Chapter 1: Introduction

• Role of Occupational Therapy
• Working in partnership
• Core Offer
• Referral to Occupational Therapy

Chapter 2: Supporting functional skills

• General principles for supporting children with everyday tasks
• Building attention span and concentration
• Motivating the child to do their best
• Links with other supporting agencies

Chapter 3: When and how to use the Toolkit

• Build up a picture of how the child is coping in school
• Observations in PE/break time
• Meet with parents to discuss child’s needs

Chapter 4: Motor co-ordination

• Why is Movement important?
• Developmental Co-ordination Disorder

Chapter 5: Working out which parts to use

• Overview of the toolkit
• Working out which parts to use for individual children

Chapter 6: Supporting children with gross motor skills – ideas and resources

• Introduction to gross motor skills
• Different aspects of gross motor skills – and how to develop them:
  • Motor planning – organising and sequencing movements
  • Body awareness – knowing where the different bits of your body are in space at any one time
  • Position in Space – knowing where your body is in relation to the objects or people around you
  • Balance
  • Upper body strength
  • Shoulder stability
  • Integrating both sides of the body so that they work in harmony
  • Gross Motor Activity Ideas for PE

Chapter 7: Supporting children with fine motor skills – ideas and resources

• Introduction to fine motor skills
• Different aspects of fine motor skills – and how to develop them:
  • Hand/eye Co-ordination
  • Hand & Finger Dexterity & Strength

Chapter 8: Pre-writing and handwriting skills

• Helping with handwriting
• The foundation skills for good hand writing
• Motor co-ordination difficulties and handwriting
• The essential role of effective Early Years provision
• Classroom strategies: enabling children with motor co-ordination difficulties
• Left handedness
• Useful equipment and resources

Chapter 9: Scissor skills

Chapter 10: Supporting children to become more independent with everyday activities

Appendices

• Appendix 1 – Characteristics of child with co-ordination difficulties
• Appendix 2 – Ready to Write Checklist
• Appendix 3 – Pre-Writing Shapes
• Appendix 4 – Hands up for Handwriting
• Appendix 5 – Information Gathering: Parent Questionnaire
• Appendix 6 – Information Gathering: Child Questionnaire
• Appendix 7 – Toolkit Checklist
• Appendix 8 – Children’s Therapy Referral Form

Resources

Reference list and further reading

Role of Occupational Therapy

Occupational Therapists enable children to overcome barriers, so they can participate in everyday life. Children participate in many tasks on a daily basis, e.g. dressing, feeding, toileting, play and accessing everyday school activities. Increasing participation in these tasks enables them to develop their independence, confidence, health and wellbeing.

Occupational Therapists assess and identify the needs of children and develop plans with the child, family and agencies involved in their day to day life to facilitate identified goals (Occupational Therapy & Primary Care, www.rcot.co.uk; COT briefing 143, 2011; COT Position Statement, 2012; Missiuna et al, 2008).

Children can present with a wide variety of conditions, such as Cerebral Palsy, Downs Syndrome, Developmental Co-ordination Disorder but how this impacts on the child is variable. Strategies to meet identified goals may include adapting the task, providing alternative equipment and developing the child’s underlying skills.

Participation in focused activities on a day to day basis can enable the child to develop their underlying skills such as their gross and fine motor co-ordination.

Working in partnership

In North Lincolnshire, the Children’s Therapy Team works with schools and other specialist services to provide a graduated approach to meeting children’s needs, as set out in the new Code of Practice for SEND (2014).

Our service for children takes into account what can reasonably be provided by schools, with the right resources and some training and support from the Occupational Therapy Team. A number of researchers highlight the importance of the partnership working to help children and young people and show that teachers and parents are able to deliver interventions (COT Position Statement, 2008).

But we also recognise that a small number of children will not make the expected progress – or have more complex needs – and that for these individuals access to specialist assessment, advice and intervention is essential.

The following information outlines how we can work together to support children and young people, making the best use of our respective resources and getting the best possible outcomes.

Universal level: opportunities and support for all children

All children have opportunities at school to develop their everyday functional skills. These are available through:

• Sports, games and outside play
• Age appropriate fine motor skills e.g. painting, drawing
• Recording skills including handwriting and IT
• Correct posture for functional tasks

They have access to age appropriate play and classroom equipment and their progress is monitored as part of ‘assessment for learning’. Most children will be able to use these opportunities in a supportive environment to develop their everyday functional skills, without the need for any additional support.

Targeted level: support for schools

Some children may need extra support from home and school staff for a period of time in order to develop their everyday functional skills. For many children this intervention will be enough to get them back on course.

This toolkit is a resource of ideas and strategies to support children as soon as difficulties are first noticed. Working with these children early on will provide them with the opportunity to develop skills as they progress through their childhood, enabling them to be able to live an independent and fulfilling life into adulthood.

We hope that this toolkit will:

1. Promote the learning, achievement and well-being of children and young people.

2. Further develop the awareness, expertise and confidence of staff when working with children and young people who have difficulties with everyday functional skills.

High Level

For a minority of children, universal and targeted support will not be enough for them to progress. Once the toolkit has been used and a child still has identified functional difficulties, a referral to Occupational Therapy may be appropriate.

What do we offer?

The Children’s Occupational Therapy Service locally is commissioned by the NHS clinical commissioning group (CCG) and is provided by Northern Lincolnshire & Goole NHS Trust.

The Children’s Occupational Therapy Service is commissioned to assess and treat children with varying conditions at different levels of input. Further detail about our core-offer, referral criteria and pathways is available via the Local Authority Local Offer website.

Referral to Occupational Therapy

As previously stated, the role of Occupational Therapy is assessing levels of functional skill in everyday activities and providing strategies and advice for continued development of independence and wellbeing.

When a referral is made, please provide evidence that the toolkit has been used and ensure functional difficulties are clearly outlined within the referral, i.e. dressing, feeding, toileting, handwriting, scissors. This evidence can be provided by completing the questionnaires for Parent and Child (see Appendix 5 & 6) as well as the Toolkit Checklist as attached (see Appendix 7) as well as the Children’s Therapy Team referral form (see Appendix 8). Both of these need to be forwarded to our generic email address nlg-tr.NLChildrensTherapyTeam@nhs.net

Once a referral has been received, it will be triaged and, if accepted, be placed on our waiting list. An assessment appointment will be offered to the child and family at a clinic location. The Occupational Therapist may also make contact with other agencies involved to gather further information, e.g. Physiotherapy, school, Speech and Language Therapy.

Once assessment has been completed our team will liaise with school to provide strategies and advice to supplement strategies put in place through the toolkit.

Whilst waiting for assessment by our team, it is important that schools continue with identified strategies from toolkit to ensure children are receiving the support they require in order to maximise their readiness for specialist advice and input.

Building concentration and attention span

Some children and young people are particularly susceptible to problems with concentration and attention span and it is important that their needs in this area are recognised and supported.

General Guidelines

• Motivation is essential: choose activities which play to the child’s interests.
• Ensure the task is appropriate for the child’s level of ability.
• Prepare the activity before introducing it to the child.
• Provide structure and routine to activities. Set clear limits.
• Change the activity and allow the child to move around physically or be in different positions.
• Decrease distractions from the work environment e.g. provide an interruption free, quiet environment without lots of eye catching displays.
• Break up work assignments into small sections, with rewards given once each section is complete.
• Combine verbal instructions with demonstration. Too much talk can be distracting.
• Sensory/fidget toys can help focus and sustain concentration.

Suggested activities to build skills in this area

• Listening – Listen to stories through earphones (this magnifies the voice and reduces external sounds). The child can then talk about or draw pictures about the story.
• Dead Lions – Child lies still on the mat, with legs straight, arms by their sides and eyes closed. Try to increase the duration gradually as their ability increases.
• Hide a music box: hide the music box in the room. The child must listen and find the music box.  For a very young child, hide the music box under a blanket in front of the child.
• Kim’s Game: Show five items to child, cover with a blanket and remove one item, then ask child to identify which item is missing. Increase number of items shown and/or removed.
• Games that give feedback and operate at child’s own pace are really helpful e.g. computers, electronic toys, video games.

Further ideas to develop listening and attention skills can be found in the ‘Speech and Language Toolkit’.

Motivating the child to do their best

Making sure that children with difficulties are motivated to engage in tasks is really important – as they may well have to make lots more effort than other children to achieve the same end. You will need to make extra effort to ensure activities are enjoyable and linked as far as possible to their interests.

General Guidelines

• Repetition is helpful because it will help children to develop muscle memory and fluency of movement – and feel that they are getting better at the task.
• Grade tasks to enable children to experience success, which will improve their self-esteem.
• Find rewards that are meaningful to the individual child.
• Praise attempts and effort e.g. ‘I liked the way you tried that even though it was hard for you’.
• Give specific and genuine feedback.
• Show by your actions that you know each child is different and that you accept the child as they are. Ask the child what they are capable of doing and what they would like to learn to do.
• Be aware of the child’s emotions; listen to how they feel about the task and themselves.

Suggested activities to build skills in this area 

• Observe the child at play. Let them lead. Provide encouragement to participate in tasks as part of the play activity – so that they are practicing skills without knowing it!
• Contracts: Identify an area with the child that is of concern. Discuss goals immediately, for medium and long term. Work out steps to achieve these goals. Discuss what is to be gained at each stage. Draw the plan up on paper including a realistic time scale. Both you and the child sign what each of you needs to do to achieve this. You may wish to include rewards
• Star Charts – Identify an area you and the child wish to work on. Reward the child with a star on their chart each time they complete an activity. Let a set number of stars equal a reward and ensure the reward has meaning for the child.

Build up a picture of how the child is coping in school…

Talk to colleagues who know the child to discuss your concerns and identify any other possible needs. Decide together whether you should investigate their skills further.

Observe Posture within the Classroom…

Most children will be required to sit at a table and chair in order to complete activities within the classroom, such as handwriting, computer skills, art and play skills.  A child’s ability to carry out such activities can be affected if they are not in a good sitting position.

Ensuring that the correct table and chair heights are available for all children within a classroom will enable them to complete activities to the best of their ability. Ask yourself the following questions:

Is the child…

• able to place their feet flat on the floor, providing a good base of support for their whole body?
• able to place their bottom into the back of the chair, providing good support for the natural curves of the spine?
• able to place their forearms onto the surface of the table, providing good support for upper body.

These simple strategies can make a big difference to every child in the classroom as well as an overall impact on the child/young person with difficulties.  Some children may require verbal/physical prompts to facilitate positioning, but this will enable them to become more aware of how they sit and will hopefully become a natural sitting position for them eventually. 

Observation in PE (and maybe at break time)…

If you decide more investigation of a child’s co-ordination skills is needed, then observe the child in PE. This can be a great opportunity to see how the child is able to complete tasks requested as well as how they manage to get themselves changed before/after PE.

So, what would you be looking for?

Getting changed

Do they find it easier to get undressed rather than dressed?

Are they able to find items required in the correct sequence?

Are they struggling to dress/undress the top half or bottom half in particular?

Is footwear placed on the correct feet?

Once in PE

Are they able to retain and recall information given?  This may be evident as they should be able to complete the task requested or they may only complete one element of the task, i.e. the beginning or last component of the task.

Are they able to plan and co-ordinate their movements effectively?

For example, when jumping, are they able to use their arms and legs effectively to gain height?  Do they land whilst maintaining their balance?

Do they land heavily on their feet?

Do they appear to observe their peers, in order to gain information as to how they may be able to complete the task required?

Another opportunity to observe their abilities would be within playtime at break or lunchtime. Can they complete games/activities at the same level as their peers? Do games go wrong, leading to behavioural outbursts or isolation?

Meet with parents to discuss their child’s needs…

Once you have gained some evidence from your observations, liaison with the SENCO or class teacher should take place to discuss these further.  At this point, if it is felt that activities from the toolkit are appropriate, liaison with parents would need to take place.  Consent needs to be gained from the parents before completing the activities and in readiness for a possible referral to Occupational Therapy. This is included in the referral form so there is no need for more paperwork!

You should also talk to the parents about how the child is at home and about any concerns they may have.  For example, are they able to get themselves undressed and dressed independently?  Are they able to use a knife and fork appropriately? Do they need help cutting up food? Are they able to clean their teeth independently?  Are they able to ride a scooter or bike?  (see Appendix 5)

Having a conversation with the child and asking them if they find any day to day activities difficult or any activities that they would like to find easier to complete (see Appendix 6).

Identify areas of the toolkit to be used…

Once you have gathered the above information, you will be able to identify the areas of the toolkit that may be beneficial.  It is recommended that these are tried regularly for at least a term, in order to be able to notice any changes in skill building and improvements in e.g. attention or co-ordination.

When can you put the identified activities into place?

Dependent on the child’s needs, there are a variety of ways to put activities in place:

• Within the classroom e.g. ensure good posture during table-top activities (e.g. handwriting, using scissors) or for dressing.
• During PE sessions, particularly for gross motor activities.
• Group based sessions or in a 1:1 situation – if the child is already receiving interventions the activities can be added onto the beginning or end of these interventions.
• Consider group based sessions with children who have similar difficulties.

How often should you complete activities?

Some of the activities can, and need to be, put into place every day, such as positioning for handwriting/dressing or using the correct pencil grasp. Other activities, where a child is working on a specific skill (e.g. gross and/or fine motor skills), will benefit from regular practice – at least three times a week.  This will enable you and, hopefully, the child to see an improvement in their skills.  Completing activities little and often (rather than doing one hour per week) provides a range of benefits including the opportunity for repetition thereby helping ongoing development of skills and the child’s motivation is likely to remain higher.

When to refer to Occupational Therapy…

As stated previously, it would be beneficial to continue with the activities for one whole term.  This gives the opportunity to identify if there has been any carry over following half term breaks.  If you find that after one whole term of implementing the toolkit, you continue to have ongoing concerns then this would be the best time to complete a referral including the questionnaires from Parent and Child (see Appendix 5 & 6), Toolkit Checklist (Appendix 7) and Children’s Therapy Referral form (Appendix 8).   Both of these need to be forwarded to our generic email address – see Children’s Therapy Team referral form.

Why is movement important?

Opportunities to experience movement enable children to develop their sensory and physical co-ordination skills, therefore progressing through the expected developmental milestones, in order to achieve independent and functional movement.  Each stage of development enables them to develop their body awareness, core stability, upper limb strength, hand eye co-ordination and fine motor skills. This enables them to participate in everyday activity such as playing with their peers, being able to feed and dress themselves, participate in school activities and socialise within their family and friends.  Please see website links within the Resources section of the toolkit.  These are links for further information about normal developmental milestones including gross and fine motor skills.

Therefore even from an early age and throughout childhood, movement is so important in enabling each child to continue to develop skills through everyday opportunities such as playing in the garden, woods or park; participating in sports/dance clubs; engaging with P.E. at school.

Motor Co-ordination Difficulties

There is a very wide variation in the normal range of physical ability – with athletic people at one end of the spectrum and those with co-ordination difficulties at the other end. Many people have difficulties with co-ordination – especially when they are tired or anxious. Children/young people have been noticed to have more difficulties after a growth spurt or during adolescence.

‘Co-ordination difficulties’ is an umbrella term used when a child/young person has a developmental difficulty with co-ordination – for example, they may bump into, spill, or knock things over and have problems with balance.  Some children with co-ordination difficulties may have missed out achieving developmental milestones or may find it more challenging to achieve them within the expected range.  They may experience difficulty with gross motor (whole body), fine motor (use of hands) skills or a combination of both.  Co-ordination difficulties can be caused by a wide variety of conditions e.g. Cerebral Palsy, Head Injury, Brain Tumour, Developmental Delay or Developmental Co-ordination Disorder.

Identifying play activities that children enjoy can encourage participation as they are more motivated to become involved and continue with the activity for longer periods of time.  This is particularly important for children who have co-ordination difficulties as they can sometimes be aware that they will find activities challenging and therefore find it hard to participate or will immediately withdraw.

Many of the activities and strategies in this toolkit will be relevant for any child who appears to have co-ordination difficulties, regardless of their diagnosis. The next chapter will help you to find your way around the toolkit so that you quickly find the most useful strategies for the difficulty that you have identified.

Developmental co-ordination disorder

Developmental Co-ordination Disorder (DCD) is a condition that impacts a significant proportion of the population (there is a ratio of 4:1, boys to girls (Addy, 2007).  Evidence shows that within a classroom of twenty five children, at least one child will have difficulties affecting their motor co-ordination and perceptual difficulties, which will impact on their learning and warrant additional support (Lingam et al, 2009).  However, this is often not recognised as difficulties with co-ordination can appear mild compared to other conditions – as the International Clinical Practice Recommendations (CPR) for DCD state:

“Motor performance difficulties of individuals with DCD are often viewed as ‘mild’ and, thus, not warranting attention compared with the needs of individuals with more severe movement impairments such as cerebral palsy. Therefore, it may be argued that the net benefits for assessment and intervention in DCD may not be justified as an investment for society.

However, the numerous data on epidemiology (DCD is by far the most frequent motor disorder relevant for daily activities) and the findings on the outcome of DCD clearly suggest that DCD is a considerable burden and therefore it is also important to intervene…” (Blank et al, 2019)

This intervention can take many forms, but starts with the recognition that there may be some co-ordination difficulties and using the toolkit to address these.  If a child continues to have difficulties, and no diagnosis has been given that explains the difficulties, it is important to raise concerns with the child’s parents/guardians in order to pursue further investigation/diagnosis.  Early identification and intervention is recommended (Cairney et al, 2007).

Diagnosing developmental co-ordination disorder

The diagnosis of DCD may be given when a child or young person is recognised as having co-ordination difficulties over a sustained period of time. Children will only receive a diagnosis of DCD if they have received a thorough, specialist assessment, by a multi-disciplinary team which includes an occupational therapist. The diagnosis must be given by a paediatrician who will make sure that there are no underlying health problems affecting the child’s abilities (this is in line with the International CPR for DCD; Blank et al, 2019).

In order to be diagnosed with DCD a child/young person must fulfil four criteria:

1. Acquisition and execution of motor skills is significantly below that expected of the child’s chronological age. Therefore if an intellectual disability is present, the motor skills need to be significantly below that expected of the child’s intellectual age.
2. The motor difficulties significantly and persistently interfere with activities of daily living (e.g. self-care), school productivity, leisure and play.
3. The motor difficulties are not attributable to any other medical, neurodevelopmental, psychological, social condition or cultural background. This includes other neurodevelopmental disorders (e.g. severe intellectual disabilities) or other psychological conditions (e.g. attention problems) as primary causes of the co-ordination difficulties.
4. Onset of symptoms is in childhood.

(adapted from DSM-5 and International Clinical CPR for DCD, Blank et al, 2019)

As the child/young person may still be developing their motor skills, diagnosis would not typically be given before five years of age (Recommendation 4 of the International CPR for DCD, Blank et al, 2019).  However, intervention to assist with motor development and development of functional skills can still be provided.

Dyspraxia

Dyspraxia is a term that is sometimes used informally to describe similar difficulties to those of DCD.  It cannot be stressed enough that this label should not be given to any child by any person (medic, therapist or education staff).  For the long term health and wellbeing of a child with co-ordination difficulties, it is imperative that a diagnosis be made by a medical professional who can rule out other conditions that can cause similar difficulties to DCD. International consensus does not recommend the use of the term ‘dyspraxia’ for children with physical motor co-ordination difficulties. (International CPR for DCD, Blank et al, 2019).

For terminology for children with verbal and/or oral motor co-ordination difficulties, please refer to the Speech and Language Therapy Toolkit.

Co-occurring conditions

Diagnosis by a medical doctor is also important as DCD commonly occurs alongside other conditions (Lingam et al, 2010).  It is recommended that if a child is diagnosed with DCD, consideration should also be given within the assessment process, as to whether or not the child may also have any issues that relate to any of the following conditions:

• Attention Deficit Hyperactivity Disorder
• Specific Language Impairment
• Learning Disorders
• Autism Spectrum Disorder
• Dyslexia
• Reading Disorder
• Joint hypermobility
• Social, emotional and behavioural issues
• Sensory processing difficulties

Characteristics of DCD

Careful observation of and patient listening to children with DCD will reveal that difficulties arise in many areas of their lives e.g. it can affect them physically, perceptually, emotionally, and psychologically at home, school and where they spend their leisure time.  As with any condition, DCD affects different children or young people in different ways and to different extents.  Some of the characteristics that children/young people may experience (this is not an exhaustive list) are:

Physical characteristics of a child/ young person with DCD

• Children’s movements may appear clumsy or awkward; they may trip a lot or bang into objects.
• New motor skills may be difficult to learn therefore they may be slower than their peers when learning new tasks.
• There may be a particular difficulty with skills that require the co-ordinated use of both sides of the body such as cutting with scissors, using a knife and fork, and tying shoelaces.
• Children may be delayed in picking up functional everyday skills such as dressing or riding a bicycle.
• There may also be difficulty with organising the movements of parts of the body that they cannot see, such as co-ordinating their legs when swimming.
• Reduced strength and stamina: because motor skills require more effort for a child/young person with co-ordination difficulties, they may tire more easily.
• Avoidance of physical activity, especially team sports (Smyth & Anderson, 2000).
• Children and young people with co-ordination difficulties are very likely to have problems with handwriting. This skill involves continually interpreting feedback about the movements of the hand while planning new movements, and is a very tricky task for most with co-ordination difficulties (Addy, 2007).

Likely impact on learning and attainment

• Pupils may have difficulty with writing legibly.
• Children may experience pain and/or discomfort when writing.
• Writing at an acceptable speed is likely to be a significant issue and therefore they do not show their true understanding of a subject. This will impact exams as well as classroom work.
• Young people may have difficulty with practical lessons, such as science or DT.
• Organisation of themselves, their belongings and their environment may be a difficulty – may include placing work appropriately on a page, remembering their PE kit, writing down homework before the end of the lesson.
• Reluctance to participate in physical activities and other tasks that they struggle with both in the classroom, P.E. and in socialising with other children in the playground.
• Engagement with learning may be reduced to emotional and psychological effects of having DCD e.g. due to frustration or avoidance of challenging tasks.

Emotional/behavioural consequences of co-ordination difficulties

Studies comparing children with DCD with their peers over a long period of time, highlight that they are at risk of psychosocial problems (Green & Sugden, 2006; Losse et al, 1991).  Research evidence shows that, for many children with DCD, substantial psychosocial difficulties often have an impact on engagement, participation, psychosocial well‐being, and quality of life (International CPR DCD, Blank et al, 2019) including in the following ways:

• For a child/young person with co-ordination difficulties, more effort is required when participating in motor skills activities. As a result they may tire because of the increased effort needed and can experience repeated failure. As a result they tend to avoid participating in motor tasks and can then experience low self-esteem and/or frustration, particularly if the challenges they face are not understood by others.
• The child/young person may avoid socialising with peers, particularly on the playground. Some will seek out younger children to play with while others will go off on their own. This may be due to decreased self-confidence or avoidance of physical activities.
• The child/young person may be resistant to changes in his/her routine or in the environment. If they have to expend a lot of effort to plan a task or learn a new task, then even a small change in how it is to be performed may present a large problem.
• Reduced physical activity negatively impacts self‐efficacy in children with DCD (Hay & Missiuna, 1998); Cairney et al, 2005).
• DCD can cause lower life satisfaction (Poulsen et al, 2008).
• Problems with behaviour and in interacting socially were shown to have persisted in a long‐term follow‐up (Stephenson & Chesson, 2008).
• Children with DCD are known to experience poor self-esteem, educational underachievement and passive lifestyles that can have a lasting effect – with an increased risk of becoming socially isolated and suffer from mental health illnesses into adulthood (COT briefing 143, 2011).

What can we do?

The impact of DCD on everyday tasks and secondarily on social participation, physical and mental health (alongside the high prevalence rate) point to the fact that the social and economic burden of addressing the issues that arise from DCD is significant (CPR DCD, Blank et al, 2019).  More importantly, the impact of DCD on individuals can be significant with far reaching implications.  However, the impact is likely to be reduced with early identification and intervention, so that the child/young person and eventually adult has the support and strategies necessary for them to experience health and wellbeing through participation in everyday life.  Education staff, in partnership with parents (alongside education by health professionals) are ideally placed to recognise signs of motor co-ordination difficulties.  It is therefore important that if you as a teacher/TA suspect that a child has co-ordination difficulties that impact their functional skills, that you follow the recommendations of this toolkit and then follow the referral to Occupational Therapy or a medical doctor as soon possible.

Overview of the toolkit

The toolkit has been broken down into specific areas as follows:

• Gross motor skills (large movements such as running and hopping) – chapter 6 and colour coded Green
• Fine motor skills (including handwriting) – chapter 7 and colour coded Yellow
• Pre-writing skills and handwriting – chapter 8 and colour coded Pink
• Scissor skills – chapter 9 and colour coded Blue
• Dressing skills – chapter 10 and colour coded Purple

We have taken each area and…

• Described what is involved.
• Explained how difficulties in this area may affect the child or young person.
• Given some general ideas about how to help.
• Provided some activity suggestions – so that the child or young person has opportunities to practise the skill. These can be delivered flexibly – in PE lessons, in small group sessions, in 1:1’s, in lunchtime clubs.

Working out which parts of the toolkit are most useful for individual children

You will have collected a lot of information about the child’s abilities and difficulties already – through your discussions with other staff, parents and the child or young person themselves – as well as your observations. Using the table overleaf to help highlight key areas to focus on, you will be able to identify which areas of the toolkit are likely to be most helpful.

Does the child or young person (tick or cross – for ticked items, go to the following sections for help)

Tend to trip or fall – and have lots of bumps and bruises?

• General gross motor
• Balance

Struggle in or avoid PE?

• General gross motor
• Balance
• Body awareness
• Position in space

Lose their balance easily?

• General gross motor
• Balance
• Body awareness

Have a haphazard approach to tasks – doesn’t know where to start and gets in a muddle easily?

• Body awareness
• Position in space
• Motor planning

Bump into things a lot?

• Balance
• Body awareness

Fidget a lot – and be constantly moving around?

• Balance
• Body awareness
• Position in Space
• Motor Planning

Apply too much or too little pressure e.g. handwriting?

• Upper body strength
• Upper body stability
• Body awareness
• Posture

Cannot push or pull (with their arms)?

• Body Awareness
• Upper body strength
• Upper body stability

Struggle with writing on a vertical white board or similar?

• Balance
• Upper body strength
• Upper body stability
• Motor Planning
• Posture

Slouch at their desk – or lie on the desk?

• Posture
• Body Awareness
• Upper body strength
• Upper body stability
• Fine motor skills
• Handwriting skills

Struggle to hold the page when writing?

• Body awareness
• Both side of the body working together
• Motor planning
• Fine motor skills

Struggle with buttons and zips?

• Independence with everyday activities

Struggle with cutlery?

• Independence with everyday activities

Struggle with pencil control?

• Body awareness
• Motor Planning
• Both sides of body working together
• Upper body strength
• Upper body stability
• Fine motor skills
• Pre-writing and handwriting

Introduction to gross motor skills

These are large movements such as running, jumping, moving from sitting to standing, climbing, crawling etc. All of the following are important for gross motor skills:

• Motor planning – organising and sequencing movements
• Body awareness – knowing where the different parts of your body are in space at any one time
• Position in Space – knowing where your body is in relation to the objects or people around you
• Balance
• Upper body strength
• Upper body stability
• Integrating both sides of the body so that they work in harmony

Babies start to learn gross motor skills right from  birth, starting with head control – and leading on to sitting, rolling and finding ways to move from one place to another.

Signs that a child may need some help with gross motor skills

• Late to reach motor milestones
• Balance problems
• Generally poor co-ordination; may have lots of bumps and bruises
• Difficulties with PE and may avoid PE, playtimes and other physical activities

General ideas on what to do

• Find a gross motor activity that child enjoys or wants to try e.g. riding, walking, swimming.
• Try to encourage a more active lifestyle e.g. walking to school.
• Grade activities to encourage success, motivation and self-esteem i.e. start with the child staying still when they do an activity (e.g. throwing a ball), then make the activity gradually more challenging (e.g. they might need to catch a ball whilst standing on a balance board).

 General activity suggestions

• Rolling: Lie on back with hands above head and roll in a straight line along the mat or between ropes to collect bean bags etc.
• Bridging: Lie on back with knees bent, feet flat on floor, arms by side and lift bottom off the floor. Try not to wobble. Pass a bean bag under bottom then over tummy.
• Four Point Kneeling: On hands and knees:
  • Lift one arm straight in front.
  • One leg straight behind.
  • Develop to lifting opposite arm and leg at the same time.
• One Leg Balance: Balance on left foot, with other foot on top of football. Lift this leg on/off ball ten times.
• Half Push-Ups: On hands and knees, put bean bag down, just in front and centre of hands. Bend arms to take nose down to bean bag, e.g. like cat drinking milk.
• Obstacle Courses: Develop a course around the room or to get across the room stepping on, over, in, balancing etc.
• Stamina Circuits: Repeat an activity for 1 or 2 minutes, then rest and move onto next one, e.g. star jumps, jogging, step-ups, half press-ups.

Sometimes, a child’s gross motor skills will be particularly affected by one of the sub-skills or factors mentioned previously:

• Motor planning – organising and sequencing movements.
• Body awareness – knowing where the different bits of your body are in space.
• Position in Space – knowing where your body is in relation to the objects or people around you.
• Balance
• Upper body strength
• Upper body stability
• Integrating both sides of the body so that they work in harmony.

The following sections will help you to spot which skills to work on, so that you can provide the right sort of help to assist them in moving forward.

Motor planning – organising and sequencing movements

Good motor planning enables the child to think of an idea, organise and plan a task and carry it out in a coordinated and sequenced way.

Signs that a child may need some help with motor planning

• Not sure how to approach a task – where to start and what to do next.
• Completes tasks in a messy or haphazard way.
• Finds it difficult to master a new skill and may avoid trying new things.
• Prefers familiar, sedentary activities and is at risk of becoming overweight.

General ideas on what to do

• Demonstrate how to do the task.
• Break the task down into stages with the child so it is not overwhelming.
• Encourage the child to talk about what he/she is doing and what he/she will be doing – as this should help the child to organise themselves.
• Create a check list with the child and use this to prompt the sequencing of tasks such as dressing or their morning routine. Photographs are ideal to use to create sequence prompts.

Over time encourage the child to use these strategies independently e.g. Can they use a checklist without your help?

Activity suggestions

• ‘Simon Says’ – Copy body actions and postures. Add interest by making two requests such as left hand on head and right on tummy.
• ‘Walk like a …’ – name an animal and move as it does.
• Instruct the child to perform a sequence movements e.g. Walk, clap, jump.
• Walk along a path – make it narrower, walk backwards or sideways.
• Use playground equipment – slides and swings.
• Introduce the child to new games and tasks in a safe environment with just the right amount of challenge.
• Use hoops to jump into, pull over head, twist around arms, legs and waist.
• Bean bag targets.
• Hop scotch, off ground tags – Jump and hop.

Body awareness

Body awareness is an appreciation of our body position in space.  Just as our eyes and ears send information about what we see and hear to the brain, our muscles and joints sense the position of our body and send these messages to the brain.  This information enables you to know exactly where your body parts are and how to plan your movements.

Signs that a child may need some help with body awareness

• May fidget and roll around on the floor.
• Constantly on the move – can’t sit still – always trying to get feedback from their muscles and joints.
• May struggle to position themselves to negotiate spaces and objects.
• May apply too much or too little pressure e.g. handwriting, brushing teeth.

General ideas on what to do

• When sitting at a table, ensure that the child is seated correctly with their feet placed flat on the floor, bottom into the back of the seat and upper body supported by the surface of the table.
• Complete wake up type activities to prepare muscles and joints ready to participate in a task.
• When the child is involved in sedentary activities, such as doing homework, reading, playing board games, encourage them to take frequent, short movement breaks.
• A Move ‘n’ sit cushion may be beneficial within the classroom B. A Move ’n’ sit cushion should only be used for 20-30 minutes at a time.
• If the child becomes too active, try encouraging them to rub their arms/legs to help wake their muscles up; apply gentle pressure to their shoulders; encourage the child to put to their hands on their head and put gentle pressure down through their head (make sure that the child is sitting up straight); or massage their hands in between fine motor activities.

Activity suggestions

These will help the child be more aware of their body position and/or become more calm and organised:

• Do “heavy work” activities such as carrying equipment, a pile of books, shopping, a laundry basket, or a rucksack.
• Play ‘backpacking’ by placing bags of beans or rice into a backpack and pretending to climb mountains and jump off rocks at the park.
• Play ‘sandwiches’ where the child is placed in between cushions or mats and the adult gently adds pressure as they pretend to put on pickles, cheese, lettuce etc.
• Roll the child in duvet/blanket and roll along floor, gently adding pressure.
• Child rolls on the floor covered with different materials of different textures. Touch stimulation will help the child to develop a “map” of their body.
• Give the child opportunities to sit or lie on a fitness ball or bounce on a trampoline.
• Add some light wrist weights to the child’s arms when learning a new skill to give extra feedback about the position of their arm/hands e.g. when throwing a ball.
• Play ‘back to back’: Two children stand back to back. One child pushes the other, providing resistance but only to the degree that he or she can be pushed slowly across the room. Repeat same activity but hand to hand, shoulder to shoulder, feet to feet etc. N.B. avoid head to head as this may cause a neck injury.
• Outline the child’s body on a large sheet of paper and get them to paint and label the body parts.
• Ask the child to copy the adult touching their own body parts as demonstrated by the adult. Start with large parts first,  for example head, shoulders, arms, legs etc. then move onto smaller parts, i.e. eyes, ears, hands etc. Can be completed with eyes open or closed.
• Ask the child to lie back and relax with their eyes closed. When the adult names a body part, the child touches the named part, i.e. right little finger, toes, head.
• Draw a picture of an incomplete person and encourage child to add the missing pieces.
• Help the child to complete body or face puzzles to reinforce body concept.
• Encourage the child’s family to get involved in activities such as walking, swimming, outdoor sports games. Doing an activity as a family can often be more fun for the child.

 Position in space

 This involves knowing where your body is in relation to the objects or people around you.

Signs that a child may need some help with object awareness

• May have difficulty in the playground or in PE with apparatus.
• May bump into other children or objects in the classroom.
• May have difficulty staying on their chair.

General ideas on what to do

• Body awareness activities can be useful to emphasis relationships of body parts to each other and objects in space.
• Encourage physical activity that explores movements of the body or objects from one position in space to another.
• Begin with large movements, progress later to fine movements. Begin with concrete concepts (i.e. crawl under the chair) before using abstract concepts (i.e. draw a picture of yourself under the chair).
• Children need to understand spatial concepts, i.e. in/on/under/above etc.
• Focus on teaching strategies to organise/use spatial information.
• For older children (12 years and over) focus on compensatory strategies to deal with spatial information.

Activity Suggestions

• Collage: cut out pictures or shapes with scissors. Arrange and paste them on the paper, in specific positions, to form a collage.
• Playground: climb or play on the equipment as appropriate, with supervision.
• Body awareness: refer to body awareness sheet.
• ‘My Body’: following verbal instructions the child places the object in relation to their body/body parts e.g. “place the brick under your chin”.
• Puzzles: child cuts out a picture from a magazine, glues it on cardboard and cuts it into pieces. Increase the pieces as the child’s ability improves.
• Copying Objects: make a 3-dimensional shape (e.g. with cubes or bricks), which the child has to try to replicate exactly.

Balance

This involves 2 different skills:

• Being able to stand still on one leg (static balance)
• Being able to balance when hopping, jumping and walking on a line (dynamic balance).

Balance depends on adequate muscle strength and tone.  The child also requires a good awareness of their body (see section on body awareness).

Signs that a child may need some help to develop their balance

• Frequent falling or stumbling within school, i.e. classroom or playground.
• Requires additional support for balance type activities in PE, either physical support or use of equipment.

General ideas on what to do

• Provide opportunities to practice during play, e.g. walking along a line or hopping in the playground.
• Provide a safe environment to practice – use equipment available such as mats to create a safe environment for child if they lose their balance or fall.
• Start with activities close to the floor.
• Start with a wide base of support (i.e. lying) and then progress to kneeling, finally progressing to activities involving standing, jumping and hopping.
• Provide physical support or use equipment available (e.g. rails) to provide support. Reduce as the child becomes more confident or develops the skill.  g. use a chair for child to hold onto whilst trying to balance on one leg.

Activity suggestions

• Rope game: stretch a long rope on the floor which is taped down at the ends. Ask the child to walk along it without falling off.  You can give them other challenges too: jumping over the rope with both feet all the way along the rope; walking backwards along the rope; walking with a foot on either side of the rope.
• Balancing on hands and knees: ask the child to get into a crawling position, then raise one arm and extend it forward. If they can do this, ask them to raise and extend one arm and leg on the same side, then change to opposites (left arm/right leg).
• Batting the ball with your hand: ask the child to kneel on both knees, progress to kneeling on one knee. In kneeling the child bats and rolls the ball to the instructor with one hand then changes hand.
• Can-stilts walking: ask the child to walk on the small sized can stilts (help them remember to pull up on the rope as the knot is raised).
• Rocking board/wobble board balance: encourage the child to get on their hands and knees on a wobbly board. If the child can maintain their balance, encourage them to progress to standing.
• Balance beam activities: Encourage the child to walk forward along a beam, walk heel-to-toe, walk sideways, crawl along the beam, walk backwards.
• ‘Twister’: as rules of the game.  Adapt by getting the children to maintain their balance for as long as possible.
• Shape walking: ask the child to walk along shapes outlined on floor.
• Wall push-ups: the child stands at arms-length from the wall.  They then raise their hands, keeping their feet still and allowing themselves to fall towards the wall.  When their hands make contact with the wall they can push themselves back to standing position.
• ‘Row, row, row your boat’ and other large action rhymes are useful.

Upper body strength

Upper body strength and stability is needed to enable a child to carry out many gross motor movements and to maintain an upright posture to complete activities such as handwriting, cutting and eating meals.

Signs that a child may need some help to develop their upper body strength and stability

• Poor posture – slumped at their desk.
• Struggles with hand writing and other fine motor skills – may be slow to produce written work.
• May press too hard or not enough when writing.

General ideas on what to do

Ensure that the child’s desk and chair are appropriate in height. Look for the following:

• Bottom to the back of the chair.
• Back upright.
• Hips, knees and ankles positioned at right angles.
• Feet placed flat on the floor.
• Forearms placed on the surface of the table to provide upper body support.

Sitting in this position will encourage the spine to follow the natural curves, increase comfort and help the child to sit still, concentrate on tasks and complete table top activities to the best of their ability, see page 15.

• Weight bearing activities encourage taking weight through the arms – such as half sit-ups. This will strengthen muscles of the shoulders, neck and back to provide better head and trunk control when sitting.

Activity suggestions

• Encourage kneeling on all fours to do a puzzle, pass a ball etc.
• Balancing on hands and knees: ask the child to get into a crawling position, then raise one arm and extend it forward. If they can do this, ask them to raise and extend one arm and leg on same side, then change to opposites (left arm/right leg).
• Create an obstacle course where the child has to crawl through boxes, hoops and moving up, over and under obstacles.
• Art activities on an easel or with paper pinned on the wall. Encourage the child to make large vertical, horizontal lines and circular patterns on the paper. Any activities which involve working on a vertical plain are useful e.g. games on a chalkboard, helping with hanging out washing, cleaning windows, painting outdoor walls with a paintbrush dipped in water.
• Shoulder press-ups against the wall are helpful, with the child fully extending their arms and then bringing their head to the wall. Start with ten and gradually increase.
• Encourage the child to stand at a table (positioned at the approximate height of the child’s hips) then participate in a table-top activity e.g. roll out dough/pastry with a rolling pin, press cutter shapes into the dough; hand prints with paint; wipe table clean (making large circular movements to cover the area).

Shoulder stability

In order to have a stable shoulder joint, all the muscles around the shoulder joint must be working well together.

Signs that a child may need some help to develop the stability of their shoulder joint

• Struggles with pushing and pulling – can’t offer much resistance.
• Poor posture – slumped at their desk.
• May need help with writing on the board (because it is vertical).
• Struggles with hand writing – especially moving their hand across the page.
• May struggle with fine manipulative skills e.g. sewing, measuring, sticking, cutting.

General ideas on what to do

• Be aware of appropriate upper body positioning before attempting activities.
• Assistance and practice of activities as essential to facilitate skill development.
• Developing shoulder stability will assist the child with precision movements of the hands.

Activity suggestions

• Push and pull: ask the child to stand with their arms extended horizontally in front of them, gripping the adult’s thumbs in each hand. Whilst the child stands firm, the adult pushes and pulls on the child’s hands.  The child needs to try to stay still.
• Freeze tag: played with a group of children, as per normal tag, except the child ‘freezes’ like a statue when tagged and remains in this position until they are untagged.
• Playground games: the child plays on equipment, supporting themselves by holding onto the ropes/handle and thus encouraging their shoulder stability.
• Gym games: the child climbs or crawls across the rungs of the equipment, stabilising their shoulder by firmly extending their elbows.
• ‘Inchworm’: the child stands at one end of a mat. They must keep their feet still on the spot.  The child ‘walks’ on their hands and collects/delivers beanbags.
• Wheelbarrows: the child positions themselves on all fours on the floor; the adult holds the child’s knees/lower legs/feet and lifts them off the floor. The child moves him/herself around by ‘walking’ on their hands.
• General exercises: the child practises press-ups, ‘row a boat’ games, lifting their head and shoulders off the floor whilst lying on their front with their hands behind their back or neck.

Both sides of the body working together

This skill (sometimes called ‘bilateral Integration’) is the ability to use two sides of the body together to complete a task effectively (e.g. cutting or riding a bicycle).

Signs that a child may need help to get both sides of their body working better together.

• Only uses one side of their body during an activity, i.e. left side/arm tends be away from table or held at side of body so that it is not actively involved.
• During handwriting, the child does not stabilise paper with their non-writing hand and this results in movement of the paper.
• Struggles with or is unable to complete tasks such as using scissors, getting changed in PE – may be unable to do up buttons.
• Swapping hands during an activity, i.e. beginning the task using their right hand (e.g. to hold a pencil) and then changing to using their left hand.

General ideas on what to do

• Many gross motor activities tend to use both sides of the body and so help both sides of the body to work together, e.g. using a bat and ball; catching a large ball.
• Ensure that the child is positioned symmetrically before beginning an activity. Place the objects that are needed right in front of them, rather than to one side.
• Encourage children to use their non-dominant hand for stability/support in an activity e.g. holding the page when writing.
• Sensory stimulation (rubbing/massaging arms/hands) can be useful to increase awareness of hands and arms before starting a task

Activity suggestions

• Hopscotch
• Star jumps
• Drumming
• Ball games – use a large ball and progress to a small ball. Play with a bat and ball. Keep a balloon from falling to the floor using a bat.
• Arm windmills – use ribbons; complete clockwise anti clockwise.
• The child catches a bean bag or ball in a box or bin that they are holding.
• Pastry, Play dough activities.
• Construction toys such as Lego, stickle bricks.
• Threading beads
• Folding clothes, paper tearing, cutting out.
• Washing pots
• Nuts and bolts
• Open and closing jars.
• Food preparation – buttering bread.
• Swimming
• Horse riding

How to work on gross motor skills in PE

These activities can easily be incorporated into PE activities and are likely to benefit all the children in the class.

Remember to: 

• Provide as much physical, verbal and visual information as possible.
• Give instructions in short sequences.
• Demonstration is often helpful.

To help with balance and shoulder stability, ask the children to…

• Jump over a rope with both feet together – forwards, backwards and sideways.
• Walk on ‘stepping stones’ or footprints – follow a path across the floor. Try walking on different parts of the feet, for example heels, toes, insides or outsides.
• Walk along a balance beam.
• Pull themselves on their tummies up a sloping bench.
• Sit or stand on a bench (turn bench upside down to make this more difficult once they can walk on the wide surface of the bench) and try to throw and catch a ball/beanbag whilst maintaining balance.
• Wheelbarrow races, crab walking.
• Obstacle courses, they can do this on their hands and knees if walking is too difficult.
• Push ups, against the wall or on the floor.
• Balance beanbags on outstretched arms or on top of their heads – trying not to let them fall whilst walking or moving.
• Push/pull games, for example tug of war: ask them to sit or high kneel in pairs facing each other, stretch out their arms, placing their palms flat against each other and trying to push each other over.
• Netball – trying to shoot through the hoop.
• Wobble board games: once they are able to maintain their balance, incorporate games such as throwing and catching a ball.

To get both sides of the body working together… 

• Ball games – using a large ball and two hands, roll, catch and throw. Progress to a small ball or beanbag, alternatively use a bat to keep a balloon or ball from falling to the floor.
• Catch a beanbag or ball using a box/tub held in both hands.
• Star jumps.
• Arm windmills – to make this more fun, use cardboard batons with ribbons attached, make windmill movements, snakes, circles (clockwise and anticlockwise), lazy 8’s.
• Simon says – give instructions that involve crossing the body, for example left hand on to right ear. Increase from one step instructions to 2-3 step commands.
• Large figure of 8 marked out on the floor using rope or tape – ask the children to jump, walk or hop along it.
• Lazy 8’s – perform this movement in the air with each hand individually or with hands clasped together.
• Throw beanbags into a hoop/box – place beanbags on the floor at one side of the body, use the hand from the other side of body to pick them up and throw them into a hoop/box. 

To help with motor planning – organising and sequencing movements… 

• Pretend to walk or move like animals, for example a rabbit, kangaroo, crab, frog, cat etc.
• Dribble a football or golf-ball around cones or between skittles.
• Movement instructions: with their eyes closed, the child has to follow instructions that they are given – for example turn to the right, one jump forwards, two steps to the left etc. Begin with the eyes open, if closed is too difficult.
• ‘Twister’ game.
• Use of large PE equipment to encourage movement, for example climbing frame, wall bars etc.
• Using a limited number of ‘stones’, create a path from one side of the room to another, stepping on the stones only not the floor.

Introduction to fine motor skills

All children develop their hand function in developmental stages moving from the larger movements to the smaller movements that occur in the hands, wrists and fingers. These smaller actions enable children to be able to effectively engage in functional tasks such as picking up small objects between the thumb and finger; using a pencil to write carefully; holding a fork and using it to eat.  See website links within the Resources section of the toolkit for further information with regards to stages of hand development and how achieving these stages enables children to participate in everyday activities.

Signs that a child may need help with fine motor skills

• Struggles with ‘fiddly’ aspects of dressing e.g. buttons, buckles, laces.
• May struggle with using cutlery effectively e.g. cutting using a knife and fork.
• Handwriting is not clear or is hard work for the child.
• Needs help with using scissors, sticking, tying things together.
• Needs help with the ‘fiddly’ bits in construction activities and play.

General ideas on what to do

• Try to do fine motor activities that the child enjoys or wants to try, i.e. threading, construction toys, pegboards, jigsaws, painting.
• Ensure that the child is sitting in an appropriate position.
• Weight bearing activities can help to improve arm/hand function by stimulating the muscles around the joints and increasing stability.
• Focus on activities which require fine movements.
• Supervision and guidance on how to do tasks is essential to develop appropriate movement patterns e.g. cutting: show the child how to hold the scissors, how to hold the paper etc.
• Focus activities very specifically on the particular movements with which the child has difficulty – and give lots of practice.

Activity suggestions

• Threading – cube shaped beads, large/small beads, cut up straws, macaroni.
• Construction toys requiring two-handed play e.g. Stickle bricks, Lego or similar.
• Interlocking barrels, screwing lids on jars – varying sizes.
• Tearing paper of different thicknesses for collage pictures.
• Folding paper to make simple models, paper chains or to fit in an envelope.
• Winding toys, e.g. a musical box. Wind a cord onto a bobbin.
• Plastic nuts and bolts.
• Pegboard activities.
• Clapping games, action rhymes, e.g. Pat-a-cake.
• Simple musical instruments, copy / tap out rhythms.
• Use play dough, salt dough/pastry/Plasticine to complete the following:
• Squeeze tightly in each hand to make fist imprint.
• Roll between palms to make a ball.
• Flatten ball with palm pushing down on table.
• Roll into a sausage.
• Pinch with thumb and each finger in turn.
• Roll a sausage as long and thin as possible without breaking, using palm and fingers.
• Roll small balls between thumb and forefinger.
• Roll out with rolling pin using two flat hands.
• Jigsaws
• Pick up pennies, post into a money box.
• Deal out ‘snap’ cards or matching pair cards.
• Dot-to-dot pictures.
• Simple mazes – trace the path with the index finger, then complete using a pencil or crayon.
• Pencil trails.
• Colouring in activities.

In order to become proficient at these sorts of activities, children need good:

• Hand and eye co-ordination
• Finger and hand dexterity

In the sections below, we have provided some additional information on these sub-skills as some extra help in these areas may enable them to master fine motor tasks.

Hand / eye co-ordination

This is the movements of the hand that are directed by the eyes.

Signs that a child may need help with hand/eye co-ordination

• Needs help with cutting, using cutlery, writing, drawing, dressing.
• Struggles with ball games and sports which involve hand/eye co-ordination e.g. badminton, netball, tennis

General ideas on what to do

• Break the task down into small movements, such as colouring in small areas. Then increase it to larger movements, such as dot to dot.
• Focus on something still and then work towards following something moving, for example in PE, work away from the body such as throwing a ball towards an object, then moving towards the body, such as catching a ball. This can be developed further by incorporating the two movements – throw a ball against the wall and then catch it when it comes back.

 Activity suggestions

• Bean Bag Games – Throw the bean bag underarm, first forwards then towards a target, for example, into a box or to knock the skittles over.
• Ball Games
• Roll a ball between two posts (or into a goal). This can be made more difficult by moving the posts closer together.
• In pairs, throw the ball to each other. If you drop the ball, go down on one knee.  If you catch the ball you can stand up again, but if you drop the ball again, you go down on both knees.  Again, if you drop the ball, you sit on your heels.  If you drop it again, you go to one hand and then, if you drop it again, you go to no hands and the game starts again.
• Play Dough – Roll into snakes and balls on the table and then between two hands. These can be made up into coil pots or thumb pots.
• Ball and Cup – Catch the ball in the cup.
• Jacks – Play ‘Jacks’.

Hand and finger dexterity

Dexterity of the hands and fingers are important to enable children to manipulate tools using more refined movements with increasing complexity.

Signs that a child may need help with hand and finger dexterity

• Needs help with cutting, using cutlery, writing, drawing, buttons and zips.
• May struggle to turn small objects in their hand (e.g. a peg for a peg board) without dropping it or turning it against their body or the table.

 Carry out the following activity on a daily basis to improve dexterity of the child’s “writing” hand.  Shake hands between exercises:

• A bandage is laid across a table. The child sits at the table trapping the end of the bandage between the wrist of the “writing” hand and the edge of the table.  Using fingers only, the child tries to gather the bandage under the hand.

As the child progresses, they can be timed.  This can then be recorded and the child can try to beat these times during subsequent attempts.

• A bandage is laid along the edge of the table. The “writing” hand is held above one end of the bandage with the wrist resting on the edge of the table.  Using fast thumb movements only, the child tries to slide the bandage under the hand until the other end of the bandage is under the thumb.  For example, if the right thumb is used, the bandage is moved to the right.
• Try to roll bandage up using one hand only on a thigh.
• The child sits at a table and tries to move their fingers as if playing fast music on a piano (you could play piano music while this is going on!).
• The child sits with the heels of the hands together and fingers curled, fingertips apart. The child tries to touch corresponding tips one at a time then progressing to touch as quickly as possible.  Repeat this with eyes closed.

Hand-Grasp Strengthening:

Hand and wrist strengthening is essential for development of the control of fine manipulative tasks. Try the following:

• Holding onto the ropes of a swing while it is swinging.
• Playing “tug of war.”
• Using scissors to cut through different densities of paper/card.
• Spraying with a trigger type spray bottle.
• Kneading, poking, rolling playdough/pastry.
• Cutting round shapes, letters in playdough/pastry.

Pinch and Pincer Grip:

Developing isolation of finger movements with opposition to the thumb is an important prerequisite for pencil control and other fine motor tasks.  When encouraging/practicing a pincer grasp it is essential to encourage the child to pinch using the tips of the index finger and thumb, so that the thumb and index finger are curved to create a circle shape i.e. the index finger and thumb should not be straight.

These activities should help to develop pincer skills:

• Tearing paper for collages.
• Roll torn tissue paper into small balls then stick onto paper/cared to make collages.
• Picking up small objects such as counters/pennies/beans etc. and placing in jars/containers.
• Popping bubble wrap.
• Threading – using threading cards.
• Playing with an old telephone with a dial; pressing cassette recorder buttons etc.

Dexterity and Use of Tools:

A tool is only as accurate as the hands and fingers that control it. Try the following to help with the use of tools:

• Wrapping a pencil with putty or playdough may help to relax a tense grip.
• Provide opportunities to use a variety of tools.
• Art projects requiring less precise use of pencils and crayons.
• Adult sized pencils and crayons may be easier for little fingers to control.
• Drawing around each other on the floor.

Co-ordination difficulties and handwriting skills

Handwriting is an important skill for school aged children, as it is one of the key ways that they are expected to express their thoughts, ideas and knowledge. Research has shown that children who can write well perform at a higher academic level.

Unfortunately, children who have a range of difficulties often have difficulty with handwriting. They can appear lazy and unmotivated but this can be because they regularly experience failure and frustration. Going back a few steps to work on the foundation skills for handwriting can often make a big difference.  For children in the Early Years, building opportunities to acquire these skills – as part of the Early Years curriculum – will ensure the best possible start with literacy skills and avoid or reduce barriers to progress.

The foundations of good handwriting

Each of the following is key to helping children develop the foundation skills needed for learning to write. Working on these areas, either with children in the Early Years, or older children who are lagging behind with handwriting, is likely to be helpful.  Within the toolkit, there are also additional activity ideas that can help support development of these key areas and enable independence with this functional skill.

Body awareness

Body awareness is an appreciation of our body position in space.  Just as our eyes and ears send information about what we see and hear to the brain, our muscles and joints sense the position of our body and send these messages to the brain.  This information enables you to know exactly where your body parts are and how to plan your movements.

Some children may not get as much feedback from their muscles and joints as they need when they sit still – so they constantly fidget and change position. This can affect the quality and speed of their handwriting.

Upper body strength

Upper body strength and stability is needed to enable a child to maintain an upright posture for handwriting.   Without it, children can feel uncomfortable and restless and have a tendency to slump on the desk – which makes it hard to write.

Shoulder stability

Good upper body stability is really important. It means that all the muscles around the shoulders are working well together so that the child can control the fine movements needed for making letters, apply the right level of pressure and move from left to right across the page with ease.

Hand/eye co-ordination

This is the movements of the hand that are directed by the eyes.

Activities to develop hand eye coordination

• Roll and throw large sized balls. Roll left to right to track and stop.
• Play balloon volley ball, scarf toss and catch
• Pop bubbles
• Draw and scribble
• Colour simple shapes, use paints, magic water books
• Water play use various containers
• Play ‘Simple Simon says’
• Directionality games, up down, back and forth, front and back, left and right.
• Action rhymes/songs. Wheels on the bus, music man.

Hand skills

Hand skills refer to the hand strength and dexterity in our hands; both depend on how we use the small muscles in our hands. However, we also need muscles in our arms and shoulders to provide strength and stability to coordinate movements to do things such as holding a pencil, using scissors, managing buttons, handling coins and using cutlery.

Useful activities to practice hand skills are:

• Lace beads or use easy lacing cards.
• Peg boards
• Rubber bands place over a jar.
• Unzip a purse and put pennies into a piggy bank.
• Use tongs and tweezers to pick up items.
• Use scissors
• Construction toys
• Paint with cotton buds
• Dough, pastry, pizza.
• Crafts
• Colouring
• Sand or flour writing
• Sort small items- paper clips, buttons, coins, pasta shapes.
• Keyboard use
• Sign language

Sensory skills

Sensory skills are important for handwriting as they tell our brain what we feel, how we move and where our hands are when we do a task. The brain must coordinate these sensations with what we see so we can adjust our muscle control and coordination. Imagine if you were wearing thick gloves and goggles to do your written work; you would find coordination of movements difficult and fluency of movement would be interrupted. Children need to receive accurate sensory information when developing pre writing skills.

Ideas for helping children develop their sensory skills:

• Allow “movement breaks” little and often, where the child has the opportunity for moving around their environment and participating in an activity of their interest.
• ‘Pan for gold’ – hide pennies, beads or other small objects in dough, sand or rice tubs for the child to find.
• Draw shapes and lines on sand paper or carpet squares. Shaving foam sand, peas. Use chalk outdoors. Draw shapes in the air.
• Sing and Dance.
• Feely bag – identify everyday objects by touch only.
• Increased opportunity every day for as much physical activity in a task of interest to the child.

Pre-writing skills

All too often children are given writing tools before they are ready to use them.  Young children use their hands to explore and learn about the environment and themselves.  Developing good hand skills will prepare the child to take the next steps to mark making and writing including children who are older and find writing difficult.

Before letter formation can begin, children need to be able to draw pre-writing shapes (see Appendix 3).  Initially, these will be imitated and then the child will learn how to copy prior to being able to reproduce them from memory.  The child can then develop the ability to join these shapes together to write letters, i.e. vertical lines and a circle for writing letters ‘b’, ‘d’, ‘p’.

Pre-writing activities – no pencils required!

• Make lines, shapes letters by: finger painting (in sand, paint, squirty cream or shaving foam); painting with water outdoors; drawing on walls/pavement with chalk.
• Play shape and letter matching or recognition games.
• Play with puzzles, magnetic letters.
• Use dough and pastry to make shapes and letters.
• Draw tracks/shapes on a wall with chalk and encourage the child to run a car along them.
• Walk on straight, curved, diagonal lines e.g. on a taped or string line. So the same with shapes.
• Encourage the chid to draw over the top of previously drawn lines, then draw lines/shapes that you have drawn, then finally ask them to copy lines/shapes that have been drawn without the child seeing the drawing being done.
• Relate shapes to real life objects e.g. the wheels on the car are a circle.
• Draw around everyday objects e.g. a round yoghurt pot; a square box.
• Dot-to-dot pictures.
• Encourage an awareness of where shapes begin and end by getting the child to feel around objects (e.g. an orange is round; a Lego brick is square); encourage colouring in shapes/pictures staying inside the lines.

Classroom strategies to help the children succeed in handwriting

• Positioning for deskwork:

Ensure the child is positioned properly for deskwork. Tuck seats in under the desk. Make sure the child’s feet are flat on the floor (a foot block/step may be necessary) and that the desk is at an appropriate height to enable the child to relax their shoulders and have their forearms comfortably supported on the desk. If the child frequently moves on their seat use a Move ‘n’ Sit cushion to provide proprioception feedback (N.B. A Move ‘n’ Sit cushion should not be used for longer than 20-30 minutes at a time). Consider if the child is more productive standing to work at a desk, lying down over a wedge cushion or do they benefit from a regular change of position?

•  Hand strengthening

Warm up the muscles in the hand prior to engaging in handwriting if possible.  Include hand strengthening activities such as ‘hands up for handwriting’ activities – dough and construction toys also assist the child to become more able to use their hands effectively. A good awareness of the sense of touch is important in learning to use the hands to hold tools such as pens and pencils.

• Holding a pencil

A ‘dynamic tripod grasp’ is accepted as the most efficient way to hold a writing implement for maximum endurance and writing legibility.  Inefficient/immature pencil/pen grasps can result in pain/discomfort and decreased writing speed and legibility.  Developing hand strength and a good pincer grasp (with an open web space) will help a child to use a dynamic tripod grasp.  Pencils grips such as the ‘ultra’ pencil grip and ‘cross guard’ pencil grip are useful to assist the child with placing their fingers on the pencil shaft appropriately.

• Short term goals

Set goals which are achievable to enable work to be completed and maintain motivation. Be clear with the child about the purpose of the lesson and focus on this.  Therefore, if a creative story is the goal then accept messy handwriting, uneven spacing and multiple erasures. If the goal is to set out a maths problem correctly, allow time to complete this even though the maths problem is not solved.

• Paper

Use paper that matches the child’s handwriting abilities, for example:

• Widely spaced line for a child who writes with large lettering.
• Raised lined paper for a child who has trouble writing within lines.
• Graph paper for a child whose writing is too large and improperly spaced.
• Graph paper with large squares for a child who has trouble keeping numbers aligned in maths.

• Copying

Copying can be difficult either because when the child lifts their head to look at the board, other visual distractions appear or they struggle with their eye co-ordination, reducing focus on the task. If copying from a book or a white board, the child can lose where they are up to quite easily. 

To help with copying …

• Seat the child opposite the desk/whiteboard to reduce head movements.
• Use an angled writing board to reduce inverting of the child’s head which some children can find difficult.
• Provide prepared worksheets to reduce the demands of copying from the whiteboard. Consider the font and size of the print – which will they find easiest?
• Prepare printed questions or ‘fill in the blanks’ for the child to use to demonstrate their knowledge and reduce the demands of handwriting.
• Take time to teach the child strategies to copy such as returning to the right place in the work being copied by sliding along a ruler or post-it note or use a place finder (these are marketed for this purpose).

• Letter formation

Opportunities to practice letter formation at home and school are essential to assist the child’s learning through repetition.

• Encourage letter formation in a consistent manner. It is important that school and home work together to ensure a united and consistent approach.
• Practicing little and often (e.g. 10 minutes per day) is much better than practicing for an hour per week.
• Remember to practice pencil control and letter formation to develop pre-writing skills (see above) rather than just repeatedly practicing letters e.g. use multi-sensory activities, i.e. drawing letters in shaving foam, sand, finger paints.
• Modelling – show the child how it is done, repeat the movements over and over again, and provide physical guidance so they can feel how to perform the necessary movements.
• Give the child opportunities to imitate you instead of copying from a book.
• Practice groups of letters that use similar component shapes e.g. [d, g, q, a, c] or [h, n, m] or [p, b].

• Different ways to demonstrate learning

Consider providing the child with different ways to show what they know. For example, presenting a report verbally; using drawings to illustrate their thoughts; typing a story or report on the computer; recording a story or exam on a recorder; using a scribe.

• Computers

Introduce computers as soon as possible to reduce the handwriting demands that will be required to attain higher grades. Although using a keyboard will be difficult initially children with various difficulties can often develop skills, and become proficient, in using a keyboard. ‘BBC Dance mat two handed key board programme’ assists in developing key boards skills to increase speed and attainment in all areas as a long term goal.

• Extra time

Provide the child with extra time to complete fine motor tasks such as maths, writing a story, practical science and art work. If speed is necessary be willing to accept a less accurate product. The ‘Speed up’ handwriting programme by Lois Addy may be appropriate to consider when supporting the child to increase fluency/speed of handwriting.

• Exams

Provide extra time and/or computer access for tests that require a lot of written output.

• Support

Ensure that the child is able to communicate that they require support and that it is readily available. A coloured card, with one side green and the other red, may assist the child if they are struggling and assistance is required – they can simply turning the card to the red side when they require assistance. 

Left Handedness

Many left handed children develop awkward pencil grasps to assist them to see their work as they move along the page but this interferes with the smooth control of the arm and finger movements; this is why printing is often easier for left handed children than cursive writing. Smearing of written work can also occur during writing with a pen and this requires sensitive understanding as generally all children aim to please and succeed.

The child should grip their pen/pencil, using a dynamic tripod grasp, between 3-5cm from the tip to allow them to see clearly what they are writing and to avoid smudging the writing.  This should also help the child to avoid developing an awkward grasp.

Position the child’s paper with the right side of the paper in midline and allowing the child’s left forearm to rest on the paper. The child’s elbow on the paper should allow an arc without crossing the midline. This paper positioning allows the child to see what they are writing. Additionally, slant the paper 45 degrees so that they can see, more easily, what they are writing.  This position means that the left-handed writer is more likely to require more space to their left and this should be taken into consideration when arranging/allocating seating places in the classroom.

Reduced written requirements are often helpful to maintain motivation.

It is important that the pen has ink that flows easily (or the pencil has a soft lead).  Left-handed writers can tend to grasp their pen very tightly and push it across the page.  Ink that flows easily should mean that they do not have to push down hard through the pen/pencil and should therefore be more relaxed when writing.

Provide left handed scissors. However, it may be that the child writes with their left hand but is happy to use standard scissors using their right hand in which case no assistance will be required, unless accuracy is clearly better with the use of left handed scissors.

Learning to use scissors provides an opportunity to improve upper body stability, get both sides of the body working together, and improve fine motor skills and visual perceptual skills.

It is important to ensure that the child is positioned correctly with the appropriate height table and chair.  This will have an impact on the child’s level of ability and control when attempting cutting out activities.

Learning to cut with scissors is a skill learnt in stages. There are some skills that need to be in place before the child is ready to master this skill. It is really important to check whether the child can do the following:

Open and close their hand

Certain arm and hand movement patterns are required for a child to be ready to learn to use scissors successfully.  The child must have the ability to open and close their hand at will and to easily grasp and let go of objects.

Use their hands together – one hand leading and one hand helping

The child must be able to use one hand (assistor hand) to stabilise the paper while the other hand (leader hand) manipulates the scissors to cut.

Move their thumb, index and middle fingers separately and together

The child needs to be able to place individual fingers in the scissor loops, and isolate the movement of the thumb, middle and index fingers.  The child must be able to move these fingers separately as well as in a co-ordinated fashion to manipulate the scissors.

Co-ordinate their arm, hand and eye movements

The child must be able to co-ordinate the movements of their arms, hands and eyes to get them all working together to manage the task.

Keep their upper body stable and balanced

The child needs to be able to keep their upper body balanced and stable whilst they move their arms and hands (not slouched or slipping off the chair). Making sure they have a good sitting position can really help with this.

Be at the stage of ‘constructive’ play

This is the stage when children like putting objects together, attending to detail, and are aware that ‘whole’ objects have parts. They are beginning to understand how objects relate to each other and have an awareness of different sizes, shapes, and colour.

Children must be at this stage before they are ready to start learning to use scissors.

Some children may still be at the ‘destructive’ play stage – when they mouth, drop, throw, shake or bang toys in order to learn about the toy and their own skills and abilities. These children are simply not ready to start using scissors.

Before beginning any activities requiring use of scissors it is essential to have the right equipment and environment to support the child/young person in developing their scissor skills:

• Ensure child is positioned appropriately at the correct height of table and chair, so that they are able to pull the chair into the table with both feet flat on the floor (a step maybe required to facilitate this), bottom placed into the back of the chair and forearms resting on the surface of the table. This enables the child to have a good base of support providing stability and supporting the natural curves of their spine.  This good positioning enables a child to also experience improved attention and concentration to task and participate to the best of their ability.
• Ensure the child has upper limbs weight bearing through surface of table; this provides stability and enables them to participate in the activity to the best of their ability.
• Ensure right/left handed scissors are available. Specialist scissors are available to assist with development of skills.
• Ensure scissors are not blunt, have rounded ends and are 150mm long.
• Begin activities with 2cm or 4cm wide strips of paper – this enables the child to achieve at the task by snipping with scissors. As they are able, increase width of paper.
• Use reinforced paper or card – rigidity facilitates manipulation of the paper.

Stages of Developmental Scissor Use

The ability to use scissors follows a developmental pattern. Try observing the child you are working with to see which stage they are functioning at. Below, there is a description of each stage and some ideas for how to move them on to the next.

Stage 1

What the child can do

• Tears paper into strips
• Interested in scissors – brings the scissors to the paper and pretends to cut – but doesn’t hold them the right way

How to help the child move to the next stage

• Squeezing empty plastic bottles in water to make bubbles, or to blow air at feathers or ping pong balls across a table.
• Finger or glove puppets.
• Hand and finger rhymes , e.g. ‘Incey Wincey Spider,’ ‘Peter Pointer,’ Two little dicky birds.’
• Modelling clay/play dough – rolling and pinching.
• Squeaky toys.
• Tearing up paper to make papier maché/collages.

Stage 2

What the child can do

• Holds the scissors the right way but not using them yet

How to help the child move to the next stage

• Enable child to stabilise wrist/arms on the table.
• Encourage thumb to be positioned on top of paper and scissor blades at 90° to page.
• Provide hand over hand support, if needed to facilitate and establish consistency.

Stage 3

What the child can do

• Holds the scissors the right way and can open / close them in a controlled fashion

How to help the child move to the next stage

• Allow child opportunity to cut different textures of paper/fabric etc.
• Cutting rolls of clay/playdough.
• Cutting cotton wool balls – paste onto snowman, lamb outlines

Stage 4

What the child can do

• Can use the scissors to cut random strips

How to help the child move to the next stage

• Start with short, thick lines to cut along and move to long thin ones.
• Start with cutting out large pictures and then move to smaller ones.
• Start with cutting down lines which are wide apart from each other, and then try ones closer together.
• Cutting paper/fabric for collage.
• Cutting newspaper for papier maché.
• Cutting string for outlines of picture, friendship bracelets.
• Cutting small pieces of leaves to stick on a picture of a tree.
• Cut up streamer or strips of paper to make paper chains.
• Cut strips of paper to make lion’s mane, spikes on hedgehog.
• Cut up plastic straws for a necklace.

Stage 5

What the child can do

• Tries to cut forwards and has a goal in mind.

How to help the child move to the next stage

• Increase the length of line to be cut, i.e. start with piece of paper approx. 1cm wide gradually increase width of strip of paper as child able to achieve goal.

Stage 6

What the child can do

• Can cut left to right.

How to help the child move to the next stage

• Encourage child to turn the paper for correct orientation.

Stage 7

What the child can do

• Can cut a straight forward line.

How to help the child move to the next stage

• Glue cardboard/lollipop sticks/sandpaper strips each side as a guide to cut between.
• Make Chinese lanterns.
• Cut crayons – place between waxed paper, cover with newspaper, iron and hang on window.
• Cut leather strips for plaiting.

Stage 8

What the child can do

• Can cut out a simple geometric shape.

How to help the child move to the next stage

• Cut along the lines of a printed shape.
• Cut out shapes/stickers.

Stage 9

What the child can do

• Can cut a simple shape out from a background.

How to help the child move to the next stage

• Cut from hole to hole, picture to picture.
• Medallions/Christmas decorations.
• Cut out a picture and mount onto cardboard locket for necklace.
• Start by drawing geometric shapes around pictures to be cut out.
• Cut out pieces for collage i.e. circles for flowers/chickens.

Stage 10

What the child can do

• Can cut out a complex shape from a background.

How to help the child move to the next stage

• Make jigsaw puzzles – using magazine pictures pasted onto cardboard.
• Paper dolls – cut out clothes.
• Cut out curves and make letters.
• Trace around stencils, cut out and copy design.
• Cut around edge of paper to make a long snake.
• Snowflakes – fold paper and cut/snip off chunks.

Stage 11

What the child can do

• Can cut non-paper materials.

How to help the child move to the next stage

• Cutting rolls of clay/playdough.
• Cutting cotton wool balls – paste onto snowman, lamb outlines.
• Cut up plastic straws then thread them on a string to make a necklace.
• Cut crayons; place between waxed paper; cover with newspaper; iron and hang in the window.
• Cut leather strips for plaiting.

Most children want to become independent and look after themselves as they get older – and will get satisfaction from being able to do the following without help:

• Cut up their own food.
• Get dressed themselves.
• Tie their own shoe laces.
• Clean their own teeth.
• Toileting hygiene.

In order to become independent in these activities, some basic skills need to be in place. For example, when putting on a pair of trousers a child needs to:

• Be positioned correctly.
• Have good body awareness. understand where their legs are to place the garment on and where their arms are to be able to hold the garment.
• Have good balance to be able to place one leg into the garment at a time and then be able to stand (gross motor) to pull the trousers up.
• Fine motor skills to be able to manipulate the button and/or zip on the trousers.

Usually, children will develop these skills naturally as they mature – but children with various difficulties are more likely to need extra support.  However, there are strategies that can help the child to develop their confidence in these skill areas.  It can make a huge impact on a child’s self-esteem to master these everyday activities.

Dressing

Whatever you are targeting, it is useful to remember the following:

• Success is important as this will improve the child’s motivation to participate. Focusing on one area of dressing may be better, i.e. when getting changed for PE a child’s target may be ‘to be able to remove their polo shirt independently’ and then build on this. Give lots of positive and specific feedback.
• Ensure the child is positioned appropriately, i.e. when practising putting clothes on, it may be appropriate for the child to begin the activity sitting down. The child could either sit on a chair or on the floor with their back supported by a wall when pulling trousers/socks on.  This allows the child/young person to have an increased base of support and is more likely to be successful in building their independence skills.
• To start off with, help the child until you get to the last part of the task – and then let them finish it off on their own. This technique is also known as backward chaining and helps to ensure that the child experiences a sense of achievement for completing a task.   For example, when putting on socks place the child’s socks over their toes and ankle and then encourage child to pull the sock up their leg.
• Allow enough time for the child to practice the task without being rushed. Can you build in extra time? E.g. give them a 5 minute head start when getting changed for PE?
• Help them to organise clothing before PE, for example laying out clothes on a table or the floor in the correct sequence and ensure that clothing is placed the correct way i.e. not inside out.
• Try not to watch “all the time” – the child may do more when left alone.
• Develop dressing skills through play with dressing/undressing teddies/dolls. Use play or visual stories to show the sequence of clothing. Learning through play may provide them with the confidence to try for themselves when getting dressed/undressed.
• If a child finds fastenings particularly difficult, participation in activities which work on both sides of the body working in harmony, fine motor skills, hand eye co-ordination and hand/finger strength will be beneficial.

Feeding

All children will go through developmental stages in developing their independence with feeding.  Initially being dependent on an adult; then using their hands for picking up food to finger feed and being fed with a spoon; next they will move on to feeding themselves with a spoon; followed by using a fork to spear food; and eventually learning to use a knife and fork together.

Mealtimes bring a range of different skills into play. For example, being able to use a spoon requires:

• Good sitting balance (gross motor).
• Being able to grasp the spoon (fine motor).
• Loading the spoon and bringing it to the mouth (body awareness, hand-eye co-ordination).

Helpful hints

Ensure that the child is sat at an appropriate height table and chair thereby enabling the child to participate to the best of their ability and aid digestion.

• Encourage the development of mealtime skills through play, i.e. feeding dolls/toys; make play food using play-dough and practice cutting it up with a knife and fork.
• Using fork/knife to stab/cut soft foods, such as banana during snack preparation.
• Non-slip matting placed under plates/bowls may help by preventing the plate/bowl from moving whilst attempting to cut/load food.

Toileting

Some children have difficulties with being able to manage independence during toileting.  This may be due to the following challenges:

• Accessing the toilet – are they able to manoeuvre themselves in and out of the toilet cubicle and sit/stand from toilet?
• Maintaining balance whilst sitting on the toilet – if the child is unable to place their feet flat on the floor, this could impact on balance whilst sat on the toilet – particularly when twisting to clean themselves. Use of a step would assist with increasing the base of support and balance.
• Manage clothing during toileting – are they able to pull their clothing down/up and manage fastenings on clothing? Activities within the dressing section can help with this.  These skills could be practiced when getting changed before and after PE.
• Cleaning themselves after toileting – are they able to manipulate the toilet paper; have adequate amount of toilet paper; and be able to complete the wiping sequence? Activities within fine motor skills such as hand strength and dexterity can help to develop skills for wiping.
• Hand hygiene routines after toileting – are they able to access the sink; press down taps and soap dispenser; access hand towels or dryer? Using a visual timetable may assist with sequencing.

• Appendix 1 – Characteristics of a child with coordination difficulties [PDF, 137Kb]
• Appendix 2  – Ready to write checklist [PDF, 162Kb]
• Appendix 3 – Pre-writing shapes [PDF, 146Kb]
• Appendix 4 – Hands up for writing [PDF, 189Kb]
• Appendix 5 – Information gathering: parent questionnaire [PDF, 750Kb]
• Appendix 6 – Information gathering: child questionnaire [PDF, 514Kb]
• Appendix 7 – Toolkit checklist [PDF, 197Kb]
• Appendix 8- Children’s Therapy referral form [PDF, 124Kb]

• Resources [PDF, 93Kb]

• References [PDF, 216Kb]