interest in intentional writing patterns. Children develop writing skills at different rates, and some might take longer than others to learn these skills. A child’s readiness for writing is highly underrated and nowadays we are struggling to find the right time to introduce such tasks. Children are finding themselves having to meet faster-paced classroom standards or adult expectations even though they might not be developmentally ready for it. This is an important notion to keep in mind, as not all children exhibit handwriting readiness at the same rate.

It is a known fact that some early years classrooms practice writing letters using a writing tool as part of the Kindergarten curriculum. As an educator it is important to keep in mind that by doing so we are lacking behind on basic play that will help a child to mature further the foundational skills required for writing. 

We need to consider the pre requisite skills required for a child to be ready to write. Among some of the skills include; fine motor skill development, eye hand coordination, ability to hold a writing tool, capacity to form basic strokes independently and letter perception. These are skills which are to be developed and acquired in the first years of a child’s life. While a child is doing hand prints and exploring various utensils to make a huge mess out of his painting, he is maturing his fine motor skills, tactile processing, bilateral skills and eye hand coordination abilities. This also happens while they are playing with blocks, play dough, running after their peers in recess, making moulds with magic sand or scribbling on a piece of paper. The early years at school should be used as a platform to help the children develop such skills to be prepared for the production of efficient letters and words later on in the scholastic year.

Here are some Pre-writing ideas to practice with your 3 and 4 year old:

The post Handwriting Readiness appeared first on Occupational Therapy Malta.

As an Occupational Therapist, I meet many parents and children who dread the time of that time of the day – HOMEWORK TIME. Parents want children to sit still and work, while the children want a break and play, play and play. This often results in a daily power struggle.

Here are some occupational therapy tips to help you and your child out during homework.

Choose the best time

Many parents assume that homework is best done as soon as the child comes back from school. However, for some children school can be very tiring. Start by discussing with your child the activities that need to be done after school. This will help them understand the task routine. It will also help them understand that both homework and play are chores that need to be set into the after school routine. You and your child need to find a common time when to carry out the homework tasks. Although this should be decided together, you might need to help out by choosing the time that your child is mostly energised. Some children  might feel too tired after school while others might prefer to finish it off as soon as they are home. As parents, we need to respect our children’s thresholds which for children who have sensory processing difficulties will be harder to regulate and control.

Visual aids, timers and rewards

Children who are under responsive to sensations might need auditory and visual cues. This will promote their processing and prompt them towards task completion. A timer can be used for the individual homework tasks, following which your child can be given a movement break.

The use of rewards and timers will work well with Sensory seeking children. They crave novelty so these strategies will motivate them to work harder towards finishing their homework. However you need to keep in mind that for some children a timer might cause anxiety. You need to use other strategies such as the use of a checklist. This will work as a visual reminder of the pending tasks.

Sensory friendly homework spot

Some children work best in a quiet, distraction free environment while others need to change positions frequently, have alternative seating options or have the radio on. As a parent, you need to find the best homework spot depending upon your child’s needs. Make sure you cater for those sensory needs so you can help your child regulate and cope better with such tasks. These include adequate lighting, using visual aids, controlling noise levels, allowing movement breaks or using fidget tools. You might need to consult with your occupational therapist to help you find the best sensory strategies.

Try to make the homework spot a place where the child wants to be. Doing the homework at the dining table or in the living area is not an ideal handwriting spot. Those spaces have specific functions and are suited for other family tasks such as leisure or mealtime.

Set Brain Breaks

Children need to move. Short brain breaks during work time will reduce frustration and increase attention and productivity. These need to be timed and set into your child’s schedule. Make sure to use a timer.

During brain breaks allow for movement activities which need to be set with a purpose. These will stimulate your child’s movement centres in the brain to promote attention, level of alertness and motivation to learn. Some ideas include: bouncing on a therapy ball at various speeds, bouncing while throwing and catching, wheelbarrow walk, tug of war with a parent, jumping on the spot, jumping jacks etc.

Liaise with teacher

Children can refuse to do homework for many reasons. Some children might be struggling with understanding the content or tend to fatigue easily but don’t know how to tell you. We need to avoid putting high expectations on them. Try to have a healthy discussion about what they are feeling during homework and school work. You can also reach out to their teacher and discuss in further detail their literacy and academic abilities. If there are issues with these aspects, discuss with their teacher the best way to address this. Some children would benefit from a decrease in homework load and would benefit from repeating previous lessons. If your child is struggling in such areas you might need to seek specialist advice from an educational psychologist or literacy specialist. 

Mum and me playtime

Keep in mind to reward your child after they finish off their work. Find the time to do an activity with them after they finish off their work. Our busy routines might get in the way and we forget to acknowledge the importance of play. We can simply reward our children by having fun together. If your child is a sensory craver, carry out activities with intense sensory input while if your child has a sensory sensitive profile engage in more sedentary tasks. You will surely give your child a break from the home and daily chores if reward your child with a visit to the local playground.

A word of Advice

If homework struggles are related to issues with attention, fatigue, pencil grip difficulties, writing quality or heightened activity level do contact an Occupational therapist. If on the other hand issues are related to literacy seek advice from an educational psychologist or literacy specialist.

At WonderKids paediatric Centre Malta we can help.

The post Home work time appeared first on Occupational Therapy Malta.

Paediatric Occupational Therapist, Advanced Sensory Integration Practitioner

LinkedIn: https://mt.linkedin.com/in/ema-bartolo-a5632616a

Ema received her Bachelor of Science in Occupational Therapy degree from the University of Malta in 2009. She is a registered Occupational Therapist with the Maltese Council for the Professions Complementary to Medicine and has been working in the paediatric field for the past 11 years. She worked in a variety of settings such as schools, public outpatient clinics, neonatal intensive care, inpatient care and private clinics. Ema has experienced several roles in her career, ranging from clinical therapy to management, surmounting to founding two leading paediatric clinics in Malta.

Ema gained several years of clinical experience in the assessment and treatment of children. She has experience working with a multitude of diagnoses such as Autism, Down Syndrome, Genetic conditions, Cerebral Palsy, Learning Difficulties and Attention Deficit Hyperactivity Disorder. Her primary interest is in the area related to neurodevelopmental dysfunction and carried out further studies in the area of neuroscience, focusing on Sensory Integration. Ema also has a postgraduate degree with the University of Ulster in Sensory Integration.

Ema specialises in assessing and treating children with neurodevelopmental conditions who experience Sensory Integrative dysfunction. She has training in diagnostic assessments such as the Sensory Integration and Praxis Test (SIPT) and ADOS. She has completed multiple continuing education courses such as feeding therapy and therapeutic listening in order to provide a more comprehensive assessment and treatment to the children and their families.

Ema is a clinical fieldwork educator and is involved in supervising Occupational Therapy students during their clinical placement as part of their undergraduate studies.

Apart from the clinical therapy Ema is passionate about knowledge. She considers the education of parents and teachers as an important part of her professional role. She has delivered local training to parents and teachers and is now working in collaboration with the psychology team to deliver lectures for foreign educators.

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