Libby was seen in an office for a 45-minute treatment session with focus of session on improving her fine motor skills especially in the area of grasp patterns, ocular motor skills (saccades), self care skills, handwriting, as well as improving her flexibility for wearing different clothing and wearing her hair different ways. Upon arrival to pick Libby up she was independently brushing her hair in the art room. We began treatment in room with going over her last week's hair and clothes options. She didn't seem to have had practiced as much this week wearing different things or different styles of hair. Reviewed the first five letters of the uppercase alphabet that we we're learning and reinforcing from last week. We reviewed the letters A,B,C,D and E in a multi-sensory format. First we traced over our glitter letter index cards which had now dried from last week. OT had her say the letter, the letter sound and draw a little picture on the index card of a thing that started with the letter sound. Next, we made the letters out of sticks from Handwriting Without Tears Program. Libby was able to identify A,B,C, and E well but struggled with the uppercase letter D - wanting to call it B. We wrote each letter, using a coconut as a starting point and auditory cues for formations. She wrote them adequately with this type of assistance. Lastly, we worked on ocular motor skills with tracking and saccades activities. Libby did well trying to separate her head from eye movements. By the end of the session she was able to recognize D. Good work today and she is a pleasure to work with.