Tips to Help Make Virtual Learning Successful this School Year

This school year is going to be incredibly different for children, teachers, and all family members.  When thinking about homeschooling, working in a learning pod, and/or working with a tutor it is particularly important to consider movement and the inherent benefit of whole brain learning.  What does whole brain learning mean?  It is a term that symbolically represents the brain being activated both by lower route sensory motor pathways and higher route pathways responsible for meta-cognition, executive functioning and academic potential. 

When a child goes to school there are many movement opportunities built into the day.  There are natural transitions around the classroom, from class to class, and there are extracurriculars that are designed to enhance learning potential.  With school being virtually based, this fall due to COVID-19, we wanted to provide some easy to execute body and mind boosting activities, exercises and environmental adaptations to consider.


·        Screen time breaks

  • Eye relaxation exercises

  • Guided meditation

  • Guided breathing exercises 

·        Contra-lateral movements to activate both sides of the brain


  • Brain Gym exercises 

  • Dance breaks to preferred music 

  • Movement/relaxation before screen time, intermittently throughout the school day and after learning

·        Tactile exploration in sensory bins or while asked to attend to a virtual lecture

  • Put Velcro under the table to be manipulated

  • Allow the child to squeeze putty, play-doh, stress balls etc…

  • Invest in multiple hand fidgets and let the child choose which fidget they want to use while learning

·        Postural support

  • Remember the importance of ergonomics while a child is seated for learning

  • Provide multiple seating options including standing desk opportunity, rock back chairs, child sized ball chairs, bean bag chairs. Variety is the spice of life and when a child has the opportunity to explore novel positioning they are more able to engage, attend and learn. 

  • Use slant boards

  • Use foot rests and foot fidgets 

  • Use a wrist pad 

  • Allow access to attention enhancing snacks/toys while viewing online lectures

  • Crunchy foods

  • Chewy foods

  • Biteable straws 

  • Chewlery 

Environmental Adaptations: 

It is very difficult for a child to process visual input from a screen while attending to auditory instruction.  There is a heightened level of difficulty with virtual learning due to the multi-sensory processing demand and reduced processing time children are being allotted. Children can become incredibly overwhelmed and overloaded.  This dysregulation may even occur prior to starting virtual school due to anxiety.  Here are some things to consider when setting up your home school environment:

  • Screen Size:  When possible it is better to utilize a big screen such as a smart TV or larger desktop computer.  This will enhance your child's visual field and may improve visual attention. 

  • Headphones:  Use of open air headphones or having computer speakers may enhance the quality of sound

  • Advocate:  Advocate for your child ahead of time and make sure visual supports such as checklists, organizers, class outlines etc… are printed and ready to be used 

  • Visual Supports:  Use a visual timer to show your child how long they will be asked to attend.  Use a white board to help with in the moment notes. Use highlighters and bright colored or motivating writing utensils to help with internal motivation and visual organization. 

  • Computer Accessories:  Use a mouse, a detached keyboard and a touch screen stylus whenever possible. 











Strategies to Encourage Children to Wear a Face Mask


  1. Make it Fun: There are so many different styles, colors, and prints for face masks. Include your child when picking out the face masks and try to find options that will help motivate your child to wear it. 


  1. Provide Choices: Allowing your child to pick which type or what color mask to wear can provide your child with a calming sense of control. Children often have tantrums when they feel a loss of power. Providing simple choices throughout the day, including which mask to wear can go a long way. 


  1. Modeling: Lead by example! Start by wearing a mask in front of your child to help normalize wearing a mask. Does your child have a favorite stuffed animal or toy? If so, have your child put a face mask on it. You can have your child, his or her favorite toy, and yourself stand in front of a mirror with face masks on to provide visual feedback. You may also wish to take a picture of you and your child with masks on and use it as a visual aid. Show this picture to your child before it is time to go out and put a mask on to ease the transition. 


  1. Slow Exposure: Going from never wearing a mask to having to wear a mask can be challenging. Slowly introduce the mask to your child. Start by practicing in the home and have your child wear a mask when he or she is most relaxed (favorite TV show, iPad time, coloring etc.) Gradually increase the amount of time he or she wears the mask. Next you can practice wearing a mask outside to get the mail or for quick errands and like in the home gradually increase the time. 


  1. Adapt: Some kids may find the ear loops to be annoying. Simple solution: buttons! Search the web for different tutorials on how to sew buttons on hats or headbands to make your child’s face mask more comfortable. You can even use this method for yourself! 


  1. Modifications (based on sensory processing needs): If a child has difficulties with auditory processing or is deaf it is recommended to use masks with a clear front window.  This will allow the child to continue being able to understand what you are saying by being able to view your mouth. 


*As stated by the CDC, face coverings should not be placed on children younger than 2 years old. For any medical questions regarding face masks please consult your medical physician or visit the Centers for Disease Control and Prevention and the Department of Health websites. 


Below are just a few items on the market you may wish to purchase. Make sure you look at the sizes and feel free to browse other options to find the right match for your child! 


































A Tribute to Dr. Jean Ayres: 

The Incredible Vestibular System 


Dr. Jean Ayres (July 18, 1920-December 16, 1988) was born on this day in 1920. For those of you who are not familiar with Dr. Ayres she was a pioneer, teacher, and visionary for the profession of occupational therapy and the world. Dr. Ayres was ahead of her time and created the theory of sensory integration.

“Ayres Sensory Integration® (ASI) is a well-established and growing area of therapeutic practice with applications in various settings including the home, school, and community. Developed by A. Jean Ayres, PhD, OTR, FAOTA, an occupational therapist, psychologist, and neuroscientist, this framework was originally shown to be effective with children with learning and behavior difficulties and has since emerged as an evidence-based practice for use with children with autism. Applications have been broadly applied with individuals with a variety of disabilities and age groups. ASI is trademarked to help researchers, therapists, and parents identify the core principles which define ASI and to differentiate this evidence-based intervention from other approaches which may use some aspects of sensory-based activities, but do not meet the criteria for ASI (CLASI, 2020).”


Dr. Ayres was my first guru, inspiration, and teacher.  I remember reading her articles and books in college and feeling so inspired to become an occupational therapist.  Her dedication to her craft, compassion, unmatchable clinical observation skills and ability to engage with children is something I aspire towards and always will. Dr. Ayres knew the importance of movement and the intricate operating of our vestibular system long before technology could back her theories.  Still researchers in our field are working to maintain Dr. Ayres legacy and to further advance the evidence to back her theories and principles for intervention.  Please check out the CLASI website ( to learn more about Dr. Ayres, ASI and what her peers, colleagues and former students are doing to provide global standards and learning opportunities.


The Incredible Vestibular System

I have been nervous to take on the profound job of trying to discuss the vestibular system in a casual and brief manner.  Why is because the vestibular system is so incredibly profound, complicated, and complex.  If you enjoy what you are about to read, I highly recommend you further your research and education on the vestibular system.  I highly recommend Tracy Murnan Stackhouse’s MA, OTR/L lecture “ The Mighty Vestibular System” (available at  I also have provided links to book recommendations at the end of this narrative.

This post today is for the curious caregiver and clinician alike. For the purpose of todays discussion, we will be talking about the function of our vestibular system and how difficulties may present. I will not be discussing the anatomical or intricate neurology of this dynamic system. For that I hope you tune in to the recommended resources I have suggested. Please feel free to email me with any questions related to the information provided today.

What is so cool about the vestibular system?

The vestibular system is incredibly important and a crucial aspect of all our abilities to move, play, dance, sit, stand and just be! This system is often overlooked or misunderstood due to the dynamic, complex, and intricate unconscious processing that takes place every moment of our lives. This system is one of the first senses to develop in a growing fetus. It is stimulated by the movement of the mother’s body.  It is the foundation for our overall sense of safety, well-being, and our unique sense-of-self.  It allows a child to move, to sooth, to engage, and to play.

“the vestibular system enables the organism to detect motion especially acceleration and deceleration and the earth gravitational pull.  The system helps the organism to know whether any given sensory input- visual, tactile, or proprioceptive- is associated with movement of the body or is the function of the external environment (Ayres, 1972).”

So it is safe to say the vestibular system is a really big deal! This system is intricately connected to most other sensory systems and helps to create a foundation for development of all skills.  The vestibular system has a large impact on muscle tone, postural stability, ocular control, balance, bilateral coordination, motion perception, spatial-temporal processing, stability, ability to inhibit and start movement, emotional processing, and auditory perception (just to name a few)! Children and adults with vestibular processing difficulties can present incredibly different due to the vast array of interconnections the vestibular system has. I have read many OT blogs that cover the basics of vestibular processing but today we are going to dive a bit deeper. Let’s talk about vestibular modulation vs. vestibular discrimination!

I was extremely lucky to be mentored by the incredibly talented Tracy Murnan Stackhouse MA, OTR/L who is the executive director of Developmental FX in Denver, Colorado. Tracy along with other scholar clinicians are working diligently to provide cutting edge research and clinical reasoning tools that have strong roots in Dr. Ayres principles. Tracy really helped me to understand the vestibular system in a highly skilled and clinically astute way.  I again recommend taking her courses available at


Vestibular Modulation: modulation of sensory information is our ability to perceive, respond, react, and recover. A child with vestibular modulation difficulties may has difficulty taking in the information from the world/their body and they may not know how to respond to it.  What does this mean?  This means that simply just being alive and, in the world, may be scary.  These children may have significant social-emotional, cognitive or motor difficulties that are easily observed.  However, they also may have subtle difficulties that are more difficult to observe.  Therefore, it is so important for clinicians to further their education on sensory processing and integration.  To treat the child appropriately we need to be able to see where our main target treatment areas are.  Saying the child has a “vestibular problem” or “vestibular sensitivity” or “craves vestibular input” is just not enough. Children with vestibular modulation difficulties may have extreme aversion to movement or appear to not be able to get enough of it.  This is again because the ability to modulate requires being able to perceive/receive and to recover/adapt from the stimulation.  Modulation is highly connected to one’s arousal and ability to adjust their affect to changes in the environment and their own internal state. These children struggle to feel safe within their own skin. They may have difficulties with connecting to loved ones and peers because how can you connect to another if you feel disconnected within yourself? These children may be mis-labeled as behavioral, difficult, shy, unruly, unpredictable, and difficult to console. In intervention the first thing I have been taught to look for is modulation difficulties because it is often past over and is incredibly essential for meaningful and joyful development. 


Vestibular Discrimination: discrimination is our ability to understand, adjust, adapt, and do.  Vestibular discrimination allows us to initiation, sequence, execute, problem solve and adjust our approach. It is incredibly important for body awareness, self-monitoring, and development of skilled motor functioning.  Dr. Ayres spoke in length about the importance of vestibular discrimination and how when difficulty occurs it can lead to several observed difficulties in development.  Dr. Ayres identified that for a child to motor plan their actions they needed sound vestibular discrimination skills. Difficulties that may occur if discrimination abilities are impacted include; difficulties with body awareness and motor coordination in specific areas of the body, difficulties with visual processing and ocular control, overall generalized disruption off motor organization, bilateral motor coordination involving difficulties with balance, difficulties with midline orientation and more!  As you can see writing about the vestibular system in this casual format is exceedingly difficult because its functioning is so amazingly intricate!

Today I hope you too got excited about what our vestibular system is doing for us from moment to moment.  I hope in the spirit of Dr. Jean Ayres you observe your child in motion and play with amazement and gratitude.  I hope that next time your child has an unexpected meltdown or burst of excessive movement you think about their vestibular system and how it may be impacting their behavior.  I hope you bring up these discussions with your occupational therapist, friends, colleagues and children.  Lastly, I hope you go out and engage in new, fun, and dynamic movement today!  Movement is a gift, the root, and the zest of life.

Happy Birthday Dr. Jean Ayres I hope you are looking down on us with delight in your heart.


-Kaitlin Dollard MS, OTR/L & Jaclyn Campson MS, OTR/L



Stackhouse & Graf (2017) The SpIRiT© (Sensory processing/Integration Reasoning interactive Tool) of Pediatric OT 

Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles: Western Psychological Services.

CLASI. (2020). About Ayres Sensory Integration.

Book Recommendations: 


Bilateral Coordination and Why it is important

  10%off your purchase with Promo Code: BTSOT 

Bilateral coordination in its most simplistic definition is the ability to use both side of the body together to complete a task.  As seen on our “Tips Tuesday” Instagram post bilateral coordination may involve both sides of the body doing the same thing or opposite actions. 

For example, we need sound bilateral coordination skills to open a water bottle (stabilizing with one hand while manipulating with another).  We also need bilateral coordination skills to do symmetrical movements such as rolling out cookie dough. There is a lot of information online available regarding why bilateral coordination is important and activities that can enhance it.  What we wanted to spend some more time on today, during this Feature Friday post, is what underlying skills are needed for sound bilateral coordination and how difficulties can present in sneaky ways!

What are some foundations skills that are required for bilateral coordination?

  • Communication between the right and left hemispheres of the brain

  • Efficient vestibular processing abilities

  • Efficient midline orientation and body awareness (sense of self)

  • Efficient midline crossing

  • Efficient ability to grade force on objects

What are some less talked about ways difficulties with bilateral coordination present?

  • Frequently knocking things over

  • Exerting too much or too little force on objects

  • An all or nothing approach to object manipulation activities

  • Difficulties with coordination, ball handling, balance, and gradation of movement

  • Lack of observed hand dominance in kindergarten or first grade

  • Resistance to crafts or activities that require sound bilateral coordination abilities

  • Difficulties with arousal and activity regulation

  • Handwriting difficulties

How can we adapt bilateral coordination activities to provide more support to children who are struggling?

  • Scaffolding tasks for the “just right challenge” (a concept developed by Dr. Jean Ayres).

    • Example: If you want a child to learn to catch a ball start with rolling a large ball to each other.  As the child gains more skill you can have them sit in a chair to catch a medium sized ball.  As they can do this you can challenge them to stand up with their backs against the wall to catch a ball. Eventually you can work on the child catching a variety of sized/textured balls without postural support.  The key will be to take it easy and allow the child the time to find their confidence with their performance at all stages!

  • Increasing the feedback provided by an activity to enhance awareness and force gradation:

    • Example:  Have a child squeeze Play-Doh or a small amount of putty in their non-dominate hand when trying to stabilize an object

    • Use Squeezable balls, squishes and weighted objects when practicing symmetrical bilateral coordination activities

  • Provide more postural support

    • Example: If a child is struggling with age-expected bilateral coordination skills assess their postural control abilities.  Is this a child who hikes their shoulders up for stability when cutting?  Is this a child who is always falling out of their chair?  Is this a child who becomes avoidant or defiant when asked to complete table-top tasks?  If so, you may need to provide more postural support via adapted seating, foot stools, slant boards etc.. Before a child can develop refinement of skill they need basic body awareness and midline orientation.  Can you and your child become creative like Goldie Locks trying to find the perfect chair!

  • Products and games that we recommend to work on bilateral coordination development at home, in school, and in the clinic:


Visual Motor Integration Explained

Before we dive into visual motor integration today, we wanted to spend some time discussing this blog, our vision, and purpose behind it.  Jackie and I have created this blog to provide more in-depth knowledge to clinicians, teachers, and families who are looking for a more information regarding commonly talked about intervention domains.  The information provided here is not an accurate depiction for all children.  If you have concerns related to your child’s visual motor integration development, we highly recommend you consult with a pediatric occupational therapist near you. If you are here in San Diego, CA I am more than happy to schedule a free 30-minute phone call with you today! 

Visual motor integration (VMI) is a highly specialized skill that we often take for grated during our everyday lives.  VMI allows us to write our names, fill out our calendars, highlight a passage in a book, make a bracelet with beads, shoot a basketball etc… To have sound visual motor integration skills the coordination between our visual processing systems and our motor systems needs to be efficient.

Visual processing includes but is not limited to:

  • Visual perception

    • Visual discrimination

    • Visual figure ground perception

    • Visual spatial relations

    • Visual closure

    • Visual memory

    • Sequential memory

    • Visual form constancy

  • Ocular motor control and coordination

    • Ocular pursuits (tracking & eye teaming)

    • Ocular saccades

    • Convergence/divergence

Motor control and coordination includes but is not limited to:

  • Trunk control and stability

  • Upper extremity coordination and localization

  • Scapular stability and strength

  • Fine motor coordination and dexterity

  • Eye hand coordination

A child could have skills in both the visual and motor domains but difficulties with integrating these skills to produce mature visual motor integration skills.  For example, a child could have incredible visual processing abilities, be athletic, and appear to be strong but they could struggle with the completion of mazes, handwriting, eye-hand coordination activities etc…  Therefore, it is important to have more understanding on what foundational aspects impact visual motor integration (VMI).

The visual system is intricately connected to our vestibular system.  If a child is having difficulties with vestibular processing it is not uncommon for VMI difficulties to be observed. Similarly, if a child is having difficulties with grading their force on objects or producing smooth and controlled upper limb movements, due to proprioceptive and/or tactile processing difficulties, then they may present with VMI difficulties.  Why is this important?  This is important because many children will not be able to enhance their VMI skills by engagement in VMI activities alone. They may need to work on more foundational neurological processing while working on VMI development. Below we have listed some ideas on how to enhance sensory processing while working on VMI development.


Activities for home:

  • Create an obstacle course in your home or backyard.  Hide writing utensils throughout the obstacle course.  At the end of the obstacle course have a VMI (maze, connect the dot, tracing, writing) worksheet.  You could tape the worksheet to the wall or use a slant board to further enhance shoulder stability

  • Incorporate music and movement into ball handling games and target throwing activities.  For example, play freeze dance.  When the music stops the child is encouraged to throw a given number of bean bags at a target.

  • Do target throwing games while the child is on suspended equipment like a swing.

  • Use vibrating pens when completing mazes or tracing shapes, number, and letters.  This is fun for kiddos and stimulates the tactile receptors in their hands

  • Use bathtub crayons and complete VMI games and activities in the bathtub.

  • Play keep it up with a balloon on a trampoline or in the swimming pool.

  • Do a bowling activity with various sized, textured, and weighted balls

  • Complete letter formation activities with molding clay or Play-Doh prior to using a writing utensil.

  • Complete upper limb coordination games (copy this movement, Simon says, follow the leader) prior to VMI activities.

Recommended Products for home, school, or clinic:

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