Starfish Therapies

April 23, 2016

Why Your Child’s Inner Ear is Important for More Than Hearing

Standing Vestibular

Imagine learning to stand for the first time, but everything around you appears to move. You can’t stabilize your gaze and everything sort of spins. Now imagine learning to walk for the first time, except you can’t focus on an object for balance. Either would be tough for anyone, especially a child.

That ability to focus your sight – That’s what’s called your vestibular system – and it’s not a part of your eye. It’s actually in your inner ear. It plays a large role in balance, telling you where your head is in space. In turn, your body responds to what you vestibular system is telling you.

But the vestibular system also plays a part in stabilizing your gaze. Try looking at an object in the room. While keeping the object in focus, shake your head from left to right – are you a little dizzy? Maybe… But were you able to keep that object in focus? Probably. That’s because, while you were shaking your head from side to side, your vestibular system was communicating with little muscles around your eye, telling them to respond, which allows you to keep your focus (known as the vestibular ocular reflex, or VOR).

And if you weren’t able to keep the object in focus? Well, it makes balance and development that much more difficult.

What could be a sign that your child’s vestibular system isn’t working properly? Some children may have trouble standing without holding onto a surface, and even fall when standing at a table without reacting to the fall (think of a falling tree). Others may have trouble walking without holding on to an adult or surface, with a tendency to rely too heavily on that support, at times appearing as an impulsive movement.

If you notice or are concerned about your child’s vestibular function, it’s a good idea to discuss it with your child’s pediatrician. They can make a good assessment or help refer you to a specialist.

April 15, 2016

To Flip-Flop or Not

Filed under: Developmental Milestones — Starfish Therapies @ 8:08 pm
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Flip Flops 3

So, you’re in the department store shopping for your kid, because they seem to be growing every week! They are in dire need of new shoes and it’s summer, which means it’s flip flop weather, right?!

Not so fast! Although, I love the cute sandals they have for kids now a days – I think it’s important to look at how sandals may be effecting your child’s walking.

When you think about how a tennis shoe is secured to your child’s foot and then think about how a sandal is secured to your child’s foot – they are very different. When you’re wearing a tennis shoe you don’t have to think about keeping the shoe on your foot, which allows your walking pattern to be similar to how you would walk barefoot.

Now, when you’re wearing flip-flops, you have to secure the shoe on to your foot by gripping your toes into the sandal. This creates some confusion for your body. As you’re swinging your leg through, your hip is moving up/forward, but your toes are pushing down trying to keep the flip-flop onto your foot – do you see the confusion? Not only is your body confused, but by gripping your toes onto the sandal it places pressure and tension onto parts of your lower leg and foot that were not intended for that purpose.

But it’s hot out and my child and I need summer shoes! Consider a shoe that is secured to the foot – something that cups the heel. It can have straps and openings, but when the shoe isn’t secured to the foot such as flip-flops and slippers – it places abnormal pressure and tension on your child’s body.

Just some things to think about as you are buying your next pair of summer shoes!

April 8, 2016

Hip Dysplasia

Filed under: Developmental Milestones — Starfish Therapies @ 7:41 pm
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swaddle

As parents of babies or young children you may have heard the term hip dysplasia or you may remember your pediatrician moving your little ones hips around at all those check-ups during the first year.  They are feeling and listening for clicks or clunks which, when felt may indicate hip dysplasia.

Hip dysplasia is the term used to describe a hip joint that is not properly formed so that either the hip can be dislocated and relocated with passive movement or is already in a dislocated position. The term developmental dysplasia of the hip (DDH) is used when the condition is present in a newborn or develops sometime around birth, usually in the first year of life. As physical therapists, we know that most of the time DDH is present at birth and can be attributed to the baby’s position in the womb. Specifically, the breech position is found to be a cause for DDH present at birth. While the exact cause of DDH in other cases is not known, there is an increased likelihood with a positive family history as well as in the female gender, with girls being 4-5 times more likely to have hip dysplasia than boys. However, we also know that DDH can develop over time in otherwise healthy hip joints or can further the amount of hip dysplasia in a mild case that is maybe yet to be diagnosed. Read the tips below so will know the signs of hip dysplasia as well as how to prevent it from developing or worsening by understanding how to position baby with swaddles, carriers, etc.

1. Signs of hip dysplasia that you can take note of and tell your doctor about:

  • Asymmetry of skin folds: when your baby is lying on his or her tummy, the gluteal and thigh folds should be symmetrical at the same height.
  • Loud, audible clicking or clunking felt during diaper changes
  • Limited range of motion available at one or both hips

2. Swaddling

  • Swaddles should be loose around the hips and thighs to allow for baby’s natural hip position (flexed and externally rotated). Baby should have free movement from the waist down.
  • Swaddles should not hold baby’s hips extended or close together.

3. Baby carriers

  • Baby carriers should support baby underneath the buttock and thighs and allow the legs to spread apart with flexion at the hips.
  • Baby’s hips are more at risk when they are allowed to dangle straight down or are held close together in a sling type carrier.

For more information as well as images that demonstrate proper hip positioning during swaddling, use of baby carriers and car seats, visit the International Hip Dysplasia Institute website here. If you have questions about specific products out there, let us know!

March 31, 2016

Educational vs Medical Based Physical Therapy

Filed under: Developmental Milestones — Starfish Therapies @ 5:00 pm
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Desk

If my child is receiving medically based physical therapy, why don’t they get physical therapy at school?

This is a question we are asked all the time. While some children may have both an educational and a medical need for physical therapy the answer comes down to the purpose of services.

When a physical therapist recommends services medically this is based on the child’s health and rehabilitating a prior level of function or a need for therapy in order to achieve something that will improve their health and decrease their need to access other medical services.

For a physical therapist to recommend services at school, the therapist has to document that the child needs to do something at school to be safe or access their school curriculum that require the services of a skilled therapist to achieve. When a child is on an individual education plan (IEP) this is driven by needing the services of a skilled therapist to meet the goals identified for them to indicate adequate educational progress. When a child is on a 504 plan, this means that in order to progress with their current group of peers, they require the support of a skilled therapist to meet educational standards.

This means that once a child is safely able to move around their classroom, the campus, and use the playground on site safely and as independently as they will able to given other factors like age, cognition, or behavior they frequently are found to not need educationally related physical therapy as they are successful in that environment. While this does not mean they’ve met their maximum motor abilities or that in a different model of service delivery, like the medical model, they would not have a need for the services of a physical therapist, it does mean that there mobility skills are no longer limiting their education.

We frequently try to explain it in the simplest ways, physical therapy in the educational environment is to support the student safely accessing their education.  In school, gross motor development generally falls under physical education.

This is just to help with a basic understanding of the difference in the models.  It would be easy to go further in depth but we wanted to help answer a question we get a lot of times.

March 25, 2016

Working on Control (How to Squat)

Filed under: Developmental Milestones — Starfish Therapies @ 4:46 pm
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Sitting

I recently wrote a post on Power vs Control and afterwards I had someone reach out asking how they could help their kiddo learn how to squat or sit down easier so I decided to write some of my ideas down and share them with all of you.  Hopefully you find them helpful!

For kids that are having a harder time than others developing control so that they can easily lower themselves into a chair, or attain a squatting position to play, or go down the stairs fluidly, you want to remember that it is still a component of strength.  That means, you still want them to work on strengthening their leg muscles that help them do the opposite, i.e. stand up from a chair, get up from the ground, go up the stairs, etc.  Overall strength will help them with the control.

Next you want to remember that they are probably nervous to bend their knee because they don’t know that they can control what they are doing and might fall.  Now if you ask them this, I am not sure that they would be able to tell you that is what they are thinking, but it is what their body is feeling.  A way for you to possibly relate is this: have you ever tried to do a push up and get your body down really close to the ground before you push back up?  That means you are bending your elbows almost all the way to a 90 degree angle.  If you are really good at push ups this won’t mean anything to you.  If you are like me, you can only bend your elbows just a little bit because if you try to go further you don’t have the strength to support your body weight and you lose control and crash to the ground!

So, we covered that strength is important.  What’s next is you want to help them start to feel comfortable ‘unlocking’ or bending their knees.  What you might also see is when they do bend their knees they go from straight to all the way down super fast without any control.  If they were trying to sit it would look like they are ‘plopping’ in their chair.  So here are my ideas:

  1. Sitting onto an elevated surface – If you have a bench or chair or surface that you can pile up with pillows so they can only have to bend their knees a little bit to sit down they will only have to bend a little and be successful.  As they experience more success you can lower the surface.  You can also give them something to hold onto to give them more confidence.  If the support surface is slightly unsteady they will have to depend on their legs more.  If it is more stable they will use their arms more.  A fun thing to do would be make a big pile of cushions and have them practice sitting back into that.  It won’t hurt if they ‘crash’ and they will have to work a little harder to stand back up!
  2. Picking toys up off the floor – If you have a shape sorter or a puzzle or anything with lots of pieces that they are interested in you can scatter them around the floor, or on slightly elevated surfaces, such as step stools, so that they have to bend down to pick them up in order to use them.  You will need to play with the height because they may be able to just hinge at the waist and hips but your goal is to get them to bend their knees.  You can make it close to a coffee table or couch so they can hold on while they reach down to get it.  To make it even more challenging you can have them on a slightly elevated surface and the toy on the floor so they have to really bend their knees to get it.  Just remember a mini squat or a deep squat is going to be the easiest, getting them to bend their knees to the mid range (90 degrees) will be the hardest.
  3. Step downs – get some step stools or cushions or other raised surfaces and have them around on the floor and make a game out of walking around and having to climb up and down each of them.  Make sure they are switching feet so they get to work on both the left and right side going up and down.  You may need to give them a hand at first to be successful but try to wean the support away.  Pairing things with a song or a toy with lots of pieces always helps with motivation.

I’d love to hear other ideas that you have!

March 19, 2016

Sport Specialization in the Young Athlete

Filed under: Developmental Milestones — Starfish Therapies @ 9:10 pm
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Sport Specialization
It seems that children are being forced to specialize in one sport at a younger and younger age. There are various travel teams and summer leagues that you, as a parent, might feel the pressure for your child to join, because this will give them a leg up on the competition. It will get them seen by the right recruiters and your child will be given a scholarship for college.
Well… not necessarily.
Children who specialize in one sport are 70-93% more likely to be injured than those who participate in multiple sports. They are also more likely to burnout from stress and are often the first ones to quit. Most college athletes actually come from a multi-sport background.
So when should a child specialize and how much time should be spent in a single sport? Here’s what the research says:
  • Before 12 years old – 80% of time should be spent in different sports or deliberate/free play
  • Between 13 to 15 years old – 50% of time should be spent in a single sport and the other 50% of time in different sports or deliberate/free play.
  • 16 years old and up – 20% of the time should be spent in different sports or deliberate/free play.

Get more information about sport specialization here

March 10, 2016

Priming the Muscles

 I was giving a presentation the other night on Strength Training for Children with Developmental Coordination Disorder and it led to an interesting conversation with the attendees.  It was actually a really great conversation because it was a collaboration amongst a mix of pediatric and adult therapists.

We were discussing children who have hypotonia (low muscle tone), and how they have a harder time turning their muscles on and keeping them on.  Strengthening helps them to be more efficient with turning their muscles on but their low tone never goes away.  It came up that they often become tired easily, and this can show up in school, because they have to focus on their posture (staying in their seat) as well as whatever activity they are doing.

One therapist shared a great story about a child she was working with who was struggling with a specific test that he had to take every week at school because he was focusing on staying in his chair, writing on his paper, and answering the questions in a timed fashion.  His scores were not very good.  They came up with a strategy (that the school approved) for him to do a modified plank on his knees before the test.  Immediately his test scores started to improve because he was priming his muscles to turn on during the activity.  It was easier for him to keep himself in his chair because he reminded his muscles that they need to work.  A few weeks later, the teacher reported that all of the kids wanted to do this and started doing the modified plank with him (so now he doesn’t look any different than his peers).  I thought this was a great example of how to support education through physical activity.

I know myself, when I do a 10 minute yoga routine I put together, my posture is better (without me thinking about it) for the rest of the day.  This is because I have reminded my posture muscles that they are supposed to be working.

So how can we use this?  For kids that have lower muscle tone, we might want to consider giving them a physical activity at the start of their day that can prime their muscles.  This could be modified plank or bear walking or some simple yoga poses.  Or if not at the beginning of their day maybe before a test at school or before they start their homework or before PE or other physical activity.

I know families who have kids with low tone who have been able to move on from physical therapy and get their kids involved in martial arts, swimming, or gymnastics (to name a few).  This is great because these activities help with whole body muscle activation as well as provide a social way to keep active.

I’d love to hear other ideas you have for ‘priming the muscles’!

March 1, 2016

Power vs Control (or why going up stairs is different than going down stairs)

Filed under: Developmental Milestones — Starfish Therapies @ 3:30 am
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Power vs control

Muscles can work in several ways: they can get shorter, they can lengthen, and they can stay the same length.

Generally when a muscle shortens it is generating power.  For instance, when you ‘make a muscle’ you are bending your elbow and moving your hand closer to your shoulder.  Your biceps is getting shorter to make this happen.  It is generating power so that you can lift your hand (or a weight if you were holding one).  That is why it looks like you are ‘making a muscle.’

When a muscle lengthens it is producing control.  For instance when you are carrying a sleeping baby and you want to slowly lower them into their crib so they aren’t jostled, and they stay asleep you are moving your hands further away from your shoulder.  Your biceps (and other muscles) are getting longer and they control how quickly they lengthen to help to make it a smooth transition and landing so your baby continues to sleep.

When a muscle stays the same it is usually holding something static or still.  The muscle has to stay partially contracted so that it can keep your body part in the same position.  If you have ever carried a grocery bag by the handle, with your arm partially bent, you have probably experienced this.  I know my arm is screaming for relief by time I get back to my apartment!

I want to focus on the shortening and the lengthening, also known as power and control (at least in the way I describe them).  We often have families who ask us why their child can go up the stairs without a problem but they still want to scoot or crawl down the stairs, or just want to be carried.

Going up the stairs requires the generation of power from their legs.  When they step up, they are shortening their calves, quadriceps (thigh muscles) and their gluts (bum muscles) so that they can lift their body weight up to the next step.

Going down the stairs requires control.  The calves, quadriceps and the gluts are slowly lengthening so that they are controlling the body weight for the foot will land on the next step.  If there is no control, the muscles just release and the foot/body drops down onto the next step.  This is especially scary for kids going down stairs because they see all the stairs in front of them that they might fall down.  A great way to work on this is to break it into one or two step chunks so it is more manageable for them.  You will also often see kids turning sideways to lower down to the next step.  This does not require as much control as going forward down the stairs as you don’t have to move your leg over your foot so the calf does not have to do as much work.  Going down a step backwards also takes out some of the control needed by the calves so you may see kids using this as an alternative method.

And, as kids grow, strength, power, and control will change with each growth spurt and the muscles will need to get used to the new dimensions of the body and get caught back up again!

I’m not sure if anyone else out there has ever started working out again and your thigh (quadricep) muscles are really sore.  If you try to sit down gracefully in a chair, it is not pretty, but standing up out of the chair, while sore and painful, doesn’t look nearly as bad.  That is because sitting down requires control and standing up is power.  (My legs feel like this at this very moment…)

February 25, 2016

Participation and Children with Coordination Challenges

A walk in the rain to dance class

I was recently at our Combined Sections Meeting for the American Physical Therapy Association and I sat in on a talk called ‘Developmental Dyspraxia: Sensory Considerations for Motor Skill Development’.  It was presented by a PT and an OT.  It was a great presentation and looked at some of the various types of dyspraxia that are out there and how they are similar and how they are different.

Here is the definition of Developmental Dyspraxia that they used: ‘the failure to have acquired the ability to perform age appropriate complex motor functions.’  The definition of Participation they used is: involvement in life situations and includes physical, social, and self-engagement in activities.’

What struck me most about this talk, and my biggest take-away was the fact that kids with Developmental Dyspraxia, or coordination challenges, can find a back door into Participation through social engagement.

We talked about Participation in a previous blog post but I wanted to revisit it for a second.  Participation is one of our main focuses when we work with kids.  We are helping them with various skills so that they can find a way to belong and contribute to their community throughout their development.

In this day and age, a lot of kids are enrolled in a plethora of after school and weekend activities. For a child who struggles with gross motor or other aspects of development, this may not be fun for them and they may feel isolated or left out, they may also not want to go or participate.  And this is why I loved the take-away I had from the talk.  If we alter the activity so that the child finds it enjoyable and they find a sense of belonging or community, they will enjoy participating in the community.  As they enjoy participating they will want to participate more, and they may even be willing to try activities that are challenging for them.  And now you have started to create a cycle of success.

An example could be: your family loves to go bike riding in the park but your middle child struggles to ride a bike and doesn’t want to do it.  What if you switched to taking a walk in the park as a family so that you were all able to participate and have fun?  If they enjoy it they are going to want to go the next time.  Maybe one of the times they will want to ride the bike for part of the time.  You have just helped them to enjoy being outside with your family, so they are active, even if it isn’t riding a bike, and through this enjoyment you are fostering their desire to continue to be engaged in this activity.

I’m not sure if I’m making sense. I’ll try again with another example.  You really want your child to be on the soccer team.  Whenever they play soccer they struggle to keep up and they end up sitting on the sidelines or they feel that their teammates get frustrated with them.  They start to push back when it comes time for practice and games until all of a sudden they just want to stay home.  What if you got them involved in brownies or cub scouts, or informal play groups, or maybe some type of martial arts?  They could develop a sense of belonging with a group/community that they enjoy belonging to.  With enjoyment they may be willing to try playing soccer with their friends or siblings just for fun.

The key is, we want kids to want to engage in their community and with their families and peers.  Finding social outlets to get kids involved can be a great step in this direction and then introducing the activities they find to be challenging.

I hope I didn’t make this too confusing, I was just so excited when I heard it that I wanted to share.  I would love to hear stories of how you have successfully navigated supporting your child to participate meaningfully in their community, however they define it.

February 15, 2016

Low Tone and Growth Spurts

Low Tone Growth Spurt

We frequently have children of all ages in the clinic who have been diagnosed with low muscle tone (hypotonia).  This can often be confusing for parents and difficult to explain to others so we wrote ‘What Does Low Tone Mean?’ to help with that explanation.

Recently, my coworkers and I were talking about a few babies/children who we were seeing who have low tone and how we could see the progress they were making but it was often hard for the parents to not only see but to understand why it might possibly be taking ‘so long’ or longer than other children.

As a sidebar, I love having other therapists around to discuss the kids we are lucky enough to work with.  By discussing the kids, we are able to help pull the pieces of information and ideas we have in our head and synthesize them into something that makes sense and we can explain to others! What came out of our discussion is:

When a child has low tone, we have already acknowledged that they have to work harder to engage their muscles and keep them turned on to complete activities.  As the child uses their muscles they are helping to get them stronger so that they can generate more force and maintain that force generation for longer periods of time (endurance).  For instance, when a baby is working on tummy time they have to turn their muscles on to lift their head up off the support surface – to do that they need to be able to generate enough force so that their muscles can turn on and lift the head.  Once they have their head lifted up, they need to be able to keep that force turned on long enough so that they can look around.  With practice it gets easier to lift their head and they can do it for longer periods of time.

That is until they grow.  A child in their first year of life is in a constant growth spurt for the most part.  Not only is their body changing, but they are constantly learning new skills for their development.

If you think back to when you were a child in elementary or middle school and you hit a growth spurt (or to other children you have seen if you can’t remember yours!), it was as if you woke up with a whole new body.  You were probably a little bit clumsy (in my case a lot clumsy since I was already clumsy to begin with) and your movements were not very coordinated.  I often visualize a baby lamb or horse or giraffe taking their first steps when I think of young kids going through growth spurts.

Now, put that same awareness on a little baby who is changing every day.  Especially if that baby has low muscle tone.  Our muscles learn to work in a certain way and they get really efficient at it.  If you change their length or change the weight that they have to move, all of a sudden they are a little less efficient.  For kids with low tone, they are playing a constant game of catch up.  They are working hard each day to get stronger and become efficient but then someone goes and changes the parameters of the game on them.  Now they have to learn how to work at a new length with a new weight, and very often a new activity.

And, each time they grow or are faced with a new developmental task, they need to find their stability again before they can work on their mobility.  For instance, its very hard to reach for a toy in sitting, if they are having trouble generating the strength to hold themselves in sitting, or its hard to crawl if they can’t hold themselves in a hands and knees position.  So, with each growth spurt, they will need to relearn how to find stability before they can go back to working on their mobility.

Hopefully I helped to explain things a little and didn’t just make it more confusing!

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