Positioning and the environment
It's really important that your child is correctly positioned before they carry out any activities with their hands.
The theory is, if the trunk is supported and stable, the branches (arms and fingers) can perform better. Once their posture is stable, they will be able to focus much better on their fine motor skills rather than on what the rest of their body is doing. Good positioning can be achieved using your own furniture. Sometimes a different chair can help or sometimes more specialised seating is needed, and an Occupational Therapist or Physiotherapist can help with this.
The basic principles of good positioning:
The Chair
It is important that the chair is a suitable size, to provide stability when eating:
- Hips bent at 90 degrees.
- Feet flat on floor and hip width apart. A stool or box could be used to provide support.
- Bottom and back supported.
- Chair tucked in under the table.
- Elbows supported on the table.
The Table
- Ensure that your child is sat close to the table. Make sure that the table is at the right height (e.g. elbows rest comfortably on the table).
- Keep the table space clear from clutter. This will encourage them to concentrate on the task in hand.
Environment
- Try and remove any unnecessary distractions such as television, radio etc...
- Try and keep the table or work space free from clutter to encourage concentration on the task in hand.
- Try and keep noise levels to a minimum.
- Try and keep a calm work zone and allow ample time when working on a new skill.
- Sit your child next to adults who can model the skills being worked on
If your child is sitting on the floor to play, the following sitting positions will help them use their hands, and develop their balance and core stability:
- Crossed Legs
- Long Leg sitting (legs straight out in front of the torso)
- Side Sit (Legs bent and tucked to one side)
- Lying on tummy (propped up on elbows)
- Lying on their back (propped up on elbows)
- Stool Sitting: sit on a small stool
Sometimes when children are sat on the floor playing, they sit in the 'W Position' which is when their legs bend in the shape of a W. In this 'W Position' the child's base of support is wider, and their centre of gravity is lower providing the child with more stability through their hips and knees. If the child is struggling to balance, they may adopt this position to play so that they can use their hands without toppling over. This sitting position however should be DISCOURAGED because it limits the amount of trunk rotation, so that it is difficult to shift weight from side to side. It affects the development of balance reactions, and the ability to cross midline. Hip and leg muscles can also become shortened and tight which may lead to toe walking and lower back pain as the child grows. 'W Sitting' should be gently but firmly discouraged. Encourage a variety of sitting positions, as above.
Giving help
Children and young people need lots of opportunity to participate in, and practise everyday living skills to the best of their abilities. They need to be supported and encouraged from a young age to join in so that they have the best chance of becoming independent people. Some children or young people may be dependent on support but where they can be facilitated to participate in their care or activities, the impact on their wellbeing will be huge.
There are lots of ways you can support your child when they are learning and developing their everyday living skills:
Setting the right challenge
It will be important to know what activities are appropriate for your child's developmental level.
Some children will find activities easy or hard for a variety of reasons and therefore it's important to find the just right challenge so it's not too easy that they get bored, and it's not too hard that they give up. It might be helpful to break an activity down in smaller chunks or simple steps so that you can teach smaller sections at a time and maybe find out where things are going wrong.
Here's an example of breaking down a scissor activity into simple steps:
- Pick up and position scissors in hand
- Grip the paper in non-dominant hand
- Line up the scissors to the mark to be cut
- Open scissor blades
- Make a cut
Prompts
Offering your child some prompts to help them understand better what they need to do within the task can help. There are 3 different types of prompts you can use:
- Visual Prompts: these are photos, symbols, or words to word to aid learning. An example could be a schedule of first, second, third, Now and Next cards. You could make a slide show or photo album of photos to show either the order of tasks needed in a day
- Physical: these are hands-on prompts such as modelling the task, showing and demonstrating the task in person or by video. Manual prompts such as a tap to tell them which hand to use or a point to show them where to look. You can use gestures such as nods or thumbs up for good work or a shake of head for 'Not that way'
- Verbal Prompts: these are the verbal commands or information you give to instruct or direct your child when completing a task, for example 'what do we do first?' or 'What next?' or 'Can you put red over green?'
The Prompt Continuum is:
- verbal
- gestural
- modelling
- manual prompts
When using prompts you may start with lots of prompts and a mixture of all of them, and gradually remove them or delay your timing of giving them.
When helping your child to learn a new tasks
- SHOW your child how to do it, or show them videos of the task
- TELL your child how to do it, talking through exactly what you are doing each step of the way
- DO it together using hand-over-hand. This is where you place your hands over the hands of your child to help guide the right movements of the hands. Hand-over-hand prompting may help a child learn how to hold scissors, make the movements to draw or colour in, brush their hair and use a knife and fork. The goal of the adult is to begin to fade the hand-over-hand prompt, perhaps pairing it with a verbal prompt as the physical prompt is faded. Sometimes the hand-over-hand prompt can be faded to a less invasive prompt, such as a finger tap on the back of child's hand, to remind them of the hand movement needed.
Try out different ways of helping until you find what suits your child. You can use each of these ways individually, or any combination, depending on what suits your child. For a lot of children it can be difficult to watch and listen at the same time. So try each way individually before you try using combinations. Once you find what works for your child stick with this approach.
Adaptive equipment
Sometimes adaptive equipment can help your child perform a task more successfully such as a different type of pencil or scissors. See the section on Equipment.
