Transitions

Transitions can be hard for everyone involved.  However, its also a good skill to practice so that it can slowly become easier.  We have been trying over the last several months to try to reschedule kiddos with a different therapist when their regular therapist is going to be out.  There are some really great benefits when this is done.

• Kids are given the opportunity to use their skills with a new person (are they able to generalize outside of their comfort zone)
• There is a new set of eyes on the kiddo which may see things that the regular therapist doesn’t notice because of familiarity
• Brainstorming and idea generation can occur to keep therapy fresh
• Transitions not only benefit the child, but the parents/care takers as well. Parents become so comfortable with their therapists, that it may be more difficult for them to do the transition, than the child.
• Provides a fresh venue for the child and will often highlight challenges that the child is still having outside of the therapeutic environment because they are working with someone new and less ‘comfortable’

I know this is a short post but I thought I would share some of our observations!  That being said, I do believe in the continuity of a therapist working with a child, I just like to mix it up every once in a while because I do believe it is beneficial for all involved.

More Please – Repetition for Skill Mastery

When kids begin to learn new skills repetition is key.  This is how they learn what works and what doesn’t work and what they need to fine tune until they have mastered the key.  For some kids repetition comes naturally, for some, they may need a bit more encouragement.  Basically you need to figure out what motivates them.  Over the holidays I was hanging out with my god daughter and I couldn’t help but push her gross motor skills a bit.  (poor kid her mom is a speech therapist so she didn’t stand a chance with the two of us around!)

Some of the things we practiced were jumping, going down stairs and standing on one foot.  Jumping as you can see in the video was easy to get the repetition.  We put words to the actions, I showed her what to do and she mimicked me.  She thought it was hysterical and wanted her dad to keep saying ‘bend-jump’.  For that activity it didn’t take much to motivate her to practice the skill (she even got air a few times).  With going down the stairs, I basically showed her once or twice on the bottom two steps how to hold her hand on the wall/rail and step down and she was just so proud of herself that my cousin reported she now only wants to walk down the stairs.  Lastly, with the single leg stance we were playing with the stomp rocket so the toy itself was motivating.  She loved ‘stomping’ on it and making the rocket fly.  She even got good at putting the rocket back on the launcher (ok, she needed some help but she knew that it needed to line up).

For some kids, doing a novel activity is enough to get them to practice because they want to keep doing the new thing, especially when there is a ‘reward’ at the end (i.e. the rocket flying off the launcher).  With tasks that aren’t as novel look for ways to change it up and make it fun.  For instance, with stairs practice at the park or in the house or make little steps (using stools) that are a path they have to follow throughout the house.  Change it up and add some fun and you’d be surprised at how quickly kids will engage!

Making Exercises Meaningful for Pre-Teens

We decided the ladder was the best for our needs based on the packing that was occurring and he tolerated me taking a picture as well as the video so I couldn’t complain when it was slightly blurry!

So I spent part of the week in San Diego helping my friend and her family pack to move across the country.  While there I spent some time with my ‘nephew’ because she has mentioned that he can struggle with running sometimes.  We’ve talked about the fact that he’s a toe walker and that his calves and hamstrings are extremely tight but its hard to give out advice over the phone, and even harder for ‘mom’ to motivate him.

I already had some ideas but I watched him for a few days to see what I thought and then on my last day, I asked him if he wanted some help with his stretches and some exercises to help him possibly run faster on the football field.  He agreed so we had an impromptu work out.  I gave him 3 simple stretches for his hamstrings and calves that he can easily do while watching tv and I didn’t make them very time consuming or requiring a lot of contortions.  I had him try them out and decide if it was something he could ‘easily’ do.  He agreed.

Next we went into the backyard (mainly so we could have some space since their house was in the midst of being packed up) and we practiced jumping and bounding.  I showed him the exercise and then he tried it.  Of course he did it really fast (the way he would normally) and then I asked him if he would try going slow and concentrating on each jump/hop/bound and pausing between each one so he could really make his toes into ‘jet rockets’.  When he did, he felt and saw the difference between how high he could jump/hop and how far he could bound.  I asked him if he knew why and he said its because he was thinking about it so he was able to make his muscles work the way he wanted.  I asked him what happened if he kept practicing it while thinking about it – and he (without prompting) said eventually he would be able to do it without thinking about it!  I loved that he got the concept!

Now, I know that he’s a 10 1/2 year old boy that would rather be watching tv or playing DS but he was genuinely interested in running faster during football practice and during the game.  When I asked if he wanted me to make him a chart, pictures or a movie, he picked a movie so we filmed him doing his exercises with the explanations and then I worked my magic with iMovie and made his own personalized exercise movie.

Do I think he will do it every day? Probably not but he had some choices with the exercises as well as with the delivery of the exercises.  He also got to ask questions about why we were doing them and how practice would make it easier.  He even got to see that when we went back to make the movie, the bounding and jumping were harder because his muscles were tired.  He could relate it to learning how to play football and the time he puts in on the practice field, so that by doing these it will get easier and he will start to see results.

Now, I’ll have to check back in a month or two to see how diligent he has been but my fingers are crossed!

What ideas have you used?

Activity Bingo

   

I love to find new and creative ways to get kids to do activities that may not always be their favorite, and to get them to do multiple repetitions of it.  We came up with a new game based on BINGO.  Instead of letters we used numbers on both the column and row labels.  This way the kids could roll two dice and find out their activity.  One die would correspond to the column labels and one die would correspond to the row labels.  Then you would follow the row and column until they met and figure out the activity.  Our pictures show a pre-made one for activities our OT is working on with a kiddo.  You could also use it for handwriting and put letters or numbers in the boxes.  You can pretty much get creative with what you want to work on and put into the boxes.  Once a box has been used you can have the kiddo cover it up (either by writing on it or using a bingo chip or a torn piece of paper, etc).  When the kiddo gets 6 in a row (as seen in the second picture) they can stop the activity.

You can modify this almost anyway you want to, whether its the activities in the boxes or the way you label the columns and rows.  Its just another idea for a novel approach to getting kiddos to do the activities you want them to do!  You can also do it on a white board so that you can make it reusable or you can laminate some pre-made ones so that you can have them ready to go.

Has anyone tried something like this?

Role Models = Inspiration and Motivation

image retrieved from: http://www.oscarpistorius.com/

I was one of the many who were inspired by Oscar Pistorius during the Summer Olympic Games just recently.  I have seen several blog posts by others who were inspired as well.  He helped to provide hope to people that they too may not be seen as different and that they can strive for something that may not be the norm at this point and time.

My favorite inspirational story surrounding this amazing athlete is that he has become a role model for one of the boys I work with and have talked about often in my blog posts.  He is a 7 year old with spastic quadriplegia cerebral palsy and he is learning how to walk without his canes.  This is an amazing feat because of the amount of energy it takes for him to take each step and maintain his balance.  Motivation has been a challenge because who as an almost 8 year old wants to work that hard every day to learn how to walk?  Well he saw Oscar Pistorius run in the Olympics and has decided he wants to be like him.  He has found his inspiration and motivation to help him take each step.  Don’t get me wrong, he still has his moments of whining but he has an internal motivation that we have sought to provide for him and have not always been successful.

The other similarity in this story is that the little boy I work with, just like Oscar, has never once seen himself as disabled….
Who are your kids role models and inspirations?

TV Teacher – Another Handwriting Tool

image retrieved from: tvteachervideos.com

I just wanted to share another great handwriting tool for people to put into their bag of tricks.  Sarah, one of our OT’s reviewed The TV Teacher for PediaStaff in this post.  Just like in her review of Callirobics she talks about it in relation to a kiddo she was working with and give her perspective on ways the program can be beneficial for various kids as well as things to watch out for.

Has anyone else used this program?  What are other programs or tools you use?

Home Exercise Programs – Ideas to Increase Compliance

Well I am almost 3 weeks status post my hip surgery and I am swamped in my home exercise program. This post surgery protocol is almost a full time job.  I am lucky that I am able to devote the time to completing it because I’m not able to do patient care currently and my admin work allows for flexible hours.  I don’t know how I would complete it without this luxury of a flexible work schedule.  As a PT I understand a lot of what they want me to do but even still I needed to create a chart (see photo above) so that I could understand and follow the complex information they gave me and make sure I completed the correct exercises and progressed them appropriately each week.  Again, a bit ridiculous I think.

I know that as a PT I have given many home exercise programs, or suggestions of things for families to work on with their children.  I try to make sure that I also provide them with ways to fit it into their lifestyle because a home exercise program is only good if it is completed.  It doesn’t matter if I have created the doctoral dissertation of all home exercise programs because if it doesn’t get done its just a waste of paper and time.  I contributed to another blog where I talked about my thoughts on home exercise programs and how to make them effective for families.  I thought I would take a moment and make some suggestions now based on my new found personal experience. My thoughts are still the same but I have found some ideas for maybe making sure it gets completed.

1. Figure out how much time you can devote to physical therapy exercises each day or week and share it with your therapist so they can help to select the priority for exercises/activities you should focus on
2. Let your therapist know what your other therapies are giving you for ‘homework’ because there may be overlap and you can ‘kill 2 birds with 1 stone’
3. As ridiculous as it sounds make a chart for each week so you can check things off.  Put the chart in a place where you will see it so it will be a reminder of what you need to do.  (I love charts and lists because I love checking and crossing off)  For older kids you can use sticker charts so they buy into practicing the things they need to work on.  I talk about ways to motivate kids in another blog post I did.
4. Make it a part of your day as best as you can.  There are many things that therapists give you to work on that can easily be incorporated into your daily routine.  In my case, in a few weeks I am going to need to start standing on one leg (my surgical leg) and what I will do is stand on one foot while brushing my teeth, doing the dishes and other opportunities like that.  Ask your therapist for ways you can include their exercises into day to day activities, usually they’ll surprise you with what they can come up with.
5. Ask why.  I know for myself I am more likely to do something if I understand why I am doing it.  Believe me, I woke up this morning and didn’t want to do my exercises.  I gave myself a figurative kick in the behind and reminded myself that I had this surgery for a reason and I wanted it to be a success and that these exercises were getting me one step closer to having a hip that worked correctly again.  If you aren’t sure why your therapist is suggesting an exercise or an activity as them why they are recommending it, we usually have a good reason for the things we do and its good to make us explain it every once in a while!

I would love to hear other suggestions people have for making home exercise programs compliance more likely whether you are a therapist or a parent or a patient yourself.  I love new ideas and maybe even some motivation for myself! (Luckily I have had the Olympics to keep me occupied during this time and provide motivation for doing my exercises as well)

A Simple Shift in Perspective

A photo from one of our previous ‘Fun Fridays’

Sometimes I’m amazed at how much I can learn from the kids I work with.  On Friday I was chatting with one of the kiddos about his day and he informed me that he got to play all day at school today.  So I asked about after school (when he came to therapy).  He answered yes.  When I dug deeper and asked about PT (which we were currently doing) he said that yes he was getting to play because today was ‘Fun Friday’ which means he gets to have fun.  I loved his perspective on this because we were doing the same type of exercises as we always do this current Friday (we do occasionally do fun activities on Fridays) but just because we call Friday’s ‘Fun Friday’ in his mind it meant he was playing.

I don’t think I processed the whole conversation at the time but later when I was thinking back on it, I realized how simple it is to change our outlook sometimes.  I think I am going to try to practice the ‘Fun Friday’ lesson more often.

Spots – Multiple Fun Uses!

     

I love when I find an unexpected treasure (and in the $ bin no less)!  This morning I stopped at our local Rite-Aid to stock up on soda (not healthy I know but sometimes that’s what it takes to keep up with the kids) to feed our addictions at work and I was meandering through the store and I found these frog and ladybug circle pads that are made of foam and look just like the spots that we used to buy from Ikea (which they no longer carry).  I love the fact that they have animals on them because the kids love using our bean bags that are shaped like turtles and frogs and bugs, so having spots with animals gives them one more cue as to where we want them to be.  What do we use spots for you may wonder?  Well the list is endless but here are a few of our top things:

• We make paths with our spots for having kids jump along the path, hop on one foot along the path, and skip over spots while jumping or hopping.  It creates a great visual cue when you are able to tell them a color or animal to jump to next.  Its great for beginning jumpers as well as for jumpers that you are working on getting consecutive jumps out of.
• They provide a great visual for a kid to stand on.  I use them all the time when I want the kiddo to be standing ‘still’.  For instance when playing catch or bean bag toss or basketball, they often want to move closer and I can ask them if they are on their circle and they generally immediately go back to it.  We use them in group for circle games so the kids have an idea of where their space is.
• They are great targets for the stomp rocket or throwing things.  You can have the kids work on aiming for the spot, especially with bean bags or flat discs since they don’t roll.
• We use them on the stairs to provide a visual cue for which foot to place down next.  This is great for working on alternating feet as well as giving a clear visual target for where to place your foot.
• Also when they are in a path it can be used to work on narrowing a kiddo’s base of support by having them stay on the circles or for increasing their step length by having them place one foot on each circle.
• You can have kids balance them on their head for posture and body awareness while standing or walking.
• We use them in obstacle courses so that at each spot they have a new task/skill that starts such as standing on one foot, lifting the heavy ball, doing jumping jacks, etc.
• They are also great visual cues for early jumping jacks skills by placing them in a sequence of 1-2-1-2 to begin working on jumping open, then jumping together.  It is also great for early hopscotch of one foot, two feet.

What are some of the things you use spots for?

Stickers – So Simple, Yet So Effective

When working with kids motivation is the key.  Depending on the day, the hour or the child that motivation could look different.  One of the simplest yet so effective methods of motivation are stickers.  Kids love them!  Not only are they great motivation but they actually work on skills and the child doesn’t even realize it (that’s my favorite kind of motivation)!

I’ve talked about using sticker charts before and we make use of them in many ways.  We have some kids who have ongoing ones that will result in something once it is all filled up.  One of these uses is where they have to earn a sticker each day for behavior/participation/etc.  Others have an ongoing one with tasks they are working on and each session they do the skill/task they earn a sticker until the whole chart is full.  Others have sticker charts for each session where they write down their tasks or they have a goal for a certain number of stickers and they get to put one on every time they accomplish what they were supposed to.  We also just hand out stickers at the end of the session sometimes and they love to wear it proudly on their hand or shirt or forehead occasionally!

Other than motivation you may be wondering what else the kiddo is working on.  Well here are a few things:

• Bilateral Coordination – If they are peeling the sticker off they need to stabilize the paper with one hand while manipulating the sticker with the other hand.  Also for precision of placing the sticker they need to use a stabilizing helper hand as well.
• Mature Grasp Patterns -In order to effectively peel off the sticker it works best with a pincer grasp.  They may evolve to this and you may need to help them by starting with larger stickers first and then working your way down to smaller stickers.  Also, in the beginning the more you start the peel for them the easier it will be for them to get it but eventually you want them to be able to manipulate the sticker off the paper by themselves.
• Fine Motor Control – This goes along with both of the above points but it also takes control to put the sticker on the surface that they want, especially if they want it in a certain location.
• Visual Motor -If you have a square on a chart or they are making a picture with stickers they get to work on visual motor skills and precision by placing the sticker in the correct spot.  To encourage success, start with larger areas and work your way down to smaller areas for them to place the sticker in.
• Body Awareness -You can have the kiddo place the sticker on a specific body part for increased body awareness.  Its always interesting to see where the stickers end up when you say something like ‘place the sticker on your forehead’!
• Counting/Reading – For the kids who are working on charts they always want to know how many they have or how many more they need so its a great opportunity to work on counting and one to one association because they will have to point to the sticker or empty space while they count.  Also if you have specific tasks/skills written down they can work on locating the word(s) for where to put the sticker.
• Choices/Decision Making – We will also use letting the kiddo pick out their own sticker as another whole type of motivation.  Sometimes we pick it out for them but on some ‘special’ occasions we let them pick it out.  The thought process that goes into what sticker is pretty amazing and you can see them weighing the pros and cons of their sticker choice as they go through the sheets of stickers and decide yes/no/maybe for that sheet to narrow it down and then making the final decision.  Sometimes its based on what they like and sometimes its based on what is already on their chart and wanting just the right mix of stickers.

How do you use stickers?