XYs learning their ABC’s with OT

by Julia Malakoff

A worksheet was sent home from my son’s school with a note from the teacher. Please have your son practice his letters every day. I remember shaking my head in confusion. My son, who was in first grade at the time, had attended three years of preschool and completed public kindergarten. We had arduously reviewed writing the alphabet, using dot to dots, coloring books and tracing letters. I had spent countless hours of one on one time with him, for he was the fortunate oldest child who had my divine attention.  In fact, in my opinion, at the time, he seemed on course and I truly did not realize that he was struggling with his handwriting at school.

We continued to practice, but, my son’s frustrations grew in the classroom.  It was then that I was introduced to the occupational therapy. My first son was finally diagnosed with dysgraphia, by the school’s occupational therapist. Dysgraphia is a learning disability that affects handwriting. The school’s occupational therapist kindly took it upon herself to work with my son at his desk. She fitted his pencils with rubbery wedges, in colorful and zany shapes.  These wedges helped secure my son’s pencil grip and she replaced his worksheets with pre-printed paper that had horizontal lines with a cloud at the top and grass at the bottom. Put your pencil at the top of the cloud, she guided him and draw a straight line down to the grass. This simple and yet effective visual approach started to bring a sense of fun into my son’s difficulties with handwriting. She then told him to use a variety of writing utensils at home, including pens, crayons and markers. Write all of your letters in different colors-use your fingers to paint your letters in pudding, in rice and in sand. Learn to feel the letters with your finger. I took these suggestions to the grocery store where we invested in canned icing, flour and Jello. Food seemed to be an easy way to practice writing letters, in fact, it was a finger licking good way to learn, agreed my son.

Moving away from food play and to more serious worksheets was a struggle. It was suggested that on-going sessions of occupational therapy would be beneficial and so we found ourselves driving out to Fairfax Hospital each week to their Rehabilitative Services Department. My first son’s OT experience was very structured. Most of his session took place in a little room with a desk where he would practice drawing and writing lines and curves and eventually working his way up to sentences. It was a painful experience, for both of us, for he was frustrated at himself for not being able to write neatly and I was exhausted dragging him week after week, tempers a flare. Once my oldest son was discharged from OT, my second son unfortunately seemed to be showing similar frustrations in preschool.

Son number two started his own OT sessions and once assessed, he was found to have low tone issues which challenged his muscle strength and flexibility. As I learn more about the therapeutic process of occupational therapy, I am reminded that everything is connected: muscles, bones and the mental process of coordination. Many children find themselves in a category that includes low tone muscles and low motor planning. Obviously early intervention can’t change our bodies’ genetic make-up, but, it can help tailor the growth and development, moving towards a stronger and more flexible person that allows for a more active lifestyle.

Occupational therapists of today should be proud of how they have helped modern society. A profession which started as a way to rehabilitate injured or very sick patients needing to re-learn their daily living skills has evolved to a profession where it can also act as an early intervention for children with developmental delays in: visual motor skills, fine motor skills, sensory and organizational skills. Occupational Therapy can now be used to help alleviate a frustrated child who is having difficulties in the early learning process. Son number two was assigned a new therapist and she was younger, filled with more energy and a lot of enthusiasm. Son number two lucked out in having Ms. Lara Jackle as his personal therapist, who states that “the most essential aspect of OT, in my mind is using activities that are child-directed and motivating to the child, in order to inspire them to reach their full potential.”

It was evident that Lora Jackle, being young herself, (a mere 22 years old) when we first met her, not only had a passion for her profession, but an appreciation for children. Rehabilitative Services in Fairfax Hospital is located on the first floor where they have a large therapy room for adults and a smaller gym for children. Son number two started in the gym which was filled with colored balls of all sizes, including a ball pit which satisfies a child’s need to bounce. After twenty to thirty minutes of expending anxious energy, swinging, rolling, and jumping, we would move into a more academic room with ABC murals a small child’s desk and shelves filled with activity books and arts and craft materials.  Lora would pick out an age appropriate project, designed to promote eye-hand coordination, motor-planning, and handwriting.

During OT sessions with son number two, his toddler aged female sibling would accompany us. Thankfully, she showed no signs of handwriting or low-tone issues, however, at this point in time, I became pregnant again. Like all of my pregnancies, we never did find out the sex. Upon son number two’s discharge, I happened to mutter under my breath, “If this is a boy, we’ll be seeing you in a few years.” I don’t know why, but there does seem to be a larger pool of boys who seem to struggle with handwriting and low tone issues. In fact, my husband has agreed that he himself would have benefited from O.T. early intervention, for he has troubled handwriting, had been active in crew and found his calves and thigh muscles extremely tight. And now, in his mid- forties, he has experienced back problems which could have been somewhat prevented if he had been introduced to the low tone exercises at an earlier age.

Five years later I dialed the number for Fairfax Hospital’s Department of Rehabilatative Services. I left a voice mail message for Lora Jackle who called me back laughing. “You certainly kept your promise,” she chimed, “I would be glad to treat son number three!”

Son number three decided to fall neatly into the footsteps of his brothers with similar low-tone issues and early signs of dysgraphia. Fairfax Hospital’s Rehabilitative Services was recently awarded a grant that allowed them to purchase more sophisticated therapeutic gym equipment. Son number three had a multitude of swing choices including a hammock swing, which every time I saw my son curled in the fetal position and gently rocked, I too felt the urge to slide right next to him, and take a much deserved calming nap. There was also a tube swing, which we refer to as the soda can, a ladder swing and a swing that reminds one of a circus or jester’s hat with its red and blue swirled cone shape. “Your choice”, Ms. Jackle would tell my youngest son and he would pick a swing, and start to formulate his own obstacle course extending the routine to include balls, mats and a trampoline. This is the genius behind Ms. Jackle’s approach. She has the ability to gain her patients respect by giving them a sense of control over their session. Her patients become young assistant OTs aiding in the creative process of their own personal therapy. Ms. Jackle strategically adjusts each exercise to make it suitable for the patient’s own goals by adding in letter recognition including games such as jigsaw puzzles, chalk writing puzzles, alphabet blocks and a collection of wooden pieces consisting of straight lines and curves. Before starting the physical part of the obstacle course, the patient is asked to pick an alphabet block, say the letter and then climb on a swing. The patient swings over, Cirque de Soleil style, to the next station, where he will draw the letter on the chalk board, roll down a mat and then construct the letter using the collection of wooden pieces.

My older sons have since learned to type. They eventually figured out their own styles of handwriting, although son number one is still quite sensitive about his struggles with the hand written word. To this day he avoids handwriting and prefers to communicate via text, email, Facebook and Skype. But, he is also now thirteen, partaking in the typical teenage technical communication modes. Son number two has turned dysgraphia into an art form. He was never embarrassed by his handwriting and in fact he has practiced writing his name in so many different block and bubble formats that he has developed a knack for graphic design. Son number three has started to recognize and write his letters and seems prepared to tackle kindergarten.  Five years later, Ms. Jackle, still young and enthusiastic, uses her superhero approach to teaching children how to fly through the air and still learn to write their ABCs, keeping it fun, with OT.