Creating Functional Activities
For the DD Population
By Barbara Smith
PROVIDING FUNCTIONAL ACTIVITIES for developmentally disabled people can be a challenge in both work and residential settings.
Finding age-appropriate yet stimulating materials for a severely to profoundly involved population is an even more daunting task. Functional activities include not only activities of daily living, work and leisure but activities used with the goals of increasing attention to a task, improving hand use, promoting sensory stimulation and decreasing undesirable behaviors such as self-stimulation and avoidance of social contact.
Severely developmentally disabled clients may demonstrate sensory defensiveness, fear of failure, hyperactivity and physical limitations that require special materials to motivate them and facilitate success.
Given this population, the nature of the materials becomes critical. The activity must beckon the user through its sensory appeal in the same way toddler toys demand to be manipulated. Such materials are not easily found in toy stores or therapy catalogues, and when they are, they often need to be adapted to the user.
My solution to this has been to make my own therapy materials out of common household recyclables, such as plastic bottles and cardboard boxes. Most of the following activities I designed while working at a state institution for developmentally disabled adults. I have compiled many of these activities into a book with detailed directions on construction and adaptations for different skill levels. I will describe a few of the activities.
Materials which provide lots of stimulation are often successful. Visually stimulating materials have bright colors, color contrast and moving parts. A clear plastic bottle filled with water and tiny plastic pieces inside invite shaking and visual attention. Using materials covered with interesting textures such as fur, terrycloth or felt encourage tactile exploration.
A cardboard tube covered with textures becomes a vibrating tube when you insert an inexpensive vibrating pen (with pen tip removed) inside. One end of the tube can be closed with cloth and duct tape while the other end must have a removable cover to turn the vibrator on and off. The entire tube will vibrate, thus providing a multisensory experience.
While clients may enjoy vibration, care must be taken that they not be overstimulated through prolonged use. The client must be able to drop or stop using the vibration as needed.
Laundry and dishwasher bottles are extremely useful as sources of strong, colorful plastic and also as containers which fit comfortably inside the palm.
I punch out circles of plastic using a heavy-duty holepuncher to use in clear plastic shakers. Clients who can use only a palmer grasp benefit from activities made from the bottle handles. Bottles can be cut using leather shears, although once they are used to cut plastic, they will be too dull to cut anything else. Bottle handles can be attached to objects such as sponges, erasers, magnets, string and balloons, music button switches and ink stamps to increase hand function.
The laundry bottle also provides an excellent base to create bilateral tasks.
Many clients prefer to use only one hand until an activity requires stabilization. Attach several small pieces of hook Velcro on both sides of the bottle. Then attach some to several small objects such as blocks, pegs, pieces of plastic, or bottle caps. Attach the objects onto the bottle. The client can remove the objects and drop them inside the bottle. This activity is often very successful because it requires few manipulation skills, and separating Velcro feels and sounds good. The materials are colorful and varied.
Dropping objects into containers works on grasp-release patterns and eye-hand coordination. This activity can be performed in minutes and is thus ideal for clients with short attention spans who can benefit from a sense of completion.
The task can also be adapted in several ways. Clients who need to get out of their seats periodically may remove objects attached to a wall board. The client can hold a box or bag to drop the objects into, thus, again working on bilateral hand skills. The objects can be attached to the four sides of a cardboard box.
The client will learn that once all the objects are removed from one side, she needs to turn the box to begin working on the next side. This adaptation can develop memory skills. Place the objects with Velcro on a large cardboard tube, and the client will need to rotate the tube to remove them.
Taking a simple familiar motor skill such as pulling apart objects attached with Velcro and altering the task in small ways will make it more interesting and challenging, yet not threatening.
Ring stacks also can be adapted in many ways to increase interest and challenge. They can be built to require bilateral hand skills by placing two dowels on a base about 15 inches apart. The objects to be stacked can be cardboard, wood, plastic or cloth and need to have two holes cut out of them to correspond to the dowels.
Grade the activity by altering the size of the holes, the weight of the pieces to be stacked, the height of the dowels and the perceptual complexity of the task.
The "ring stack" can be varied in unlimited ways. Clients have used three dowels on a triangular base and four dowels on a square base. The dowels do not need to be round. Dowels in square, triangular and rectangular shapes are increasingly challenging. The adaptive equipment department where I worked was able to fabricate these stacking activities out of wood, but it is possible to make a less durability version out of cardboard. Single-dowel ring stacks can be made in different shapes and durability, and easy-to-clean "rings" can be cut out of laundry bottle plastics.
Standing ring stacks can be made by inserting a tall cardboard tube inside a box which is weighted down for stability. "Sensory rings" can be made by filling a sock with sand, beads, bells, plastic foam pieces or dried herbs. Sew the ends closed to create a ring. A vibrating ring stack is made by inserting a vibrator inside a tall, cylindrical screw-cap container, securing it in place with fabric.
Cut rings out of cardboard and decorate as desired.
Another type of ring stack is made with elastics attached to the stack base and tied to each plastic ring. The client must stabilize the stack while pulling the ring to fit over the stack. This activity has been particularly successful with clients who are visually impaired and have motor-planning problems, because of the proprioceptive feedback pulling elastic provides. Ring stacks, which can be held in one hand while the other hand does the stacking, are made by inserting a dowel inside a bottle handle. Attach protrusions to the dowel, such as bells or beads, and the user must motor plan how to guide the rings over them.
Music is a wonderful sensory modality which can be incorporated into many fine- and gross-motor activities. I have used music as a reinforcer so that the client must perform a task to hear it. For example, place a switch connected to a tape deck under a ring stack. After a certain weight of rings are stacked, the tape deck will be activated. This activity can be easily graded by using heavier or lighter rings.
This same switch can be placed under a shape sorter, pegboard and other manipulatives or under a texture board to encourage simple reaching and touching. Place a music switch in a large container and ask the client to place weighted bags on top.
Lifting bags weighted with sand will provide proprioceptive feedback, promoting bilateral manipulation skills, which is good for hand strengthening. I have incorporated this activity into a gross-motor group with behaviorally involved clients who usually prefer not to use their hands in functional activities.
Sensory stimulation materials can be incorporated into many gross-motor activities. Instead of using a ball to toss or throw into a box or hoop, use "sensory bags." These are bags the size of pillow cases filled with different materials to encourage tactile exploration.
I have filled bags with small plastic balls, bells and sand. Plastic supermarket bags have an interesting sound when squeezed; plastic foam packing peanuts, beads and crushed newspaper can be used.
The bags can be covered with textures or even manipulatives, such as a string of beads. I have used these bags during a gross-motor group to toss into a large box, to knock over a stack of cardboard boxes, to toss to another person and to hit when suspended from the ceiling like a tether ball. Varying the objects in a familiar repetitive activity, such as toss, helps to maintain interest.
One of the keys to creating successful activities is to build on the skills the client already possesses and incorporate sensory modalities which make the activity fun and inviting. Such activities often improve motivation in staff, which in turn impacts client learning.
Sometimes we need to use trial and error, as well as clinical observations to see if an activity will be a success.
Using readily available recyclables and inexpensive materials enables the therapist to test a large variety of activities.
Barbara Smith, OTR/L, has been working with developmentally disabled children and adults for more than 20 years. Ms. Smith is the author of The Recyling Occupation Therapist, which can be purchased through Therapy Skill Builders. Call 800-211-8378 for ordering information.