From Stuck to Soaring: The Power of Therapy Intensives to Transform Lives

What if a few focused days could create the kind of breakthrough that months of therapy only begin to touch? Therapy intensives are not just more therapy packed into less time—they are immersive, life-changing experiences rooted in science, compassion, and purpose. At Peppler Occupational Therapy, we believe true growth begins when we nurture current capabilities while daring to believe in something greater. Our intensives are designed to build strong neurologic foundations that unlock independence, resilience, and joy—especially for children with neurodiversity or developmental delays. Here, faith meets neuroscience, and creativity sparks transformation, allowing families to shift from surviving to thriving.

What is a Therapy Intensive?

A therapy intensive is a focused and immersive therapeutic experience that typically takes place over several consecutive days or weeks. Unlike traditional weekly therapy, which offers gradual progress, intensives accelerate the process by offering multiple sessions per day, allowing the brain and body to fully engage in a rhythm of learning, practicing, integrating, and resting. This immersive format creates momentum—giving children and their families a concentrated window of time for breakthroughs that may otherwise take months to achieve.

Rather than simply “more of the same,” our intensives are designed with intention and purpose. Each plan is customized to your child’s nervous system, developmental profile, and goals. We blend the latest neuroscience with play-based, compassionate care—creating an environment where joy, safety, and transformation meet. Every activity is aimed at improving core neurological functions like balance, coordination, regulation, motor planning, and sensory processing—all foundational for thriving in school, relationships, and daily life.

Intensive sessions can offer:

• Alternative to traditional therapy:  offering longer sessions over a shorter time frame. At Peppler Occupational Therapy an intensive can be 3-5 hours long, and scheduled over several days for maximum impact.

• Goal-driven and focused: they are designed to provide more in-depth and focused approach to therapy, allowing for a deeper dive into specific reflexes or by using a variety of neuro-foundational tools.

• Concentrated Practice: they allow for concentrated practice of specific skills and quicker progress in achieving developmental milestones. 

• Convenient scheduling: For those with busy schedules, or those who live farther from the Peppler OT office, intensives can be a more convenient option than attending weekly sessions. 

• May be a good starting point: Intensives can be a good way to jumpstart therapy or to address specific issues before starting weekly therapy sessions. 

Who Can Benefit from a Therapy Intensive?

Therapy intensives are ideal for children with neurodevelopmental delays, sensory processing challenges, motor coordination issues, emotional regulation struggles, and those with diagnoses such as Autism, ADHD, Cerebral Palsy, or genetic conditions. They're also a great fit for families who:

• Have hit a plateau in traditional therapy

• Are seeking a jump-start before a school year or life transition

• Travel from out of town and need concentrated services

• Desire quicker, more noticeable results

• Want a whole-child approach that integrates movement, play, connection, and nervous system regulation

Even for children without formal diagnoses, intensives can offer meaningful growth in attention, confidence, motor skills, and daily functioning. Parents often say they witness not only skill gains, but a renewed sense of hope.

What to expect during an intensive:

Each therapy intensive begins with a comprehensive intake process—gathering your child's history, strengths, challenges, and priorities. From there, we craft a tailored plan that aligns with your child’s developmental level and nervous system needs.

• Multiple hours of therapy: Intensives typically involve multiple hours of therapy in a given day, and can be scheduled over one or more days. But don’t worry, we take breaks, fuel up on snacks and drink lots of water along the way. 

• Personalized approach: I work with you to develop a plan that meets your specific needs, we are flexible within that time to move to more restorative work if the intensity becomes too much.

• Potential for lasting change: The focused nature of intensives can create a space for lasting change, especially when you build those hours up over several days!

• Collaboration: It's important that we work closely and communicate clearly before and during the intensive. Your goals, how you see your/ your child’s body responding, and taking time to answer any questions is important to getting the most out of an intensive.

• Realistic Expectations: While intensive therapy can be very effective, it's important to have realistic expectations and understand that progress may vary. 

• Consider your/your child's needs:  Not all individuals will benefit from intensive therapy. It's important to carefully consider the specific needs and goals before pursuing an intensive program. 

A typical day may include:

• Movement-based neurodevelopmental work to organize and strengthen foundational reflexes

• Sensorimotor play to support regulation, coordination, and body awareness

• Fine motor and functional skill building through meaningful, playful tasks

• Parent coaching to empower carryover at home and school

• Quiet integration time to support neural consolidation and emotional safety

And while intensives are hard work, they are also filled with laughter, creativity, and genuine connection. We believe that joy is therapeutic—and that transformation doesn’t have to feel clinical or overwhelming.

More Than Therapy—A Turning Point

At Peppler Occupational Therapy, we approach intensives not as a quick fix, but as a powerful turning point. Grounded in faith, guided by wisdom, and delivered with creativity and nurturing, our goal is to meet your child where they are—and give them the tools and support they need to grow.

Whether you're looking for a reset, a leap forward, or a new approach, therapy intensives offer a unique opportunity to move from frustration to flourishing. You don’t have to keep waiting and wondering. Let’s partner to unlock the next chapter of your child’s journey—together.

Masgutova Method Family Conference

For those looking for an even more in-depth experience of the Masgutova Method – consider one of the Family Education Conferences.  Held throughout the United States (and internationally!) these multi day conferences provide 6 hours of MNRI techniques for your child during each scheduled conference day with a Certified MNRI specialist. Each day is split into six 50-minute sessions; each session focusing on MNRI® techniques related to one of Dr. Masgutova's many-core program courses such as: Reflex Repatterning, NeuroTactile Integration, Neurostructural Integration, Archetype Movements Integration, and Oral-Facial / Visual Auditory Integration and often a specialized session for Proprioception/Cognition, Breathing or Immunology.

These conferences are not just therapeutic—they’re transformational. The immersive format allows for deep nervous system engagement, while families gain hands-on tools, insight, and support that can be carried into daily life. Parents and caregivers are invited to observe, learn, and connect with others walking a similar path—fostering both knowledge and community. Whether your child is new to MNRI or has been working with the method for years, the Family Education Conference offers a unique opportunity to build momentum, deepen healing, and strengthen the vital connections between brain, body, and heart.

Seeing the World Through Other Eyes - Using Our Visual Processing Skills

Message from Misti

When a child is struggling with visual skills, my go to reflex to check is Symmetric Tonic Neck Reflex (STNR). When the head can’t stabilize against gravity, the eyes are not free to move with control.  The Vestibular Ocular Reflex (VOR) is necessary for us to stabilize our eyes even as we move in our chair or through a room. Both these reflexes allow for control. Visual perception and visual motor control have so many different components, this month we will look at visual modulation. Visual modulation plays a large role in how we interact with the world around us; when the brain is over or under sensitive to visual information, our behavior and learning are impacted. Our academic classrooms are set up for visual learning, which makes problems with visual modulation even more difficult. This month I share many accommodations to the environment which help children who struggle with modulating visual input. Even when our head and eyes can stabilize and our perception is working properly, our eyes need to move smoothly across a sheet of paper or within the environment. Visual Motor skills such as tracking, saccades, gaze stabilization and convergence/divergence  can be practiced to improve social participation and reading, so there are several activities I use that help develop these important skill.

I hope you find this information helpful in understanding the relationships between these three topics. As always, please share this blog with someone who may have concerns in this area.

Reflex Highlight: Symmetric Tonic Neck Reflex (STNR)

Protective Purpose: This reflex works alongside the Tonic Labyrinthine Reflex to control the head against gravity and prepare the infant for crawling. Body responds within three distinct positions: lying on belly prone, sitting, and later resting on all fours. Moving through all 3 positions shifts the infants gravity center for later controlled movement such as crawling.

Sensory Stimulus: Visual or auditory information causes movement of the head up or down

Motor response:

Position 1 – On belly/arms with rear end in the air: downward movement of the head causes flexion of the elbows and extension of the lower limbs. Upward movement causes arms to straighten, legs to flex.

Position 2 – Sphinx position, sitting on heals with hands resting on floor in front of knees: upward head movement causes extension of the arms and flexion of the lower limbs. Downward movement of head causes arms to flex, legs to straighten.

Position 3 – On hands and knees: upward movement of the head causes extension of the arms; lower limbs bend to keep the body in position. Downward movement of head causes arching of spine, flexion of arms and extension of legs.

Effects of Proper Integration

·      Helps to integrate the TLR

·      Coordination of the head with hand/arm and core trunk muscles

·      Helps develop postural control necessary for later fine motor development

·      Helps develop binocular vision and visual field stability

·      Assists in developing easy focus and memory

·      Allows for curiosity, moving to learn and explore

Effects of Non-Integration

·      Poor differentiation of head from arm and leg movements

·      Immature TLR and ATNR patterns

·      Often uses “w” sitting pattern

·      Fatigue when sitting, prefers to stand or will lock legs around chair legs

·      Extreme difficulty maintaining a hands and knees position, arms collapse down, or legs move back to a push up position.

·      Hypo/hypertonic neck muscles leading to decreased head control

·      Impulsivity, hyperactivity, symptoms of ADD/ADHD

·      Poor balance and equilibrium

·      Poor binocular vision and decreased depth perception

·      Poor spatial and temporal awareness

·      Academic challenges with reading, writing, art, music, copying from a board

Vestibular Ocular Reflex (VOR)

Purpose: maintaining a stable visual field during head movements. It works by producing eye movements in the opposite direction of head movement, keeping the visual image fixed on the retina and allowing for clear vision even when the body is in motion. Without VOR, even slight head movements could cause blurry or shifting vision, making it difficult to focus on objects and navigate the environment. This is actually a reflex of the vestibular system; however we discuss it here this month as it contributes a large role in gaze stabilization.

Sensory stimulus: Head movement in any direction.

Effects of a functioning VOR:

·      Maintains focus

·      Keeps visual image clear

·      Essential for balance

Effects of malfunctioning VOR:

·      Oscillopsia, blurry images when moving

·      Abnormal nystagmus

·      Motion sickness

·      Clumsy

·      Difficult maintaining balance

Sensory Connection:

Visual Regulation Difficulties and Adaptations

When a child’s head can’t stabilize, their eyes are often not in optimal position to develop necessary visual skills for receiving important information from the environment. Our eyes play such an important role in determining what we pay attention to and how we move through our world.

Children who are under-responsive or hyposensitive strive to see the differences in visual information; in turn they may seek extra or additional information to help them make sense of what they are seeing. These children might

·      enjoy bright, reflective, spinning objects or light patterns

·      they might not see objects within challenging backgrounds

·      have a hard time understanding the differences in colors, shapes, and sizes.

 For these children, we want to reduce visual clutter both in the environment and on worksheets. This can be done in a room by

·      covering open shelving with a curtain

·      covering bulletin boards or anchor charts with plain paper when that subject is not being taught

·      covering half of a worksheet to reveal a smaller amount of work.

 Hyposensitive children also struggle with processing the information in front of them, so it helps to create a visual structure such as creating a highlighted box around important information or creating a border around different pieces of information on a whiteboard. It also helps to keep important object or information in the same place, so it is easily located when needed ie: having a specific place to keep shoes and backpack by the door or writing homework assignments in the same place on the whiteboard. Color coding information or materials is another strategy to help these children organize information and objects.

A classroom which has too much visual information, making it difficult to focus on important information.

Even though this bedroom is very organized, it has too many different patterns and extraneous objects on the shelves making it difficult to find and focus on any specific object.

Children who are over-responsive or hypersensitive are most commonly overly sensitive to light, however they can also be sensitive to motion, patterns, shadows, or colors. This intense hypersensitivity can lead to headaches and nausea. It is also very hard for these children to screen out unimportant information – they are noticing everything in the room all the time. From the small string on the floor to the paper waving next to the window they are noting it. This makes it difficult for them to focus on the important information at hand. These student need:

·      reduced visual clutter

·      Keeping toys and items organized on shelves,

·      providing covers for shelves when items are not in use

·      keeping knickknacks or artwork to a minimum.

Children who are sensitive to light may need sunglasses when they are outside or even inside if their desk or chair or in a sunny spot. Sometimes, they benefit from wearing a hat with a brim to block out visual information and light from above. Try to provide soft, natural light or a floor lamp for their play and workspaces, with the ability to dim the light.

After intense periods of processing visual information, these children may need a break and seek out a very dark corner or sit with eyes closed to help them regulate and be ready for more interaction and learning.

An example of using borders and color coding to direct attention to important information

A classroom with items organized by size and color with open space on walls and bulletin boards making it easier to find important information.

Although avoiding eye contact is associated with being on the Autism Spectrum, there are other reasons why individuals may not meet eye contact from others. While those on the spectrum may find it difficult to take in the social, behavioral, or emotional responses they are seeing, those who are visually hypersensitive may be distracted by specific features or movements of another face. Additionally, someone is who is hypersensitive to visual information may find it very difficult to engage both the auditory channels and visual channels at the same time. During conversation they might look away to better understand what they hear. When a child is avoiding eye contact it does not necessarily mean they are not paying attention, and demanding eye contact may lead to sensory overload where they actually can’t attend to take in information.

One note about vision and safety: when we are not attending to the important information in the room either because we don’t notice it or we are too busy noticing everything else, moving through the space and between objects can be challenging. Remember, busy patterns on walls, furniture or rugs can make it difficult for individuals to know where objects begin and end. Using simple, contrasting colors to decorate walls and furniture helps children better organize information about where items in the environment exist. You can use colored tape to highlight around door frames or potential trouble spots to increase safety awareness for those who have trouble distinguishing spatial relationships between objects or themselves.

Skill Development: Visual Motor Skills

The ability to control our eye movements is important for body awareness, postural control, coordination, and reading. To interact within our environment, we need to be able to follow people and objects moving through space or stabilize our eyes as we move through space. Although a child may have 20/20 vision, they may still have significant difficulty “seeing” letters and words on a page because controlling the movement of their eyes is impaired.

·      Visual tracking is an important visual skill necessary for reading. Visual tracking is the ability to focus one's eyes and follow a moving object without moving the entire head.

·      Gaze Stability  - the ability to keep your eyes focused on a stationary point while your head is moving, which relies on the Vestibular Ocular Reflex.

·      Visual convergence is the coordinated movement of both eyes inward when focusing on nearby objects. It's a vital visual skill that allows us to see single, clear images at near distances, essential for tasks like reading, writing, and using devices. When the eyes fail to converge properly, it can lead to double vision or other visual problems. 

·      Visual divergence refers to the ability of the eyes to move outward, away from each other, when focusing on a distant object.  Proper divergence is essential for tasks like reading distant signs, watching movies, or focusing on objects far away. 

·      Visual saccades, also known as saccadic eye movements, are rapid, jerky eye movements that shift the focus of vision from one point to another. They are essential for tasks involving visual attention, such as reading, driving, or scanning a scene. Saccades are not smooth, but rather involve quick jumps in gaze, allowing us to quickly shift our focus to different points of interest. 

Difficulties with visual motor skills in the environment leads to poor ability to catch a ball or bumping into people and objects when moving through a room. When children have difficulty with visual motor skills, reading difficulties could look like losing their place easily, skipping words or lines, or confusing one word with another. This leads to poor reading comprehension. Short periods of reading can cause fatigue or headaches. Fortunately, there are fun games and activities you can play to improve visual motor abilities.

In three-dimensional space:

·      Games with balls – use large, lightweight balls like beach balls or balloons that move slower through the air. This allows more time for a child’s eyes to fixate on the object and follow it. Use brightly colored balls to help distinguish it as it moves. Use a badminton racket or pool noodle to keep it up in the air.

·      Practice throwing a ball at a target, emphasize using the eyes to look at the spot they are throwing to.

·      Flashlight games – in a darkened room with two flashlights, play flashlight tag having the child follow your light trying to catch you. Start with slow movement across the walls and ceiling and increase the speed as the child is better able to follow and catch your light.

·      Playing tag- the child needs to visually track people around them while moving.

·      While walking or riding in a car, point out objects that they can then describe or tell you one or two characteristics- they will need to stabilize their gaze on the object while moving to take in the details.

·      Marble runs are great for tracking moving objects because the marble will move in a predictable path.

·      Wind-up cars, slot cars or remote-control cars – following the car builds visual attention while working on eye tracking.

·      Play with bubbles, blow a few bubbles, and have the child track the bubbles to pinch/pop them.

·      Mazes! With and without a pencil. I often have children use their finger first so they can visually plan when they are using the pencil. There are also many kinds of books that are made for using your finger so you can do them over and over

·      Dot to dot drawings require the eyes to locate (fixate) on a target then stabilize on the target while drawing with the pencil.

·      Scanning for letters in a paragraph: have the child circle all of a certain letter in a paragraph. There are also many free resources out there to print out your own worksheets. I love this resource at senteacher.org where you can change the letter, color, typeface, control size and spacing between lines, use all upper case or all lower cased, or mix it up and use both. As a bonus, you can set the target to be a grouping of letters like ing, st, or th.

·      Another fun way to work on tracking on paper is to have the child track through lines of print and first mark the a, then the next b that comes along, then the next c, and so on. This incorporates more cognitive thinking while visually scanning.

·      There are a few fantastic apps for the iPad or tablet that work specifically on visual tracking. For younger kids that don’t have letter recognition skills yet, there is Bugs and Buttons,. For older students that have letter recognition down there is Visual Attention which assists the player in starting on the left side each time and has an option to not let the player skip letters.

·      Matrix Games 3 is an app for school age kids and older that has the eyes tracking up/down while also tracking left/right on a grid to match the correct shapes.

While all these activities help build better visual motor skills, if you notice a child is struggling with any of these games, it’s time to get an occupational therapy evaluation.  For the eyes to work together and track objects the head needs to be stable, hence making sure the STNR and ATNR reflexes are fully integrated is a first step.  Then assessing the individual visual motor skills and perceptual abilities would be next. 

If you know a child who seems clumsy, is struggling to learn or is easily overwhelmed,

contact Misti to set up an evaluation.

Holding On - Grasp and Hand Skills for Handwriting

Message from Misti

We’re almost to summer - the pressures of school let up and the long days can feel endless. As we transition to this next season, I felt the need to address one of the most common issues pediatric occupational therapists are asked to address: hand function and pencil grasp. While handwriting skills are more often brought up as the concern, pencil grasp is one of the key indicators that tip off parents and teachers that something isn’t working correctly. While many reflexes affect fine motor skill development, the Robinson Hand Grasp Reflex is what brings power and maturation for dexterity to the hand. For the hand to mature and develop we need a functioning Tactile Sensory System to feel and discriminate where our hands come into contact with various surfaces. Even when our Hand Grasp Reflex and our Tactile System are maturing and intact, our hands need many different experiences to develop the skills necessary for controlled movement of a pencil. While books can/have been written on each of these topics, hopefully this blog post pulls together information that allows you to walk away understanding of the interplay of the three, and you can form activities for the children in your life that help with hand development. 

Reflex Highlight: Robinson Hand Grasp

This reflex consists of securely gripping and holding an object with fingers flexed and thumb laying on top of the fingers. This grasp allows the hand to hold small to large objects. Once established, it leads to greater refinement of fine motor skills, controlled release of objects, and coordination. It allows the child to explore at midline and is instrumental in hand eye coordination. It also holds the protective meaning of “holding on for dear life” as many individuals hold their hands in this gripped fashion when emotionally distraught or feeling unable to “get a grip” on the current situation.

When not integrated a child will use too much pressure while holding a writing or eating utensil leading to finger and hand fatigue. They may use an immature or inefficient pencil grasp which makes controlling the pencil more difficult. This can lead to an avoidance of handwriting and other tasks which require fine motor engagement. Additionally, fine motor development in the hand corresponds significantly with the fine development of muscles in the face and mouth needed for speech and communication. Being sure this reflex is integrated is important for fine motor development, emotional resilience, and communication. If you are unsure, seek out assessment with a therapist who can address this reflex.

Sensory Connection: Tactile Sensitivity and Discrimination

Our tactile system is not just regulated to or hands, it covers our whole body to provide us with important information regarding our environment! There are 12 different types of tactile receptors located in varying depths of our skin and tissue. They transmit information such as hot, cold, smooth, rough, itchy, prickly, pain, pressure (light or deep), vibration, texture, and shape. They are categorized into 4 types: thermoreceptors, pain or nociceptors, proprioceptors, and mechanoreceptors. Some areas of our bodies have a lot of receptors per square inch of skin like our hands and around our mouth, while other areas have less which are more spread out like out back and trunk of our body. The more receptors in a small area the greater we can discriminate exactly what we are touching.  

Sometimes a tactile system can be over responsive, with the receptors needing much less stimulation to be activated. This overstimulation of the nervous system can elicit feelings of pain or an uncomfortableness that can lead to nausea when severe. Touch processing is overwhelming for these individuals and leads to avoidance of activities and interaction. When required to engage with greater amounts of tactile information such as walking in a crowded hallway and bumping into people or completing an art project, the individual may have an over-reaction or a fight or flight response.

Other nervous systems are hypo-sensitive to tactile inputs, they need greater amounts of tactile input for the brain to recognize it. These individuals may not notice when they bump into something, may use too much pressure to hold items, or seek out extra pressure and touch everything all the time. Being under-responsive can lead to difficulty discriminating information, they may not feel when their clothes are twisted on their body, when their hands or face are dirty or if their nose is running.

As noted before, the hand has an enormous amount of tactile receptors in the skin. This helps us to manipulate objects of different sizes, textures, and weights with our hands. The information we gain from feeling the object allows the brain to plan how much pressure to use, which muscles should flex, and which should relax, and how the shape of the hand should form in relation to the object. This is so important as we learn to use tools such as crayons, pencils, spoons, forks, knives, scissors, snaps, buttons, zippers, and toothbrushes! The tactile system is key for development of hand and fine motor skills.

Skill Development: Pencil Grasp and Hand Skills Necessary for Handwriting

Even when the Hands Grasp Reflex is integrated and the tactile system is working properly, there are still hand skills that need to develop for children to hold a pencil and learn to write. The refined movements of the fingers, hand and wrist allow the precision needed for pencil control.

Starting with the gross Palmer grasp, a child typically develops through various stages to a tripod grip on a pencil. The more refined pencil grasps can be described as static or dynamic. The difference between them being the fingers in a static grasp stay still and the movement comes from the shoulder, forearm, or wrist. A dynamic grasp occurs when the fingers control the movement of the pencil and the shoulder, forearm and wrist are stabilized. While the tripod grasp pattern is important, research suggests there are other grasp patterns which are just as effective and efficient. Children should have an effective grasp pattern by the end of kindergarten. If a child entering 1st grade is still using a palmer, digital pronated, or digital grasp; evaluation and direct intervention should be considered.

Pencil grasp matures as the hand moves through specific skill development. These hand skills allow a grasp to be dynamic and the fingers to control the movement. Without these skills the hand will not be able to have the precision necessary for handwriting. If a child is struggling to hold and use a writing utensil, it is helpful to notice if they can do the following skills.

• In hand manipulation: the ability to manipulate objects in the hand without support from the body or other hand. This skill may be of even greater importance than having a tripod grasp. It allows the pencil to be moved and positioned within the hand to adjust it for control. In hand manipulation consists of 3 types of movement: translation, shift and rotation.

• Translation: using your fingers to move an item from your palm to your fingertips or fingertips to palm, like when you move coins from your palm to your fingertip to place in a vending machine.

• Shift: using the pads of your fingers to move an object, like when moving a button through the hole or adjusting the pencil in your hand.

• Rotation: rolling an object with the fingertips, like when turning a pencil over to use the eraser.

• Separation of two sides of the hand: the ability to use the thumb, pointer and middle finger or the precision side of the hand independent from the ring and little finger or the power side of your hand. This is important for automatically tucking the ring and little finger into the palm while holding the pencil.

• Endurance: using strength to hold the tool over time while maintaining an efficient grip. This includes being able to maintain fingers in flexed positions without collapsing or hyper extending joints. Without intrinsic hand strength an individual may experience fatigue or soreness over time while writing.

• Wrist extension: while this is not technically a hand skill, wrist extension allows the hand to be placed optimally so all above hand skills can perform with ease. A lack of wrist extension indicates decreased strength in the upper extremity which needs to be addressed.

Activities To Develop Hand Skills and Grasp

Now that you understand the foundational skills for a functional pencil grasp, here are ways to promote stronger muscle strength and motor patterns that underly pencil grasp and handwriting without using a pencil.

• Tongs, tweezers and clothespins: using all and any of these pinching tools helps strengthen the pattern of thumb opposition to fingers and the muscles of the thumb. Scale the activities by using different sizes of tools to match different sizes of objects to pick up and place with the tool. You can pick up and place blocks, use a tweezers with water beads, or a clothespin with colored pom poms.  

• Rolling and pinching playdough, clay or putty: These mediums are a fantastic for strengthening muscles and developing precision. While using tools with playdough is fun, interacting with playdough just by itself provides the hand with all the experiences needed to help develop a grasp.

• Beading on strings or pipe cleaners: holding a string or pipe cleaner still with a thumb and forefinger while manipulating a small object on such as a bead, noodle, or Cheerio is great for practicing a pincer grip.

• Lacing cards: like beading, lacing involves taking a string, ribbon or pipe cleaner through small holes on a form. Lacing activities can be scaled from easy shape boards available for preschool kiddos to sewing with a plastic needle on plastic canvas to create designs, or using craft foam and plastic lace to sew pieces together.

• Sensory bins: filling a large bowl or bin with beans, rice, noodles, or other medium and then hiding objects in it offers lots of opportunities for hands to practice tactile discrimination. Although sensory bins are often associated with preschool ages children, many early elementary children still benefit from this important tactile medium when developing hand skills. For the elementary child hide cards with words to form sentences, letters for spelling words, or numbers to solve math fact cards.

• Spray and Squirt Bottles: This gets a little messy and is best done in the context of cleaning up, or outside on a warm day. A favorite activity is to hang a balloon, spray a smile face on with shaving cream, then use a spray bottle of water to make the shaving cream melt off the face (best down out of doors where messes can be washed away)

• Work on vertical surfaces: the use of an easel or taping your coloring page to a window or wall is a great way to encourage wrist, elbow, and shoulder stability. Use dry erase markers or window makers on windows to draw. Another great idea is to attach a flat Lego base to the wall and use Legos to make different marble runs. Arranging magnets on a refrigerator or drawing with chalk on a chalkboard offer a way to practice wrist extension while stabilizing the shoulder.

• The Differentiatedkingergarten.com has a wonderful printable kit to make take home fine motor kits for practice. She also has several blogs with pintables and ideas for creating Morning workstations and bins that allow for fine motor practice. Although these activities are geared toward kindergarten, many 1st and 2nd graders have not had enough practice with these activities in their earlier years due to the pandemic and it is highly recommended that teachers and parents look at the ideas and try to incorporate them into the day if possible.

 There are also many ways to work on improving pencil grasp and control without the pressure of handwriting as well.

• Use broken or tiny crayons and little pencils: break crayons into small 1 inch size pieces, the small space forces just the thumb and index finger onto the crayon without the other fingers.

• Rainbow circles: use colored pencils to fill in small circles on a page, staying inside the circles using small rotational movements.

• Pencil control pages: there are many different pages to practice tracing small shapes, spirals and slim path following.

• Mazes, dot to dots, and color by numbers: engaging control with games is a great way to practice grasp and control.

• Magnadoodle: drawing on a magnadoodle is a fun way to practice pencil grasp without holding a pencil.

• Ms. Olga of OT Closet has many videos to practice hands skills with pencils, coins and other simple materials. These are great 4-5 minute videos that an entire class can follow along with as warm up to handwriting practice.  

Sleep: The Foundation of Health and Well-Being

Message from Misti
Sleep plays a crucial role in our overall health, but many of us struggle to get enough of it. Whether you’re a child, teen, or adult, sleep deprivation can have serious consequences. Let’s explore the importance of sleep, how much we really need, and ways to improve our sleep habits.

Lack of sleep affects us all, but the consequences can be particularly harmful for children and teens. Signs of insufficient sleep include:

·       Irritability and mood swings

·       Learning and memory problems

·       Increased susceptibility to illness

For adults, chronic sleep deprivation is linked to serious health conditions such as high blood pressure, diabetes, and depression. Let’s explore what we need for a good night’s sleep and tools to help improve our sleep including the new Rest and Restore Listening Protocol.

REFLEX HIGHLIGHT: Abdominal Sleep Posture Reflex
The Abdominal Sleep Posture Reflex is a natural position where the body lies on the stomach, with the face turned toward a bent arm and that leg on the same side flexes up, while the opposite leg remain straight, and the opposite arm may extend up or down. Soft massage and muscle stretching is then provided to 5 specific neuro-tactile locations on the body. The position itself is calming to the nervous system as it turns off the auditory channels, allowing the brain to calm and move out of a state of vigilance.  It brings about slower theta brain waves which are most common during the first phase of sleep.

Even if you are not one to sleep on your stomach and there is no one there to provide massage on the neuro-tactile points, placing yourself in this position can help you calm and get to sleep.  You might realize this posture is the reverse of the Asymmetric Tonic Neck Reflex. Interestingly, engaging in ATNR repatterning exercises brings about the faster alpha brain waves which is the opposite effect we want before bed; thus, we do not recommend ATNR activities right before bed. 

SENSORY CONNECTIONS: The Science of Sleep and the Nervous System
Our bodies follow natural sleep cycles controlled by circadian rhythms and the Vagus nerve system. The Vagus nerve helps regulate relaxation and recovery during sleep, while exposure to bright light during the day supports a healthy circadian rhythm.

The Autonomic Nervous System and the Vagus Nerve
The autonomic nervous system (ANS) plays a crucial role in sleep regulation, balancing between the sympathetic (fight or flight) and parasympathetic (rest and digest) systems. The Vagus nerve, a key part of the parasympathetic system, promotes relaxation, slows the heart rate, and enhances digestion—creating the ideal state for deep, restorative sleep. Activating the Vagus nerve through deep breathing, meditation, and relaxation techniques can help improve sleep quality and overall well-being.

Circadian Rhythms, Sunlight, and Melatonin
Circadian rhythms are the body’s internal clock, regulating sleep and wake cycles. Light exposure plays a crucial role in maintaining these rhythms. Getting natural sunlight in the morning helps signal the brain to be awake and alert, while dim lighting in the evening supports melatonin production, the hormone responsible for sleep. Blue light from screens suppresses melatonin, making it harder to fall asleep. To optimize sleep, aim for at least 30 minutes of sunlight exposure in the morning and reduce screen time before bed.

How Much Sleep Do We Need?
While individual needs vary, here are the general sleep recommendations from the CDC:

Sleep Challenges in Childhood Neurologic Disorders
Children with neurological conditions such as autism and ADHD often experience unique sleep challenges. Common issues include:

• Difficulty falling asleep: Hyperactivity, sensory sensitivities, and anxiety can make it hard to settle at bedtime.

• Frequent night waking’s: Children with autism and ADHD may experience more nighttime awakenings due to difficulties with self-soothing or increased sensitivity to environmental stimuli.

• Irregular sleep patterns: Disruptions in melatonin production can lead to difficulty maintaining a regular sleep schedule.

• Daytime fatigue and behavioral issues: Poor sleep can exacerbate attention problems, emotional regulation difficulties, and impulsivity.

To support better sleep in children with autism and ADHD, consider structured bedtime routines, calming sensory tools like weighted blankets, and behavioral sleep interventions.

For more details on children’s sleep habits, visit: Raising Children’s Sleep Guide.

Teen Sleep Challenges
Teenagers experience a shift in their circadian rhythms, leading them to fall asleep later (often after 11 PM) and wake later. Unfortunately, over 90% of teens don’t get enough sleep on school nights, which impacts concentration, learning, and mental health. This sleep deprivation is associated with higher rates of depression and anxiety in adolescents.

Sleep and Adulthood
As adults, our sleep is often disrupted by caffeine, alcohol, stress, and anxiety. Poor sleep hygiene further exacerbates these issues, creating a cycle of fatigue, poor mood, and decreased overall health.

Breaking Down Sleep Cycles
Each night, we cycle through different sleep stages, including:

• Light Sleep (50-60% of total sleep time): This stage helps transition into deeper stages and is most common in the first half of the night.

• Deep Sleep (15-25% of total sleep time): Crucial for physical restoration, deep sleep is most abundant in the first half of the night and decreases as the night progresses.

• REM Sleep (20-25% of total sleep time): This stage, where dreaming and cognitive processing occur, increases in duration as the night progresses, with the longest REM periods happening toward morning.

  To feel truly rested, we need to balance time in each stage and ensure we complete multiple sleep cycles throughout the night.

SKILL DEVELOPMENT: Healthy Sleep Habits
Good sleep hygiene is essential for quality rest. Here’s how you can improve your sleep:

• Create a bedtime routine to signal your body it’s time to wind down.

• Take a warm bath to promote relaxation. The effects of warming the body begin to wear off after about 20 minutes, so be sure to get into bed shortly after the bath.

• Limit screen time before bed to avoid blue light exposure; recommended to limit exposure for 2 hours before bed.

• Try weighted blankets or Lycra sheets for a calming effect on the proprioceptive sensory system.

• Ensure adequate sunlight exposure during the day to support circadian rhythms.

• Dim the lights in the evening to support melatonin production and prepare your body for sleep.

• Engage in Vagus nerve-stimulating activities such as deep breathing, humming, or gentle yoga to promote relaxation before bed. See below about the new Rest and Restore music program to promote deep calm through Vagus nerve stimulation.

• Exercise regularly but avoid intense workouts close to bedtime.

• Avoid caffeine and heavy meals in the evening, as they can interfere with your ability to fall asleep.

• Maintain a consistent sleep schedule, even on weekends, to regulate your internal clock.

• Keep your sleep environment comfortable, ensuring your bedroom is cool, quiet, and dark.

  By making small adjustments to our daily habits, we can improve sleep quality, enhance overall well-being, and set the stage for better health at any age.

New! Rest and Restore Music Program to Calm the Vagus Nerve

Listening to music modified for optimal rest and recovery of the nervous system can improve sleep qualitiy

Vagus nerve researcher Stephan Porges has paired with Anthony Gorry, a music and audio innovator to create a new listening program called Rest and Restore. This is a new tool to gently move into biobehavioral states of calmness and relaxation. Early research shows RRP may improve sleep, digestion, anxiety, trauma-recovery, and more.  Misti is now a certified provider for this tool as well as reflex repatterning, if you are interested in using these tools to improve your ability to calm, contact Misti now.

Sweet dreams!

E-learning In the Time of Sheltering In Place

Stress levels are high all around, and supporting your child during this time of e-learning can be difficult, especially when they have learning difficulties and attention problems.  Here are some tips taken from an ADDitude Webinar entitled Coronavirus Crash Course for Students with ADHD given by Ann Dolin of Educational Connections Tutoring, Test Prep and Executive Function Coaching and author of Getting Past Procrastination: How to Get Your Kids Organized, Focused, and Motivated . . . Without Being the Bad Guy and several other books about working on executive functioning. 

 Create a Routine (And Put It In Writing) 

Kids crave routines, especially our kids with ADHD. If they don’t know what to expect, life feels loosey goosey. A routine allows life to go on autopilot. Remember to include the important daily routines: Wake-up, get dressed, mealtimes, and bedtime. 

Some children may not respond to a strict schedule made in 20-30 minute increments of a specific subject or task. They may need more flexible timing such as work periods where they choose what to work on in the allotted time frame or station.  Allow for that sense of choice, and use a timer to set the work periods. 

When: Decide when your learning periods will be

Human energy and motivation has peaks and valleys through the day. Doing the harder tasks should be done in the morning. Around lunchtime is when we have our optimal energy.  That’s why it’s important to do the harder tasks in the morning. In the afternoon we all experience a great dip in our energy level, which will come back up around 3:00, but not rise to our earlier optimal levels.  

Pomodoro Style, a researcher from Italy found that when people have a specific amount a time they are more likely to get their work done. He also researched the optimal amount of time and found 25 minutes is best. After the breakfast routine is done, have a set start time and a large chunk of study time that is broken into smaller increments.

Where: Designate places for Learning 

For younger children set up different stations for them to move through. Consider a library/reading station; a math station; a puzzle or lego station; a science station; and art area, a section of the table for writing. It’s not your job to keep them occupied at the station, it is their job to stay busy in the station. 

Older students should have 2-3 spaces they can move between to complete work - but NOT their bedroom.  Keep their learning places in the public areas of your home. 

What: Organize what they will do each day

If your school is providing work to do, go through the assignments each day and make a list with your student (a whiteboard is great, but you can also just use a piece of paper). Divide it into 2 columns.  List the things that need to be done this week on the right side. Next, list the things that need to be done today on the left side. Last, have your student break down the longer assignments into smaller tasks and have them list a small amount on the daily side. Be sure to cross off the assignments as they are finished, crossing things off a list gives a feeling of accomplishment.  

If your school hasn’t provided work, here are some good websites that allow kids to engage in learning.  It’s important to say “This is a priority, we are still going to engage in learning during this time. You can choose some areas of interest to study.”  

You can find a lot of free resources to boost up your stations:

Scholastic learn at home

IXL.com - has very specific learning

Brainpop.com or Brainpopjr.com- it has a built in quiz that lets them know what they know and what they don’t know, and provides them some feedback.

Ask kids to figure out what they might like to do, have them select things they would like to practice or be more engaged in learning. 

 Breaks: We all need them, how to organize them

Optimal concentration time for an adult is 25 minutes, a little shorter for younger learners.  Set learning sessions or stations up in set time frames. The same researcher who found that 25 minutes is the optimal work zone, also researched break times. He found a 5 minute break between sessions to be optimal, it is easier to get back to work after a short break. However, after several of these 25 minute work sessions, 5 minute breaks you will need a longer break. Older students should be able to do 2-3 sessions before taking a longer 20-30 minute break. Younger students may need a longer break after 2 sessions. It is important to have them figure out what the break is before the break - what will they do, make sure they know the time frame. 

Other important points: 

How do I convey to resistant learners this is not spring break/winter break, especially teens? 

Ask questions to help them have more agency in the process.  

What is something small you can do to keep up with your learning and work?  

How much time can you commit to?

What can you get done in the next __minutes? 

Asking a question helps them to be more open to ideas if they are part of it. 

When you are working at home - Don’t expect the kids to be like you 

Get them going, set very specific expectations, then walk away.  Set aside times to check in and let them know when that will be so they can expect help at that time. 

Ask your child: If you’re super stuck and you don’t know what to do, what is an option?

Ways to help kids learn time management and learn to regulate their own behavior. 

These extensions/apps help show the passing of time and do not allow them to move into other apps.  These will block the websites they really want to resist for that period of time, it’s a visual reminder ‘I’m in study mode.’  Have them list the things which really distract them, they usually can identify the things that distract them the most (youtube is a big one). 

Stay focused, chrome extension for older students 

Self control, for mac 

Forest - for iPhone 

Rewards are fine. But if you offer screen time, you can’t offer it any other time of day.  Then it’s not as valuable. If your work is completed by x time, then you can play fortnight for x amount of time.  

You can have activity rewards - if you get your work done, we can bake tonight, or we can have a dance party.

What should we do on weekends

Free time (within reason, not 12 hours of video games) especially if you have a resistant child, no school work

What about kids that are refusing to get outside?

Go outside with them, make it non-negotiable.  Set a time and take a 20 minute walk. Everyone needs to get outside and get some movement. Let them know you understand why they don’t want to, but that afterwards they can do a self-chosen activity.

Suggestions for when you have kids at different age levels:

Set up stations for the younger child that are more hands on, things they really like to do. It will help them sustain their attention far longer. Still set up expectations of work, for 30 minutes it will be quiet time for everyone. The younger child can move through school work and the desired stations giving the older child longer work sessions.  

We can’t beat ourselves up as parents.  

You have to try it for about 3 days to find out if it really doesn’t work, or your child is just really pushing back.  After 3 days you can re-adjust, does it need more structure or need to be more fluid?

I highly recommend watching the webinar, it’s about an hour long. Link to the webinar Coronavirus Crash Course for parents with student who have ADHD

Archetype Movements - The Basic Building Blocks

I’ve been working with these foundational movements for a couple of years now.  While reflexes are about automatically responding to information in our environment, Archetype Movements are the biomechanical patterns that allow our bodies to move and respond. These 7 key movement patterns are found in all of our sensorimotor reflex responses, our automatic motor responses and our consciously controlled motor skills. They develop sequentially in utero; we are born with the innate ability to move through them.  By using these patterns over an over, we build strong pathways in the brain that allow us to move with more complex movement patterns leading to skilled, conscious movement and choices. 

So these patterns are important!  If we haven’t built that strong brain pathway, we start to rely on less efficient motor schemes, we work harder and fatigue easier when we move.  These patterns are so important, practicing them daily leads to brain growth that positively impacts learning and regulating our stress responses.  The Masgutova Method recognizes 7 Archetype movement patterns and an 8th one that links all of the patterns together for purposeful movement. 

1. Core-Limb Flexion Extension or 6 Ended Star: This pattern is about connecting our body center (gravity point) to our head, arms and legs.  It allows us to be grounded and sets up the midline of our body. Emotionally it allows our Core Tendon Guard Reflex and Moro Reflex to function appropriately. Finding equilibrium between flexion and extension allows for postural control of the trunk to develop. 

2.  Horizontal Spine Rotation: Often associated with mouth-spine-rotation as the infant’s head turns toward a food source.  As the infant matures other stimuli such as sights and sounds draw their attention and they learn to control the head and rotate toward information. This is foundational for rolling over. The eyes start to track, which is needed later for reading.  Rotational movement is also known to improve memory. 

3.  Trunk Extension: Our genetic code demands that we go upright against gravity, trunk extension is about moving the head upright while stretching the feet downward.  Toe walkers are often not able to do this; they are searching for upright without being grounded downward.  Trunk extension allows us to organize around our midline, that invisible thread the runs through the middle of our body from our head to our feet.  This movement relaxes the tension of the protective reactions of the cerebellum allowing for clarity when thinking.  This pattern is the basis of reaching, taking and pushing and is good for awakening before test taking or new learning. 

4.  Lateral Flexion-Extension:  In this pattern one side of our body is flexing to the side simultaneously while the other side is extending.  It is the basis for locomotion or being able to stabilize one side of the body while the other is moving.  It is needed for tuning over and plays a large role in our ability to move and respond to 12 different reflexes. 

5.  Homologous (Bilateral) Movement: Here we move both of our arms or both of our legs at the same time.  The symmetrical movement is necessary for taking, pulling pushing, raising, etc.  The purpose here is to form motor coordination between the right and left limbs such as clapping. By bringing either hands or feet together we gain an inner sense of our bodies midline. 

6.  Homolateral (Same Side) Movement:  This involves the right arm/leg or left arm/leg moving in coordination with each other. The brain begins to access one hemisphere at a time, and dominance of one side starts to emerge. We are free to shift our weight from one side to the other across midline.  Differentiated, specialized movements of the limbs develop. The affect of this pattern on learning leads to improved memory, improved motor planning and control, eye-hand coordination, and improved expressive language. 

7.  Cross-lateral Movement:  This is about coordinating movement across body midline and from top to bottom (right arm/left leg or left arm/right leg).  It is necessary for crawling, standing up, walking, running, and jumping.  All skilled sports use cross lateral movements. It relies on all the other movement patterns to be fully developed.  The brain begins to coordinate thinking between the detail oriented, analytic left side and the big picture, gestalt right side. 

8. Intentional Movement:  This last pattern coordinates all the other patterns together for purposeful, goal-oriented movements like reaching for an object.  Intentional movements such as skipping, galloping or hopscotch develops.  Movements transition into automatic skills. Precision and controlled movements for manual skills such as writing develop. Cognitively we can set goals, improve our timing and processing speed, as well as improved focus and selective perception. 

When these patterns are not working properly, we can re-train the brain and body to bring automaticity, allowing freedom for the body to respond appropriately when reflexes are stimulated. The Masgutova Method has developed simple, repetitive movement exercises that allow the brain to form the strong pathways needed for automaticity and freedom.  

One study demonstrated how incorporating these movements into a classroom daily helped to improve reading scores in kindergartners. A friend of mine was trying to complete such a study with a school district using a control group of students who didn’t get the movement intervention. With the introduction of Archetype movements reading scores in the test group improved rapidly. After four months the district suspended the study because they couldn’t justify not providing this movement based intervention to the control group.

These movements are powerful for allowing the brain to organize, which in turn allows for greater learning.  Let me know if you want to learn more about them. 

Moving toward Mental Health

It’s been quite a while since I sat and wrote here.  Sometimes life throws a curve ball and you have to take time to sort it out.  This past year has been a concentration on mental health – mine, my children, my partner.  We are all working to manage our mental health crises and day-to-day functioning better.  Coping strategies, toxic relationships, radical acceptance, family meetings, in-patient hospitalizations, black and white thinking, partial hospitalizations, day programs, substance use/abuse, these have all become common vernacular to me now.  And I realize I am not alone – there is a growing multitude of parents who are learning these terms and living daily with children that are not able to cope and function in the society around us. 

What better topic to write on as I venture back into the land of my professional life.  Let’s look at some statistics from the Centers for Disease Control and Prevention. 

·      13% of children 8-15 have a diagnosable mental disorder during the school years.

·      One in ten youth have a disorder severe enough to impair how they function in the home and community. 

·      Just 50% of children with mental disorders received treatment in the last year. 

·      Half of all lifetime cases of mental disorders begin before age 14.

·      9.4% of children aged 2-17 (approximately 6.1 million) have received an ADHD diagnosis. 

·      7.4% of children aged 3-17 years (approximately 4.5 million) have a diagnosed behavior problem

·      7.1% of children aged 3-17 years (approximately 4.4 million) have diagnosed anxiety.

·      3.2% of children aged 3-17 years (approximately 1.9 million) have diagnosed depression.

·      Suicide is the second leading cause of death among youth 12-24 years old. 

Depression and anxiety have increased over time

• “Ever having been diagnosed with either anxiety or depression” among children aged 6–17 years increased from 5.4% in 2003 to 8% in 2007 and to 8.4% in 2011–2012.

• “Ever having been diagnosed with anxiety” increased from 5.5% in 2007 to 6.4% in 2011–2012.

• “Ever having been diagnosed with depression” did not change between 2007 (4.7%) and 2011-2012 (4.9%)

Reading these statistics doesn’t shock me, but I am greatly saddened. Add to this the crisis of opioid and drug use among teens and it’s no wonder that our schools are time bombs. 

According to the CDC “Mental health in childhood means reaching developmental and emotional milestones, and learning healthy social skills and how to cope when there are problems”  With that as the definition of  what health is I’m left with so many questions. What are we doing wrong?  What are we doing right?  When there is a breakdown in any of this, what can we do to bridge the divide between mental illness and mental health? There are many smarter and more knowledgeable people than me studying this and I won’t pretend to be an expert.

I did do something professionally that changed my entire perspective on behaviors this past year. Beyond learning the statistics and vernacular, improving and utilizing coping strategies, better defining boundaries, refining my communication skills; I attended Svetlana Masgutova’s class on Stress Hormones and Trauma.  The deeper understanding of our bodies stress response system completely changed my view on the meltdowns and breakdowns our kiddos are having.  By intervening on the hormonal level we can reduce breakdowns and repair the ability to regulate.  I’m hopeful that using reflex patterns and techniques aimed at releasing the protective stress response as well as increasing chemicals from the parasympathetic system like dopamine, serotonin and GABA can make substantial differences in the mental health of our youth.  And not just our youth, we as parents need to support our own mental health and wellbeing.  When an individual in a family system struggles with mental illness, stress increases for all family members. 

If you or someone you know seems to being having difficulty navigating daily life, seek help.  Talk to your family doctor about the symptoms you notice and they will help you navigate the next steps. Here are some organizations that can help you better understand what is happening and connect you with information and resources. 

https://www.mentalhealth.gov/talk/parents-caregivers

https://www.nami.org/find-support/family-members-and-caregivers/learning-to-help-your-child-and-your-family

https://www.nimh.nih.gov/health/index.shtml

https://teenshealth.org/en/parents/emotions/