Regulation Rendezvous: Incorporating Heavy Work into Daily Routines for Resistant Students

Heavy Work is one of our most recommended strategies for students who need calming or seek proprioceptive input. However, sometimes students can be resistant to sensory strategies. Some reasons behind their resistance could be:

• difficulty with change and accepting strategies that are new or different
• limited practice with strategies makes them feel like tasks rather than tools
• poor interoceptive awareness leading to not knowing when sensory strategies are needed to help  them regulate
• not understanding how sensory supports can help them
• rote "no" or refusal response when presented with sensory option (i.e. "Do you want your weighted vest?") 

For resistant students, we often recommend creating routines surrounding their sensory supports so that they become a predictable and consistent part of their day. Today's Regulation Rendezvous will provide a variety of ideas for Incorporating Heavy Work into Daily Routines for these Resistant Students. 

Transitions

One way to incorporate heavy work is to embed it during natural transitions. This is helpful because the student knows there is a definite beginning and ending point to when they have to engage in the activities. Supports such as weighted backpacks, weighted jugs to carry, or a heavy work cart or pusher can all be used during transitions. 

Weighted jugs and backpacks
Rylie Jarrett
Stevenson Elementary, Mad River

Wooden pusher
Wendy Sondergaard
Rushmore Elementary, Huber Heights

Classroom transitions can also be a good opportunity for heavy work. In the example below, the student's chair has weights attached and she moves it between her desk, group table, and carpet area at each transition. 

Weighted student chair
Emily Colbert
Bruce Elementary, Eaton

Heavy Work Jobs

Another daily routine where heavy work can be incorporated is into daily jobs. There are many jobs that provide proprioceptive input from washing tables, sweeping or vacuuming, or collecting recycling. In the example below, the student collects milks after breakfast and lunch in the cafeteria. 

Collecting milks job
MCESC ACT team

Heavy Work Centers

Many classrooms have a variety of adult-directed and independent centers for students. We have seen some great examples of independent heavy work centers. These can be incorporated into the student's daily schedule either during centers time, as anchor activities when finished with work, or when the student shows signs of dysregulation and needs a quick break to regulate. 

Beanbag ABC matching station
Rylie Jarrett
Stevenson Elementary, Mad River

Book sorting by color station
Rylie Jarrett
Stevenson Elementary, Mad River

Books on shelves station
Jessica Stewart
Trotwood ELC, Trotwood

Lego wall station
Debi Gnau
Mad River ECEC, Mad River

Joint Compression station
Taylor Ruef
Stevenson Elementary, Mad River

Weighted bars station
Amy Pratt
Springcreek Primary, Piqua

Choices

Another effective way to get student buy-in is to provide choices. This gives the student some shared control in deciding what heavy work activity they want to do versus giving an open-ended option such as "Do you want the body sock?". Choices can be given by presenting two items or for some students a choice folder can be effective. 

Sensory choice folder
Keelin DeMuccio
Fairbrook Elementary, Beavercreek

Be sure to give the student ample opportunities to practice with the sensory items before providing them with that tool as a choice so they develop a better understanding of how to use it and if they like it or not. 

Body sock
MCESC ACT team

StretchEze bands
Amy Pratt
Springcreek Primary, Piqua

Incorporating Interests

Many of our students have specific special interests which can be very motivating. Find ways to incorporate these special interests into heavy work so the student develops a positive association with the activity or tool. 

Firefighter vest with added weights
Pam Locker
Washington Primary, Piqua

Weighted bobcat stuffed animal
Lori Bicknell
Mound Elementary, Miamisburg

For more ideas on incorporating Heavy Work for your students, check out our previous post

Heavy Work

A-LIST Spotlight: Terri Dinkelaker, Physical Therapist at Montgomery County ESC

Many teachers would agree that the support and expertise of related service providers is invaluable to increasing student success in the classroom. This is especially true for the teams working with Physical Therapist Terri Dinkelaker. Terri has a wealth of knowledge and specializes in many different areas to help her students. Also, she is a fabulous team collaborator and is always open to brainstorming and problem-solving. In today's A-LIST Spotlight we have asked Terri to share some of her favorite supports and strategies and luckily she has shared TONS of fabulous examples!

Terri shares: "I started my career as a physical therapist in the hospital setting and transitioned to the school setting close to 15 years ago. I am employed by Montgomery County ESC and have been for the last 5 years. I have been in the Mad River Local School District for these past 5 years in addition to some time spent in the West Carrollton City School District, and Jefferson Township. I work with some phenomenal team members including fellow Occupational Therapists through the Montgomery County ESC, Intervention Specialists, Multiple Disabilities teachers, teachers, SLP’s, parents, building principals, special education supervisor, paraprofessionals, school psychologists, APE, school counselor, nursing, and fellow PT’s. We often utilize a collaborative team approach with the goal of meeting the students’ needs while promoting independence and success. The team discusses sensory motor strategies, heavy work/motor break routines, mobility, strengthening/stretching exercises, seating options, communication, and strategies for implementing motor into the classroom.

Interventions:

Sensory Motor Rooms: The OTs and I in each of my buildings have worked to develop sensory motor rooms. With collaboration of the team, we have built individual sensory motor routines to allow re-organization and focus to return to the classroom ready to work. These individual programs are designed to meet the needs of the students so that they can be successful throughout their school day. Once trialed by the PT and OT, the programs are implemented on a daily basis by the teaching staff. They are adjusted and adapted and sensory needs change. 

Sensory Motor Pathways:

In collaboration with the OTs and teaching team, a sensory motor pathway has been developed in the front area of Stevenson Elementary to give the students a quick movement break to reorganize and refocus the students. This pathway is typically utilized by whole classes, individual or groups of students. The students are escorted by teachers, paraprofessionals or other support staff.

A sensory motor pathway was developed at Saville Elementary and Spinning Hills Middle School in the hallways using floor tape to give the students a quick reset near the classroom. This allows the students a movement break without traveling too far so that class time instruction is not missed.

A sensory motor pathway at the Mad River Early Childhood Education Center was developed using sit spots on carpet and situated in the hallway near the classrooms. Due to the age of the building, floor tape is not able to be utilized  and thus the sit spots on the carpet have been valuable in promoting a motor pathway and a quick movement break.

 

Adaptive Equipment/Mobility Devices:

As a PT working with students and teams in the schools, mobility and accessing the school environment through mobility is very important. Determing what appropriate mobility device to help students navigate the school environment is crucial and then providing staff education on how to implement these devices successfully throughout the school day is equally as important. These mobility devices include walkers, gait trainers, and wheelchairs. Standers are utilized and can be dynamic or static. I have students that are able to walk but demonstrate behaviors that impact their ability to mobilize successfully from one location to the next in the school environment, thus a wagon is utilized. This has been a successful tool to transition students. A weighted mobile cart has been utilized with a varity of students to provide a heavy work movement break. Purposeful walks using pictures that are highly motivating for the student have been utilized successfully and daily for our students. These walks can be utilized with a weighted back pack, weighted mobile cart, pushing or riding in the wagon, riding a bike or a scooter, or walking with or without a mobility device. Tricycles and adaptive bikes have been utilized a highly motivating movement break for students. These have been implemented into daily individual sensory motor routines. Adaptive seating is trialed and implemented into the classroom with collaboration of OT, PT, and teaching team.

Motor Groups:

PT, OT, and SLP motor groups were implemented at preschool and Stevenson Elementary to provide our students with a multi-disciplinary approach to meeting all their needs on a once a month basis. 

Structured 3 Bins:

The 3 tiered bin system has been utilized the past couple of years during PT sessions and PT/OT sessions with great success. I have utilized both a mobile bin system and 3 individual bin systems labeled 1, 2, and 3 with choice at the end. The students match the number on the outside of the bin and the stuctured work is located in each bin. This system has allowed consistent structure and minimized behaviors. This bin system is utilzed for the majority of my treatment sessions.

I am super blessed to work with some amazing team members. Special thank you to my awesome OT’s Denise Campbell (whom is featured in some of these pictures), Ashley McCoy, Jess Foster, and Jenn Dietz. They sure make my job as a PT wonderful!!!!"

And we are super blessed to have Terri as one of our A-LIST partners! Thank you so much Terri for sharing all of these amazing examples and welcome to our A-LIST!