Microsoft Word - First School
Microsoft Word - First School
CONTENTS
Page no.
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52 54
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59 68
69 70
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PURPOSE OF PACK
As part of our work within Northumberland Childrens Occupational
Therapy we have developed a resource pack for parents and
those working with children in school. The aim is to help identify
why the child is having difficulty with a particular activity and to
provide some ideas on how to deal with them.
The pack has been set out so you can find the area of difficulty
(e.g. handwriting) and look at the questions to find the most
relevant sheets (e.g. child unable to form letters correctly).
If after using the advice provided in the pack the child still
continues to find tasks hard it may be appropriate for the child to
be referred to the occupational therapy department. The strategies
you try can then be used as part of the referral. We have also
included a suggested format of how to log the strategies that have
been tried. Please see page 58.
Please feel free to contact us if you have any questions,
comments or suggestions about the pack. We would be grateful if
you could use the feedback form (page 69) when you use the
pack, this would help us to make any necessary improvements.
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36
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21 - 31
32
32
12
39
40
56
41
42
33 - 34
36
37
38
12
43
Scissor skills
44 47
Hand dominance
Using two hands together
Crossing the midline
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37
38
51
37
35
girdle 33 - 34
Attention
56
General
advice
57
52
Buttons
Zips
Finger isolation
Pincer grip
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54
9
10
Cutlery
55
Finger isolation
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33 - 34
ADVICE SHEETS
1. FINGER ISOLATION
This is the ability to use one finger separately from the others,
particularly the index or pointing finger.
Pointing songs or games twinkle, twinkle little star, two little dickie birds
sitting on a wall or make up songs about two little birds and use index
finger and thumbs as the beaks of the birds singing.
Using fingers like tweezers to pick up objects, such as cotton wool, small
blocks, pasta pieces, raisins, frozen peas, berries.
Play with toys that have holes that need poking or probing.
Play with telephones, dialling with auditory feedback, using the index
finger when dialing
Finger painting encourage the child to use each finger but one at a time.
Encourage the child to point to things in books / pictures e.g. find the.
Encourage the child to turn the page in the book, by using his fingers
rather than his whole hand.
2. PINCER GRIP
Pincer grip is the ability to grasp small objects with thumb and
forefinger. It is an important part of the childs fine motor development,
and necessary for holding and manipulating a pencil.
Encourage the child to pick up small objects (toys, sweets etc.) with their
thumb and first finger rather than her whole hand, or thumb and middle
finger.
Encourage the child to form these fingers into a beak and pretend they
are a bird picking up seed to encourage and promote the idea of tucking
her other fingers away.
Clothes pegs opened with the thumb and index finger help to strengthen
pincer grip e.g. pegging out paintings to dry.
Making play dough into small shapes, pinching a play dough sausage with
thumb and first finger and flattening play dough balls into pancakes.
Pick small items e.g. buttons beads out of play dough with the thumb and
index finger.
Pop popping plastic with index finger and thumb.
While doing pincer grip activities place a small object (e.g. pencil grip /
piece of play dough/ a rubber) in the childs palm to be held in place by the
middle, index and little finger. This will help with pincer isolation i.e. only
using thumb and first finger.
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3. PENCIL GRIP
The most effective pencil grasp is the one shown, which allows the
fingers to move without using the wrist, or whole arm. This means that
less effort is used and writing can be more fluent. The forearm should
be resting on the desk for stability.
Put a sticker or band around pencil to show to hold it near the tip.
Place a grip on pencil to encourage a dynamic tripod grip (introduce
use slowly), or try using a triangular pencil.
Details for pencil grip and triangular pencils (see page 61-62)
Homecraft Rolyan
Nunn Brook Road, Huthwaite
Sutton in Ashfield
Nottinghamshire, NG17 2HU, UK
UK Customer Services,Tel: 08702 423 305
Fax: 08701 660 211
www.homecraft-rolyan.com
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Children need to be able to draw pre-writing shapes before they are able to
form letters correctly. We first learn to go up and down, then side-to-side
and then circles, then diagonals.
If a child cannot do these basic shapes then it is likely they will have
difficulties with forming letters and numbers.
l _ O / \
+x
Start with child imitating your movement so they learn how to make the
movement.
Start with large shapes e.g. in the air, on the white boards, floor or large
piece of paper. Once they are able to form the shapes correctly then it will
be easier for them to make the shapes smaller.
Visual:
Write or scribble on different kinds of paper e.g. - regular, sugar,
greaseproof, foil, and brown.
Use different tools e.g. paintbrush, chalk, crayons, markers, and
changeable markers or light up pen.
Use special colouring books in which the colour appears when children
paint with water.
Tactile:
Finger painting
Using painting or crayons on sandpaper, around shapes, on textured
surfaces.
Write in sand, salt, foam, mud, talcum powder etc.
Trace finger around shapes made of yarn, craft sticks or cut out of sand
paper.
Use magic pens to trace over shapes and the colour changes.
Sometimes put the paint or markers in the refrigerator before the activity to
change the temperature and lotion can be warmed in the microwave.
Olfactory:
The sense of smell can be incorporated into pre-writing tasks:
Try drawing with scented markers.
Add vanilla, mint, cherry flavourings to finger paints (be careful- the smell
may be too great that the child may want to taste the pain- use edible paint
only).
Add a few drops of bubble bath or scented oils to homemade finger paints
or use scented lotions to draw in.
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Auditory:
Pre-writing activities can even include an auditory component:
Use musical toothbrush to paint.
Attach bells to paintbrush.
Gustatory:
Even the sense of taste can be incorporated in pre-writing activities for young
children.
Draw on frosting on a cake to decorate it.
Try finger painting in whipping cream on a flat pan of gelatine.
Draw with cheese spread out on crackers.
Use liquorice to form letters.
Proprioception:
Proprioceptive media are those that stimulate joint muscle feedback. They
include activities in which there is increased weight or resistance to twohanded involvement with the pre-writing tool.
Weighted pen or paint with weighted toothbrush.
Vibrating pen.
Write on a childs back or hand and get them to guess what letter you have
drawn.
Use rolled up paper as a wand to write in the air with both hands.
Use a scarf as a streamer to make lines or circles in the air.
Vestibular:
Activities in which the child has to move and change positions also affect the
vestibular or balancing system:
Walk, run, skip, jump, knee walk - shapes on the floor, over string or rope,
with or without shoes.
Follow the leader to form letters, shapes.
Imitate shapes with the body or blindfolded.
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7. LETTER FORMATION
Provide a visual cue to help with the size and spacing of letters e.g.
lined paper, a margin to show where to start writing
Children often find it easier to learn letters shapes in groups. The Hand
Writing Without Tears resource book provides a technique of teaching
letters by similarity of formation. There is also a lot of information and
details of how to get the books on their web site: www.hwtears.com.
This way of learning letters can help to prevent reversals e.g. b and d.
Ask the child to describe how the letter is formed before they draw it.
You could get the child to correct a piece of work that you have written
e.g. with letters formed incorrectly, not on the line or with incorrect use
of capitals.
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Wall Presses: Stand a short distance away from the wall. Place hands flat at
shoulder height on the wall. Lean toward the wall, keeping feet in place. Stop
just before your nose touches the wall. Hold for 10 seconds, see how many
you can do - try 10 at first and then see if you can do 20!
Statues: Stand as still as a statue, get a helper to try and move you from your
position. Take it in turns and get the statue to move. Sit facing on a chair
and get to hold your thumbs with his arms out in front of him and elbows
slightly bent. One of you should be like a statue and see if you can move the
others arms and cause him to wobble.
Chair Presses: Whilst seated, putting hands on the side of the char and
pushing to lift you up off the chair. Hold for 5 seconds.
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Animal walks:
Bear Walks: Walking on all fours with legs as straight a possible, bottom in the
air
Crab walk: move from flat on you back, lift arms over head and push against
the floor till you body is up in the air and you look like a crab. (Body, head and
neck parallel to floor).
Walrus walk: lie on stomach on the floor and push body weight onto straight
arms, keeping legs straight and on the floor. See if you can move forward
walking on your hands with legs dragging behind you.
Everyday school tasks:
Moving heavy items such as stacking chairs, moving PE equipment,
carrying books, wiping the board, ringing the bell, holding door open etc.
Complete activities where you have to reach up e.g. wipe the black board;
paint a picture on paper stuck on the wall or put books away on high shelves.
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9. HAND DOMINANCE
Children develop hand dominance at around 3 5 years (but some times
later). Having hand dominance allows one hand to become the stabiliser
and one to be active, which is required to complete many tasks e.g.
handwriting or using scissors. To work out which hand is dominant ask
them to pick up a pencil (from the middle of a desk), ask them to open a
jar or ask which hand they brush their teeth with.
Encourage the child to use one hand as the stabiliser and the other and
the lead hand (e.g. left hand is the stabiliser if youre right handed).
If the child doesnt hold the paper still with one hand when writing cut
out a picture of a hand as a reminder for them.
Opening jars and containers, remind your child to hold the jar/container
very still with one hand whilst turning with the other hand.
Use stencils or rubbings, which the child has to hold very still with one
hand.
When using scissors encourage your child to rotate the paper with one
hand whilst cutting with the other hand.
Tasks that involve mixing (e.g. paint and glue or cooking) so the child
has to use one hand to stabilise bowl and the other to mix/beat.
Musical activities e.g. hold a drum with one hand and beating with the
other.
Collecting items (e.g. pencils, brushes) from around the classroom
hold the pot in one hand and pick up with the other.
Threading beads hold the string with one hand and pick up and thread
the beads with the other.
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Encourage the child to steady the paper with their right hand in the middle or
towards the right edge of the paper, not under the line where they are writing.
The left fore arm should remain parallel with the sides of the paper to prevent
development of a 'hooked' hand.
Check the child has left handed scissors for cutting.
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The hand dominance activities will also help (also see section 9).
Tearing paper and pasting it with glue to make a collage
Play with toys that need two hands, e.g. stickle bricks, Velcro fruit,
Duplo blocks
Use big toys that require two hands e.g. big balls, balloons, and big
teddy bear.
Use both hands during action songs e.g. head shoulders knees and
toes.
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Children need to be able to use their arms (and legs) and eyes across
their body (midline) e.g. to write across the page, read or use cutlery.
The midline is an imaginarily line drawn vertically diving the body into
two equal parts.
At the table
Encourage the child to use the same hand when drawing across the page /
board rather than swapping hands (e.g. hold the other one behind their back).
Position equipment / objects so the child has to cross the midline when
reaching.
Encourage the child to sit straight and not twist when drawing.
On a board or easel or large pieces of paper tacked to the wall, stand in
one place and draw right to left across the paper in large strokes, for example
Caging the lion or join the dogs lead to the owner.
Diagonally do the same thing drawing lines joining kite strings to hands.
These could include matching game (e.g. in maths or reading).
Large dot to dots on the wall (keep the pencil in one hand and get them to
stand still) so they have to cross their midline.
Activities e.g. in PE
Touching hands on knees on the same side of the body and then on the
opposite knee as quickly as possible 10x daily.
Throwing diagonally e.g. with the right hand to hit a target on the left.
Stepping-stones walk across the room on steeping stones (made out of
paper) placed so the child has to cross their legs.
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Use visual and verbal cues e.g. coloured lines to encourage the child to
place the letter in the correct place (see attached example):
____________________________
___Blue_________________________
___Green________________________
___Brown_________________________
Blue line symbolizes sky, green for grass, and brown for earth. E.g. for a p
start at the grass, go down to the earth and back up to the grass
This should give the idea of spacing and size of letters.
As the child improves you can just put coloured dots at the start of the
lines.
Eventually s/he may only need one thick straight line margin for a visual
cue:
E.g. _____________________________
If this is difficult use wood or clear glue to make a line as a guide. The glue
will provide a raised surface to give sensory feedback and help to write on
a line.
If the child is also having problems with forming the letters correctly it may
be hard for them also to think about where the letter should be placed. You
could use pictures to make learning more fun e.g. drawing the car or train
wheels along the track / road or drawing stalks from the flowers to the soil
(see attached sheets as examples).
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You could get the child to put a small sticker between the words.
Use and ice cream stick between each word the child could decorate and
individualise the stick.
Get the child to try and read a sentence where there are no spaces left
between the words so show why spaces are needed.
When the child has completed a body of work, get them to look through
and mark where they could have used more space between words.
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Play dough writing: flatten it on desk or table and use a pencil to write in it.
For those that press too hard, the letters and lines come out all torn up so
they get immediate feedback to lighten their pressure.
Writing on tin foil backed with cardboard encourage the child not to rip the
foil when they write.
Painting: using a soft bristled brush, have child paint lines of various
colours from left to right across paper. Encourage child to use consistent
pressure so that each line is the same width across the page (may need
lines to stay between drawn on paper). Also encourage child to only use
the tip of the brush.
Crayon rubbings: using template under paper, rub crayon over. If pressure
to great, paper will often rip.
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Use crayon rubbings - If too little pressure is used, the image does not
come through clearly onto paper. After achieving the perfect pressure
when watching, ask the child to maintain the same pressure with eyes
closed.
Get the child to rub wax over a square of paper and then turn it over onto
another piece of paper. Get the child to press hard onto the paper and draw
shapes so the wax leaves marks on the other piece of paper.
Try using a softer pencil; any artists supply store sells pencils in a range of
graphite density. The softer leads are B and the harder are H.
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Practice grasp and release, use kitchen tongs or tweezers to sort objects.
Shooting with a squirt gun or squirting water from a spray bottle
When cutting with the scissors the thumb should always be up so that the
child can see it (not pointing down towards the table). You can put a small
sticker on the top of their thumb and tell them they always need to be able
to see the sticker.
Remember to keep both elbows on the table when cutting
The child should open the scissors widely and close them fully when
cutting, and not use small snips in a tearing fashion.
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Curves
Start with wavy thick lines before moving onto harder shapes.
Draw a circle on a sheet of paper and lines for sunbeams. Get the child
to cut off the sunbeams by cutting the small curved segments.
Remember that the left hand which is holding the paper needs to move
around as s/he is cutting, in order to stabilise the paper properly
Some example sheets are attached
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20. RULER
Encourage the child to hold the ruler very still with their stabilising hand
(their left hand if they are right handed).
Some times a ruler with a handle can help the child learn to do this more
effectively:
If the ruler tends to move about a lot you could try putting a piece of Dycem
under the ruler (this will prevent it from slipping):
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Clothes with Velcro / elasticised are easier than buttons, laces and zips.
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22. BUTTONS
Practice first doing buttons with the item off as this is easier e.g. on the
back of a chair.
Use an old, large shirt with big buttons and buttonholes (you may need to
adapt an old shirt for this) Adult size jackets or cardigans are good as the
buttons are usually big and the buttonholes loose if it has been worn a few
times.
Talk through each stage of the task in terms of what the next step is find
the button, open the hole, push it through, grab it.
Backward chaining: (completing the entire process, but leaving the last
part for him to do).
- Do all the buttons up for the child, leaving the very top one.
- You may need to assist him/her by breaking the task down further:
Have the child pull the buttonhole edge of the shirt over the
button that is already halfway through
Have the child pinch button and pull the buttonhole edge of the
shirt over the button that is just started in the hole
Have the child pinch button and start it through hole to button
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23. ZIPS
Use a jacket with a large zip, or you may like to add a large tab to the grasp
part of the zip.
Backward chaining: (completing the entire process, but leaving the last
part for him to do). Start with the shank already inserted into the slide
bottom, and then introduce the insertion procedure:
Have the child zip zipper when three-fourths zipped
Have the child zip zipper when one-fourth zipped
Have the child zip zipper from bottom, with shank and slide
bottom already fastened (he may need guidance to grasp the pull
tab)
The child holds slide bottom with one hand, and is guided to
insert shank into slide bottom, and zips
The child zips separating zipper independently
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24. CUTLERY
Encourage the child to hold the knife and fork in the correct hands with the
index finger pointing out towards the front of the utensil. Some time caring
cutlery can help develop the correct grip as it has indents to guide where
the index fingers go.
Details for caring cutlery (see page 68)
Junior caring cutlery: Knife (code: F21012), Fork (code: F21024), Spoon
(code: F21036) all approx 4.75 each.
Nottingham Rehab Supplies
Novara House, Excelsior Road, Ashby Park, Ashby de la Zouch,
Leicestershire, LE65 1NG
Tel: 0845 606 0911 fax: 01530 419 150
www.nrs-uk.co.uk
Encourage the child to stab with the fork (to stabilise the food) and cut with
the knife.
You could practise on play dough or just cut one item up e.g. a potato on a
separate plate.
Start with just the fork if it is difficult to hold both at the same time.
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25. ATTENTION
Reduce distractions e.g.:
- Visual: remove items not required off the desk, things hanging down from the
ceiling or extra writing on the board. If the child is getting distracted by other
things on the page try using ruler to guide what line they are reading from or
block out other things with a frame (see attached example).
- Noise: Is the radio on or the doors/windows open with noise coming in.
- Place: look at where the child is sitting are they next to a notice board with
lots of posters, or next to a window or door with people walking past. Could
they be at the front of the class so they are facing forward and not looking at
what other children are doing?
Give short and clear instructions and give them once the child is
concentrating on you. You could get the child to repeat back instructions so
you know they understood what you said.
Help the child to work out which part of the task she is finding difficult and
then how to work through it allow extra time for this.
Games such as Kims game and I went to the market and bought are
also good to increase attention and memory.
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Activity
Pupils Name__________________
Skills
Observations
Class______________
TAs Name_____________
Staff
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Desk slopes
Writing slope approx 17.50, Desk slope (A4) 34.08
Back In Action, 11 Whitcomb St, Trafalgar Sq, London, WC2H 7HA
Tel 0207 930 8309
Pencil grips
Homecraft Rolyan Item #: 09-100-6816
Description: pen & pencil grip pack of 12
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Triangular pencils
Homecraft Rolyan Item #: 09-115-0655
Description: pencil handhugger black
Homecraft Rolyan
Nunn Brook Road, Huthwaite
Sutton in Ashfield
Nottinghamshire, NG17 2HU, UK
UK Customer Services
Tel: 08702 423 305
Fax: 08701 660 211
www.homecraft-rolyan.com
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Approx 32.99
38.76 inc VAT
Product Code:
MT01082
63
Scissors
Homecraft Rolyan Item #: 09-110-2805
Description: scissors self-opening right handed
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Homecraft Rolyan
Nunn Brook Road
Huthwaite
Sutton in Ashfield
Nottinghamshire
NG17 2HU, UK
UK Customer Services
Tel: 08702 423 305
Fax: 08701 660 211
www.homecraft-rolyan.com
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Dycem roll
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Caring cutlery
Junior caring cutlery: Knife (code: F21012), Fork (code:), Spoon (code: F21036)
all approx 4.75 each.
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Feedback sheet
Please return to:
PAEDIATRIC OCCUPATIONAL THERAPY
Child Health Centre,
Woodhorn Lane, Ashington, Northumberland, NE63 9JJ
Tel: 01670 564050
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Referral Protocol
For concerns at school the referral to Occupational Therapy must come
from a health professional e.g. GP, Community Paediatrician, Social
Worker, Physiotherapist, School Nurse (please see attached referral form).
Children should be attending main stream school and not requiring the
input of a CAMHs or LD Occupational Therapist.
Referrals will also be accepted on a CAF form. If referring on a CAF form
please ensure adequate information is included particularly in the sections
relating to physical development, self care and independence and learning
to enable the service to prioritise the referral.
In addition the following information must be enclosed with the referral
form:
Copy of childs IEP
An example of childs handwriting
Record of Work Activities tried with Pupils from this booklet
A drawing sample
Any relevant reports
Children and their parents/carers will be contacted by the Occupational Therapy Service on receipt
of referral and on a regular basis. If they do not respond to our contact we will discharge them and
advise the referrer accordingly.
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Full Name:
Title:
Email:
CHILDS DETAILS
Childs Name:
Address:
Parents Name:
Date of Birth:
Postcode:
Consultant Name:
Address:
Reason for Referral Please relate to specific functional concerns in the following activities:
Self care (e.g. dressing/eating/drinking toileting/bathing etc)
School work (e.g. writing/cutting with scissors/PE etc)
Play/Leisure (e.g. riding a bike/football etc)
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Relevant Background Information including social situation i.e. transport issue, child protection, home visit precautions, living/caring
arrangements, issues with non-compliance/attendance, looked after child
Specific Child Information Does the child have difficulty with any of the following
General learning disability
Specific learning difficulty
Social Interaction
Does the child use a hearing aid
Communication skills
Behaviour issue
Does the child wear
glasses
Private
Council
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Name of child:
D.O.B:
Address:
Tel No:
School / Nursery:
GP:
Surgery:
Sex: M / F
Key Stage:
______________________
Reading age_________________
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5.TASK BEHAVIOUR/COMPLETION
7. SELF-CARE ACTIVITIES
Able to dress and undress independently e.g. for PE
If No, what are the difficulties?
Able to use cutlery to eat
Able to go toilet independently
Able to clean self after toiletting
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Language/s spoken at
home:.
If English is a second language please tick proficiency level of the parent:
Fluent
Adequate
Non-fluent
N
Y
______________________________________
____________________________________________________
ADDRESS: ___________________________________________________________
______________________________________________________________
TELEPHONE: _______________________________
DATE: _______________
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References
Addy, L & Teodorescu, J (1996)Teodorescu Perceptuo-Motor Programme (book
1 and 2), LDA: Cambs.
Berkett, V (2003), Survive and Succeed as a Teaching Assistant, LDA: Cambs.
Chu, S, (1997), Occupational Therapy for Children with handwriting Difficulties: A
Framework for Evaluation and Treatment, British Journal of Occupational
Therapy, 60 (12), pp 514-520.
Olsen, J (2001), Handwriting Without Tears, MacArthur Blvd Cabin John: MD
20818.
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