Guest Post from Denmark – Olympic Game Day

I’m a pediatric physical therapist from Denmark and I paid Starfish Therapies a short visit last fall. I have always thought that it is very exciting and inspiring to see how other PT’s work and luckily Stacy and the Starfish Therapies team were very kind and showed me around and answered all my questions.  I especially like the idea of having a blog where you can reach out to parents, caregivers, teachers and colleagues and exchange knowledge and ideas. And now I’m very excited because Stacy has asked me to do a guest blog.

I want to tell you about an Olympic game day that was arranged at my current workplace Borneterapien – a Danish Pediatric Rehabilitation Centre (www.borneterapien.dk). In pediatric rehabilitation we believe that it is important to identify local networks for families with disabled children. In Borneterapien we have experienced that the parents need information about opportunities for recreational activities and social participation. We think that participation in activities and sports is a great way for children to form friendships and develop skills.

So basically we wanted to create a context in which children with disabilities and their parents were able to network with equals. We thought that an Olympic game day would be a splendid way to accomplish that.

On September 7, 2011 the first Olympic game day took place. Thirty-eight children aged 1½ – 14 years and their parents participated. We divided the children in a preschool group and school group. In each group children were allocated in subgroups of 3-6 children according to their functional and intellectual abilities. The activities included horse riding, relays, 100m run, orienteering race, pulling car, obstacle courses, swimming etc. All children participated in 2-3 activities. Afterwards we had a medal ceremony and all children, parents and therapists had lunch together.

The Olympic game day turned out to be a really great success. All parents expressed that the event was a good experience for both children and adults and they felt that it had been very rewarding to meet other children and their parents. The parents especially liked to see their child being happy and excited. All the children expressed that the event had been very good and that it had been very much fun to meet the other children. The top three experiences stated by the children were: 1) To pull car; 2) To receive a medal and 3) To compete in relays.

What started out as a onetime thing has now become an annual tradition that the children, parents and therapists look forward to with joy.

How have you tried to facilitate networking between children and parents? Any ideas?

Best wishes,

Michelle

 

About Michelle Stahlhut:

Michelle graduated from Metropolitan University College, Denmark with her Bachelor in Physical Therapy and from University of Lund, Sweden with her Master in Medical Science. She has worked in preshcool and school settings as well as a rehabilitation setting. Michelle has primarily worked with children with cerebral palsy, developmental delay, developmental coordination disorder, autism and Down syndrome.

Michelle believes that it is essential for the pediatric physical therapist to create opportunities for the children to participate and interact with their environment. With mutual respect and presence she feels that the therapy truly makes a difference.

Guest Blog at Embrace Your Chaos on Obstacle Courses

I’m so excited to be a guest blogger at Embrace Your Chaos today.  The post is about all the great ways to play using Obstacle Courses.  Please hop on over and check it out!

What are your favorite obstacle courses?

Ideas for Torticollis

Torticollis can affect almost any child.  It is caused by a tight muscle called the sternocleidomastoid.  Often this can happen as a result of positioning in the womb or as a result of a child spending too much time in one position and developing plagiocephaly.  There are other reasons but these are two common ones.

It is highly recommended that you see a doctor and/or a physical therapist to make sure there are no other underlying causes for the torticollis but often the way to help with its improvement involves stretching, strengthening and functional retraining (not as scary as it sounds).

For stretching you want to be really gentle.  Whatever direction your child holds their head, you would want to gently stretch in the opposite direction.  For example, if your child prefers to look to the left and tilt their head to the right you would gently try to bring their left ear towards their left shoulder while keeping their eyes looking straight up (i.e. their head is not turned to the left or right).  You would also try to turn their head to right while keeping their body straight (don’t let their shoulders follow them).  I’m sure you can imagine that kids may not enjoy this (although it is a little easier when they are tiny) so you may want to have something they enjoy looking at in the direction you are stretching them.  You want to distract them from what you are doing.

I have also worked on strengthening by using a therapy ball.  I love to use a therapy ball for tummy time (which is important to work on with you child).  By using the ball you can move it so that your child has to use different muscles in their neck.  Their head will automatically want to right itself in the middle (prolonged torticollis can affect this ability which is why you want them to get lots of exposure to different positions).  So for the same example we were talking about above you would want to move the ball (while stabilizing your child on it) so that they have to lift their head to the left.  You can also have something really engaging to the right so they will turn their head to look at it while they are on their belly.  Don’t put it too far off to the right but just slightly so that they have success.  In the beginning only have them practice moving their head in these directions.  As they get stronger you can have them hold it for longer periods of time.

Functional retraining (my definition for this post) is to encourage your child to actively engage in looking and moving in the direction opposite of their torticollis.  So, if you normally sit on one side of them or hold them on one specific side then hold them on your other side.  If you have them sleep with their head at one end of their crib, switch it so they are lying at the other end.  By changing their positioning they will have to use different muscles to look at things and not get ‘stuck’ in the same pattern.

 

Using a Mobility Harness

When we were at our conference recently we purchased a small harness from Wingman Multi-Sport that looked like it had a lot of potential for use at work.  Well its only been two weeks and so far our favorite use is for helping with bike riding.  The handle on the back saves our backs (which is always a bonus) and it allows us to take our hands off the bike without compromising the safety of the child.

Another use we’ve found for it is to attach it to the weights in our Universal Exercise Unit so that the kiddos can climb up the cargo net against resistance and further strengthen their muscles while doing a functional activity.

There are a ton of other ideas we’ve had for using it such as assisting with crawling (to decrease weightbearing), providing assist with walking (so that we don’t actually have to have our hands on the child) and roller blading/skating.  We just haven’t had kiddos that are appropriate for these activities yet so we will have to wait until that happens to trial our other ideas!

‘Peter Pan’ Scavenger Hunt

Okay, so the title may be confusing but this is what our therapist and her kiddo called it.  I loved the idea.  They took these awesome carpet squares that we had found at ScrapSF and spread them out across the carpet and mat.  They then had some clothes pins on one side of the room and a cut out shape in the middle of the crash pad.  The child had to start on the side with the clothespins and pick up one and then hop from carpet square to carpet square (without touching the mat or carpet) all the way to the crash pad where they got to crash and then put their clothespin on the cut out shape.  They then would make their way back across the carpet square path to get their next clothespin.

Now this was brilliant in several ways.

1. They got to work on fine motor control and strengthening by using the clothespins.
2. They had to plan out which path they wanted to take so they had to sequence as well as judge distances and their ability to hop across the distance without touching the ground between the squares.
3. Each time they hopped (leading with one foot) from one square to the other the square had some slight sliding movement and they had to work on their static standing balance so that they wouldn’t fall.  In addition, after they realized that the square would be moving they were able to start relying on some anticipatory postural control so that they were prepared for the slight movement.
4. There was lots of repetition of all pieces of the task, especially if they touched the ground because they started over again!
5. They got the proprioceptive sensory input of jumping into the ‘crash pad’.
6. There was practice of gross motor skills for hopping/leaping from target to target.
7. They worked on visual scanning as they picked the next target to hop/leap to.

What ways could you modify this to work on the skills you wanted?

Functional Carryover

I know I’ve been missing in action recently and I have no excuse other than life and work got a little hectic.  I’m hoping it settles down a bit because of course when I have no time to write I have lots of ideas floating around in my head!  All of us PT’s recently went to San Diego where we saw some great products that we are excited to try as well as sat in on some stupendous talks that got our creative treatment juices flowing!

One of the talks we went to was on gait deviations and I hope to do a longer post on that topic later but one of the greatest reminders I got from that talk was to work on impairments during treatment (i.e. range of motion, strength, etc) and then at the end of that treatment to work on the impairment in the way you want to use it functionally.  For example, for strengthening the hip extensors (gluts) to help with stance during walking, there are lots of ways you can target the muscles but then as you are finishing up with those exercises use one that has them standing on the leg with their hip moving towards extension and the opposite leg moving forward (as if you were taking a step).  They had kids doing sit to stand over a bolster and then twisting to hand a ball to someone else.  When they twist, the opposite leg moves into extension while the other leg is forward, just like with walking.

I loved this reminder because I have been looking at my treatments and then looking at how I can put a ‘functional twist’ on at the end.

I’d love to hear ways you have incorporated this idea.

Rubber Bouncy Balls

This idea is so simple I wouldn’t have thought of it except my nephew initiated it and we had a blast.  Basically my parents keep a glass jar of rubber bouncy balls for him to play with (note if you have little kids make sure they don’t put them in their mouth).  He brought the jar down and we went into the three season room (not sure why its called this since they use it all four seasons) which has a tile floor (any hard floor will do) and we turned the jar upside down and watched the balls bounce all over the floor.  We then had to go around and pick them all up.  In the process of picking them up we worked on squatting, quadruped, crawling, weight shifting, reaching, in hand object manipulation, various grasps, body awareness as we maneuvered around the furniture, visual scanning so that we didn’t step on the balls as we picked them up (and scanning to locate the ones to pick up).  Then we put them back in the jar which works on voluntary releasing, visual motor accuracy and tripod or pincer grasp.  If you wanted to really spice it up you could sit the jar on a chair or some other elevated surface and try to toss the balls into the jar.  Then you get to go chasing after them when you miss!  Or, you could practice bouncing the balls and trying to catch them which works on visual motor and hand eye coordination.

How do you use bouncy balls?

Community Involvement with Physical Activity

I’m home visiting my family for the holidays and discovered that our township had expanded their bike path.  I love it!  It creates a safe environment for families to ride their bikes, walk their dogs, rollerblade, or run.  In a day and age when sidewalks in neighborhoods are disappearing and its harder for kids to get outside and be active, its great to see that some communities are taking strides to create opportunities for families to be able to spend time outside.

It reminds me of the San Francisco peninsula which has a great bike path along the bay that I have spent many hours biking or running along while I have trained for a race!

I’d love to hear stories of other communities creating space for people to engage in exercise – please share!

Some Fun Ideas for Encouraging Activity

I was browsing through the newest Family Fun magazine and I have to say I was quite impressed with the items they had that encouraged kids and families to be active.  Not only that, several of them also encouraged learning as well.  I thought I would share some of the activities in case you would like to try them, and I would love to hear any variations of these activities that you have tried!

1.  The first one (on page 36 of the November 2012 issue) is simple, it involves using a therapy ball for fitness.  They recommend a 45 cm ball but you want to make sure it is the right size so that if your child is sitting on it their hips and knees are bent to approximately 90 degrees.  The fuller the ball is the harder it is to balance.  They then go on to show exercises that work on core and leg strength.  They give them great names such as ‘On top of the world’, ‘Do you know squat’, and ‘Hand walking the plank’.  On top of the world has your child sit on the ball and lift one leg a few inches off the floor for 10 seconds while holding their balance and then switch.  This will work on your child’s balance and core strength.  Do you know squat has them do a squat while holding the ball against a wall with their back.  Have them try to hold the squat for as long as they can.  This will work on their core and leg strength.  The last one, Hand walking the plank has them lie on their stomach on the ball and walk their hands out as far as they can in front of them while maintaining their balance on the ball and then walk them back in.  This will also strengthen the core and their arms.  What other ball exercises do your kids do?  I know I sit on the ball while I watch tv so at least I am doing something healthy while my brain takes a vacation!

2.  In the spirit of Thanksgiving they introduced the idea of 21 Turkeys on page 33.  This game has people line up across from each other and throw a football back and forth (you can use little footballs or other balls for smaller kids).  If they can throw it right to their chest so its an easy catch they get 2 points.  If they have to reach for it or move to catch it, they get 2 point and if they miss its 0 points.  This will also allow the kids to work on adding and counting as well as throwing and catching.

3.  On page 40 they describe calculator hopscotch.  I love this idea.  Set up a calculator with sidewalk chalk (see photo) and you can play a few different ways.  You can have one person pick out a math problem by hopping from square to square and the other person jump on the answer (depending on your kiddo’s math ability you may want to just practice hopping on a number or recognizing how many of something there are and then jumping on the number).  You can also toss a stone onto a number and then in one minute come up with as many equations as you can that equal that number.  Or you can do the last one as a group activity and see how many equations you can find before moving on to the next answer.

4.  A great relay race on page 55 has you divide into teams and each team gets a bag of plain popcorn.  The first runner puts a cup attached to a rubber band around their shoe so the cup sits on top of their shoe.  Fill them with popcorn and then cross to the opposite side of the room/yard and empty the cup into the box.  Go back and pass the cup to the next team mate.  Continue this until the bag of popcorn is gone!
Has anyone played these games or do you have any other variations?

Should We Wrap Kids in Bubble Wrap?

I know the trampolines they are talking about in the article are the outdoor ones but I don’t have a picture of one of those!

I recently read an article on Huffington Post about a new statement from the American Academy of Pediatrics (AAP) stating that kids should not jump on trampoline’s because its not safe.  Now I am sure they have looked at the numbers and seen how many injuries have occurred (its actually down in 2009 from 2004 according to the article) but have they looked at the other factors?  How many of those injuries were on a trampoline that was being used correctly?  How many had multiple kids on the trampoline, maybe even big and little kids together?  How many had the proper safety equipment that was recommended?  All of those factors can influence the information.

I’m not saying that there is no risk for injury if kids are being supervised and the equipment is being used properly but the risk most likely decreases.  (I hate to say it but as a child I hurt myself plenty of times when playing while my feet were planted on the ground)  When used properly trampolines can provide kids with cardiovascular exercise, strengthening for their muscles, sensory input, and the ability to explore movement.  With all the complaints of obesity in our youth and their overall sedentary lifestyle why take away something that when used properly can be fun and a great way for exercise?

I have talked about this before but I thought this article brought up an opportunity to reiterate the need for kids to have a chance to get sensory exploration and movement in their environment while engaging in active play.  How many school playgrounds have swings these days?  Or when was the last time you saw a merry-go-round on a playground.

Safety is extremely important but it is also important to let kids play and explore.  With proper supervision and use many ‘dangerous’ activities can actually have much lower risk.  (I made a similar point about the Bumbo chair recall)

What are your thoughts on this topic?