This blog is not about technique. It’s about offering you a novel step by step fluency based treatment plan for shoe tying that will not only meet your goal 2X faster, but it will be a lot more fun than you have ever had shoe tying. I promise!
Shoe tying is almost like a ‘rite of passage’ for most Pediatric occupational therapists. Chances are you will need to teach this basic life skill of shoe tying at some point or another in your career as an OT.
Of course there are countless methods, hacks, tips and tricks on ‘different ways to to tie your shoes, however there is little discussion on how to make the actual process of teaching shoe tying faster and better.
Having taught this basic life skill for many years as an OT, here are some things I have noticed……
No student has ever been excited about learning how to tie their shoes.
Generalization to the home or classroom setting rarely occurs.
If students are slower than their peers in shoe tying, then they are likely to give up.
These nuances of traditional shoe tying methods are the reasons I turned to the science of fluency building and data collection. And I am so glad I did. Not only did it truly transform my ‘run of the mill’ shoe tying interventions, it led me to achieve much better outcomes in OT.
I also created a digital resource called the shoe tying treatment plan worksheet, which you can find here. It provides a checklist format to create an intervention plan and I will be referencing it throughout my step by step process below:
Step 1: Determine the fluency goal for shoe tying.
Ask yourself: How many times can the average fluent person tie their shoes in 1 minute with accuracy?
While there are several published fluency norms out there, I have yet to find norms for this basic life skill of shoe tying. So when you run into this situation (where there are no standardized norms) then the next best option is to a….Do-it-yourself fluency test.
That’s exactly what I did.
I asked several adults of similar age groups and took data on how many times they were able to tie their shoes with accuracy in 1 minute. I then took an average of this score to get a fluency goal of 7-10 reps/ minute.
This range is meant to serve as a guide and you would always need to consider individual client factors and other physical limitations of the student.
Remember, you can always scale up the expectations slowly and work at the client’s pace to eventually achieve the fluency goal. The point is to always include timed practice, because that is what builds fluency and leads to true mastery of a skill.
Step 2: Add the fluency aim to your shoe tying goal.
Now that you have determined your fluency goal, simply insert it into your shoe tying goal. For example:
By his next Annual review, Gavin will demonstrate increased independence in ADLS, by tying his shoelaces independently using the single loop method on at least 7 of 10 trials in 1 minute.
If you would like more insight on this process, check out my blog titled: How to write fluency based goals in OT
Step 3: Address the prerequisite foundational skills for before you work on shoe tying.
What are these foundational skills exactly? Well they are specialized movement sequences that we often take for granted, but they are the building blocks required for participation in most activities of daily living.
For example consider the fine motor component skill of grasp and release. If your student can pick up and release in quick succession (i.e. fluently), this is likely to affect how quickly they learn how to perform various ADLS: i.e. tie their shoes, zip up their coat, button a shirt or type on the keyboard etc.
By the same logic, if the learner is missing some of these pre-requisite foundational skills, it will be more challenging to teach them the higher level composite skills of shoe tying, buttoning, zipping etc.. So addressing the foundational skills is often a good place to start.
Ok back to the shoe- tying treatment plan.
On the shoe tying treatment plan worksheet I have separated these foundational skills into 2 categories:
This checklist has been especially helpful when working with students who have physical limitations or motor delays and perhaps when they are not making the progress you were expecting. It offers a way to pinpoint the missing skills which might need to be addressed before working on the actual skill of shoe tying.
Step 4: Create an activity analysis of shoe tying that breaks down the task into the tiniest steps possible.
Did you know that activity analyses are one of the most powerful yet underutilized tools in OT? If you don’t believe me, give this rather old but so incredibly poignant article a read:
“The Use of Activity Analysis by Occupational Therapists in Treatment Decisions” (Yoshikawa 1993)
One of the key points highlighted is how OTs recognize the value of activity analysis in treatment decisions, but find it too time consuming to do.
Oh and I certainly agree. However, I have also realized that if you can do it …. It really is time well spent and so incredibly worth it. An activity analysis offers a structure to your treatment plan and can really be helpful when you are trying to determine next steps or problem solving performance issues.
The article also discusses how OTs tend to use their memory of the general the steps involved in an activity rather than a formal list. While I still catch myself doing this sometimes, I have also realized that I cannot break down the activity into very small palatable steps (which is one of key features of an activity analysis.) When I simply think about the steps, I tend to categorize them rather broadly, which in turn is not as helpful.
Also, as a visual learner, I do much better with checklists.
Here is a FREE resource you can download and try right away. It is a shoe tying activity analysis worksheet where you can also collect data. Depending on the technique you choose, your activity analysis may look very different than this one, but this gives you a starting point.
Again, no matter what technique you use, the key is to break down the parts into very tiny thin slices, which can be grouped together for advanced learners or separated for those who maybe struggling.
Let’s take an example of the first few steps involved in shoe-tying activity analysis:
Makes an X or tepee by crossing laces
Pushes the top lace over & through the tepee.
Pulls laces away from each other tightly
Makes a loop and holds it with one hand etc….
So, as you can see, the steps are very simple and parsed apart into very tiny levels. The plan would be to build fluency in these steps before moving on and adding the next step. It offers a scalable option when working with students of various abilities.
Step 5: Grab a timer and add practice opportunities to your session
While you may spend most of your OT session working on underlying skills necessary for shoe tying, you will want to reserve the last 5 minutes of the session to practice and build fluency. This means that you will have at least 3 to 4 opportunities to practice every session.
So let’s pretend our student example appears to have all the foundational skills but has never attempted shoe tying and is fairly neurotypical. In this case you may choose combine the first 2 steps in our activity analysis and practice these for 1 minute timings until it becomes fluent and effortless.
Steps 1 & 2 Makes an X or tepee by crossing laces & Pushes the top lace over & through the tepee.
As soon as the student is fluent in Step 1+ 2 of shoe tying, you may choose to add the 3rd step or even the 4th step, if you feel that the student is ready. You will always need to use your clinical judgment to scale the number of steps as required for your student, with a grand goal in mind of practicing all the steps as many times as possible in 1 minute.
Now, you may be wondering gif you it is better to use a shoe or a shoe board. The answer is either. You can always use an old shoe to practice each step. Basically, what you would do is…… ask the student to tie the shoe laces and then you would untie it every time, then repeat this over and over again for a minute etc.
However, in order to get as many practice opportunities as possible in a minute, I prefer not to waste time on the untying part. My preference is to use a shoe tying board. And not any shoe tying board… a fluency shoe tying board.
This is an egg carton shoe tying fluency board I made using simple household items. I added a bag of beans for a little weight and resistance, but you certainly do not need to. Either way, it is a cheap and lightweight alternative to carrying old smelly shoes around and offers at least 6 practice reps before you need to untie and repeat.
Of course, you could also just gather a bunch of old shoes and place them in a row. The student would simply move from one shoe to the next during the 1 minute timing practicing each step. It’s certainly doable, however a shoe tying board is a lot more convenient and handy to have around especially when you are on the go.
In case you are in a crafty mood and want to make a shoe tying fluency board of your own. Here the items you will need:
Step 6: Use positive reinforcement strategies to motivate your student.
Believe it or not, fluency based skill building in itself is very reinforcing for most students and therapists alike. I equate it to playing a ‘minute to win it’ game but with a functional purpose in mind. Most of my students enjoy beating their own scores and competing with themselves is all the motivation they need. However, for this you will need to track the data.
Taking data on the correct responses during every 1 minute timing and offering the student a visual display of their performance can be so reinforcing. Students love to ‘see’ if they have beat their previous score and often display a surge of excitement when they do so.
Below is an example of how you can display shoe tying data ( #/ minute) on a Standard Celeration Chart (SCC).
Using positive reinforcement strategies can truly boost overall engagement and motivation especially when you hit a plateau in the overall progress. I have used points, tokens, stickers, board games, and even rewarded students with extra time. Time to just chat about their favorite topics (dinosaurs, princesses etc.) …whatever they fancy. While it might sound boring to you and I… it can be a huge reinforcer for some students.
If you do choose to use an extrinsic reinforcer…. make sure it is what the student finds reinforcing, rather than what you think might be reinforcing. The rule of thumb is: If you don’t see the desired behavior increasing, then you probably do not have the right reinforcer.
Also, don’t forget to reach out to parents to get their input. I recall, on one occasion a parent informed me her son was eyeing these trendy sneakers which were only available with laces. Working for those preferred sneakers organically became the biggest reinforcer for this student.
Remember success is the ultimate reinforcer. This is why it is so important to make sure you break down the activity analysis into very tiny do-able parts, to ensure success is inevitable. This will fuel your student’s desire to participate, do their best work and this is also how the activity itself becomes the reinforcer.
If you are interested in learning more about how to use this above mentioned SCC chart, I do have a course called Introduction to Charting & data Collection in OT which is available here.
While shoe tying is an important basic life skill most of our students, it can become awfully boring, mundane and difficult to teach. Adding time based practice ( fluency) to your shoe tying intervention plan is the solution you might be looking for.
Fluency can add a ‘fun’ element to any intervention and can also help you make more progress and save time. Here’s a recap of how…
- Determine the fluency goal for shoe tying.
- Add the fluency aim to your shoe tying goal.
- Address the prerequisite foundational skills for before you work on shoe tying.
- Create an activity analysis of shoe tying that breaks down the task into the tiniest steps possible.
- Grab a timer and add practice opportunities to your session
- Use positive reinforcement strategies to motivate your student.
I do hope I have sparked your interest and that you will give this new method a go.
One last thing. I’m curious………
How Fluent are YOU at shoe tying ?
How many times can YOU tie your shoes in 1 minute with accuracy? 6, 7, 10, 12 times?
Don’t forget to tell me in the comments below….
Happy shoe tying!