Sensory Modulation Training Children who would most benefit from Sensory Modulation Training are: ·overly sensitive to touch, movement, sights, or sounds ·under-reactive to touch, movement, sights, or sounds ·easily distracted ·experiencing social and/or emotional problems ·unusually high or unusually low in level of activity ·physically clumsy or careless - poor motor planning ·impulsive and lacking in self control ·experiencing difficulty making transitions from one situation to another ·experiencing delays in speech, language, or motor skills ·delayed in academic achievement What is sensory modulation? Sensory modulation is when the senses work together. Each sense works with the others to form a composite picture of who we are physically, where we are, and what is going on around us. Sensory modulation is a neurological function that is responsible for producing this composite picture. It is the organization of sensory information for on-going use.
Typically healthy sensory modulation occurs automatically, unconsciously, and without effort in typically developing children. For children with a variety of developmental challenges, the process is inefficient, demanding effort and attention with no guarantee of accuracy. When this occurs, the goal to regulate sensory input and to "make sense of the physical world" and the "place of self within that world" is not easily attained.
Sensory experiences include touch, movement, body awareness, sight, sound, and the pull of gravity. The process of the brain organizing and interpreting this information is often called sensory integration or sensory modulation. Sensory modulation provides a crucial foundation for later, more complex learning and behavior.
For most children, sensory modulation develops in the course of ordinary childhood activities. Motor planning ability is a natural outcome of the process, as is the ability to adapt to incoming sensations. But for some children, sensory modulation does not develop as efficiently as it should. When the process is disordered, a number of problems in learning, development, or behavior may become evident. Who has problems with sensory modulation? A child who, although bright, ·has difficulty using a pencil, playing with toys, or ·doing self-care tasks, like dressing. ·so fearful of movement that ordinary swings, slides, or jungle gyms generate fear and insecurity ·whose problems lie at the opposite extreme uninhibited and overly active, often falling and running headlong into dangerous situations. In each of these cases, a sensory modulation problems may be an underlying factor. Its far-reaching effects can interfere with academic learning, social skills, even self esteem. Some examples of situations in which sensory modulation problems are a concern are: ·Premature birth - More and more premature infants survive today; they enter the world with fragile, easily over stimulated nervous systems and multiple medical complications. Parents need to learn how to give their premature infant the sensory nourishment their child requires for optimal development, and how to avoid detrimental over stimulation. ·Autistic spectrum disorders and other developmental disorders - Severe difficulty with sensory processing is a hallmark of these disorders. Children with autistic spectrum disorders seek out unusual quantities of certain types of sensations and are extremely hypersensitive to other types. Similar traits are often seen in other children with developmental disorders such as Cerebral Palsy, Downs Syndrome, and other genetic disorders. Improving sensory processing leads these children to more productive contacts with people and environments. ·Learning Disabilities - As many as 30% of school-aged children are estimated to have learning disabilities. The majority of these children, although normal in intelligence, are likely to have sensory modulation problems. These children are also more likely than their peers to have had a premature birth, early developmental problems, and poor motor coordination. Early intervention can improve sensory processing and self-regulation in these children, minimizing the possibility of school failure before it occurs ·Delinquency and substance abuse - Numerous studies indicate that learning disabled children are at risk for later delinquency, criminality, alcoholism, and drug abuse. Repeated failure in school opens the door to self-destructive activities. By interrupting the vicious cycle of failure, intervention to help children with sensory and processing dysfunctions and learning problems may also prevent serious social problems later in life. Goals of Sensory Modulation Training To guide children through a number of activities that challenge their ability to respond appropriately to sensory input and make a successful, organized response. These sensory stimulating experiences hopefully through repetition and continuous exposure allow children to become more capable of adjusting to sensory input and to regulate both their physical and emotional responses to these sensory stimulations. This process encourages self-regulation of sensory input and improves the children's ability to respond to the world of sensory input in a more adaptive way. This activity allows children to feel comfortable with the sensations of this world and to cope with how their bodies respond to these sensations.
By making sensory modulation training fun and playful, garners the motivation of the children to participate more fully in these activities. Most children tend to seek out activities that provide sensory experiences most beneficial to them at their own point in their current physical, emotional, and social development. It is this active involvement and exploration that enables children to become more mature, efficient organizers of sensory information and thus more relaxed with their experience of the sensory input of the world. What does a Sensory Modulation Experience Look Like? Typical Sensory Modulation Training experiences involve the child in handling such physically interesting substances as shaving cream, finger paints, whipped cream, sand, water, Jell-O, raw beans, pellets, or balls in a table activity. First Example: We gave young James a chance to explore shaving cream. The look at his face was: "Hmm. This is different!" He is not sure how he really feels about this stuff. James being exposed to shaving cream in a table side sensory modulation experience gives him an experience he would not have naturally and it expands his experience. During the process with shaving cream, James was prodded to continue to keep his hands in the gooey substance, which results in his becoming more relaxed and involved in this sensory experience. James needed less pressure or guidance to manipulate the shaving cream. He relaxed and began to really engage in spreading it around the table.
Second example: Sophie had been doing this shaving cream "thing" for a while and she gets into the process with no hesitation. Sophie looks at her hands and begins to contemplate what she might do with this wonderful white texture. She explores the feelings of the material more. She is on her own in this activity and needs little prodding. Her teacher is sitting next to her, but allow Sophie to take the "lead" in this exploration. Sophie touches the palm of her hand. She is more "in tuned" with her body parts through this activity. She is willing to experiment with this substance as she proceeds, because she can do it at her own pace with no pressure to do so. "Well let's get into this thing more!" Sophie slathers the cream on her arm. Sophie is not all alarmed or frightened by the feel of the cream on her arm. She has become more "centered" in her sensory tracking of this experience. She is a veteran and expands to new exploratory heights in her sensory training using shaving cream to experience her body's sensations. Finally she looks at the well lathered hands and arms and recognizes that she is the one responsible for them getting white. Sophie did not need any prompting or cueing in this sensory modulation activity. She took the "lead" and went to new heights to experience the sensations which it entailed. This is the goal of such activities to get the child to "take the lead" and to be desensitized to the discomfort or dysregulation which comes from such sensory input. This type of sensory exploration needs to be done on a regular daily basis with children who have problems with sensory regulation. It is imperative that children be allowed to explore these sensations with no major limitations or prohibitions. So be aware that these activities can be messy so prepare yourself for the "Fun involved." A Sensory Modulation Path As a volunteer at a local elementary school in Tampa, Florida. I work with the four children I am talking about here. I set out to assist the staff to improve the sensory modulation of each child. To accomplish this goal, I decided to build a sensory modulation path next to the group's portable classroom. The path is 24 feet long, 4 feet wide with six different sectors. There are two sand "traps" at the beginning and end of the path. There then is smooth river rocks, followed by cypress bark, eucalyptus mulch and small river pebbles. The teacher encouraged the four children to enter the path so as to join each other to explore the feels and textures on the path. Some explored the sand with their toes. The children are encouraged to enter the path with bare feet. They are given up to 30 minutes a day of time to explore this sensory path. The goal is to allow the children to experience the varied textures, temperatures, and smells not only with feet but to get into the materials and experience them all over their bodies. Sometimes the kids would sit down on the pebbles, then look at their toes, and notice they were raised. This was a sign that they were very defensive to the touch of these pebbles to their feet. This path is a sensory challenge, one which all of the childre needed to proceed with gradually at their own pace. It does not take much prodding after prolonged exposure to the path to get the children to explore the path as time goes on. The children would eventually walk the wooden rails rails of the path. They would manipulate the objects on the path like cleaning the pebbles out of the mulch or sitting in the sand box. Since the path is accessible daily, the children are able to explore textures, smells, and other sensory experiences such as "cold stuff" on a daily basis. It only cost about $100 to construct this path. It has become a useful component in the classroom day to assist these children's to extend their sensory awareness. The children are free to explore, create, define, and experience this path setting with little to no restrictions placed upon them. Only thing they are told is "no throwing of the sand, pebbles or mulch" and "no walking off." How can you tell Sensory Modulation Training is Working? Children with hypersensitivity to touch, often walk on tip toes. The children's use of the path demonstrated the value of sensory modulation training because the children become more at ease with the different textures on the path over time. A good example is the eucalyptus mulch on the path. Initially the children were in a hurry to get off of it. The smell and texture seemed to upset them. They would quickly move to another component of the path such as the river rock bed. There is a need for children to be exposed to sensory inputs in a gradual non-threatening way. By the childrent taking the lead they know how they are responding to these textures and they will show us how they can best deal with them.No one forced them to engage with any "hostile" sensory experience. As the children relaxed with the sensation of the textures on their body and feet, their toes and feet began to settle down.and they would finally began to put the pebbles or other objects between his feet. Their movements would become more relaxed and their feet were less rigid. They were often able within seconds to go from great sensory discomfort to having fun and enjoyment as they explored the use and feel of the pebbles or other path objects on their bodies.
All We Need is Love...! "Wow! Here I am in something new!" "I don't like this very much." The kids would show that they were not sure if they liked the stuff on the path and it was not clear if they would like to run away from it. They however were never pressured to do anything but to be themselves and to explore this arena. There is no guaranteed structured formula to follow in doing sensory modulation training. All that is important is that you expose the children to a variety of sensory experiences. Use your imagination and you will come up with a multitude of experiences which will suit the needs of the children with whom you are involved. Common behavior was "toe walking" on the mulch. Toe walking is a common sign of sensory dysregulation. The kids would say to self: "This sure feels icky I want to get as far away from this stuff as I can." The often walked with flapping arms and hands. This posture is common with children with low muscle tone. It takes time to regulate or modulate one's sensory response to new and different sensations. Kids will need encouragement and support to continue on this path to sensory regulation and modulation. After their trip on the path, what the kids needed was "loving" from their teacher and reassurance that they would be OK and would survive this assault on their senses. Hugging is a marvelous way to assist a child to modulate senses and they can never get enough HUGS! Do not rush children into these new experiences. Let them take the "Lead." They will benefit from the process if they are not rushed or forced into doing any of these sensory activities.
Sensory Modulation and Sensory Integration Activities for Home and School
TACTILE STIMULATING ACTIVITIES
Indoor Tactile Path * Create a path through your room, house or classroom * Use duct tape or strong masking tape to outline the path * Make sure the path covers carpeted, tile and wood floors, if available * Have the path go through any indoor areas like: sand box, water play pool, trampoline, small balls boxes, indoor cloth tunnels, play houses, etc. * Have certain rest stops on the tactile path which are delivery zones with "post-office" boxes each painted a different color * Use the tactile path for a number of indoor activities
Taking a Dry Swim at Home * Use an imaginary pool to swim in * Use different floor textures to swim on if available * After swimming, use a beach towel to dry the child down using deep rubbing down strokes * As you rub each body part, name the part or have the child name the part
Follow the Leaders on the Path * Animal walk--have the child follow you on the indoor path playing an elephant, horse, alligator, dog, cat, etc. walking on all fours as you follow the path, and have the child make the sounds of the animal if possible * As you animal walk, have the animals walk only on three legs rather than four * Now be snakes and crawl the path hissing as you go * Now become logs which are being rolled along the path
Scooting the Path * Using a scooter board, have the child become the animals while lying forward on the scooter board * Have the child be the animal lying on his back, using the scooter board to get along the path * Have the child be a beetle crawling on scooter board along path * Have the child be a tugboat who is pulled by holding onto a rope (you are pulling the child along the path) or have the child pull the scooter board with a rope along the path
Large Exercise Ball Activities * Have child lie face forward on ball and roll body on the ball * Have child lie on back on ball and roll body on the ball
Taking a Ride on the "Sheet Slide" * Have child lay face down on the sheet slide and pull the child along the indoor tactile path * Have child lay on back on sheet slide and pull child along the indoor tactile path
Body Part Erasers * Use carpet squares or carpet samples as a chalk board and, using soft chalk (like sidewalk chalk), dry oatmeal, sand or aquarium pebbles, write something on the square and then have the child use her feet to erase the words written or the picture drawn * Do the same thing but this time have the child use hands as an eraser * Do the same thing but this time have the child use elbows as an eraser * Do the same thing but this time have the child use knees as an eraser
Body Chalk Board * Using your hand draw a number, letter, shape, or word on the child's back and have the child try to guess what it is * Do the same thing but now on the stomach * Do the same thing but now on the bottom of the foot * Do the same thing but now on the palm of the hand
Body Painting * Using a variety of brush types, pretend to paint different body parts of the child * Use 3-, 2- or 1-inch house paint brushes * Use large, medium and small artist brushes * Use pastry, cooking and cleaning brushes * Paint pretend objects on the body, such as freckles on the face, hands and arms * Paint glasses on the face * Paint various types of clothing on the body
Touch and Feel Box * Cut a hole in a shoe box with a lid on it * Put various types of textures on the floor of the box like carpet, sand paper, tile and wax paper, and have the child feel the textures * Put various objects in the box and have the child try to guess what the object is
VESTIBULAR STIMULATING ACTIVITIES
Vestibular: The child's perception of movement due to the inner ear being activated and the position of the head being changed. These vestibular stimulating activities must be done with caution and calmly so as to prevent the child from falling or bumping his head. Children who are non-verbal may not be able to tell you if they are hurting so be cautious.
Inner Tube Activities * Use an old tire inner tube, or get the swimming pool inner tubes and have the child sit on tube and bounce * Having the child sit on the tube, have child scoot on indoor tactile path to run a race * Have various objects and obstacles placed on the path to have the child tube over
Rolling Games * Play "follow the leader" by rolling over the indoor tactile path * Have child roll along the path faster and faster
Spinner Games * Use the scooter boards to have the child spin * Spin the child on a swing * Spin the child on a sheet on a slick floor
Ball Games * Have child bounce on the ball * Have child rock body on ball either facing down on ball or with back on ball
Whirling Games * Have child pretend being a top and whirl in room * Have child hold hands out and pretend you are tuning her arms like tightening a key on an alarm clock
Trampoline workout * Have a small indoor trampoline on which the child can jump * Have child sit on trampoline and bounce on it * Have the child run in place on the trampoline
PROPRIOCEPTIVE STIMULATING ACTIVITIES
Proprioceptive: Kinesthetic or body awareness which provides information to child from inside the body from the muscles, ligaments and joints. These are especially helpful for children who have low muscle tone and who are not able to be sure where their bodies are in space. They are in need of heavy work activities, which involve heavy weight for the body to carry.
Heavy Load Walks and Hiking Trips * Have the child walk the indoor tactile path with a loaded backpack * Have the child wear a heavy weighted vest on the indoor path * Have the child wear weights in the pockets in his shirt and pants as walking the indoor path * Have the child creep along the path, with heavy weights * Have the child cross an obstacle course, with heavy loads
Cocooning * Wrap the child tightly in a sheet, blanket or beach towel, and then hold tight like a caterpillar in a cocoon
Climbing the Mattress Hill * Place the foot of the child's bed mattress on the floor and the head of the mattress on the top of the middle of the child's bed, and then have the child climb the mattress to get on top of the mattress "hill"
Tom Sawyer Travels * Using a carpet square or carpet sample, have the child lie forward on the sample and use arms and legs to raft along a slick floor * Have child lie backward on carpet and repeat the raft travels * Have child rafting, this time only with her arms in both forward and backward position
Delivery Game * Have child pull a wagon, push a wheelbarrow, carry a large shopping bag or cardboard box (pretend truck which must be pushed or carried along path) filled with heavy objects of different colors and have child place each matching color object into matching color delivery stations, located on the indoor tactile path * Have child collect objects from each delivery station until the carrier is loaded with heavy objects and brought to the end of the indoor path
Animal Walks * Similar to the tactile walks, but have child use only three legs and alternate legs as the walk progresses along the indoor tactile path
Body Wheelbarrow Walk * Hold child's feet and have child crawl on floor and play the wheelbarrow walk along the indoor tactile path * Now hold hands and have child walk along path leaning on your body for a reverse wheelbarrow walk
Jump Up Game * Have child squat and wind up child and have child jump up when winding is done, like a jack-in-the-box does * Have the child jump up every time you call his name * Have child play frog, and from a squat position jump along the tactile path
Get That Out of My Hands * Pretend the ball or object given to the child is a "hot potato" which the child must get rid of immediately and keep the pace going fast * Use large balls, bean bags, etc. in this "hot potato" game of catch
Paper Mountain * Have child crush pages of newspaper one at a time and throw them into a designated site like an empty wading pool or in an imaginary circular boundary, until there is a huge mound of paper creating a paper mountain * Now have the child go inside the mountain and explore it * Have the child climb over the paper mountain * Have the child crush the paper mountain * Have the child throw the paper mountain away into a big waste can
Walls Moving In Game * Have child pretend the room's walls are moving in and have child push against the walls to stop the movement
Rescue Game * Have child sit on carpet square or sample, wagon, scooter board or inner tube, and pretend the child needs to be rescued; pull the child by her arm so the vehicle and child can be rescued and pulled out of the indoor path to safety
Body Windshield Wipers * Have child lie on floor and use legs as windshield wipers * Have child lie on floor and use arms as windshield wipers * Have child sit on floor and use arms and legs as windshield wipers
Body Function Charades * Have child pretend brushing teeth, washing face, washing hands, washing body * Have child pretend dressing up with pants, shirts, socks, shoes * Have child pretend to eat, drink, and clean up the mess
MOTOR PLANNING AND EQUILIBRIUM STIMULATING ACTIVITIES
Motor Planning: Child's ability to organize, plan and then execute new or unpracticed fine motor or gross motor activity.
Equilibrium: Child's ability to maintain balance when shifting positions.
Walking the Line * Have the child walk along a rope place on the tactile path * Have the child walk along a beam, which is placed on the floor * Have child hopping along the rope on the floor * Have child hop or jump over the rope on the floor
Roll and Bounce That Ball on the Wall * Using a large exercise ball, have the child move the ball along the wall by having the child's stomach do the moving * Have the child now bounce his body against the ball so that the body is bouncing against the ball and wall in a back and forth fashion
Follow the Leader Walks * Animal walks on the indoor tactile path using alternating legs, whichever the leader chooses * Choo-choo walks with the engine leading the train along the path
Pushing the Object Games * Use a broom to push a heavy object along the indoor tactile path * Use a bat, yardstick or dowel rod to push beanbags along the path * Use other heavy objects to be pushed along the path
Deep Pressure and Heavy Activities for School Age Children
Another form of sensory modulation is "Deep Pressure" or "Heavy work" activities. These are wonderful for providing children with the input they crave including deep proprioception and joint compression.
Heavy Work Activities for Teachers 1. Scooter board to and from a designated location (sit or lie on stomach and propel with arms). 2. Place chairs on desks at end of day or take down at beginning of day. 3. Erase or wash the chalkboard. 4. Carry beanbags on shoulders or head and walk across the room. Wear weighted vests, belts or wrist weights. 5. Help rearrange desks in the classroom. 6. Push the teacher around on a wheeled chair or scooter board. 7. Pull someone while they sit on a scooter board holding onto a hula hoop. 8. Child can pull himself/herself up a ramp while on a scooter board. 9. Help out the janitor with emptying wastebaskets, mop the floor, etc. 10. Fill egg crates (small ones that kids can carry) with books to take to other classrooms. Teachers could ask kids to move these crates back and forth as needed. 11. Help the gym teacher move mats, hang them up, etc. 12. Chewy candy breaks (this addresses the janitor's "no gum rule"). There are lots of chewy candy that take awhile to chomp and don't get stuck on furniture. 13. Sharpen pencils with a manual sharpener. 14. Cut out items for display with oak tag. 15. Have students carry heavy notebooks to the office or from class to class. 16. Wear a weighted backpack when walking from class to class. Parents can put a notebook, book or books (depending on the size of the child) into their backpack each day for the ride or walk to school. One therapist suggested that "you might want to be careful about adding weight to backpacks as it could result in low back pain." It might also be contraindicated with diagnoses such as Spina Bifida. Maybe weight could be added elsewhere such as in fanny packs. 17. Carry books with both hands hugging the book to yourself. 18. Tie a Theraband around the front legs of a chair that a child can kick his/her legs into. 19. Propel scooter board across carpeted floor. 20. Have child pass out papers/objects to class members. 21. Wash desks or chalkboard/dry erase board. 22. Push the lunch cart or carry lunch bin to the cafeteria. 23. Staple paper onto bulletin boards. 24. If there is a garden project at the school, have child dig the dirt. 25. Play with medicine balls (get from gym teacher). 26. Run around the track at school. 27. Bounce up a ramp on a Hippity Hop ball. Put two ramps fastened together at right angles and let the kids hop up one, cross to the platform of the second ramp and hop down. After about 10 to 15 trips, it takes out "aggressiveness." 28. Push a large therapy ball across/around the room (can purchase weighted therapy balls). 29. Push square plastic nesting boxes (the largest one was 18 to 20 inches) from the classroom to the OT room and back. The next child would do the same thing. This particular school had a carpeted hallway which provided extra resistance. One or two of the nested boxes can be removed to decrease the weight or small balls and/or bean bags could be added to the box to increase the weight. I also found that turning the smallest box upside down over the balls and bean bags helped easily distracted students complete the task at hand. 30. Use beanbag chairs in classrooms, allowing kids to use them during silent reading time or to lay over or under them during independent work tasks to get a change in position and the benefit of consistent pressure input. More of a passive mechanism, but definitely helpful for students. 31. Push a wheeled therapy stool while someone is seated on it. If necessary, person on stool can assist by "walking" with their feet. 32. Have kids pull themselves by a long jump rope tied by one end to a doorknob while they are seated on a scooter board with their legs crossed and off the floor. Can also have one child hold the jump rope while the other child is pulling him/herself on the scooter board up to the child holding the rope. A variation is to play "army jungle maneuvers" where the child on the scooter board can deliver secret messages to the other child, and that child (who is holding the rope) has to write a secret answer back to the commander (teacher). This could be incorporated into academics in lots of ways. How about the first child taking a math problem to the second, the second solves the math problem and sends it to the commander (teacher). 33. Bouncing on a large therapy ball while counting down from 100. 34. Prior to seat work, have child pinch, roll, pull theraputty; use hand exercisers, balloons filled with flour. Give the child firm pressure on the shoulders. Play on playground equipment, hanging from a bar, running up steps, etc. Wrap the forearms with ace bandage. 35. Use bubblepack as part of an obstacle course. Children can jump onto it or run across it. They love the noise it makes! 36. In the classroom, use heavy duty tape to fasten a large phone book to the bottom of students chairs then teacher arranges the student's schedules so that the students move to a new area of the room (taking their chair) between subjects. Teach the use of wall push-ups or the idea of "the room feels small this morning, can everyone help me push the walls out" for younger students. 37. Have student move several packs at a time of Xerox paper from the storage area to the school copy center. 38. Use the Ellison cut-out machine. Students can collect orders from teachers (who provide the paper and use these cut-outs for bulletin boards, etc.) and then presses out the number of pieces required under the supervision of an adult. This very heavy work is a great strategy for organizing behavior. 39. Pull therapist's suitcase on wheels or therapy cart. 40. Climbing activities (such as playground equipment). 41. Swing from the trapeze bar. 42. Push against a wall. 43. Fill up big toy trucks with heavy blocks, push with both hands to knock things down. 44. Sports activities involving running and jumping. 45. Two adults can swing child in a sheet. Watch child's face carefully to note when child has had enough. 46. Have the child color a "rainbow" with large paper on the floor in a quadruped position. 47. Play "cars" under the kitchen table (or table in classroom) where the child pushes the car with one hand while creeping and weight bearing on the other hand. 48. "Hot dog" game where child lies across end of a blanket and is rolled (ends up inside the rolled up blanket with head outside) 49. Walk up a ramp or incline 50. Use theraband or tubing attached to a door and pull it then let it snap. Supervision necessary. 51. Wood projects requiring sanding and hammering. 52. Play wrestling: pushing game where two people lock hands facing each other and try to see who can push and make the other person step back first. Use other body parts also, but be sure to have rules (no hitting, no biting, no scratching, one person says stop then both stop). 53. Open doors for people. 54. Quiet squeeze toys such as the cow, fondly named by everyone as "Moo" (squeaky squeeze toys are frowned on by our teachers). Kids can be taught to squeeze Moo or the likes of him on their laps under their desks so as not to disturb the class. 55. Chew on fish tank (aquarium) tubing, Theratubing or refrigerator tubing, if appropriate. One therapist stated that "refrigeration tubing (the kind the water runs through to the ice maker in your freezer) is FDA-approved while aquarium tubing is not. Cut the tubing into 2- to 3-inch strips and put it on the end of the elementary school age child's pencil to be an appropriate "chewy" when food is not allowed." 56. Chair push-ups. 57. Fall into a beanbag chair. 58. Jumping and rolling games. 59. Slowly roll a ball or bolster over the child, applying pressure. 60. Bounce on a Hippity Hop ball. 61. Sandwich games (child is place between beanbags, sofa cushions, mattresses and light pressure is applied to top layer). 62. Play catch with a heavy ball. Bounce and roll a heavy ball. 63. Push weighted carts or boxes across carpeted floor. 64. Animal walks (crab walk, bear walk, army crawl). 65. Play "row, row, row your boat" both sitting on the floor, pushing and pulling each other. 66. Rice play, koosh balls, water play, jello play, theraputty. 67. Mini trampoline. 68. Stack chairs. 69. Two children can play "tug of war" with jump rope or heavy Theraband. (If you use the Theraband, children need supervision so they don't purposely let go of Theraband and "snap" the other child.) 70. Isometric exercise breaks. 71. Push on large therapy ball with someone else giving resistance from the other side. 72. Have child hold therapy ball with arms and legs while lying on his/her back. Try to take the ball away and tell the child to hold on to the ball as hard as he can.