Starfish Therapies

April 9, 2014

Making Use of the Junk Drawer

Filed under: Developmental Milestones — Starfish Therapies @ 9:00 am
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Wait don’t throw that away! Our junk drawers can hold some quick and easy fine motor and visual activities for our kids. Let’s get creative with what we unknowingly have in our possession already. Here are some great ideas and activities to do with 3 things that may be in a junk drawer:

Rubber band:

  • Place the rubber band on the index finger and thumb and have them open their fingers against the resistance of the rubber band. They can also put the band on their thumb, index and middle finger to work on strengthening the tripod grasp as well.
  • Stretch the rubber bands over blocks and paint the bands for a fun stamp.
  • Stretch the rubber bands around a small white board and hang the board up or leave flat on the table in front of child. They can place anything under the bands to make their own picture. Animals, crayons, or any small item that’s available. Picking up the bands works on pincer grasp and they have to use two hands to both hold the band and place the item under. Hanging the board up would also work on reaching with bilateral hand use.


  • Make a chain of paperclips or undo a chain of clips. This works on motor planning, bilateral hand use and finger dexterity skills. You can pretend its fun jewelry after putting it together as well.
  • Hang a paperclip from a string and add a balloon to the paperclip. You can adjust the height to play different visual and gross motor games with this. Up high you can try hitting the balloon with your hand. Or use a bat or stick to make it trickier for those that have more visual difficulties. You can also have the kids jump and try and hit the bottom of the balloon with their heads. Bringing the balloon low they can work on kicking. They also can lay on their stomachs or backs and try and hit the balloon with their hands or feet together to work on flexion and extension strengthening.


  • Sorting games: you can sort the different kinds (rubber, metal), as well as the different sizes. Painting them different colors, can give them another way to sort them as well.
  • Place the washers in different spots and make a game out of collecting the washers. Give them an unsharpened pencil to walk with in one hand and they have to go around and collect the washers to place on the pencil. Increase the difficulty by having them collect in a certain pattern. This is great for eye-hand coordination, bilateral hand use and visual tracking skills.
  • Play a toss game. Taking a paper cup and placing it a small distance from your child you can play a tossing game in standing, sitting, on their belly, etc.

Next time you empty out that junk drawer, get creative and explore the different uses of everyday items that are found in your home. Your kids will love it!


April 3, 2014

The Ins and Outs of Pencil Grips

child at desk

A pencil grip can be a quick and easy fix for an awkward grasp. There is such a huge variety of them out there, but how do you know what ones to choose. Here’s some quick tips on how to choose a pencil grasp for your child.

The Simpler the Better: If your child needs a pencil grip, they are most likely having difficulty planning how to hold the pencil in the first place. Keep it simple so the grip doesn’t become as frustrating as the pencil initially was to hold. It will also make it easier to transfer from pencil to pencil if needed and recall how to hold it correctly each time.

Look at the concerns: The type of pencil grasp that your child will use is going to depend on what the areas of concern are when they are holding the pencil. Here are some common concerns, along with which direction to possibly take:

  • Low tone (fine motor weakness): This can be observed one of 2 different ways. One such way is when your child is holding the pencil too loosely and often resorts to an awkward grasp to compensate. The other way is they will look like they are actually applying too much force when writing and are using it as an over-compensation for the weakness. Thicker or jumbo grips are usually easier for these kiddos to hold onto and can cut back on some of the force when writing concerns. Weighted pencils or grips can also help in some cases, so the child doesn’t feel the need to push down the pencil so hard when writing.
  • Motor Planning: This is when your child just can’t seem to get the motor patterns correct for holding the pencil. These are the kids that the more simple the grip the better. Single grips or crossover grips would be most beneficial for these kids.
  • Kinesthetic feedback: These kids usually grip the pencil with a tight fisted grasp or barrel grasp. They’re looking for input when writing in order to fill a sensory need, as well as give them some proprioceptive feedback to assist with guiding the pencil. Wider or jumbo pencil grips or textured ones may be most beneficial for these kids.

Make it Fun: There’s different colors, shapes and even grips with glitter. You want to get the right type of grip, but you want your child to be excited about using it as well. Let them choose colors or other features of the pencil grip as long as it doesn’t impede overall function of what you wanted it to do originally.

It’s not forever: Pencil grips are just to encourage the use of an appropriate grasp for the time being and not to use as a permanent fix. It should assist your child in making the grasp more of a habit and you should be able to eventually end up with no use of no grasp at all. Just another helpful trick along the way.

March 31, 2014

Fun With Finger Play

Filed under: Developmental Milestones — Starfish Therapies @ 1:48 pm
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finger play
Our hands perform intricate movements that allow us to manipulate various objects around us. Our hands provide us with opportunities to interact with and learn from the environment. Hand function is dependent on several different factors. The large upper body muscles in the trunk, shoulder, and forearms provide strength and stability to push, pull, lift and hold. It is also important to develop strength in the small muscles of the hand in order to position our hands in precise and delicate ways.  Finger plays are a great way to promote improved hand skills. Some of the benefits of Finger plays include:
  1. Develop arches of the hand. The arches give the hand a rounded shape and help to position the fingers for accurate use.
  2. Develop finger isolation skills. The thumb, index and middle finger need to be able to be able to perform small accurate movements while the ring and small finger are tucked toward the palm. It is important to be able to move each finger individually in order to complete mature grasp patterns.
  3. Develop the web space. The web space is the space between the thumb and index finger. The web space is important because you have to keep it open and rounded (like an “ok” sign) to perform precise movements such as picking up small objects from the table.

 In addition to hand improved hand skills, finger skills facilitate improved ability to follow directions and improved imitation skills. Finger plays are a fun and exciting way to interact with your child while at the same time encouraging skill development.

Funny Bunny:

(Author unknown)

Here is a bunny (Raise two fingers.)
With ears so funny (wiggle raised fingers)
And here is a hole in the ground. (Make hole with fingers of other hand.)
At the first sound she hears,
She pricks up her ears (Straighten fingers.)
And pops right into the ground. (Put fingers in hole.)

Ten Fingers:  I have ten fingers    (hold up both hands, fingers spread)

And they all belong to me,  (point to self)
I can make them do things-
Would you like to see?

I can shut them up tight   (make fists)
I can open them wide    (open hands)
I can put them together   (place palms together)
I can make them all hide  ( put hands behind back)

I can make them jump high   (hands over head)
I can make them jump low  ( touch floor)
I can fold them up quietly   (fold hands in lap)
And hold them just so.

Three Balls:

Here’s a ball     (make ball with thumb and index finger )

And here’s a ball   (make ball with other thumb and index)
A great big ball, I see   (put arms up and touch fingers over head)

Shall we count them?
Are you ready?
One, Two, Three    (make all three balls in succession)

Open/Shut Them:

Open, shut them, (open and shut fists)
Open, shut them,
Give a little clap. (clap)

Open, shut them, (open and shut fists)
Open, shut them,
Put them in your lap. (place hands in lap)

Creep them, creep them (walk hands up body to chin)
To your chin.
Open your mouth,
But do not put them in.

Roll them, roll them, (make rolling motion with hands)
Roll them, roll them,
Roll them just like this.

Wave them, wave them, (wave)
Wave them, wave them,
Blow a little kiss! (blow a kiss)

Where is Thumbkin?:

Where is Thumbkin? (put both hands behind back)
Where is Thumbkin?
Here I am. (bring one thumb out front)
Here I am. (bring other thumb out front)

How are you today sir? (bend one thumb as if talking to the other)
Very well I thank you. (bend other thumb as if talking back)
Run away. (put first thumb behind back)
Run away. (Put other thumb behind back)

Repeat with: Pointer, Tall Man, Ring Man, Small Man.

March 19, 2014

Independent Exploration with Power Mobility

Filed under: Developmental Milestones — Starfish Therapies @ 9:00 am
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Independent exploration is an important part of a child’s development.  Power mobility is one way kids with limited mobility can begin to independently explore their environment.  Here is some information on one way to encourage early power mobility in an inexpensive way.

Did you know that there is emerging research on the benefits of early power mobility for high-risk infants? Yes, that’s right, Cole Galloway, PT, PhD and his team of therapists and engineers at the University of Delaware have been converting toy power cars into low-tech power mobility devices for infants and toddlers to begin exploring early mobility through space and are getting some great results. The best part is, with an appropriately sized toy power car, a switch your child can access, some PVC pipe, pool noodle, kick boards, and a little knowledge of power tools and electrical wiring, not to mention the instructions on their website, you can customize a car at a relatively low cost to meet your child’s unique needs. In addition to their first power car design, Mater (see above), the team at University of Delaware is brainstorming new creative ideas to promote motor skills like developing toy power cars that encourage standing by moving forward when the child stands up and power assisted walking by removing the weight bearing surface on their stand up cars to allow the child to take steps.

While only a few case reports have been published to date looking at the benefits of early power mobility with these modified toy power cars, early data suggests that they can improve a child’s social skills, cognitive function, teach spatial awareness, improve communication skills, and provide a functional and age appropriate means of transportation in a home or preschool environment that the child’s peers will love!

We have recently used one of these cars with a kiddo in their school environment.  While they needed some support to use this device, they were able to play with their peers on the playground.  The kids were pretending that they were a train and the kiddo in the car was the engine and the rest of them were the various cars of the train.  All children involved loved it!


For more information check out the GoBabyGo! website. 


  1. Huang HH, Ragonesi CB, Stoner T, Peffley T, Galloway JC. Modified Toy Cars for Mobility and Socialization: Case Report of a Child With Cerebral Palsy. Pediatr Phys Ther. 2013 Nov 20. [Epub ahead of print]
  2. Huang HH, Galloway JC. Modified ride-on toy cars for early power mobility: a technical report. Pediatr Phys Ther. 2012 Summer;24(2):149-54.
  3. Ragonesi CB, Galloway JC. Short-term, early intensive power mobility training: case report of an infant at risk for cerebral palsy. Pediatr Phys Ther. 2012 Summer;24(2):141-8.

March 16, 2014

A Few Examples of the Importance of Postural Control

Filed under: Developmental Milestones — Starfish Therapies @ 9:09 pm
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platform swing

JR is 5-year-old boy and can’t sit in a chair or on the floor for more than 1 or 2 minutes at a time. He’s in constant motion and if he focuses on sitting still he can’t listen or pay attention to anything else. When in a chair he’s sitting on his feet, standing up and down, or moving in his chair so much it’s actually moving the chair itself. When on the floor he is either bumping into his friends or rolling around.

KC is a 5-year-old little girl that can sit in a chair or on the floor, although always seems extremely tired. When at the table she is slouched forward in her chair, or leaning forward and resting her head in her hands or laying her head on the table. When seated on the floor you may see her using a “w” sit or sitting with her legs forward but having to support herself with her hands in back of her to remain in this position.

Both of these kids seem to be at the opposite ends of the spectrum in how they act both seated in a chair and when on the floor, but in actuality could be both experiencing the same postural control issues. They each have their own way to deal with weakened postural control, but may also have other underlying issues that influence the way they act in addition. Postural control allows us better control of our distal extremities (arms and legs) and can also assist in helping us attend to someone or something better when we need to.

In order to compensate for his weakened postural control JR moves excessively. The movement helps him in remaining upright, but can lead to increased distractibility and difficulty in attention. This movement keeps him alert and at an increased arousal level. KC allows her postural control to take over for her instead and she is notably experiencing a lower arousal level when seated. She allows her body to sink back into things and depends on her upper extremities for support in a lot of cases to keep her upright. This lower arousal can lead to inattention as well at times, and she can tune out others around her.

Postural control is extremely important not only in a child’s attention and focus, but also in fine motor. In both JR and KC’s cases, their fine motor abilities can be affected depending on how they are able to sit down. Good postural control is also important in our balance and in helping us navigate our different environments appropriately and safely. There are many ways to work on postural control that are fun and exciting for kids. Here are some to check out.

Great Postural Control Activities:

Kids Yoga



Yoga ball exercises

Animal Walks


March 5, 2014

Muscle Memory and Movement

Filed under: Developmental Milestones — Starfish Therapies @ 7:00 am
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I recently spent a week skiing after almost two years off.  And while I wouldn’t say I was a superstar, I was amazed at how easily the movements came, and how little thought had to go into me successfully completing the basics of skiing.  At some point and time, my body had committed the movements to it muscle memory.  Now, add massive amounts of fresh powder and I was glad for that muscle memory because powder is not my strong point (I learned to ski on the east coast) so I had to think about how to build on the basics so that I could successfully get down the mountain.

How is this pertinent?  Well when your child is learning a new movement they practice it over and over so that their body can commit the movement to its muscle memory.  Once this happens, its an automatic movement and you can start adding in variations to the movement.  For instance, a baby learning to crawl will practice on flat ground over and over until they are the crawling masters.  Once they get that down they can start experimenting with crawling on different surfaces, such as cushions, or crawling over obstacles, or up stairs.  These variations will be more work for them because they have to expand on their movement bank and think about how to be successful.  Eventually with practice these will become automatic as well.

When muscle memory happens, a person can go a while without doing a skill and when they try it again, they will need to practice a bit but it will come back that much faster than if they were learning it for the first time.  I know when I teach someone to use crutches, it is that much easier for a person who has used them before.  This is an example of a skill that isn’t used every day but once its learned, it comes back that much faster when the skill is needed again.

So, the premise of this is repetition is important when kids are learning new skills because they are committing the movement to their muscle memory so that they can expand on that movement and continue to progress to higher level skills.  So the next time you wonder why your child who is just learning a skill does it over and over again, its because they are committing it muscle memory.  For kids that need extra help to learn movements its essential that repetitions are built in to their learning.


February 27, 2014

The Role of Motor Skills in Early Language and Social Skill Development


Movement is a baby’s first way of communicating and producing social interaction. In many cases this is accomplished by using their motor skills to look at, point at, move towards, or go get an object of interest.  A baby can use several motor skills through non-verbal forms of communication to begin developing their early language and social skills.  These motor skills include:

Head control/gaze stabilization: in order to look at objects of interest and interact with people in the environment socially, a child first needs to develop adequate head control.  This includes holding their head in midline when sitting with support or on their own and maintaining their balance in these positions during neck movements like turning their head right and left in order to look around their environment.

Trunk control and arm use: in order to begin pointing and interacting with objects of interest that can be used to shape non-verbal communication or a social interaction, a baby needs to be able to stabilize their trunk in a desired position, such as sitting or supine, while using their arms to engage.  Their trunk stability needs to be adequate to reach outside their base of support and use both hands to manipulate a toy in their desired position.

Movement through space: whether this is crawling or walking, a child’s ability to move through their environment opens up several doors for a child to communicate or interact socially.  For example, now they can move towards the object they’d like to communicate about.  They can go get these items and bring them back to the person they’d like to socialize with in order to facilitate that social interaction themselves. For many babies, movement through their environment is their first opportunity to initiate social interactions.  It is during these early motor skills that kids learn language skills like:

Joint attention: This is the ability to coordinate their attention between a family member or caregiver and another object.  They do this by looking, pointing, or moving towards a toy and then looking, gesturing, or vocalizing back to the person they are socially interacting with. A delay in demonstrating joint attention through motor tasks is one of the early warning signs that a language delay may follow.

Reciprocating babbling: This is the baby’s ability to repeat back vowel or consonant vowel sounds. For many babies, communication with parents and caregivers changes dramatically once they are able to reciprocate back these vowel and consonant vowel sounds.  They achieve the ability to participate in reciprocating babbling by attaining an upright posture through sitting skills that allow for the increased expansion of the rib cage, increased respiration, and increased ability to produce phonation. Once producing sounds through reciprocating babbling a baby further learns to control the sounds they are making through motor exploration such as mouthing toys.  For example, the sound produced changes when a child vocalizes with a toy obstructing their airway because they are mouthing it.  These sounds will change in different ways based on the size and shape of the toy being mouthed and allow babies early exploration of how to modulate the sounds they are producing.  A delay in reciprocating babbling is also a warning sign that a language delay may follow.

Motor delays in acquisition of skills such as head control, trunk control, independent sitting, exploring toys in sitting with both hands and mouth, crawling, and walking can limit a baby’s ability to achieve motor based early language, social interaction, and even cognitive milestones.  These limitations in other developmental areas demonstrate how motor skills shape early leaning in many other domains of development and highlight why many kids that are unable to achieve these motor milestones also show delays in other areas.

February 19, 2014

Doing Two Things At Once

ring toss

Have you ever asked your child to walk while holding their glass of milk back to the table? “Dual tasking” or doing two things a once can sometimes be a difficult task and occasionally can lead to some spilled milk! Walking has been thought to be an automatic activity. However, recently studies have shown that walking actually requires attention and that people change their walking pattern when performing a dual task.

A study published in 2007 examined pre-school children ages 4 to 6 and their ability to perform easy and difficult dual tasks. They examined the changes in the children’s walking performance while walking normally, walking while performing a motor task (carrying a tray with or without marbles), and walking while completing a cognitive task (counting forwards or backwards). The results of this study show that in typically developing children walking is affected by carrying out a simultaneous task. Children need to create stability to carry out the dual task and therefore widened their stance, take shorter steps, spend more time with both feet on the ground and slow down their walking speed in order adjust to the task. This demonstrates that children have decreased walking efficiency and compromised balance while they carry out either a motor or cognitive task.

Walking while performing a concurrent task occurs commonly and frequently in a child’s every day life, for example walking while carrying a tray of food at school, walking a glass of milk back to the table or walking while answering a question. Teachers and parents should be aware of the cost and effort that it takes for a child to walk and perform these common tasks. This knowledge can help choose suitable activities that the child can successfully complete as well as prevent an accidental fall or spilled milk. Therefore, allow your child to walk slowly, safely and carefully the next time they are walking their glass full of milk back to the table!



Cherng RJ, Liang LY, Hwang IS, Chen JY. The effect of a concurrent task on the walking performance of preschool children. Gait Posture 2007;26:231-7.

February 12, 2014

Straighten Up: Helpful Hints for Posture at School


It’s at least halfway through the school year and a great time to think about posture!  More often than not, children tend to pay little attention to their posture while focusing on something else such as school work, television, or video games. Most commonly, you will see them slouching forward, leaning to one side, propping on one or both elbows, propping their head in their hands or even lying their head on the desk while writing or drawing. They may appear unaware of this  when corrected because unlike adults, most kids do not experience back and neck pain related to poor posture. It is also difficult to help them why good posture matters in order to prevent habits that could potentially cause problems later in life.

Tips to Improve Your Child’s Posture:

  • Lead by Example: Draw attention to your own posture and show your child what sitting up tall looks like.
  • Mirror: Using a mirror is a great way to show your child what their posture looks like or what it should look like.  Specifically, having them stand sideways can making slouching more apparent.
  • Chair: The chair your child uses can make a huge difference in their posture.  It is important for their feet to rest flat on the floor and that their knees are bent roughly 90 degrees.  It is also important to look at the length of the seat.  If the back of the chair does not touch your child’s back while their feet are on the ground place a pillow in between the space for support.  If the only chair you have to use is so high that your child’s feet are dangling in the air, place a stool or wooden block underneath for their feet to rest flat on.
  • Desk:  The height of the desk is also important.  It should hit slightly above your child’s belly button in the middle of their trunk.  If it is too low, your child will slouch forward to reach their work.  If it is too high, your child will have to elevate their shoulders towards their ears raise their arms up to reach what they are doing and will therefore, be overusing certain neck and shoulder muscles.  If your child is too low at the table, you can place pillows or cushions under their bottom but then again may need to place something under their feet so they do not hang.
  • Set Limits:  It is important to set time limits on computer/television/video game sessions.  Try limiting bursts of these activites to 20 minutes at a time.  After 20 minutes, encourage your child to get up and move around for a while.

If you have been working on your child’s posture and do not see improvement or if your child complains of pain or seems unable to sit still for periods of time, they may have some underlying muscle tightness or weakness that makes a good, neutral posture very difficult to achieve and they may need some targeted strengthening or stretching.

How do you work on your kiddo(s)’ posture?

February 5, 2014

Development of Gait (aka How We Learn to Walk)

Filed under: Developmental Milestones — Starfish Therapies @ 7:00 am
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OVERVIEW: Gait is a medical term used for walking.  Often, in a pediatric therapeutic environment, there is an emphasis on independent walking. Most parents understandably want to know when and if their child will be able walk. This is most likely because for most people, independent walking translates to increased independence in other areas of life and therefore, decreases the amount that a person will have to rely on others for assistance. As therapists, we must understand the several factors that affect the development of gait and be able to work towards independence when appropriate but also be able to determine when independent walking may not be the most important and functional goal at a given stage of development.Research has shown that typical walking has 5 major characteristics: stability in stance (when foot is in contact with ground), sufficient foot clearance in swing (when limb is moving through the air), appropriate pre-positioning of the foot for initial contact, adequate step length, and energy conservation.  These characteristics are not present from the moment we take our first steps, which can be anywhere from 9-15 months of age in typical development. They develop over time with growth and maturation. Just as you need prerequisites to advance to higher level courses in college, you need prerequisites to achieve the 5 major characteristics of typical gait.  These prerequisites are adequate motor control and central nervous system maturation, adequate range of motion, appropriate bone structure and composition, and intact sensation (mainly proprioception).  Therefore, in the presence of neuromuscular or musculoskeletal disorders, typical walking may not always be achieved. If all the prerequisites are present, then you should see typical gait, which includes the 5 characteristics listed above, emerge by 3-3.5 years of age.

Birth to 9 months
: During the first few months of life, several things are happening that lead to upright movement.  First, body compostion is changing.  On average, in the first 6 months of life, body fat increases from 12% to 25%.  This increase in fat content makes the infant weaker for a period of time.  In fact, some studies have suggested that larger infants with higher body fat percentage may achieve locomotor milestones later than their smaller friends. As they move towards their first birthday, fat content tends to drop while muscle mass increases and therefore, we see babies getting upright. Second, growth is happening more so in the arms and legs than in the head and trunk. This growth allows the baby to provide a greater resistance against gravity.  Third, the baby is naturally exercising muscles that need to be strong for typical walking.  On their backs, they are kicking which develops antigravity hip flexor strength.  Hip flexors are the big, thick muscles in front of our hips that allow us to pick our leg up and move it forward during walking. On their tummies, they are working out their hip extensors or booty muscles. These muscles work on and off and sometimes with the hip flexors to coordinate smooth walking.  Studies show that antigravity control of movement by these two muscle groups at the hip joint typically develops by 8-9 months of age.  Therefore, the baby may not even be able to stand independently and the hip muscles already know how to control gravitational forces. So, if the baby is moving and growing typically at this point, they are gaining muscle mass, losing fat content, and developing antigravity movement and therefore, postural control.



9 to 15 months: During this time, the baby is weight bearing more and developing independent walking. They are cruising, which develops hip abductor muscles strength.  Hip abductors are the muscles on the outsides of our hips that allow one leg to stay stable while the other one swings throught the air during walking.  Are we starting to see a pattern…development of the hip musculature is an extremely important precursor to typical walking. As therapists, we often go back and address this if independent walking is present but atypical. Also, during this time, increased weight through the legs changes the overall structure and alignment.  Here, the baby’s legs will begin to straighten out from their previously bow-legged shape in infancy.  If they are pulling to stand they are now performing muscle contraction in a closed chain, which means their foot is weight bearing and they are pushing through their hip and knee to achieve upright.  An example of an open chain movement would be kicking where the foot is not in weight bearing.  Closed chain movements create new demands on muscle strength and ability to move against gravity.



18 to 24 months: Now that they child is walking independently, you will see the pattern begin to refine. The base of support will begin to decrease because the hip muscles are learning to stabilize within a smaller range of motion. Also, the legs are growing longer becoming the most rapidly increasing dimension of the body.  This even brings the center of mass of the body lower down the trunk allowing for increased stability. Finally, the child is developing more mature strategies for balance and postural control which may result in a more typical looking walking pattern because it involves the ability to anticipate disturbances in balance rather than only react to them once they have happened.



3 to 3.5 years: If everything has occurred typically up to this point, the structure and angles of joints are maturing in to that of an adults. Balance strategies continue to be refined.  Walking speed normalized for height is consistent with that of adults.



6 to 7 years: By this time, walking is fully mature. Little comparison can be made to an adult pattern.  The center of mass is still slightly higher than an adult and will continue to lower with growth.



As you can see, the development of typical walking begins at birth and continues to evolve over several years during times of rapid growth.



Campbell et al. Physical Therapy for Children 3rd Edition, 2006. pgs. 161-171.


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