Purpose: To develop awareness of symmety of movement and projection on both sides of midline with peripheral visual monitoring.
Materials: Chalkboard, chalk
The materials for this exercise specifies use of a chalkboard. As these are hard to find and any smooth writing surface may be used (i.e. you might put sheets of white paper on a wall, or use a whiteboard with dry erase markers). While it is best to actually trace visible lines, sometimes it is difficult to find a suitable large writing surface to put on a wall; you can simply have the child trace circles on a blank wall with his fingers. Be aware of whether you are leaving marks on your wall and modify your approach to ensure you are not damaging your wall.
Procedure: The general idea is to have a writing instrument in each hand, and the hands are brought together at the midline, then lines are drawn straight away from the midline – right hand drawing outward to the right AT THE SAME TIME as the left hand draws a line straight out to the left. In both cases, the lines are drawn as far as the child can reach. The child should remain fixated upon the ‘X’.
Instruct patient to:
1. Place an X on chalkboard at nose level.
2. With elbows tucked in at sides and forearms parallel to the floor, approach the chalkboard and stop when hands touch it.
3. Stand in a slight straddle, facing chalkboard centered on the X.
4. Keep looking at X throughout this exercise.
5. Raise hands to the X and with palms down and thumbs touching, draw lines straight out to arm’s reach.
6. Now keep drawing back and forth 12 times.
7. When smooth and equal movements is observed, patient is to reach as high as his hairline and out as far as he had for other lines. From this position (of up and down), start drawing lines with palms down, inward, until thumbs touch 12 times.
8. Assistant speaks to patient in terms of arm position of up and down.
9. When smooth movement is exhibited, patient repeats lines at waist level, BUT with palms up. Also, starts in the “out” position. Draw lines in until fingers touch. Repeat 12 times.
10. Speak to patient in terms of arm position of down and out.
11. Chalk should be held lightly, but securely, in the palm of the hand, by thumb and forefinger.
Aspects to be emphasized:
1. The bilateral lines should be of equal length, height and slope for the three levels, and the patient should feel the sameness of the arm movements.
2. If the lines are not the same on both sides, and patient is unable to feel it, have him step back and visually appraise the trace of his unequal movement patterns. (the lines)
3. Smooth, fluid wrist motion to control chalk.
4. Develop awareness of up, down, left, and right during this activity.
Loading the activity:
You can also consider using a metronome to speed up the action. It’s important that you begin at a pace that is easy for the child to succeed with, then have them select a new pace that is more challenging.