Starfish Therapies

June 18, 2017

Pop Goes the Bubble

Filed under: Developmental Milestones — Starfish Therapies @ 12:03 am
Tags: , , , , , ,

Who doesn’t love bubbles? A lot of the kids we work with do! Here are some things that you can work on with bubble play:

  • Reaching – You can do this in almost any position.
    • Sitting – For little ones just learning to sit you can start by blowing bubbles all around them and having them move their arms towards them. As they get a little more stable you can blow the bubble and catch it on the end of the wand and hold it further away from them so they have to reach outside their base of support. You can have them reach up, forward, to the side, across the body, diagonal, pretty much any direction! For kids who are sitting in chairs you can do this as well. Make it even more difficult by putting them on a bench where their feet don’t touch, or on an unstable surface like a peanut, therapy ball, or dynamic sitting cushion. If you want to control the challenge, you can have them sit on a therapy ball and change their position while they try to reach. This can really work on the core muscles.  Make a game out of it, see how many bubbles they can pop in a minute. Then you get some counting in too!
    • Standing – All the same ideas as above except in a standing position. You can use spots to help them keep their feet in place so they have a smaller base of support, or you can use more than one spot so you are changing their foot position while they reach. Maybe even use a twister board and have them change their foot position and each time they have to pop a bubble. You can make it more challenging by having them stand on a balance board, a bosu, a dynamic disc, on top of stepping stones, on a balance beam, the possibilities are endless. You could also have them stand in more challenging positions such as tandem stance or single leg stance while reaching.
    • Kneeling  – The same ideas apply to kneeling. You can do short kneeling, tall kneeling, half kneeling. Change the surface, change the leg position, etc.
  • Single Leg Stance – What better way to pop bubbles than with your feet? Bubbles are a great way to get kids to stomp and when they are purposefully stomping they are generally holding their foot up a little bit longer than if they are just walking. Also because they are trying to stomp on the bubble they are more deliberate and trying to find their balance. You can have them go one bubble at a time (possibly holding it on the end of the wand) or you can blow a whole bunch and have them stomp through the bubble fields. You can make it more challenging by having varied surfaces that the bubbles are on so they have to stomp up onto a step or onto a mat, or down onto the ground from a slightly elevated position.

  • Squatting – Great time to get in squatting practice, or floor to stand/stand to floor practice. If you blow the bubbles towards the floor they may attempt to get to them with their hands. Then the next time you blow them up high and have them stand up for them. As long as they are entertained, you can get a lot of reps in this way! If the bubbles aren’t going where you want then you just need to catch it on the wand and hold it down low or up high for them to try to pop.
  • Other – There a ton of other things too such as oral motor control from blowing the bubbles, and breath control for the same reason. Visual motor, Fine motor control, and coordination for dipping the wand into the bubble juice and bringing it to their mouth.

What are some of the things you work on with bubbles? What are your favorite activities?

 

June 11, 2017

Kneeling: Exploring New Heights

High kneel 3

Kneeling is a great position to help progress developmental milestones, as well as a way to work on strengthening hips and core. Depending on the activity it can also be a great way to work on arm strength.

Getting into kneeling allows kids to work on transitional movements, provides a new way for sitting, lets them explore balance and balance reactions, is a precursor for activities like climbing and pulling to stand, and it lets them see whats on a level above the floor providing them a different way to engage with their environment and toys.

Here are some ideas for kneeling:

  • Unstable – Use something that isn’t stable such as a cylindrical toy, a foam roller, a ball, or even a push toy. All of these will vary in their instability and you can also create some stability by holding it still while they get used to it. This allows them to play with flexing and extending their hips, weight bearing through their arms, activating their core for balance reactions as they try to find midline or a place of stability by moving the object forward and backwards. A toy like this one also has the added fun of sound!
  • At a higher surface – You can find a surface that is not too high and not too low. It can provide stability to allow them to play with their toys or even bang on the surface. With this they are learning balance also. Every time they lift their hand or engage with their toy they need to find a way to stay stable or they run the risk of toppling over and not being able to play. Once they start to learn that toys and fun are up off the floor this can lead to exploring and figuring out how to get into kneeling!
  • Transitions – Kneeling is also a great position to be able to transition into various positions. As you can see in the pictures kids can use kneeling as a way to play and to move into other positions. Set up toys around your child that they have to manipulate or move and weight shift to be able to access. Let them explore their movement and problem solve how to best interact with the toys. You can help them by showing them how to get into a kneeling position and see what they do from there.

     

There are lots of ways to modify these activities (and tons more that I’m sure I’ll think of as soon as this goes live!). I would love to hear how you incorporate kneeling into your child’s play!

June 7, 2017

Apps for PT and Kids

jump jump froggy
Its always fun to find new apps to use with kids. They like the variety and its nice to challenge and engage them in different ways. Here are a few that our therapists have found recently! We’d love to hear what apps you have been using!
Physical Therapy For Kids (By Preferred Mobile Applications LLC) $6.99
The Physical Therapy For Kids App was created by a yoga instructor and a Physical Therapist to aid pediatric physical therapists in working with their patients. This app has fun images to provide as visuals for 56 different exercises that help kids practice gross motor strength, balance, and coordination activities. Select a picture and tap it repeatedly to see the animation of the exercise.
Recommended for children ages 3-12
Jump Jump Froggy (By Timothy Charoenying) Free
This app features four fun activities: Jump up, 30-second speed hopping challenge, sit-ups, and push-ups. Fun animations come to life with each activity; the on screen action is a direct result of the player’s engagement in the activity. Kids can play to beat their high score and there is a multi-player mode so kids can compete with their friends and family.
Recommended for children of all ages
Super Stretch Yoga (By The Adventures of Super Stretch LLC) Free
This fun app created for kids provides an interactive experience for doing yoga.
Using storytelling, animation and video examples, kids can practice 12 different yoga poses (there are videos of children performing each pose). You can go through all the poses at once or choose 1 pose to do at a time and repeat as often as you like.
Recommended for children 3 and up
Toca Dance Free (By Toca Boca AB) Free
This is a fun app help kids practice motor planning and coordination. It is available as a free version. In this app you dress your dancers and choreograph a dance.  Then a video is made of the completed dance.  Kids can watch and learn the dance created and can pause the video or repeat parts to practice at their own pace.
You can even choreograph movements like squatting, jumping or crossing midline to work on certain PT goals.
Recommended for children ages 6 and up

May 29, 2017

Transitional Movements

2017-03-28 23.23.452017-03-28 23.23.502017-03-28 23.23.28

What are transitional movements you may wonder. They are when a kiddo moves from one position to another. This can look like rolling, getting in or out of sitting, getting in or out of quadruped, getting up into standing, getting back down to the floor from standing, and the list can go on and on.

For many kids learning to transition between positions comes easily to them. However, this isn’t the case for all kids. There are many reasons that some kids may have to ‘learn’ how to transition and move. Some of those reasons may include weakness, motor planning challenges, increased time in ‘positional equipment’, and many others.

Transitions are important because they help your child learn how to move. They begin to understand that they can explore on their own. They can increase their independence with exploration and expanding their curiosity.  It also helps them to learn more about their bodies as well as cause and effect. They learn to grade their movements and how to problem solve. They begin to understand and develop body awareness.

How can you help your kiddo develop and work on their transitional movements? Rather than pick them up and place them in a new position, help them to move into it. Another way is to set up the environment so that they are encouraged to explore. Here are a few ideas:

  • Rolling – Instead of picking your kiddo up and placing them on their belly, use a toy and get them engaged and then help them roll over onto their belly so that they can get to the toy. Even if you don’t have time to get them engaged, you can still help them to roll so that they start to learn there isn’t some magic force that moves them from one place to the next!
  • Sitting (from the belly or the back) – I’m probably going to start sounding like a broken record but the same ideas apply for all the areas I’m going to mention. Instead of picking your baby up and placing them in sitting, help them to get into the position on their own.
    • You can do this almost anytime you are changing their diaper, just help them to move into sitting before you pick them up rather than picking them up from a lying down position.
    • If they are already maintaining sitting independently you can also work on this from a sitting position. Have them lean over onto one arm and have a toy in front of them so that they have to push back up to get into sitting to reach for it.
    • When your kiddo is in a sitting position you can help them move into a lying down position. You can also have them try to do this by putting toys just a little further out of reach so they have to move from sitting onto their belly to get it.
  • Quadruped – This is similar to going from sitting to on the belly. If they are already sitting put your leg on one side of them and put a toy they like on the other side of your leg. Encourage for them to reach for the toy so they move over top of your leg (you may have to help them at first so they know what to do), keeping their legs on one side and their arms on the other. As they get stronger and willing to try the movement more you can take your leg out of the way. They may go all the way to their belly a few times but that’s the fun of trial and error and how they learn.
  • Standing – Again, it’s all about finding what engages your child. Use an elevated surface that they can pull up on (not too high but not too low) and place something they really want on top. Help them to figure out how to pull/push into standing so that they see they can get to the toy they want!

As you noticed a lot of the concepts are the same. You want to make sure that their toys aren’t always right within their grasp, make them have to work a little to get to them. Don’t just pick them up and place them in a position, take a few extra seconds to ‘help’ them move to the new position. They begin to understand how to motor plan and problem solve so that they will begin to want to move and explore!

May 22, 2017

The Power of the Calves

star jumps

I don’t know about you, but I have had many children over the years that really struggle to use their calf muscles in an efficient and effective way. This could be due to many reasons but there is probably some underlying weakness and coordination challenges. I have seen this a lot in my kids who are toe walkers. Now I’m sure some of you are saying ‘wait but they walk on their toes, doesn’t that mean they use their calf muscles and they should be nice and strong?’

Not necessarily. Because they tend to walk on their toes (this may look like they are up high on their tip toes or it may look like a shuffling walk with the foot mostly flat but never getting a heel strike first) they aren’t moving through the full range of motion at their ankles and so their calves are only working in a very small range. For the kids up on their tip toes they are really strong in that one position but they would fatigue pretty quickly if you were to ask them to do multiple heel raises in a row. For kids whose feet look flatter but they are still not hitting with their heels first, they are tending to constantly stop a ‘fall’ forward by catching themselves on their foot and then ‘falling’ forward onto the next foot. They aren’t using their calves to help them push off to lead into the step, but rather ‘falling’ into the step.

So as you can see calves work in two ways, they help to control your step forward by supporting your body weight as the muscle slowly lengthens, and they also help to push off by shortening the muscle to give you power to go into the next step. These are also helpful for jumping and running activities to name a few.

Hopefully all this is making sense. I really started this post to give you some ideas for how to work on the calf muscle to help your kiddos use them more effectively and efficiently!

  • Scooter Board Push – I was inspired when I came across this post. I have a few kids that I have been trying to get creative on ways to work on their calves. I actually tried this one out and the kiddo I was working with loved it! He loves to do puzzles so we put the puzzle pieces on one side of the room and were assembling it on the other side of the room so he had to push me back and forth to get all the pieces. Because of the size of the room we had some extra challenges because he had to turn a corner as well causing him to work on his motor planning. In the beginning he had some trouble and would try to go down on his knees to push or I would help him too much so he was just walking and not pushing through his feet but he eventually got it and was so excited when we would get going fast and when we could turn the corner without running into the crash pad! I completely recommend this activity. Just an FYI, carpet causes them to work harder!
  • Wall Push Offs – You can do this one on a scooter or a swing. With a scooter you can have competitions to see how far you can push each time and if you can get further than your last time. Or you can set up bowling pins that when they push off the wall they have to try to knock them over and see how many tries it takes before they’ve knocked them all over. You could also use an exercise ball and have them push off of that and see how many pushes it takes to get down the hallway, and then try to get fewer pushes on the way back! Obviously you would have to move the exercise ball to them each time and hold it stable while they push.
  • Furniture Gliders – With the smooth side down on the furniture gliders, have them put their hands on the top side. Then create a course with painters tape and have them push their hands all along the path. The key is to make sure they are pushing with their feet and not dropping down onto their knees. You can change up the course and make it straight lines, curved lines, zig zag lines, or have it be a treasure hunt/maze where they have to follow the lines to get to bean bags or puzzle pieces and then they bring them out of the maze before going back in to collect the next one! If you don’t have furniture gliders you could do this with bear walking but its definitely more fun with being able to push yourself around! You could also try putting their hands on a scooter and pushing that way if you don’t have furniture gliders!
  • Step Downs – Stepping down slowly really helps to work on having the calves control the body weight as it lowers down. That being said, this is often hard for kids to control. We have tried putting a stomp rocket on the ground below the step so they have to step onto the stomp rocket to get it to go. If possible I recommend doing this without rails. You can change the height of the step to make it easier or harder. And the kids love to shoot the stomp rocket. We generally have targets that we aim for. You can give points to each target and have them try to get a certain number of points by hitting them with the rocket.

What are some ideas you have for calf strengthening with kids?

May 14, 2017

Ideas to Target the Core

wheelbarrow

bridging

modified plank

I don’t know about you, but I know my core muscles (abdominals, back extensors, shoulder girdle, and hips) can always stand to be stronger. This also goes for our kids, typically developing as well as kids with a neuromuscular challenge. While there are lots of ideas for targeting specific muscle groups, sometimes its good to do exercises that get a bigger bang for their buck. There are some exercises that can target multiple areas of the core at the same time. Here are a few:

  • Planks – Planks are great for getting all areas of the core. Of course they are not easy, especially if you want to maintain good form. For those just starting out with a plank you can go on your hands and knees and bring your hips in a straight line with your trunk. To make it harder to you can move to your hands and toes (or forearms and toes) and keep your whole body in a straight line. To make it even easier, you can use a bench or a table and put your hands on there so you are at an incline. The goal is to be able to hold your body in a straight line without having your belly sag or your hips sticking up in the air. Find the level of difficulty that lets you maintain that straight body. And start small. If you can hold it for 15 seconds then do that. Slowly increase your time and then increase the difficulty!
  • Wheelbarrow Walking – This also targets multiple areas, the hips don’t get as much work unless you are being supported by the ankles, but its still great for the shoulders and trunk. You can use a scooter board and sit on it and hold them by their trunk, or their hips, or their thighs, or their ankles (the further out you hold them, the harder it is). Use a hallway and have something fun like a book or a puzzle at the end that they get to do something with each time they get down there. You can also use a rolling stool. This changes the angle and makes it harder. Even harder is you just standing and walking while supporting them. Again, the goal is to hold the body straight so find the level of support that allows them to do this and gradually work your way out towards their ankles and up to you standing!
  • Walk Outs – Use an exercise ball or a peanut ball or even a foam roller (the exercise ball will be the hardest because it can move in multiple directions). Place a puzzle and its pieces a little out of reach and have them lie on their stomach on the ball and then slowly walk out their hands as far as they can go while maintaining a straight trunk and hips. Then put a piece in the puzzle and walk their hands back. Keep repeating until all the pieces are done. You can also use beanbags, or other toys that involve multiple pieces.
  • Bridging – This one really targets the hips but also works on the trunk. I’ve talked about ways to work on this in other posts. You can get creative with how to make it fun, such as balls or cars going underneath. You can also make it harder by putting one foot on an elevated surface and the other one on the floor, or both feet on an exercise ball or peanut (or other unstable surface). You could just do one leg and keep the other leg up in the air. You can do reps of up and down, or you can go up and hold it for longer and longer periods of time.

What are some of your favorite ways to work on the whole core?

May 7, 2017

I Won’t Stand for That! (unless I learn how)

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 am
Tags: , , , ,

sitting down

Pull to stand

Learning to pull to stand can come naturally for some kids, and for others it can require a bit of work. This video is one where it came naturally (please note the emerging balance reactions at the end of the video – I love to see kids getting to experiment with this). As he was learning to crawl and explore he naturally began experimenting with pushing or pulling up to stand. This may have started with your legs, a coffee table, an oversized bin, the couch, or a chair. Basically anything that is off the ground and their hands can reach. When they get to it, their natural curiosity has them try to see what’s up there, or what’s on the other side. They become successful at it when the ability of their muscles matches their curiosity!

For those kids that require a little more help, here are some ideas you can try:

  • Sit to Stand – If your child can already sit independently, have them sit on a small stool really close to the couch or an activity table or a chair. Have a preferred toy or activity on the support surface. Help them to put their hands on the support surface and move into standing. Let them play for a bit and then bring them back down into sitting and repeat again. This helps them to strengthen their leg muscles, as well as learn that if they move into the new position, there might be something they like there!
  • Playing at Support Surfaces of Various Heights – When your child can crawl, or even kneel, create an environment where they have different heights to explore on. This could be the couch, the coffee table, an activity table, an overturned storage bin, a foot stool, etc. Put toys or activities that are motivating to the them on the support surfaces, and be there to engage as well. They may begin to experiment with pushing or pulling up onto extended legs. You can also line them up near each other. For instance, have the activity table touching the couch and a little bit away have an overturned bin touching the couch so that you have made a U of activities at various heights. Let them start at the lowest height and then make them aware of the activities or toys at the higher height. They can use the lower height to help them problem solve how to reach the higher height. This can also help them learn how to lower back down to the ground because they may want to get back to the toy or activity at the lower height again.
  • Crawling Over Obstacles – Learning to crawl over obstacles helps kids to develop their total body strength as well as have to problem solve how to get to where they want. This can involve pushing up onto extended legs before they go over the obstacle, or even just crawling right over. It engages their curiosity about what is ‘on the other side’ and if you use toys that are motivating, they can crawl back and forth along the same obstacle path for many repetitions! Use your legs, couch pillows, piles of blankets or towels, small upside down storage containers, etc.
  • Manual Assistance – And sometimes you just have to give them the extra support and take them through the motions. So if you are at a support surface, and they are on their knees with their hands on the surface, help them bring one leg forward so their foot is resting on the floor (half kneel) and then give them a little boost at the hips to go all the way up into standing. Take turns with which side you help them with so they get to develop strength in both legs, as well as so that each leg learns that it can push without the other leg right next to it!

What are other ways you have taught kids to pull to stand?

April 30, 2017

Strong Outer Hips (aka abductors)

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 am
Tags: , , , , ,

bridgingside step hip abduction

One of the muscles we focus on when we are working with kids, or young adult (or even ourselves if we’re being honest) is the hip abductor, or the outer hip muscle. This muscle may be on the smaller side but it is mighty!

When this muscle is strong it helps to stabilize your hips for every day activities like walking, standing, running, climbing stairs, crawling, and on and on and on. If you have a strong hip abductor and you pick up your foot to take a step it will hold your hips level so that you have a nice smooth walking pattern. If your hip abductor is weak, it will not be able to keep your hips level and when you take a step a few things could happen. Two of the most common things are:

  1. when you pick your foot up, your hip on that side will drop down as compared to the hip on the other side, or
  2. when you pick your foot up, you will lean your head and trunk away from that foot so that you are creating a counter balance to help keep you stable.

So why is this a problem? Here are a few reasons:

  • For a little one first learning to walk, if they don’t have the stability at their hips it makes it harder to take those independent steps and they will want to hold on to support surfaces longer
  • For a little one first learning to crawl, they may have finally mastered getting on to their hands and knees, but they don’t have the stability to lift one of their legs to bring it forward, and every time they try they collapse back down on to their belly
  • For someone who may have spasticity or higher muscle tone in their inner hip muscles (adductors), they may scissor their legs when they walk (cross them in the middle rather than stepping straight in front). If their abductors are strong they can help to counteract the scissoring pull and make walking a bit more efficient.
  • For anyone working on running, your hips will do the same thing as with walking if its weak, except you are putting more stress on your knee with every step you run. This can lead to overuse injuries and knee problems that can cause pain and lead to limited physical activity.

So what can you do? Here are a few ideas for exercises:

  • Sidestepping – depending on the age and skill of the child, this can look like cruising back and forth at a support surface, or it can be walking sideways down a hallway, or even adding resistance tubing/banding while walking sideways (make sure to lead with each foot)
  • Bridging – depending on the age and skill of the child, this can look like lying on their back with their knees bent and their feet flat on the floor and having them lift up their bottom (you can make it fun by driving cars under the ‘bridge’ or rolling balls under), or it can be holding the bridge position for longer periods of time, or while you are in the bridge position lifting one foot off the ground and then the other, or just doing one leg bridges, or even adding a resistance band around your thighs to push against while doing two leg bridges
  • Climbing – depending on the age and skill of the child, this can look like crawling up and down stairs (or couches), climbing on ladders at the park, using a climbing wall (even better is to traverse side ways on a climbing wall or park climbing structure)

What are some ways you have worked on the abductors?

April 25, 2017

The Value of Peer Play

peer play

I was recently at a school working with a kiddo. This child has made huge gains and is now easily able to access her school environment. The one area that is still a slight struggle is the play structure. She is able to do all points of access on all the play structures in her school. The challenge is that she doesn’t want to. And she doesn’t want to because she thinks she can’t. Even after doing it successfully she will still not want to do certain ladders. The other challenge is that if I push her, there is a potential for a meltdown. So I have walked the fine line between challenging and stepping back, in order to boost her confidence on the various ladders of the play structure. Now don’t get me wrong, she will do the stairs, the slide, and most standard ladders. Its just when they look a little different that she doesn’t want to do them.

So, back to my story. This day, while we were heading out to the play yard for recess after doing some work in the motor room, her friend from her class ran up and asked her to come play. They usually play together but it generally involves running around and trying to tag each other. This time her friend wanted to go on the play structure. She went with him and she climbed up the stairs and then I could see him coaxing her to do the ladders with him. He got her to climb down one ladder and then patiently brought her to each ladder and stayed with her the whole way up, encouraging her and showing her how he did it. There were times she would only go up about two steps and then come back down and run away. He was able to run up to her and bring her back in a way that she was still having fun and laughing, that I wouldn’t have been able to do. She didn’t realize he was making her work, she just saw it as playing with her friends.

Its moments like this that I love being able to step back and observe the kids I work with interacting with their peers. This interaction was just as, if not more important, than the time I spent with her.

What are ways you encourage peer play and then step back and let them go?

April 17, 2017

Hand and Foot Play

Hand and foot play is an important part of a child’s development.  So is bringing the feet to their mouth (unfortunately I didn’t get a good picture of that!).  So what are some of the reasons it is so important?

  1. Hamstring stretches – They just spent 9 months cramped up in the ‘fetal’ position. This means their knees were flexed and in close to the body. By reaching for their feet they are beginning to perform hamstring stretches that will help to lengthen the muscle.
  2. Core strength – By lifting their feet up and reaching with their hands, they are working their abdominal muscles which will help to develop their core strength. You try lifting both your feet up and reaching with your hands. Its not easy work on those abs!
  3. Midline – You can see in the pictures that they can bring their hands and/or feet to midline which helps to increase their awareness of where midline is.
  4. Body awareness – Hand and foot play allows your baby to explore their body and the various parts of their body. They begin to realize that their feet are attached to them and that their hands and feet can work together.
  5. Exploration – Once they are participating in hand and foot play, you will probably see them putting their feet in their mouth. This is how babies explore. They put everything in their mouth, including their own toes!
  6. Movement – As you can also see in the photos lots of movement is happening. He isn’t just lying flat on his back holding his feet. He is rocking back and forth, dropping one foot, picking it back up again, etc. This helps to create building blocks for movement and cause and effect. If they end up on their side, what do they have to do next?
  7. Self-soothing – When they are engaged in play with their feet, or putting their toes in their mouth, they are also able to self-soothe. This can help with sensory regulation.

If your child isn’t doing this, you can help to encourage them.  Gently bring their feet up towards their hands. Maybe help them to put their hands on their feet and try to grasp them. You can make a game out of it by playing peek-a-boo behind their feet so that their feet are in midline when you are ‘hiding’. You could also do ‘This little piggy’ while you have their feet up in the air and count each toe. You can play ‘patty-cake’ while holding their hand and feet together and bringing them to midline for each ‘clap’.

What are other ways you have encouraged hand and foot play?

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