What the Puzzle Panel teaches me about proximal & distal goals - Mary Read, Take Part Occupational Therapy

How is a fuzzy wall puzzle going to help develop my child’s handwriting? 

Many children have seriously gone off handwriting by the time they get to see the occupational therapist.  Clara is 7 years old and can tell that her writing is really messed up when compared to her school friends’ writing.  The teacher has tried her usual strategies which have worked well for other children, but Clara’s parents are now in school wanting to sort this. 

Setting Goals gives us all something to work towards,  but what type of goals will make the difference? 

I’m sure you know that by getting to the root of handwriting difficulties it helps us know what to tackle first. Many of these handwriting difficulties may have a basis in how the body uses sensory information.

Here are some questions to think about: 

• Can Clara actually feel the pencil properly in the fingers using touch sensation? This is called tactile discrimination

Or :

• Can Clara actually tell the position of her body in the first place?  That’s the position, movement and force of her shoulder, arm, hand and fingers. This is called proprioception.

Or:

• Can Clara make sense of the visual images on the page –  can she interpret and make sense of the letter shapes or  see how the shapes relate to each other. These are difficulties in visual discrimination and figure – ground perception.

Perhaps:

• Clara may have difficulties planning and organising her pencil and paper on the desk and initiating and planning how she writes. This is called poor motor planning or “praxis”

Don’t forget:

Clara might be struggling to get into that ” just right” frame of mind where she can concentrate. She might be very distracted by the sounds and busyness of the classroom. She might need to keep fidgeting and need to move around.  This is called sensory modulation or sensory reactivity

I thought this blog was about the puzzle panel and setting goals, right? 

Yes, it is!  I said the goal gives us all something to work towards.   By talking with Clara, her teacher and parents everyone agreed that being able to write five words neatly on the line would be a great goal. 

That’s a functional goal because that’s what you can see, and it makes a difference to everyday life.

How do we achieve that? Do Clara’s difficulties have a sensory basis? ( Have a look at the answers to those questions above) How we tackle the underlying sensory need forms our sensory based goal.

Sensory-based goal = PROXIMAL goal                                   

 Functional goal = DISTAL goal  

In Clara’s case , she struggles to know what her body is doing ( proprioception) and has difficulty knowing where shapes lie in relation to each other ( figure-ground perception)

In starting to work on the PROXIMAL ( sensory goals) the puzzle panel would be very handy!

Clara’s proximal goals could be ( 1) to improve her awareness of her body position in space by developing trunk control in a kneeling position with shoulders raised,  and  (2) to improve her ability to position shapes in relation to each other by  copying a pattern of shapes onto a board.

See how the puzzle panel could be used now? 

Clara’s distal goal could be to see if she can write 5 words keeping them on the line. That’s what everyone is hoping for. Bring out the puzzle panel.