New Website

Hi everyone! I just wanted to let you know that we have consolidated our blog and our website. Here is the new link directly to the blog.

If you are subscribed via email you should continue to receive blog posts via email. (We just published one called ‘Proprioception and Body Awareness.’) If you didn’t get this one via email, go to our page and re-sign up. We apologize for this inconvenience.

If you are subscribed directly through wordpress then we weren’t able to transfer you over and you will need to re-subscribe.

Thank you for your patience and we hope you enjoy our updated site!

Favorite Toys: The Vet

I know we took a brief break from blogging but we’re back! We are going to start adding blogs about some of our favorite toys to use in therapy and how and why we use them. The first one is The Vet (here is another smaller version).

This toy has a lot of uses for occupational therapy since it has keys that you have to match up by color to open the individual doors. Since we do mostly physical therapy, we use it as a motivator, and the extra fine motor work they get to do is an added bonus!

We have used this toy for all ages. Currently I have a 12 month old using it (yes, the skills are higher than where he is but he is really interested in it so it works great as a motivator) and we kids up into double digits using the toy.

In this video we are working on hip stability and balance. Once she is finished her toe taps she gets to squat down (working on staying in the middle, and not shifting too far to one side) to open or close the doors. We would increase the number of taps between her opening or closing the doors and she was only allowed to open or close with each squat (anything to get more repetitions in!).

We have also used this toy to increase repetitions on the stairs as well as walking back and forth between support surfaces to improve ambulation. Anything with lots of pieces and parts is great for repetitions.

You can also use it to work on squatting. You saw some squatting in the video, but you can also ‘drop’ the keys repeatedly or have all the animals on the ground and the vet up on a higher surface to practice going down and up. If you want to work on balance with squatting and playing in squatting, just change the positions and have the vet on the floor and the keys and animals on an elevated surface. It takes longer to put the animals in and out and open and close the doors!

How have you used this toy?

Top Ten Blog Posts of 2017

It’s been a few years since we did a top ten list at the end of the year (that may be because for a few years we weren’t very consistent with posting). Since we managed to get out a post every week of this year (yes, we are patting ourselves on the back) we thought we would take a look back and see what posts were the most read by you our readers!

Here are our top 10 overall from 2017:

10.  Encouraging Rolling From Back to Stomach

9.  What Does High Tone Mean?

8. Easter Egg Hunt For Motor Skills

7.  Having a Ball with Core Muscle Strength

6.  Avoiding the ‘Container Shuffle’ with Your Baby

5.  My Child Isn’t Rolling Over:  Should I Be Concerned?

4.  A Multi-Tasking Activity

3.  A Glossary of Sitting

2. What Does Low Tone Mean?

1.Motor Learning: Stages of Motor Learning and Strategies to Improve Acquisition of Motor Skills

Interestingly enough, all of these were published prior to 2017, so I decided to dig a little deeper and find out our top ten that were published in 2017. Those are:

10. Halloween Inspired Gross Motor Games

9. Single Leg Stance

8. Transitional Movements

7. 10 Things You Didn’t Know a Pediatric PT Could Help With

6. Crossing Midline

5. Taking the Vision out of Balance

4. Core Workout: Hungry Hippos Meets Wreck it Ralph

3. Eccentric Abs (and no, I don’t mean odd!)

2. Ideas to Target the Core

1.Righting Reactions

Happy New Year, thanks for a great 2017 and we look forward to seeing you in 2018!

What is Core Strength?

Why are pediatric PTs always talking about core strength and what does that term that is thrown around so frequently even mean? And is core strength the same as trunk strength and is that the same as core stability? Hopefully, this brief overview will help to clear the air!

 

Core: When we think of the “core” of the body, our first thought is the abdominal musculature.  While the abdominals play a crucial role in all of our functional movements, they are just one of the many important muscle groups that make up the “core.” We can also add shoulder, scapular, back, and hip muscles to the list. We can think of anything from the neck down to the upper leg as part of the “core.”

 

Core Strength: Core strength refers to the ability of the indicated muscle or muscles to perform as movers. For example, a sit up or moving from extension to flexion requires core strength.

 

Core Stability: Core stability refers to the ability of the indicated muscle or muscles to perform as stabilizers, therefore, preventing movement of a joint or joints. When we are referring to core stability, we are most often referring to how well the core muscles can work to prevent unwanted movement of the lower part of the spine and pelvis. For example, when we squat to pick up our kids, laundry baskets or grocery bags, we want the abdominal muscles to work as stabilizers to prevent unwanted movement of the lower spine.

 

Trunk Strength/Stability: Okay, okay, so what is trunk strength? Well, as pediatric therapists, we often use the term “trunk” and “core” interchangeably. They are just two different terms that mean the same thing. So, if you see both terms in a report or other documentation pertaining to your child or yourself, feel free to ask us! Most likely, we are talking about the same thing but we strive to improve our consistency and you can help by bringing it to your attention.

 

For more information on the importance of the core musculature as well as for tips/ideas on how to improve the function of the core, take a look at some of our previous blog posts.

 

Core Strength – Building a Solid Foundation

 

Core = More than Just Abs

 

Having a Ball with Core Muscle Strength

 

 

 

Holiday Gift Giving Guide

It’s always amazing how fast the year goes by and how quickly another holiday season is already upon us! With that said, it’s time to start thinking about what gifts we can give to the children in our lives that they are sure to love but that will also encourage practice of motor skills and/or general physical activity.

Here are a couple of ideas to get you moving in the right direction!

1. Pewi Ybike Walking Buddy and Ride On Toy: This is great for babies/toddlers in the pre-walking phase as they can work on reciprocal stepping using it as a ride on toy and can also use it as a push toy building balance and control.  It’s a little on the pricey side but toddlers will continue to enjoy zooming around on this one way beyond those first steps!
2. Teeter Popper: We haven’t had the opportunity to try this one out but this wobble board looks like all kinds of fun.  It can promote sitting and standing balance, core stability and provides plenty of sensory feedback since the suction cups on the bottom pop as kids make the board move. Check out the video on amazon through the provided link for a demonstration.

Here are some of our Favorite Toys that can be used to encourage gross motor activity:

 

1. Squigz
2. Stomp Rocket
3. Laugh and Learn Piggy Bank
4. Stacking Cups
5. Twister
6. Melissa and Doug Puzzles (musical instruments, shapes, farm animals)
7. Feed the Woozle
8. Cones and Hurdles
9. Spots
10. Stand and Play Parking Garage
11. Balance Board
12. Monster Feet
13. Yoga Ball
14. Ring Toss
15. Hippity Hop
16. Scooter Board
17. Activity Table
18. Balls of all kinds (o-balls, playground ball, gertie ball)
19. Hopscotch
20. Activity Cards

Using a Treadmill for Walking Quality

In last week’s post we talked about weight shifting and trunk elongation to help walking quality and energy efficiency. This week we are going to look at using a treadmill.

For some kids who are working on walking quality and efficiency foot placement can be a big deal. How they take that first step can affect everything else that goes up the chain to the hips, the trunk, and the head. By using a treadmill you can slow down the speed so they have time to think about what they are doing and get in a lot of practice and repetition (remember: repeat, repeat, repeat…). We also added tape down the middle to help provide a visual cue for foot placement to help decrease scissor stepping (when feet cross over midline while walking instead of going straight in front).

We also provided a wooden dowel in front to provide some balance assist (but with only 1-2 fingers resting lightly so they aren’t leaning on it). With some verbal cues for heel to toe foot placement, and the light support at the wooden dowel to help keep the trunk upright, it also helps to prevent other compensations that can occur from underlying hip weakness such as internal rotation at the hip to lock out the joint and create stability. But it also creates a crouching pattern that decreases efficiency and energy conservation with walking.

We are lucky enough to have access to a treadmill that can start at really low speeds. We did 2-3 minute increments of walking, over 4 different speeds, twice at each speed. As we were building up occasional manual cues were provided to assist with weight shifting, as well as pelvic and trunk rotation. After we got up to the highest speed we were going to, we went back down to the slowest, and repeated 2 sets at that speed without any manual cues. Afterwards, we went to overland walking. Since it still isn’t automatic (remember it takes lots of repetition to make it automatic) there were lots of verbal cues to slow down the walking rather than go back into the habitual walking pattern that automatically arises when they aren’t thinking about each step they take.

How have you guys used a treadmill to help walking quality?

Weight Shifting and Trunk Elongation

 

We have been working on walking with some kids that are working on improving their weight shifting and all the mechanics that go with that. Many of them have hip weakness which we are addressing but we are also looking at other areas to address as well. With the hip weakness you can often see a trendelenberg pattern (when their hip drops on the leg they pick up to take a step with). One way kids counteract this is to lean their trunk towards the side that they are standing on when they pick up their other foot to take a step. This provides them some hip stability but it decreases their efficiency and increases their energy utilization because they now are actively moving their trunk side to side with every step. It also makes it harder to fix on a target when walking and can cause path deviation.

So, we decided to help them work on elongating their trunk while weight shifting onto the stance side. To do this, we used a balance board to simulate the weight shifting. As their hip strength and overall balance improves we can take the balance board away and have them shift into single leg stance but for now we decided to only add one new challenge to the task and let them keep both feet on a support surface. We placed a target above their right side and their left side that was just high enough for them to reach when they reached overhead.

Once we were set up, we asked them to shift over to one side and at the same time reach overhead to hit the target. This resulted in them lengthening their trunk on the side they were shifted to (as opposed to shortening their trunk because they were leaning to that side). Once they hit the target they shifted over to the other side and repeated the process over there. We did this in sets of 10. After that we did some overland walking with light tactile cues at their hips and verbal cues to reach overhead when they were on their stance leg.

Did it miraculously change their walking? No, but it started to introduce a new motor pattern that will require a lot of repetitions to become second nature, and it will require continued strengthening of the hips. But it is another component to helping with a more energy efficient walking pattern! Just remember, it takes lots and lots of repetitions to change a motor pattern – repeat, repeat, repeat…

What ideas have you tried?

Carnival Games

Are you working on ball skills with any of your kids? Looking for ways to mix it up? At one of our recent group sessions, we had the kids play ‘Carnival Games.’ They were working on the same skills but we changed the context and to them, it was a whole different ball game (pun intended)!

Here were some of the games we did (we’d love to hear of any suggestions you might have so we can add to our repetoire):

• Bowling – Line the pins up and have the kids practice underhand bowling. They get two chances to get the pins down. You can add visual cues such as a tape line to help them with their aim. Or two staggered spots to help them with their stepping into the roll. You can also change the size of the ball. They could start with a larger ball and use two hands to roll it (sometimes this helps them understand the concept of rolling a little easier). As they progress the ball can get smaller. For a real challenge have them stand on one foot or in tandem stance (one foot in front of the other) so they can work on their balance.

• Knock the Cans Down – I’m sure there is a more official carnival name but we’ll just go with this! You can stack cups into a pyramid or you can use bowling pins like we did and recreate the bowling formation. They get two chances to knock everything down. As you can see we also added a visual cue behind the pins to help with aiming. You can use staggered spots on the floor to help with stepping into the throw. You can switch it up and work on overhand or underhand throwing. To challenge the balance, just like with bowling, you can do single leg stance, tandem stance, or you could stand on an unstable surface like a balance board or a pillow.

• Bucket Toss – With this one the child is trying to get as many balls into the bucket as they can. They get a point for each one. You can mix it up if you want to work on underhand or overhand throwing. And you can challenge balance just like in Knock the Cans Down! Change the size of the ball or the density of the ball. You can use an o-ball for easier gripping or a ball that is deflated slightly to make it easier to hold onto. Lots of ways to vary the activity. And, you can use the visual cue on the wall to help with aiming!

• Hit the Spot – This game works on passing skills. You can put one or multiple spots on the ground and have the child work on bounce passing the ball to you while trying to hit the spot. Pick a number of times and they get a point for every time they hit a spot. If you are using multiple spots you can increase the challenge of the game by calling out what spot you want them to hit when they pass it. It also works on catching because you will be passing the ball back to them. They can have some fun with telling you what spot to hit also!

What are some other games you would include in your Carnival Games?

Thanksgiving Themed Games

Thanksgiving is a time we all love gather with friends and family. Here are some fun ideas to keep the kids (and adults!) entertained and active during the long Thanksgiving weekend:

Turkey Tag: Make small turkey faces or attach some multi-colored feathers or cut pieces of construction paper to clothespins and clip on to the back of everyone’s shirt. Everyone has to run around, trying to grab the others’ feathers! Some ways to play: once all pins are off of someone’s shirt that person is “out” or collect 5 to “win”

Variations: Mix it up by working on other gross motor skills and instead of running, change it to hopping, or skipping, or galluping, or turkey walking (looks like duck walking).

Turkey Hunt: Hide different style/colored turkeys around backyard. Make a checklist to check off what ones are found/seen. Download the free printable above here

Variations: Similar to our gross motor easter egg hunt, you can put a gross motor activity on each turkey, or create a chart that corresponds to each number so that when everyone gets back with their turkey’s you can do the gross motor activities (i.e. jumping jacks, hopping on one foot, standing on one foot, jumping up in the air, etc).

Stuff the Turkey: Make a large turkey out of brown grocery bag and two small lunch bags to make the legs on top of the turkey. Use balls of paper to toss into the turkey-who can “stuff” the turkey with the most filling?

Variations: Stand on one foot or in tandem stance when throwing, throw overhand then underhand, throw under legs or over head from behind

Turkey Waddle Relay: Place inflatable turkey or a balloon between legs, and waddle like a turkey to a designated end point and back. Make this into a family-style relay race!

Variations: waddle backwards, hop, waddle sideways, hold it in your hands and ‘duck’ walk

Turkey Walk: Great for younger kids, ask kids to walk around a designated space acting out different types of turkeys. Examples include: happy, sad, tired, scared, excited, big, little, silly.

What Contributes To Your Child’s Balance?

There are three main components that make up a person’s balance. These include: vision, somatosensation, and our vestibular system. These components need to work seamlessly together in order to allow both adults and children to maintain their balance in all different environments and scenarios.

 

Vision is pretty simple: what you’re able to see with your eyes allows you to keep your balance. You may notice that your young child needs to look down more frequently, especially in newer environments. Somatosensation is what we are able to feel, and particularly important for balance is what we are able to feel with our feet. This comes in handy for walking across uneven surfaces, such a grass or dirt. Our proprioceptive receptors are able to detect changes in terrain and accommodate accordingly. Finally, our vestibular system is what is located in our inner ear. This system allows us to detect changes in movement and motion, and accommodate accordingly.

 

If one component of balance is unavailable for use, the other two must compensate for this loss. Take vision for example: When you are walking at night or in the dark, your vision is at a disadvantage, and therefore, the vestibular and proprioceptive systems have to compensate for the corresponding loss of visual input. Many people, children included, may tend to over-rely on vision, particularly if the other two components aren’t functioning properly. It is therefore essential to ensure that all three components are contributing to one’s balance.

 

An example of the development of the somatosensory component is evident in young children when they are first learning to stand. You may remember your child rocking back and forth from their feet to their heels. This allows the child to gain knowledge of their limits of stability, and is also providing essential somatosensory input. They will learn to associate the feeling of being too far on their toes with a loss of balance, as well as going too far back on their heels. This discovery play is essential for all children, and helps to develop a sense of what appropriate balance feels like!

 

The vestibular system becomes essential for maintaining balance during movement.  The development of this system can be enhanced by encouraging  your growing child to participate in activities that involve movement—such as swinging, jumping, and playing catch!

 

It is essential to encourage kids to explore and discover their balance! Some activities that encourage balance development include: standing on one foot, walking along narrow surfaces (such as along curbs), jumping off higher surfaces, standing with their eyes closed, and walking along uneven or unsteady surfaces (such as grass or tan bark or over pillows at home).

Here are some older blog posts that address activities that can work on balance!