There are a few equipment and toy recommendations that every home-based pediatric OTR makes to a child’s parents: Play-Doh, puzzles, tunnels, …and a vertical easel. Found in every preschool, children from 18 months on can build their reach and proximal (upper body) control while coloring and scribbling on a vertical surface, rather than a tabletop.
But WHERE a child is directed to aim their stroke matters. Here is why:
- Grasp and reach have a range of efficiency. I tell adults to imagine that they are writing on a whiteboard for a work presentation. Your boss is watching. Where will your writing/drawing be the most controlled? Everyone immediately knows. It is between your upper ribs and your forehead, within the width of your body or a few inches to either side. Beyond that range, you have less stability and control. Its an anatomy thing. If you are an OTR, you know why. If you are a parent, ask your child’s OTR for a physiology and ergonomics lesson.
- Visual acuity (clarity of focus) is best in the center of your visual field (the view looking directly forward with your head centered). Looking at something placed in this range is called using your “central vision”. Your eyes see more accurately in that location, children can see an adult’s demonstration more clearly, and therefore they can copy models and movements more accurately. Kids with ASD like to use their peripheral (side) vision because it is cloudy, and the distortion is interesting to them. This is not good for accomplishing a visual-motor task or maintaining social eye contact, but they find this is a way to perform sensory self-stimulation and avoid the intensity of direct eye contact with others.
- Young children have little self-awareness of how their environment impacts them. Until they fail. Then they think it is probably their fault. The self-centeredness that is completely normal in children gets turned around, and a child can feel that they are the problem. Telling children where to place their work on an easel gives them the chance to do their best work and feel great about it.
- Children move on when a task is too hard, or when an adult doesn’t provide enough supportive strategies. Telling a child to try again, or telling them that their results weren’t too bad” isn’t nearly as helpful as starting them off where they have the best chance of success.
- Using the non-dominant hand to support the body while standing is an important part of vertical easel use. For kids with low muscle tone or hypermobility, it is very important. Standing to the side or draping the body on the surface to write are both poor choices that OTRs see a lot in kids with these issues. Make the easel a piece of therapy equipment and teach a child to place their non-coloring/painting hand on the side of the easel in the “yes zone”. Look at the picture of the older boy at the beginning of this post, then at the gentleman below. Note each person’s posture and try to embody it. Which posture provides more ease, more control?
Here is a graph of where an adult should place their demonstration on a page or board for optimal vision and motor control, and where adults should encourage a child to draw. “NO” and “YES” refer to the child’s optimal location for drawing or writing.
The exception is for height. A very tall child will need to draw higher on the chart, and a smaller child will only reach the lowest third of the easel. This should still allow them to use their central vision and optimal reach. If the easel doesn’t fit the child, place paper on a wall at the correct height.
