Libby seen in her room for a 45 minute occupational therapy treatment session. Focus of therapy on improving her ocular motor skills, visual perceptual abilities, fine motor development, visual motor skills, sensory motor skills and graphomotor skills. Libby participated well in today's treatment session. began treatment with an activity aimed at increasing strength in the intrinsic musculature of Libby's hands. Libby was asked to use small "strawberry picker" (small metal tong-like instrument) to pick up small items and sort them into different compartments. She was able to complete this activity without showing hand fatigue and with an open webspace. She continued working on fine motor development with cutting activity. Libby required cues to hold the paper she was cutting with a supinated (thumb up) grasp pattern versus pronated or neutral hand position. Lastly, Libby continued working on her writing skills which continue to improve and develop. She was instructed on lowercase letter "v and x" today. She required verbal cues and practice to make letter "v" without lifting her pencil. She was able to form lowercase "x" without any difficulties. Libby continues to require verbal and visual cues to make the letter "a" with one movement versus picking up her pencil. She also has a motor memory to form her letter "y" from right to left versus left to right. We will continue to try to replace the incorrect motor memories with the correct formations. She is progressing well in all areas addressed.