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'BUTTONS' Giving Gretel Confidence

How ‘button therapy’ has enabled one little girl to dress herself, use cutlery, and engage in new activities.

Gretel* was 4½ years old when she was referred for therapy. She had suffered a brain injury soon after birth which had left her with fine and gross motor difficulties. As a result, she avoided many activities, especially those that required skilled and coordinated hand use.

Gretel’s goals:

Gretel’s family wanted her to be able to dress herself, make progress with mark-making and writing, eat using cutlery, and have fewer spills at the dinner table.

Our first assessment:

When an ACFL Occupational Therapist met her, she identified that Gretel:

  • Had poor core stability
  • Had poor proprioception and body awareness
  • Often sought maximum support (eg she would lean against walls)
  • Had little bilateral hand use
  • Had poorly established dominance, with little lead assistor use of hands
  • Avoided activities that included controlled fine hand and finger movements

Tailoring Gretel’s therapy:

During the initial assessment, the ACFL therapist noticed that Gretel had enjoyed playing with a bag of buttons, shaking them, unpacking them and sorting them on the table. So at the next session, the therapist presented Gretel with a variety of buttoning activities, some for the session and others as part of her therapy homework.

Playing with the buttons enabled the therapist to:

  • Familiarise Gretel with chairs that provided better support
  • Persuade Gretel to sit at the table and engage with the therapist for longer periods
  • Promote bilateral hand coordination
  • Promote consistent use of her dominant hand
  • Promote lead assistor role of hands
  • Promote in-hand manipulation

Quick wins 

  • Gretel demonstrated significantly improved dexterity and manipulative skills. She was able to thread buttons and create a button caterpillar
  • She developed a pincer grip in her dominant hand by posting buttons into a container
  • Her sitting position improved, with hips and knees at 90° and feet on the ground

Longer term impacts 

  • As she succeeded in her tasks, Gretel‘s confidence increased.
  • Gretel became more receptive to working on activities she had previously avoided, including cutting, marking and writing
  • She can now dress herself, and she is using cutlery more often

 Additional gains 

‘Button therapy’ was part of a wider set of interventions which also included working closely with a physiotherapist to strengthen core stability (eg beginning sessions with large movements incorporating Gretel’s trunk and arms).

In addition, the therapist has also arranged a specialist chair for improved trunk support, suggested non-slip mats and shaped cutlery for meal times, and provided dressing strategies for poor core stability.

The result of Gretel’s increased confidence and dexterity has delighted parents, therapist and Gretel herself. She has discovered that she enjoys being successful!  

*To protect privacy, Gretel is not her real name.