Building Shoulder Strength

So I’ve talked about hand strength but what about strengthening the shoulders? In the therapy world, we refer to it as strengthening the “shoulder girdle.” These are the muscles that support the shoulder. Without strength of these big muscles, it is incredibly difficult to have controlled movements of the hand and fingers. There are so many fun and easy ways to build shoulder strength, but first I’ll give you some examples of HOW this plays out in daily activities. Here are some activities that require strength and stability at the shoulder girdle:

  • Carrying plates and cups requires shoulder strength and stability to prevent spills

  • Effectively washing one’s own hair

  • Using the fingers for skilled movements like buttoning, writing, holding onto a fork or toothbrush requires adequate strength and stability at the shoulder girdle

  • Catching a ball and throwing a ball

  • Drawing on an easel

  • Crossing across one’s body to reach and manipulate or transfer objects

  • Building with Legos

  • Lacing beads on a string or wire requires this stability- if a child lacks strength and stability you might see them lean their forearm on a table or surface or against their body

  • Scooping items and digging in the sand

  • Skilled cutting also requires stability of the shoulder girdle

Developing the muscles at the shoulder girdle begins with tummy time in infancy. Once children develop a strong c ore which includes the shoulder, they begin to sit, reach, and manipulate objects. They begin to feed themselves using a raking motion with their fingers. Infants begin to transfer objects between their hands and reach across their bodies. As children get older they begin to develop ball control skills such as throwing and catching and increased self-help skills like buttoning, zipping, and eventually tying shoes. All of these skills only become possible when the core and shoulder girdle is strong.

While this begins in infancy, children are never too old to be on the floor, playing games on their tummies, crawling through tunnels, building forts encouraging playing on the floor in a prone position, scootering on their tummy, engaging in animal walks like crab walks, wheelbarrow races (our favorite is on our way to brush teeth or put on jammies).

As kiddos get older, yoga is a great way to build strength at the shoulder girdle and core. Encouraging stabilization of the shoulders without allowing the shoulder blades to “wing out” while doing yoga or even while cutting with scissors helps to engage the muscles at the shoulder girdle. Throwing balls at a target, basketball, even reaching up to pop bubbles is a great way to work on building shoulder strength.

Here are a few of our other favorite activities to build shoulder strength:

Zoom ball is an absolute staple in my therapy bag! This is a super fun game for building shoulder strength and to work on motor planning. You can even add an extra challenge by trying to do it with your feet while sitting and engaging the core muscles!

Throwing balls, especially at a target, helps to recruit the muscles of the shoulder and work on visual motor coordination. Here are also some fun ways to make a DIY version at home:


Making a bow and arrow is a great way to get outside and go on a treasure hunt to find the perfect stick! With some yarn, you have a simple bow and arrow and a fun way to work on shoulder stability. Here is a link from a great resource out there. Be sure to click on the picture to see the full post and some other great activities to try at home!

Another easy activity to try at home is making a ball drop or ball run out of toilet paper and paper towel rolls. This is so easy and with older kiddos, it can even help to develop motor planning skills! Putting things on a vertical surface builds shoulder strength and also builds visual skills because the eyes adjust to working in a different plane rather than looking down- put a fun spin on homework and try taping it to the wall!

Some fun ways to work on shoulder strength and stability are activities done in a quadruped position- crawling through tunnels, yoga cat and cow poses, pretending to be a tunnel for cars or even younger siblings!


These cards, Yoga Pretzels, have been a favorite for years! They are easy and fun ways to integrate yoga into an OT practice, or at home for a fun and easy invitation and brain break. I recommend these to teachers too to have on hand for movement breaks, a quiet (there may be some giggles) free explore activity, or to build motor perception skills as part of a physical education curriculum. There are partner poses as well which require some motor planning, working together, and builds communication skills.

So tell me, what are some favorite ways that your kiddos play on their tummy, games that encourage reaching and stretching?


Flatters et al., The Relationship Between a Child’s Postural Stability and Manual Dexterity. Experimental Brain Research. 2014; 232(9): 2907–2917

Van der Fits IB, Otten E, Klip AW, Van Eykern LA, Hadders-Algra M. The Development of Postural Adjustments During Reaching in 6- to 18-month-old Infants. Evidence for Two Transitions. Experimental Brain Research. 1999 Jun; 126(4):517-28.

Why Do We Care About Hand Strength?


An important aspect of many fine motor skills is hand strength. Hand strength plays a critical role in writing, holding a utensil for eating, writing or coloring, using scissors, opening containers, tying shoes, and even doing one’s hair. When children have decreased hand strength, all of these activities become difficult. Grip strength has been found to be a strong correlate with legible writing. And did you know that illegible writing can hurt a student’s score on the SAT? You might say that we are moving away from writing to typing and pen and paper tasks are archaic, but school work is still largely done on paper. Studies have found that students who write versus type, express more ideas. They also write more prolifically than those who keyboard. The connection that I value the most is that writing helps build neural connections in the brain and helps both hemispheres of the brain communicate. Strengthening those pathways will help as we age to stay cognitively sharp!

Here are some signs that your child might have decreased hand strength:

  • Decreased interest in fine motor games and activities

  • Poor motor control when writing or coloring

  • Scissors appear to “fall out of the hands”

  • Switching hands while writing, coloring, or cutting

  • Holding a utensil with all fingers to eat

  • Unable to maintain grip on a button while buttoning

  • Difficulty zipping up a jacket or backpack

  • Unable to open food containers or unscrew lids

  • Unable to squeeze a glue bottle

  • Frequently dropping items out of fingers

  • Unable to grasp elastic of pants or socks to pull them up

  • Writing or coloring with all fingers wrapped around the writing instrument

So what can you do to help your child with their hand strength? Well first, play, play, play! Building hand strength should be fun because so many activities that children enjoy actually help to build hand strength! Here are a few of my favorite activities:

Squeezing Games and Activities:

Think turkey basters, tongs, clothespins, and other items you have around the house. One of my kiddos’ favorite activities is eating dinner with tongs or kid-friendly chopsticks to eat their food instead of using a fork. You can make cleaning up toys fun by using tongs to pick up toys and have a race! Set up a fun activity for your child to use a turkey baster to blow a small ball of rolled up tissue paper or a cotton ball into a “goal.”


You can involve your kiddos in the kitchen or set out a citrus sensory bin with a lemon or orange squeezer!

Another favorite in our house is open-ended art projects like making collages by squeezing glue out of a bottle and punching shapes from old maps, magazines, greeting cards with hole and shape punches. Tearing paper and washi tape is also another great way to work on hand strength. The tearing takes some problem solving or “motor planning” to figure out exactly how to tear without pulling the paper apart.

Linked below are some of my favorite items for building hand strength:

These come in so many fun shapes and are a great way to build hand strength while making a fun project!

Meatball tongs! Who would think this would be great for hand strength?! This helps develop hand strength by helping kids separate the sides of the hand as you do when cutting as well as holding your pinky and ring finger tucked in while you write! Use these for sensory bins, scooping water beads, in the bathtub to scoop up bubbles, outside to dig in the sand, set out some pom-poms and a jar to fill it up for a quick and easy quiet-time activity.

Push/Pull for Hand Strength:

Pushing on a rolling pin to pop packing bubbles or rolling out play dough is a great way to building hand strength. You can also build hand strength with pulling activities using a grip around the object. Here are some great activities that require pushing and pulling…

This is such a fun way to work on hand strength and also tie in some visual motor skills! Kids have so much fun aiming soft pom-poms at a pyramid of plastic cups!

Here is a fun DIY acorn slingshot from one of my favorite therapy websites:

Another favorite and something that is ALWAYS in my therapy bag is pop tubes! They are also so fun for developing speech and making different sounds by speaking into them.

Monkey bars, climbing trees, rock climbing, pulling up a rope on a play structure or slide (yep, going up the “wrong” way) are also great ways to build hand strength. Involving your kiddo in cooking like stirring batter, and if you dare, making slime are great ways to work on hand strength. Believe it or not, slime does have a benefit!


An easy invitation of bubble wrap and rolling pins is a great way to build hand strength and language skills!

Pop beads are another favorite in my therapy bag! My daughter loves these and can spend an hour creating with pop beads. They can be a little difficult initially because they truly do require some good hand strength.

The best tools for building hand strength truly are at your fingertips. Weight bearing activities like crawling through tunnels, crab walking, wheel barrow walks… these are all great ways to build hand strength as well as upper extremity strength. So spend some time on the floor regardless of your child’s age and have fun playing!


Alaniz, M. et al. Hand Strength, Handwriting, and Functional Skills in Children with Autism. American Journal of Occupational Therapy. 2015, 69, 1-9.

Bounds, Gwendolyn. (2010, October 5). How Handwriting Trains the Brain. The Wall Street Journal.

An OT's Favorites....

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During the past month of December, I had so much fun putting together a holiday gift guide over on my Instagram feed. Not only did it get me thinking about our favorite activities here at home, but I also dug through my therapy bag for my go-to items. I love sharing these items and games and their developmental benefit so more and more of you, and your children, can enjoy them! I have decided to put them all together on this post so you can refer back to it in case you ever need a birthday gift or holiday gift idea!

Have fun reading along!!!

I hope you enjoy these favorites as much as we do!!!

These Grimm’s rainbows are such a show-stopper! Not only are they beautiful, this is a toy you will want to keep forever. It can be used in so many different way from stacking, to a road for cars, to a swing for dolls. This is certainly one to pass on to generations!

Where’s Waldo is one of my absolute go-tos to work on visual perceptual skills. It is so fun for children to search for Waldo in this classic book. It works on figure-ground discrimination which is an important skill children use in school daily when they are reading, completing math problems, or searching for something in their desk or background.

Smencils are a favorite in my therapy bag. Children love using these for writing! Different scents can be stimulating for children (and also noxious to others). You have probably smelled something that brought back memories. Research has linked smells and memory due to the proximity of receptors to the amygdala and the hippocampus (our emotional and memory centers of the brain) which can be an added benefit if children are working on spelling words with a smelly pencil and then use it again for their spelling test!

These ball pit balls can be used for such a wide range of ages. I first bought some for my daughter at 5 months of age and we filled a laundry basket with them for a mini ball-pit for her. We have used them for 5 years now in a plastic swimming pool on a rainy day, in the bathtub, in a bounce house, for rolling games and color recognition, and bounced them on a parachute! These are also super easy to wash in a front-loading washing machine to keep them sanitary!

This Hoberman Sphere can still be found at toy stores and is so meditative to play with. We have ours in our “calming basket.” It is also a fun toy for a car ride. We love playing catch with this and there are even instructions on how to make some pretty complex shapes with it (which I haven’t quite mastered yet!)

I want one of these! What a fun birthday gift for the 6+ crew! It would surely be a hit and inspire hours of creativity. I just love that it brings something that is somewhat unique to the home for easy access rather than needing to go to an art studio or paint-your-own-pottery studio!

These play dough tools are always in my therapy bag. They are so great for working on hand and finger strength. They also help children develop motor planning skills. I have worked with a number of children who struggle to figure out how it works so the problem solving and recruiting the correct amount of strength to extrude the dough is half the fun. Then using the dough for open-ended play can lend itself to opportunities to work on language, turn-taking, setting up a pretend restaurant, or making a person out of play dough!

Sneaky Snacky Squirrel is a favorite game to play with kiddos learning their colors and working on hand strength. You use the squirrel to pick up the acorns and place them on your tree stump. This also requires proprioception to know just how hard or gently you need to place the acorn in the hole. Some children might try to shove it in, others just place it on the tree stump and it rolls off. That skill carries over to so many tasks we do daily! This is a fun way to practice it!

Simon is another favorite game for the older crowd. This works on visual memory and the difficulty increases as you get more correct. I played this as a child and loved it! This also helps children with their visual memory so they can remember sequences and retrieve it quickly.

Rush Hour is a super fun game that also helps with visual discrimination and taps into a child’s ability to use logic to figure out the traffic jam. Great for the 8+ crowd and their parents!

Pattern Play is a favorite! Thanks to my friend Mary, over at she introduced us to this game! The blocks are beautiful and this game is perfect for developing motor planning and problem solving skills as well as visual discrimination. They are also beautiful blocks just for stacking and building if the designs feel too complicated for your child. This is great for the 5+ crowd, although some children a bit younger with strong visual skills might be able to do some of the designs as well!

Here are some of my favorites for more gross motor activities and Spooner Boards are at the top of my list! These are light weight and so fun for kids to stand on and balance, sit and work on weight shifting, lay on or even use as a tunnel for their toys when it is inverted! This is a hit for so many age groups as well!

There are so many great swings on the market at reasonable prices! I love this one because a child can lay on it, stand on it and practice moving the swing side-to-side, or multiple children can sit on it and work together to move it fast or slow. What a great way to work on language and teamwork skills!

How beautiful are these play silks from Sarah’s Silks? I love this for dramatic play, building forts, capes, making tunnels for crawling under, the options are really endless! This is one of those “toys” that you would have forever to pass on to generations!

Magnetic Tiles are an absolute favorite in my house! My kids have loved these for years now. From as young at 18 months to as old as 10 or 12, children love these and can do so many things with them! They are great for problem solving, open-ended play, and imaginative play.

Mini Squigz are so much fun for building, playing in the bathtub, even on an airplane ride! They can be used for color sorting and simple math too!

Sensory Bins- What are they good for, other than a mess?


I know, I know, many of you hear the words “sensory bin” and you run the other direction. Others get the dust buster handy and dive right in. So, what is the benefit of sensory bins anyways?

Sensory bins are a favorite activity of mine both at home with my children, in clinical practice, and they are a big hit at Tot Group! Sensory bins can be put together very quickly with common household materials, and can be stored away easily and pulled out for a rainy day activity or a quick way to make learning more fun!

When your child is engaging with a sensory bin the first sense they are using is their tactile sense. Our skin has so many receptors and these receptors in our fingers send messages to the brain. Think about when you are digging through your purse or diaper bag for something. It is not your vision that you are using, it is your tactile sense. It is that ability to feel something and the brain to know what it is without looking at it that helps us with many tasks. Buttoning, picking up items in a drawer, even holding a pencil and writing relies heavily on tactile perception. I won’t get into the details of proprioception here but that is also a part of tactile perception through haptic perception.

When children have poor tactile modulation or are hyper- or hypo- sensitive to tactile input such as glue or sand, or not realizing they have food on their hands or face, it is not that the receptors are off, but the brain receives the message that something is not right. We can help children develop this and make sense of it by introducing them to a variety of tactile stimuli with gentle guidance. OTs specialize in grading activities and modifying them appropriately to help children become accustomed to various sensations and integrate appropriately. Having scoops of various size and shape helps with that modification but still offers great benefits to the tactile sense as well as fine motor movements, wrist mobility, and bilateral coordination.

That’s just the beginning of the many benefits of sensory bins. Along with tactile perception, children are working on fine motor and visual motor skills, language, and play skills.

Here are some simple ideas for sensory bin fillers:

  • Oats

  • Beans

  • Lentils

  • Dried pasta

  • Cooked spaghetti!

  • Cotton balls

  • Popcorn kernels

  • Rice

  • Sand

  • Salt

  • Epsom salt

  • Water

  • Cornstarch and water mixed to make Oobleck

    With all of these sensory bin fillers, you can add scoops, funnels, paper towel rolls, measuring cups, muffin tins, breast pump flanges, cupcake/muffin liners. I love adding figurines as well to build open-ended and imaginary play skills.

    Here are some other great activities to help babies and children develop their tactile sense:

  • Exposure to a variety of different textures, temperatures - let them explore and get messy!

  • Feel and find activities such as reaching into a bag to find various objects without using their vision.

  • Shaving cream or yogurt (for kiddos putting fingers in their mouths often)

    So dive right in, have fun, experiment with different materials to place in a sensory bin and enjoy the time connecting with your child or client! Hint* A tarp, tablecloth, or old sheet are very handy underneath the sensory bin!


Shao-Hsia Chang; Nan-Ying Yu. Visual and Haptic Perception Training to Improve Handwriting Skills in Children With Dysgraphia. Am J Occup Ther. 2017; 71(2):1-10.

Yu, T-Y, Hinojosa, J., Howe, T-H., Voelbel, G. Contribution of Tactile and Kinesthetic Perceptions to Handwriting in Taiwanese Children in First and Second Grade. OTJR Occupation Participation Health 32(3):87-94, July 2012