Occupational Therapy

An individual’s ability to participate in daily life activities, or “occupations”, is the primary concern of an Occupational Therapist. Children’s occupations are being preschoolers, playmates, or students. An adult’s daily life skills include activities such as preparing meals, doing laundry, driving, handling finances, and holding a job.

visual spatial awareness

For more information on our Occupational Therapy programs, click on a topic:

The Alert Program

"How Does Your Engine Run?" consists of a series of lessons and activities that incorporate sensory integration techniques with cognitive approaches. The program is designed to help children recognize and expand the number of self-regulation strategies they use in a variety of tasks and settings. It is important for an Occupational Therapist with sensory integrative techniques to teach the children, parents, and teachers how to recognize arousal states (levels of alertness) as they relate to attention, learning, and behavior.

Self-regulation is the ability to attain, maintain, and change arousal appropriately for a task or situation. Self-regulation involves many neurological connections in the brain. To attend, concentrate, and perform tasks in a manner suitable to the situational demands, one's nervous system must be in an optimal state of arousal for that particular task.

In the Alert Program, children learn to identify their own level of alertness by using the engine terminology. The child (with the help of an adult at first) will know if their engine level is running high, just right, or low for the activity that they are attempting.

The goal of the Alert Program would be, for example, for a child to recognize that he is in a state of high arousal and to be able to use sensorimotor strategies to calm himself for bedtime.

Source: How Does Your Engine Run; Williams, Shellenberger; Therapy Works, Inc.

Go to www.alertprogram.com for more information.

Astronaut Training

Astronaut Training: A Sound Activated Vestibular-Visual Protocol for Moving, Looking & Listening

A healthy vestibular system is important to all of us, not only astronauts. As a bridge between sensory processing and movement control, the vestibular system plays a major role in everything we do including looking and listening. This program is a long-awaited protocol for improving function in the Vestibular-Auditory-Visual Triad.

The vestibular system helps us understand the position of our head and body in gravity-bound space. It gives us information about which way is up and where we are going. It helps us with balance, spatial orientation, and maintaining a stable visual image, even when we are in motion. Since movement is a part of everything we do, the vestibular system is important for all of our interactions with the sensory world. Babies gain important information from the vestibular system about gravity as they begin to move through space of their own accord-crawling, pulling to stand, and tottering their first steps. Healthy babies who were given 16 sessions of vestibular activation had significantly more advanced reflexes and motor skills than the control group.

Vestibular deficits are often found in children with delayed motor development, perceptual or attention deficits, learning disabilities, emotional problems, language disorders, and autism. For example, gravitational insecurity may underlie a child's fear of being moved, swinging and climbing at the playground, or riding an escalator.

The vestibular system teams up with the auditory and visual systems to perform many important tasks by helping us understand the 3-dimensional space that surrounds us wherever we go. The vestibular system also provides a perception of orientation in space that must be activated by the musculoskeletal system. It is our internal guidance instrument working to tie the body senses, such as proprioception and touch, together with the visual and auditory senses. Through the proper functioning of our Vestibular-Auditory-Visual triad the sights and sounds of our world become more meaningful and entice us to move, explore, and engage with objects, people, and events...

The dynamic interaction between the members of the Vestibular-Auditory-Visual triad provides the backdrop for virtually everything we do and thus determines much about the quality of our lives. The activities of our version of Astronaut Training are designed to enhance the dynamic interplay of moving, looking, and listening.

Fine Motor and Gross Motor Ability

A motor skill is an action that involves the movement of muscles in your body. Gross motor skills are larger movements involving the arm, leg, or feet muscles or the entire body - things like crawling, running, and jumping are gross motor skills. Fine motor skills are those smaller actions like picking things up between the thumb and finger, or using the toes to wriggle into sand, or the lips and tongue to taste and feel objects. Gross motor and fine motor skills develop in tandem because many activities depend on the coordination of both kinds of skills.


Handwriting difficulty may be characterized by the following behaviors:

  • Seem "tired all the time" because they frequently prop their head on their hands during seatwork in school
  • Trouble staying between the lines of the paper
  • Complain of tired hand, fingers, or wrist when writing
  • Trouble completing writing tasks and keeping up with classmates
  • Difficulty performing smooth, fluid movements with the pencil
  • Awkward pencil grasp or grasp that is too tight or too loose
  • Avoidance of handwriting or drawing
  • Illegible writing
  • Letters are too big or too small
  • Drawing letters segmentally instead of fluidly
  • Reversals of letters

Play Skill Development

Children learn through exploring their environment and interacting with the people and items around them. Children who hesitate to explore often have difficulty understanding how to use their body in order to interact with objects such as toys. They may have a limited repertoire of skills such as limiting play to balls or sticks, playing with only familiar toys, or engaging in repetitive play schemes.

Sensory processing difficulties may impact a child's ability to grade his or her movements to interact appropriately with toys. A child who is under-responsive to sensory information may break toys or crayons because they need more intense information from their skin and muscles to "feel" the toy. A child who is over-responsive to sensory information may avoid playing with toys because the toys may feel threatening to them.

Whatever the reason, difficulty playing with toys impacts a child's development of fine and gross motor skills, visual perceptual skills, and motor planning skills. These skills provide the foundation for higher learning in order to succeed academically and with daily living activities, such as self-care skills and future career development.

Self-care skills

Self-care skills are important for independence in our daily living. A child begins learning early on how to dress, bathe, brush teeth, and use utensils for feeding. Much of this learning occurs through play and modeling from caregivers. Difficulty with self-care skills often has underlying causes. Foundational skills required for self-care skills include postural control, motor planning skills, visual perceptual skills, and body scheme and awareness to name a few. A child who has difficulty performing self-care skills may take a long time to finish activities, seem like they don't know where to start, have difficulty orienting their clothing appropriately, or have trouble using tools and utensils. It is important to assess and address these underlying causes in order build the foundational skills necessary to perform self-care skills.

Sensory Integration

Sensory integration is the neurological process that organizes sensation from one's own body and from the environment, making it possible for the body to use that information in order to perform daily activities. When an individual is so over-sensitive or under-sensitive to things they see, hear, smell, touch, taste, or feel that they cannot function properly in their environment, then dysfunction in sensory integration (DSI) may exist. DSI may be characterized by the behaviors described within each of the following systems. It is important to note that a child may show symptoms in some or all of the sensory systems. An Occupational Therapist with training in sensory integration will be able to identify sensory integrative deficits and provide the appropriate treatment.

The Gustatory (taste) & Olfactory (smell) Systems

  • Picky eater
  • Extreme reactions to strong odors

The Vestibular (movement) System

  • Always "on the go"
  • Avoids playground equipment
  • Spins/rocks self in place
  • Fearful of movement

System Proprioception (the body's sense of position, direction, motion)

  • Decreased sense of danger/pain
  • Poor body awareness
  • Rough mannerisms
  • Clumsy

The Visual (seeing) System

  • Avoids eye contact
  • Has difficulty reading or writing
  • Experiences increased sensitivity to light

The Auditory (hearing) System

  • Frightened by loud noises
  • Has difficulty listening or following directions
  • Is oblivious to noises

The Tactile (touch) System

  • Avoids getting messy
  • Does not notice when hands or face are messy
  • Irritated by touch
  • Picky eater

For more information about Dysfunction in Sensory Integration (DSI), visit:

Social/Emotional Development

Most children have a natural drive to interact with other children. However, difficulty or avoidance may have underlying causes that do not involve a shy personality or a loner mentality. Poor sensory processing and poor motor planning skills often impact a child's ability to interact with other children. A child with poor sensory processing may become overwhelmed by the unpredictable nature of other children and avoid or withdraw from them. Another child may be behind in his or her play skill development and prefer to interact with younger children.

Emotional skills may also be impacted by poor sensory processing or poor motor planning. Children begin learning self-regulation strategies at a young age including sucking on the thumb, carrying a special blanket or toy, or cuddling with a caregiver. A child with sensory processing problems may tantrum or become fearful by what is generally harmless as they perceive the situation as threatening. Caregivers often spend a lot of time trying to comfort their child and avoid anything that may upset the child. A child with motor planning problems may become easily frustrated by what appears to be a simple task. Issues with behavior often develop from difficulty with self-regulation

Assessment and treatment in the areas of sensory processing and motor planning often help to develop social and emotional skills.

Therapeutic Listening Program

Therapeutic Listening (TL) is an expansion of Sensory Integration. It is an auditory intervention that uses the organized sound patterns inherent in music to impact all levels of the nervous system.

Jean Ayres' groundbreaking work in the field of sensory integration brought to light the critical importance of integrating information from our senses for the organization of movement, learning, and behavior. In everyday listening we are doing just that - attending selectively to auditory information and integrating it with other salient sensory data. Listening is a voluntary, survival-related, whole brain, and whole body process. The survival of an animal living in the wild depends on its ability to listen and monitor and then actively respond to changes in the environment. Because of its importance in survival, Ayres acknowledged that the processing of sound could be classified as one of the 'primal forms of sensory integration'.

Many of the individuals who have sensory processing and sensory integration difficulties also have listening difficulties. This is clearly seen in individuals with auditory defensiveness or auditory over-reactivity. These individuals often will cover their ears in response to low frequency sounds such as vacuum cleaners, blenders, and hair dryers or high pitched or sudden sounds such as sneezing or screaming.

Recent clinical practice demonstrates the efficacy of incorporating sound into sensory integrative treatment strategies. In fact, many experts agree that the auditory system is a critical link in sensory integration theory.

Visual motor processing/integration

Visual motor processing/integration refers to the ability to use the eyes and hands together (eye-hand coordination). This skill is important for many daily activities and especially with drawing, copying, and handwriting. A child's academic performance can be significantly impacted by difficulty with visual motor integration

Wilbarger Brushing Protocol

Based on the theory of Sensory Integration, the brushing technique uses a specific method of stimulation to help the brain organize sensory information. The brushing technique was developed by Patricia Wilbarger, MEd, OTR, FAOTA, an Occupational Therapist and Clinical Psychologist who has been working with sensory processing theories for over 30 years. She is a cofounder of Sensory Integration International and AVANTI camp and well known for her clinical work in the NICU, schools, etc.

Our skin is our largest sensory organ, followed closely by our muscles and skeleton, connected by our nervous system and governed by our brain. The sensory systems feed information from our environment, through sense receptors, and neural impulses via our nervous system, directly to the brain. The brain then organizes it, sends it back through the nervous system for use as understanding, adaptation, learning, and skill development. When this system functions well, it allows a person to interact with their environment efficiently, developing necessary motor and language skills, and appropriate social/emotional behavior. When this system is unable to organize the information appropriately, a variety of symptoms can present; motor delays, tactile defensiveness, learning disorders, social or emotional difficulties, speech, and language deficits or attention disorders.

The program has been found very beneficial to children with sensory integrative dysfunction, as outlined in the previous paragraph. This technique helps the brain and body work together more effectively. Benefits noted are:

  • Can improve ability to transition between activities (calming after emotional outburst, improving tolerance levels.)
  • Can help children who have a fear of discomfort in being touched (tactile defensiveness)
  • Can increase self regulation, self calming.
  • Can increase the ability of the nervous system to use information from the senses more effectively, i.e. speech/motor skills.
  • Can improve attention and focus.
  • The students generally like the procedure!

Benefits received are directly related to correct administration and consistency.
Using this technique without instruction from a trained therapist could be harmful at the extreme, and at the minimum, useless. Feel free to ask your therapist about this program.

Source: www.ot-innovations.com

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ACG Therapy Center
4907 NW 43rd St., Suite C, Gainesville, FL. 32606

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Contact Information

ACG Therapy Center

4907 NW 43rd St., Suite C
Gainesville, FL. 32606

Phone: 352-372-0047
Fax: 352-372-4701
Email: angela@acgtherapycenter.com
Business Hours:
Monday–Thursday 8 a.m.–6 p.m.                                                                         Friday 8 a.m.-Noon



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