Oculomotor Control/Dysfunction

What is Oculomotor Dysfunction?

There are six muscles around each eye. These six muscles work together in an extremely sophisticated Oculomotor-Dysfunctionmanner in order to accurately control eye movements. Oculomotor Dysfunction occurs when these muscles are not properly coordinated. The causes of Oculomotor Dysfunction range from slow development to disease of the central nervous system. An eye exam easily diagnoses this condition.

If one’s oculomotor muscles are ineffective, he may have difficulty reading–he may easily lose his place or repeat sentences. People with this condition may also have difficulty with balance, depth perception, sports, or hand eye coordination. Virtually every task requires good control of eye movements.

Eye movements essential to proper eye function include:

  • Smooth Pursuits – the ability to stabilize gaze and follow a moving object with the eyes accurately;
  • Saccades – the ability to jump your eyes from one target to another accurately. Saccades are necessary for tracking skills while reading or copying information. In order to process visual information properly, the eyes must move smoothly and quickly from one object to another. Saccades are crucial to the ability of the visual system to perceive and interpret images. When smoothly tracking with the eyes, the eyes must also be able to cross the midline of the body without hesitation;
  • Convergence/Divergence – the ability of the eyes to move inward/outward in order to focus on an object as it moves near/far. To look at an object close up, the eyes rotate towards each other (convergence), while for an object farther away they rotate away from each other (divergence). These movements are crucial for near point gaze shifting, such as reading, and for far point gaze shifting, such as copying from the board.

What are some symptoms of oculomotor dysfunction?

If your child is having a hard time consciously controlling the movements of his eye or eyes, some of the resulting signs and symptoms can appear:

  • Increased activity level
  • Difficulty with visual attention
  • Decreased visual perception
  • Poor visual attention to detail
  • Poor visual memory
  • Difficulties copying from his paper or from the board to his paper
  • Difficulties concentrating and maintaining attention on school work/an activity (i.e. drawing, coloring, cutting, puzzles, reading, writing, etc.) in front of him
  • Difficulties scanning when trying to find objects in competing backgrounds (i.e. finding his shoes in a messy room).
  • Reduced efficiency and/or productivity
  • Loss of place, repetition, and/or omission of words and/or lines of print while reading
  • Spatial disorientation
  • Need to utilize a marker in order to avoid loss of place
  • Distractibility while performing visually demanding tasks
  • Diminished accuracy
  • Difficulty sustaining near visual function
  • General fatigue
  • Abnormal postural adaptation/abnormal working distance
  • Incoordination/clumsiness
  • Inaccurate/inconsistent/poor work product
  • Inaccurate eye-hand coordination

Our approach at North Shore Pediatric Therapy

When oculomotor control issues are detected, our occupational therapist will first refer your child to a developmental optometrist for definitive testing and a prescribed treatment plan for improving his ocular skills. We then design a specific treatment regimen which not only alleviates symptoms, but addresses any underlying conditions that may exist. Oculomotor dysfunction is most often due to a faulty development of muscle control, so a program of coordinating or strengthening activities is prescribed in a vision therapy program. Many ocular motor dysfunctions require optometric vision therapy/orthoptics to develop accurate and effective eye teaming, as this condition rarely resolves when left untreated. Treatment duration depends on the particular patient’s condition. At the conclusion of the active treatment regimen, periodic follow-up evaluations are required. We may even prescribe therapeutic lenses to assist in maintaining long-term stability.


Motor Planning

Motor Planning

Motor Planning Definition

Motor planning is the ability to conceive, plan, and carry out a skilled, non-habitual motor act in the correct sequence from beginning to end. Incoming sensory stimuli must be correctly integrated in order to form the basis for appropriate, coordinated motor responses. The ability to motor plan is a learned ability which is generalized to all unfamiliar tasks so a child does not need to consciously figure out each new task he or she faces. The child with motor planning difficulties may be slow in carrying out verbal instructions and often appears clumsy in new tasks.

Our Approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, our therapists use a multisensory approach to provide your child with sensory and motor experiences to help improve his responses to sensory input, his body awareness, and fine and gross motor skills. By providing him with a sensory-rich experience in a friendly, safe, and fun environment, your child’s motor planning can be greatly improved. Our trained occupational therapists also provide you with strategies to use in the home and school environments, so you can be an active participant in your child’s success.



What is Hypotonia?

Hypotonia is the term used to describe low muscle tone. Muscle tone is the ability of the muscle to respondHypotonia to stretch. When a child has low muscle tone, his muscles contract slowly and are unable to maintain a static, normal muscle contraction. Because these low tone muscles do not fully contract, they remain somewhat stretchy and loose, resulting in the child appearing “floppy.” This may cause difficulties with fine and gross motor coordination, difficulty with sitting at a desk, and problems participating in daily activities.

What causes Hypotonia?

Every muscle has receptors that detect change in muscle length. These receptors send a message to the brain and the brain tells the muscle to contract in response to the stimulation. A delay in perceiving muscle stretch, decoding the information in the brain, or problems sending the information back to the muscle can result in hypotonia.

How do I help treat my child’s Hypotonia?

Physical therapists and/or occupational therapists help treat hypotonia. Since muscle tone is an involuntary response, changes in muscle responses can be made through sensory integration treatment techniques that increase the “alertness” of the muscle by bombarding it with sensory information. This improves the brain’s ability to perceive changes in muscle length and helps with the process of sending the message to the brain to initiate a contraction. With ongoing treatment and daily practice, those responses can be elicited more often and low tone muscles can become more efficient.

Our approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, our multisensory approach provides your child sensory and motor experiences which help improve his muscle tone, responses to sensory input and body awareness. Our therapists engage your child in various activities that incorporate movement, tactile, visual, and auditory sensations to enhance muscle tone. In addition, our therapists are trained to provide environmental adaptations to assist your child to be more successful in activities throughout the day.



What is Hypothyroidism?

Hypothyroidism is a condition in which an individual’s thyroid gland does not produce enough specific, important hormones. This condition upsets the normal balance of chemical reactions in the body, and if left untreated, can cause a number of health issues such as obesity, infertility, joint pain, and heart problems. Hypothyroidism

What causes this condition?

There are a number of causes for this condition. Some of these include autoimmune diseases, radiation therapy, thyroid surgery or undergoing medications.

What are some symptoms associated with this condition?

There are various signs and symptoms related to hypothyroidism and they tend to develop slowly over a number of years. Symptoms may include: sluggishness, fatigue, increased cold sensitivity, constipation, pale and dry skin, puffy face, hoarse voice, unexplained weight gain, muscle aches, and depression.

How can I help treat my child’s condition?

Standard treatment for hypothyroidism involves daily use of a synthetic thyroid hormone prescribed and monitored by a physician. A mental health professional and nutritionist may also be helpful in addressing your child’s psychological issues and dietary needs.

Our approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, we offer a variety of services that are beneficial for people with hypothyroidism. Our registered dietitian will work with your child to create healthy eating patterns in order to maintain a healthy weight and adequate nutrition. Our licensed professional counselor can also help your child work through the psychological issues that may be associated with hypothyroidism.

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Gravitational Insecurity

Gravitational Insecurity

What is Gravitational Insecurity?

Gravitational insecurity refers to an excessive fear of ordinary movement, being out of an upright position, or having one’s feet off the ground. Children with this fear are uncomfortable with gravity, and their reactions are out of proportion to any real danger that exists or to any postural deficits the child may have.


  • What causes gravitational insecurity?

    Gravitational insecurity is a form of over-responsiveness to vestibular sensations detected by the otolith organs. Otolith organs (located in the inner ear) detect linear movement through space and the pull of gravity. Gravitational insecurity is associated with poor otolithic vestibular processing.

  • How do I know if my child has gravitational insecurity?

    Children with gravitational insecurity may display a fear of heights or be overwhelmed by changes in head position. Often they exhibit unwarranted fear, anxiety, or avoidance of stairs, elevators, high playground equipment, or uneven surfaces. These children tend to move slowly and carefully and may refuse to participate in gross motor activities.

  • How can I help my child overcome gravitational insecurity?

    Sensory integration therapy is commonly used to treat gravitational insecurity. By providing your child with graded vestibular information, he can learn to process information more effectively. Sensory experiences are introduced slowly and gradually so your child does not perceive these experiences negatively.

Our approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, our occupational therapists use a multisensory approach to help guide your child to explore his environment through stimulation of his vestibular system. This is accomplished by encouraging your child to climb, swing, jump, roll, and crawl—all things which shake his comfort zone a bit. We will create a “just right” challenge for your child, which allows him to gradually begin to participate in activities which he once found terrifying. We do not push your child; we simply encourage him in ways we are confident he can succeed.

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Graphomotor Skills

What are Graphomotor Skills?

Graphomotor skills are handwriting skills. The development of the handwriting process occurs in the earlyGraphomotor Skills elementary grades and includes not only the mechanical and visual perceptual processes of graphics and handwriting, but also the acquisition of language, learned spelling and phonology. There is a developmental sequence of graphomotor skills and as children develop, their scribbling and picture drawing evolves into handwriting.

What are some factors necessary to handwriting?

Some factors necessary to handwriting include:

  • Small muscle development in the hands
  • Hand-eye coordination
  • The ability to hold utensils or writing tools
  • The ability to form basic strokes smoothly, such as lines and circles
  • Letter perception – the ability to recognize forms, notice likenesses and differences, motor plan the movements necessary for the production of the forms
  • Orientation to printed language, requiring visual analysis of letters and words along with left-right discrimination

Some foundational skills required for handwriting include:

  • Visual-perceptual skills: these involve the ability or capacity to accurately interpret or give meaning to what is seen;
  • Orthographic coding: referring to the ability to both store in memory and retrieve from memory letters and word patterns;
  • Motor planning and execution: mainly the ability to conceive/ideate, organize/plan, and execute a novel task;
  • Kinesthetic feedback: comes from the sensorimotor system and is required for any motor action. Kinesthesia is the knowledge of where each body part is and direction in which it is moving. It is a component of motor control for legible handwriting produced at an acceptable rate; and
  • Visual-motor coordination: the ability to match motor output with visual input. It is this gross monitoring that prevents us from writing on the desk or crossing over lines, and keeps us within margins.

The development of graphomotor skills begins with scribbles on paper at 10-12 months. At 2 years, the child begins to imitate lines–vertical, horizontal and circular. At 3 years, the child copies lines clearly. When a child is 4-5 years, he copies a cross, diagonal lines, squares and some letters. He may also be able to write his name. At 5-6 years, a child copies a triangle, prints his own name and copies most lowercase and uppercase letters.

Our approach at North Shore Pediatric Therapy

To evaluate graphomotor skills, our therapists use standardized evaluations such as the Beery-Buktenika Test of Visual Motor Integration, 5th edition, the Evaluation Tool of Children’s Handwriting (ETCH), and finger and hand strength testing, in addition to clinical observations.

To improve graphomotor skills and handwriting readiness, we incorporate activities aimed at improving fine motor control, isolated finger movements, fine motor strength, enhancing right-left discrimination and visual perception, promoting prewriting skills, and improving orientation to printed language, while also promoting a fun atmosphere. Our therapists use various models of practice to improve graphomotor skills, such as:

  • The neurodevelopmental approach: this approach focuses on the child’s ability to execute efficient postural responses, movement patterns, limb control, muscle tone, and proximal stability.
  • The acquisitional approach: this approach views handwriting as a complex motor skill that can be improved upon with instructional guidance, practice, repetition, feedback, and reinforcements.
  • The sensorimotor approach: this approach incorporates a sensory integrative view of handwriting intervention by providing various sensory opportunities so the child’s nervous system may integrate information more efficiently to produce a satisfactory motor output.
  • The biomechanical approach: this approach addresses performance in terms of range of motion, strength, endurance and posture. This approach also takes into consideration paper positioning, pencil grip, type of writing tool used, and type of paper used. Finally, the psychosocial approach for handwriting intervention focuses on improving the child’s self control, coping skills, and social behaviors.

Since children learn best when they are interested and having fun, our therapists strive to promote an exciting atmosphere which encourages learning and success.

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Developmental Delay

What is a developmental delay?

Developmental delay refers to a child’s significant and ongoing lag in meeting developmental milestones in any or all of the following areas: cognitive development, social and emotional development, speech and language development, fine motor skill development, and gross motor skill development.

What causes developmental delay?

There is no single cause for developmental delay, but there are genetic and environmental factors that Developmental Delayincrease the risk of developmental delay in a child. Children with a genetic or chromosomal abnormality (like Down Syndrome) are at an increased risk for developmental delay. Environmental risks for developmental delay include: exposure to toxins (e.g. drugs and alcohol) or infections (e.g. measles, HIV) passed from mother to child during pregnancy; prematurity; severe poverty; maternal depression; and poor nutrition.

How do I know if my child is developmentally delayed?

If your child does not meet developmental milestones within the appropriate, expected time frame, do not assume that he is developmentally delayed. You should, however, consult your child’s doctor to insure that no concerns or issues are overlooked or ignored. A full evaluation completed by a professional is necessary to determining if a true delay exists.

How can I help treat my child’s condition?

Treatment for developmental delay is dependent upon the areas in which a child is experiencing delays. For example, a physical therapist would work with a child with gross motor delay; an occupational therapist would work with a child experiencing fine motor skills delay and/or deficits in sensory processing; and a speech-language pathologist would work with a child displaying delays in speech, language, oral motor skills, and/or feeding difficulties. Other professionals who may be involved in treating a child with developmental delays include a nutritionist, audiologist, psychologist, developmental therapist, education specialist, neuropsychologist and/or licensed professional counselor.

Our Approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, our therapists work with children with developmental delays using a multisensory approach to provide the child with experiences which help improve his fine and gross motor skills, speech and language skills, oral motor skills, social skills, behavior, sensory processing skills, feeding skills, attention, and any other difficulties that are hindering his ability to fully succeed socially, academically and personally.

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Anorexia Nervosa

Anorexia Nervosa

What is Anorexia Nervosa?

Anorexia nervosa is one of the most common eating disorders and is defined by a refusal to maintain appropriate body weight. Characteristics of anorexia nervosa include: an intense fear of gaining weight, distorted body image, denial of illness and amenorrhea (absence of at least three consecutive menstrual cycles).

There are two subtypes of anorexia nervosa—the restricting type and the binge eating/purging type. In the restricting type of anorexia, body weight is maintained by restricting food intake. In the binge eating/purging subtype, food intake is restricted, but individuals also engage in binge eating followed by purging (using strategies such as self-induced vomiting, misuse of laxatives, or excessive exercise)

Our Approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, we offer a variety of services that are beneficial to those with anorexia nervosa. Our registered dietitians will work with your child to create healthy eating patterns and to maintain a healthy weight. Our licensed professional counselor will assist your child in overcoming the psychological issues associated with the eating disorder.

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What is Anemia?

Anemia is a condition that develops when one’s blood lacks enough healthy red blood cells, which are the main transporters of oxygen to body tissues and organs. Symptoms of anemia–like fatigue–occur because organs aren’t getting enough oxygen.

Hemoglobin is the oxygen-carrying protein in red blood cells. If red blood cells are deficient in hemoglobin, the body is deficient in iron. Because iron is essential to hemoglobin carrying oxygen throughout the body, an iron deficiency results in a lack of oxygen delivered to the body’s cells.

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Turner Syndrome

Turner Syndrome

What is Turner Syndrome?

Turner Syndrome is a genetic chromosomal disorder in which all or part of one of the sex chromosome is absent. Typical females have two X chromosomes whereas individuals with Turner Syndrome present with only one X chromosome or there are significant abnormalities with the other. The syndrome only occurs in females and has an estimated prevalence rate of 1 out of every 2,500 girls.

What are some symptoms of Turner Syndrome?

Individuals with Turner Syndrome often present with physical symptoms, health related symptoms, and also concerns with regard to their cognitive and academic functioning.

The physical symptoms associated with females who have Turner Syndrome include: short stature, broad chest, low hairline, low set ears, and a webbed neck.

Women with Turner Syndrome often face a variety of health concerns including: congenital heart disease, hypothyroidism, diabetes, vision problems, hearing concerns, and a variety of autoimmune disorders.

Individuals with Turner Syndrome often experience a variety of cognitive and academic deficits including concerns with visual-spatial functioning and deficits with mathematics achievement.

Can the syndrome be managed?

There is no cure for this genetic condition. Generally speaking, many of the health-related issues associated with Turner Syndrome are manageable. There are some effects of the condition, however, which can be life threatening—an affected child should, thus, be frequently evaluated by a pediatrician. The cognitive and academic concerns associated with the condition are often addressed in the school setting through academic accommodations or special education support.

How can I help treat my child’s condition?

Medication can be used to minimize harmful symptoms and consequences of the syndrome. Growth hormone injections are often incorporated into a patient’s treatment plan in order to stimulate growth.

Our approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, we administer comprehensive neuropsychological evaluations in order to identify specific strengths and weakness that a child with Turner Syndrome presents. We then determine the most effective, inclusive methods for successful treatment.