Kids' Cookbook (Toby)

Primary Deficits


    • muscle tightness in hips and down his right leg
    • both arms are flexed and elbows are contracted to 85 degrees of flexion
    • hands rested in fist position
    • decreased hand function and weakened grasp bilaterally
    • decreased fine motor coordination
    • mild to moderate impairment of balance
  • Social

    • hesitant to speak
    • easily frustrated
    • does not initiate conversation or play
    • the above social deficits can most likely be attributed to Toby being a victim of child abuse
  • Roles

    • son, brother, peer
    • elementary school student
    • *Because Toby has to fill so many roles (especially those of student and peer) it is important that he be able to overcome deficits in both physical and social areas

  • Goals

    • Improve Toby’s condition both physically and socially to allow him to return to a public school system and to the leisure activities he enjoyed prior to this time
  • Through Cooking. . .

    1) IMPROVE muscle strength and ROM in affected limbs and joints through things such as obtaining ingredients, mixing, and decorating
    2) IMPROVE balance by gradually increasing the amount of sitting and standing required
    3) IMPROVE initiation skills by allowing him to express what he is interested in making and how he wants to decorate
    4) IMPROVE social skills by placing him in a group with other children as well as one on one sessions with the OT

    Adaptive Equipment

    • spatula for reduced hand strength
    • mixing bowl with suction base
    • utensils with build up foam handles
    • twist clips so that Toby can open things and close things easily with out the use of twist ties
    • strap around chair to assist with balance (until he develops the necessary strength)
  • Procedure

    Day 1

    • Pre-made gingerbread cookie house is given to Toby; his job is to decorate it

    • all the decorations are left in a cabinet and it is left up to Toby to obtain them (chooses the decorations he wants)

    • allow Toby to plan and decide how he wants to decorate (i.e. choosing icing colours or decorating it like a fire-station, as he want to become a fireman)

    • therapist can encourage imaginative play (i.e. firehouse, add a story to it)

    * See "Grading" section for future therapeutic sessions

    Therapeutic Benefit

    In Erik Erikson's stages of psychosocial development, the third stage deals with the issue of initiative vs. guilt. This stage generally takes place in children between the ages of four and five. If a child is abused, guilt and fear will take precedence over initiative (Creek, 1997). This is most likely the case with Toby.

    • Working one on one with a therapist initially could help Toby regain trust and therefore develop his interative and initiation skills
    • Allowing him to choose his own decorations increases initiative
    • Reaching for various decorations will encourage Toby to extend his flexed arms and hands as well as improving grasp
    • Going to the decoration cabinet involves walking and bending down which helps with tightness of muscles in leg & hip as well as improving his balance
    • Piping frosting onto house will encourage elbow movement, grasp and fine motor coordination
    • Putting the decorations onto the house (picking them up and placing them in the right spot) will help with fine motor skills
    • Help, encouragement and praise from the therapist will help Toby feel more confident in his actions and keep him from getting frustrated
    • Sitting for extended periods of time and walking could help improve his impairment in balance
    • Cooking gives Toby a sense of accomplishment and achievement , as he takes some cookies home at the end of each session (rewarded)
    • Cooking also provides Toby with a sense of time limits. This is important, as home schooling may not have provided him with the experience of scheduling as is seen in the public school system
  • The aforementioned therapeutic benefits will help ease Toby back into the public school system


    • Increase the complexity of the task by increasing the involvement of the patient in the process of making the cookies
    • In subsequent sessions Toby could mix the dough himself, cut out figures and then bake the cookies. This would encourage initiation and increase patience and tolerance required. It would also add the need for more movement in the arms, and in the legs (more standing and walking around is required)
    • Toby could make gingerbread men, etc. and other small objects to add to gingerbread house
    • Decorating men and small objects, as opposed to the house, requires more fine motor skills, as the surface area of the cookies decrease and the amount of detail increases
    • Using cookie cutters requires opening the fingers and positioning them around the cookie cutter
    • Conversational skills increase as complexity of ginger bread scenario increases (therapist keeps record in story book form)
    • While cookies are baking, therapist can ask Toby what else he’d like to make. Also, the therapist should discuss safety with Toby and he would probably be interested due to his expressed to become a fireman
    • Gradually place Toby with other children in a small cooking group where he can make other things (like pizza). Tthis situation may be similar to a classroom environment. This will continue to work on his physical deficits, while allowing improvement in social interaction skills
    • Sitting and standing for longer periods of time increases his stamina and helps to improve his balance

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