The other day I received an e-mail from a teacher that I adore. She is now teaching English as a Second Language to students in my district. She had the above student and was very concerned about his wrist strength/ writing etc. This was her e-mail……
“Hello my OT friend!
> I have a kinder friend who lays his hand on the surface to write (even when I use my easel, although that is better than flat on a table- see attached picture). He does better when the paper is taped to the wall. Do you have a handout I can give his teacher on other activities to help with this? Is this a wrist strength thing?”
> Thanks for any suggestions!”
And this was my response……
“Good to hear from you.
That is interesting, I have actually not seen a kid do that positioning at the board. I would say you are on the right track, that it is probably a wrist extension weakness issue. So easel is a good idea. I would also try using a large 3 ring binder turned like a slant board, on the table for writing, to see if that helps him.
Cleaning/ wiping down tables/ boards/ walls is one idea to work the wrist. Doing things on the vertical (like you are doing on an easel) is another idea. So putting magnet letters on the board, those sticky door decorations things on the wall/ door. Carrying a “heavy” bag by the handle, or a crate or box etc but not next to his body but away from his body so he is not getting support at his body. Wheelbarrow walking, crab walking, down dog walking
I do not have a hand out but you can forward her these ideas.”
But then that got me thinking, I should turn this into a blog post to help others. So let me “dissect” the above e-mail a little more.
1. Slant Board for writing
You can actually order “slant boards”. They are often used with kids that show wrist or hand strength issues. They bring the table surface up to the child at an angle that is easier for them to work at. The ones that you order are very firm and stable. You can also use a 3″ or more three-ring binder. Turn this binder so the ring part would be at the top. Put the writing paper on the binder so the top of the paper is at the highest point on the binder. When kids are weak in their wrists this slant/ angel gives them more support at their wrist for written tasks.
2. Working on the Vertical
The vertical basically means something that goes up and down rather than across like a table. Vertical surface would be like an easel, a mirror on the wall, a dry erase classroom board, a door, or the wall. I love for kids to clean these surfaces with a rag, a cotton or puff ball, a small sponge etc. Use a water/ cleaning spray bottle too for additional strengthening. Putting those gel stickers on and off the door is another idea. Magnet letters or magnet designs are another thing I love to use on these surfaces. Of course writing and drawing on these surfaces are a favorite. Working on the vertical really forces the shoulder and wrist muscles to work more and at a better position. It may make them tired quicker and should not be used as a place to always do work but a place to build their muscle strength.
3. Gross Motor Strengthening Tasks
Any gross motor activity that makes that wrist extend back is excellent to work the wrist muscles. I love wheelbarrow and crab walking. Carrying those plastic milk cart boxes, lunch trays, or baking sheets with something heavy in or on them is great. I also like to have kids push a heavy cart to work shoulder and wrist muscles. My kids almost always ride a large scooter board to OT, laying on their stomach and pushing with only their arms to move the board. There are a lot of yoga poses that work these muscles too, such as: Down Dog, Plank, Table Top (on hands and knees in normal “crawling position” or reverse the table so stomach and head are facing up to ceiling), Cat/ Cow. In these positions, you can also have a child lift one hand out in front or lift a leg and hold for as many seconds as they can. That works core muscles and arm muscles. Also crawling with something being held in the hand forces wrist extension and development of the hand arches (the size of a small ball/ ping pong ball).
4. Fine Motor Strengthening Tasks
Flipping cards, coins, or items on the table top surface forces wrist extension. Pulling velcro items off of a velcro board on the table. Getting stickers off of a sticker sheet. Pushing buttons or novelty designed erasers into a tight plastic slit in a container. Crumbling paper into balls.
The pictures below also give another example of a student showing wrist weakness. When he goes to cut on his own, in the first picture, his wrist is bent forward (flexed). In the second picture, I have corrected him, by making him shift his hand back/ wrist extension. However, for him to cut for a long time, in this correct posture, I do help hold his hand in this posture when his muscles start to really struggle. However, this is a sign that this student needs to work on wrist strength tasks.