Our guild made these a few years ago. I put a zipper with a large ring pull. Added a pocket out of silky fabric. Made some layered fleece flowers and stitched them in the center. I think the feel of different fabrics is important. Sewed rickrack down the center. The idea is the patients "fidget" with the quilt so you want lots of things to touch. Ours were about 20" square. Think I made it from flannel with fleece on the other side. Don't remember whether I put batting in. Easy & fun to make. Anything goes as long as the items are securely sewn down.