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. Began OT session with showing Libby her OT chart and little rewards (baby squishmallows) for her to choose from. OT had her put her hair up at start of session so she could earn a star and receive her first baby squishmallow. She choose a baby duck. She wore her hair up throughout session only asking to take it down once. She even walked around the school and hesitantly showed it to her brother, Teddy who was in Art. Several teachers and Miss Judie commented on how beautiful she looked with her hair up. OT also had her take her blue sweater off at the beginning of the session because it was very warm outside and she was just coming in from recess. She demonstrated no aversions to taking off her sweater and never asked to put it back on. We reviewed lowercase letters r and n and Libby was instructed on lowercase m today. While working OT realized that Libby does not know all her lowercase letters and when shown is unable to say which lowercase letter is which. She seems to know her uppercase. OT will work on lowercase letter recognition before continuing lowercase letter writing. Libby needs to be able to recognize the lowercase letter before learning how to write them. We will continue to work towards her established goals.

Luke was seen in his room for a 45-minute occupational therapy treatment session. Focus of treatment was on improving his bilateral integration/hand usage, fine motor development, graphomotor skills, postural control and sensory processing/organization for improved general performance in various environments. School had a lock down drill during the first part of our session. Once we got back Luke and OT worked on handwriting for his book. He is showing great gains with writing and endurance/focus for longer periods of writing work. He is now able to form most of the letters correctly requiring minimum verbal cues for 100% success. We continue to work on problem size and reaction size scenarios. Good session.

Luke was seen in his room for a 45-minute occupational therapy treatment session. Focus of treatment was on improving his bilateral integration/hand usage, fine motor development, graphomotor skills, postural control and sensory processing/organization for improved general performance in various environments. Began session with Zones of Regulation work. We played Zones of Regulation Bingo and Luke participated well. He is becoming more cooperative with talking and participating in games dealing with emotions and regulation. During our Bingo game OT would say a scenario and he would have to find face with corresponding emotion and put an "X" on it. After the game we talked about what had happened earlier in the day with a peer and how he could have used a different, more appropriate, and expected behavior/coping strategy to deal with the situation. He understood and listened well. Lastly, he wrote sentences today in his book that he is creating in OT.

Luke was seen in his room for a 45-minute occupational therapy treatment session. Focus of treatment was on improving his bilateral integration/hand usage, fine motor development, graphomotor skills, postural control and sensory processing/organization for improved general performance in various environments. Began treatment outside playing basketball per Luke's request. As we played we discussed expected versus unexpected behaviors. Luke said to OT that when someone just takes the basketball from him that it makes him sad and that they should ask for a turn. OT asked him for a turn with the ball and he gladly shared it. He did a much better taking turns and sharing today during our session. He used manners and was pleasant throughout session. We continued working outside at the table on emotions, strategies, and reactions to different situations. Luke is becoming well aware of what is appropriate and knows strategies; however, his impulsiveness and maturity level make it difficult for him to implement at this time. Good session.

Richard was seen in his room for a 45-minute treatment session. His session focuses on improving his postural control, integration of retained reflexes, visual motor skills and integration, fine motor skills, dexterity, manipulation, ocular motor development and graphomotor development/keyboarding as an alternative means to written communication. Began session with review of cursive letters and mountain climbing group. Instructed Richard on cursive letter "m" today. He was able to write them well. He will require continued practice since he left early today for a dentist appointment and missed half of his OT session.

Richard was seen in his room for a 45-minute treatment session. His session focuses on improving his postural control, integration of retained reflexes, visual motor skills and integration, fine motor skills, dexterity, manipulation, ocular motor development and graphomotor development/keyboarding as an alternative means to written communication. Began session with mat exercises to work on integration of retained primitive reflexes specifically the ATNR. Activities included cat/cow and push ups. Richard is able to do 20-30 solid push ups. Continued in his room to review the cursive letters from the "Island Grill" group which include "e,l,b,k, h, and f". He formed them all well except for letter "b", he could not idenify "k and f". He needed demonstrations to write b, k and f correctly. We practice the movements for the "mountain climbing" group letters. He was instructed on identification of the letters in this new group which include n,m,v,x and z. Worked on letter "n" today. Richard was provided with partial highlight as visual cues for formation of "n". He did well with visual cues. Good session.

Richard was seen in his room for a 45-minute treatment session. His session focuses on improving his postural control, integration of retained reflexes, visual motor skills and integration, fine motor skills, dexterity, manipulation, ocular motor development and graphomotor development/keyboarding as an alternative means to written communication. Began session with play "Look Whose Listening" game which works on following multiple step commands/directions and encourages whole body listening. Richard worked on auditory memory as he listened and had to repeat back 4 to five words or numbers. He was fairly consistent with 4 words or numbers and less consistent with 5 words/numbers. We continued cursive review and he was introduced to the last group of lower letters in "Script Island" called "the monkeys go mountain climbing" letters. He participated well.

Richard was seen in his room for a 45-minute treatment session. His session focuses on improving his postural control, integration of retained reflexes, visual motor skills and integration, fine motor skills, dexterity, manipulation, ocular motor development and graphomotor development/keyboarding as an alternative means to written communication. Began treatment with ocular motor activity. Richard was required to scan "Pikachu" to find the letters "m" and "c" that were mixed amongst other letters. He continued with an activity that had him decipher between a "b" and "d" to get through a maze. We continued session with cursive review of each letter he learned in previous sessions. He has been instructed on three groups of cursive letters through "Script Island". He is demonstrating adequate to good formations of cursive letters when provided with a visual model. Goal is to eliminate visual model and rely on visual memory. Richard is slow and deliberate when writing in cursive at this time. Richard was unable to recognize cursive letter "y" and "q" and wrote "g" incorrectly even when given model. He has been observed to get frustrated at times with cursive. His writing teacher reported that his print handwriting is showing much improvement. Good session.

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. Began session going over her sticker/reward chart. Libby's mother, Amanda, shared pictures and information about what Libby tried over the past week to earn sticker on her chart. She earned 5 stickers for wearing shorts and a dress on 5 different occasions. Began fine motor play with using strawberry picker to pick up small fuzzy balls. Libby required cues to use three fingers (thumb, index and middle finger). This activity aims at building strength in the hands and the intrinsic muscles for hand strength for holding writing utensils with a sustained tripod grasp. Libby put her hair up and wore it up throughout our session only asking to put it back down once. OT had Libby try different pencil grasps on her writing utensil but she did not like how they felt. She is observed to use a thump wrap grasp pattern on her pencil when writing which causes her web space to collapse. Lastly, instructed Libby on lowercase letter "n" and reviewed letter "r". Good session and good progress.

Luke was seen in his room for a 45-minute occupational therapy treatment session. Focus of treatment was on improving his bilateral integration/hand usage, fine motor development, graphomotor skills, postural control and sensory processing/organization for improved general performance in various environments. Began treatment working on graphomotor skills. Luke had the plastic "roll-n-write" letters for "a", "d", "n" and "o" on his desk as reminders for the formation of these letters. If he formed a letter incorrectly OT had his roll the marble to see how the movement goes in the "roll-n-write" plastic letter square. Luke was able to write on 1/2" lines He wrote 13 words today copying from near point. Luke continues to make the letters "n,m and o" from the bottom up. He required cues to form these three letters correctly. He tolerated being verbally cued well for most of session and started to demonstrate minimal frustration towards end of session. He followed directions and by the end of the session corrected the mistakes he was making at the beginning of the session. Good working today!