Starfish Therapies

February 4, 2016

Childhood Occupations

Filed under: Developmental Milestones — Starfish Therapies @ 12:50 pm
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Childhood Occupations

We often get asked ‘What is Occupational Therapy,’ especially when we are talking about it in reference to a child.  As a result we thought we would publish a breakdown based on the Occupational Therapy Practice Framework to help give people a better understanding.

As Occupational Therapy refers to how one occupies their time, it is a profession that believes in daily participation in occupational routines. As defined by the Occupational Therapy Practice Framework, a child participates in the following occupations including: Activities of Daily Living, Rest and Sleep, Education, Play and Social Participation. Each occupation is taken into consideration during your child’s treatment and as such obtaining an understanding of these areas will contribute to the families ability to work in collaboration with the OT and develop the ability to transfer skills into the child’s daily routine to foster independence. The following descriptions are taken from the Occupational Therapy Practice Framework.

Activities of Daily Living: Activities that are oriented toward taking care of one’s own body. These activities are, “fundamental to living in a social world; they enable basic survival and well being.” They include:

  • Bathing/Showering: obtaining/using supplies, maintaining positioning, transferring to and from bathing position
  • Bowel/Bladder Management & Toilet Hygiene: intentional control, obtaining/using supplies, clothing management, transferring on/off the toilet
  • Dressing: selecting appropriate clothing, obtaining clothing from a storage area, dressing/undressing in a sequential pattern
  • Eating: the ability to keep and manipulate food or fluid in the mouth/swallow
  • Feeding: the process of setting up, arranging and bringing food/fluid to the mouth
  • Functional Mobility: moving from one position in space to another during performance of everyday activities such as those listed in this post
  • Personal Hygiene/Grooming: obtaining and using supplies to brush hair, groom nails, wash hands, clean mouth etc

Rest and Sleep: Including activities related to obtaining restorative rest and sleep that supports healthy active engagement in other areas of occupation.

  • Rest: quiet and effortless actions that interrupt physical and mental activity including identifying need to relax to restore energy, calm and renew interest in engagement
  • Sleep: a series of activities resulting in going to sleep, staying asleep
  • Sleep preparation: engaging in routines that prepare the self for comfortable rest including grooming, reading, setting an alarm etc.

 Education: Includes activities needed for learning and participating in the environment.

  • Formal educational participation: including categories of academic classes, nonacademic (e.g. recess), extracurricular (e.g. sports)
  • Informal personal education participation: participating in classes, programs, and activities that provide instruction/training in identified areas of interest

Play: A spontaneous or organized activity that provides enjoyment, entertainment, amusement or diversion.

  • Play Exploration: identifying appropriate play activities, which can include exploration play, practice play, pretend play, games with rules, constructive play and symbolic play
  • Play Participation: participating in play maintaining a balance of play with other areas of occupation; and obtaining using and maintaining toys, equipment, and supplies appropriately

Social Participation: Organized patterns of behavior that are characteristic and expected of an individual or given position within a social system.

  • Community: engaging in activities that result in successful interaction at the community level (i.e. neighborhood, organization, work, school)
  • Family: engaging in successful interactions in specific required and/or desired family roles
  • Peer, Friend: engaging at different levels of intimacy


Reference: Occupational Therapy Practice Framework: Domain & Process 2nd Edition. The American Journal of Occupational Therapy. Novemeber/December 2008, 62:6, pg. 631-633.

January 29, 2016

Football Fun

Filed under: Developmental Milestones — Starfish Therapies @ 1:40 am
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Football 2   Football 1

In honor of Super Bowl 50 being in the San Francisco Bay Area next weekend, and the Broncos playing in the game, I thought I would share a football activity one of our therapists came up with. She used this as a motivating activity for one of our kids who is really into football and wanted his therapy activities to be meaningful.  I thought she did a great job of incorporating his age appropriate interests into something that was therapeutic and fun.

As you can see from the picture a football field was created along with goal posts.  This child was working on dynamic standing and sitting balance as well as walking, transitioning between sitting and standing, and squatting to pick things up from the ground.

With this set up his goal was to get it through the uprights. He got a certain number of points based on various criteria

  • Was he sitting or standing while he threw the ball
  • Did it go through the uprights
  • Did it land on the ‘field’
  • How far away from the target did it land

Clearly if he threw it standing and it went through the uprights he got the most points and then they were graded lower after that.  He had a target number of points that they kept on a white board (also allowing him to work on his math skills!).

After he threw the ball he had to walk to where it landed (or to the accessible place the therapist moved it to) and squat down to pick it up and then return to the bench and sit before he threw the ball again.

You could easily do this with bean bags or a soccer ball and goal or any other activity.  The part that was fun for us was all the skills he could work in a meaningful and fun way for him!  And, football was a regular discussion with regards to players, positions, teams, divisional standings, etc.

What ways have you made activities meaningful for your kids you work with?

January 21, 2016

Superhero Fun

Filed under: Developmental Milestones — Starfish Therapies @ 10:53 pm
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Who doesn’t love pretending to be a superhero? We had a Superhero week at the clinic, and as a result thought it would be fun to list some gross motor activities that we came up with that your child could practice while pretending to be their favorite superhero!
1. Imitating various animals, such as a spider, while pretending to be Spiderman. By imitating various animals, children can work on coordination of their arms and legs, improve their motor planning, learn how to move their body in space, and improve their overall strength. Some animals to try include: bear, crab, spider, snake, horse, and frog.
2. Practicing jumping forwards, in place, down from a step or hopping while pretending to be Batman jumping from skyscraper to skyscraper trying to catch the foes and save the day! By practicing jumping and hopping skills, a child is working to improve their coordination, standing balance, and strength of their leg musculature.
3. Practice running “faster than a speeding bullet” like Superman does on both even and uneven surfaces. Running can help improve a child’s cardiovascular and muscular endurance, improve leg  strength as well as improve coordination. For younger children working on floor mobility skills, have your child pretend to fly like Superman, lifting their head, arms and legs off of the floor, which will help to improve the strength of their neck and trunk muscles.
Be creative and allow your child to use their imagination to come up with activities that their favorite superhero might do!

January 14, 2016

Knee Bounces, Lap Bounces, and Lap Jogs

Filed under: Developmental Milestones — Starfish Therapies @ 1:00 pm
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Puppy Rides
Different names but all one and the same activity. Do you remember these from when you were young? Sitting as child on an adult lap and bouncing or swaying in time to a tune or poem. Knee bounces are a wonderful activity for so many reasons. Common benefits include a child spending time engaged with the parent or learning new rhythms and vocabulary from poem or hearing and feeling a beat at the same time. Not commonly known are the therapeutic benefits from knee bounces.
Lap bounces can be a wonderful way to encourage eye contact and language. When a child requests more, as therapists and parents, we typically ask for eye contact and the initiation of movement or the utterance of a word or phrase or sign. These help with the development of language by having a shared, enjoyable activity that elicits communication to repeat the desired activity.
More sneaky therapeutic benefits are trunk strengthening and balance responses. Completing the knee bounces slowly and pausing at the end range is a fun way to work on trunk strengthening and giving the child the chance to initiate a response to the loss of balance in a secure and fun way.
Another therapeutic benefit includes eye (ocular) and inner ear (vestibular) exercises. When a child is being moved in space and their eyes are locked onto their reflection in a mirror or to the parent’s face it helps to teach them how to use these two senses to tell where they are in space and how to right themselves.

Please give lap bounces a try. Look up lap bounces on the internet and see what you find or click on this link for one example, YouTube Video.

Please let us know what you find and if this works for you.

January 7, 2016

Diaper Changes, Brushing Teeth, and Stretches – Oh My

Filed under: Developmental Milestones — Starfish Therapies @ 9:12 pm
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Once we have children we realize so many activities are not enjoyable but necessary. Who hasn’t had a battle over a diaper change, brushing teeth or completing a stretch? How can we lessen the battles that occur over uncomfortable and undesirable activities?
One way to do this is to reframe the activity in one’s own mind. Washing my child’s hair can become a wonderful activity because it is the only time I get to spend time close with him as he does not want physical attention. A diaper change can become a fun activity that is based on undivided attention, tickles, songs, and love.
How do we turn this around? We start with reframing the activity in our parental mind. Second realize that the battle may derive from the fact that the child does not understand that the activity is finite and will end soon. If we believe a situation is uncomfortable and do not understand that the end is soon we also battle and fret. Help the child understand the end point is near. Try setting a timer for the activity. Once the timer rings the activity ends, even if it is not to our liking. Once the song is over the activity ends or once we count to fifty the activity ends. The child begins to learn that the activity is finite and the battle lessens. Once this basic lesson is learned we can slowly and slyly extend the time by setting the timer a bit longer, or singing the song more slowly, or asking for help while counting.
Lastly remember that most of us enjoy novel experiences. During the undesirable activities, have a basket of books or toys that are only available during said activity. Silly putty, a lava lamp, a glue and glitter bottle are all easy, enjoyable and distracting items. Here is a link to making a glue and glitter bottle. These are a wonderful distraction!

Have you figured out anything other activities that work? Please let us know so we can pass on the information to other parents.

June 1, 2015

Therapeutic Benefits of Swimming on MamaOT

Filed under: Developmental Milestones — Starfish Therapies @ 2:55 pm
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We are lucky enough to be participating in a series on the Therapeutic Benefits of Recreational Activities over on MamaOT.

Our post is the first in the series and we are discussing the Therapeutic Benefits of Swimming.  Growing up as a swimmer I was beyond excited to get to discuss this activity that is near and dear to my heart.  I hope you enjoy the read and it encourages  you to ‘take the plunge’ and go for a swim!

May 5, 2015

Motor Groups and RTI

Motor Group

May is Better Hearing and Speech Month and Speech Language Literacy Lab has organized this blog hop with multiple professionals to discuss RTI.

Being a physical therapy provider in the school district does not always provide the opportunity to become involved in Response to Intervention (RTI).  We were lucky enough to be involved in with a school district that allowed us to get involved to help address the motor needs of children at the pre-school level.  We were finding that there were a lot of referrals to physical therapy because some kiddos were not at the same gross motor level as their peers.  While a lot of the teachers implemented gross motor time, they often felt unsure if what they were offering was optimal for the kids they had in their class.  We were able to go in and support them with gross motor groups in the classroom, where the teacher is actively involved and can ask questions about why we are doing different activities, how they can carry those activities over, what else we would recommend for common challenges they were noticing with their kids, and it allowed us to have eyes on all the kids and offer suggestions to the classroom as a whole if we noticed certain skills were at various levels of mastery for the kids.

What has been great with this is the teachers are feeling empowered and supported when they do motor groups every other day of the week that we are not there.  They also have a person to talk to for their questions about motor development and if something is concerning or not.  Most importantly it opens a line of communication between the teachers and us as the physical therapists.  My experience in the school system has been that if a service provider and the teacher and teaching staff can have great lines of communication, the children benefit even more.

Besides these benefits as a therapist and teacher, the students get one extra set of eyes on them as they move through a period of time in their life that is ripe with gross motor development.  At that age, play is where they do their learning and interacting with their peers that sets them up for each successive school year.  While it may not look important whether or not a kiddo is able to keep up with his peers in play, it is a critical part of each child’s development and by implementing structured motor groups, we are setting the teachers and the students up for success.

On a different note, in terms of actual physical therapy services provided for kids, we have found that it has cut down on the number of referrals that were occurring just because the teachers weren’t sure how to help the child.  For children like this we were finding that some education to the teaching staff on how to best support the child would make the difference and they were able to continue to progress with their peers.  The motor group allows us to be proactive in providing teaching staff this support so that the children benefit sooner!


Please be sure to check out the other blogs that have participated in the Blog Hop on RTI for May’s Better Hearing and Speech Month:

Here is The Schedule (Links may take you to the author’s site as opposed to directly to their blog since this post is being published at the beginning of the month):

5/1/2015 Kick Off to Better Hearing and Speech Month!

5/2/2015 RTI for the R sound! Badger State Speechy

5/3/2015 Response to Intervention in High School– A Journey from Abject Frustration to Collaboration and Student Success Stephen Charlton Guest blogs on Speech Language Literacy Lab

5/4/2015 Technology and RTI  Building Successful Lives Speech & Language

5/5/2015 Starfish Therapies

5/6/2015 Orton Gillingham Approach & RTI  Orton Gillingham Online Academy

5/7/2015 Evidenced-based writing that works for RTI & SPED SQWrite

5/8/2015 RTI/MTSS/SBLT…OMG!  Let’s Talk! with Whitneyslp

5/9/2015 RtI, but why?  Attitudes are everything!  Crazy Speech World

5/10/2015      Consonantly Speaking

5/11/2015 Universal benchmarking for language to guide the RTI process in Pre-K and Kindergarten      Speech Language Literacy Lab

5/12/2015 Movement Breaks in the Classroom (Brain Breaks)   Your Therapy Source

5/13/2015 How to Write a Social Story   Blue Mango LLC

5/14/2015 Some Ideas on Objective Language Therapy    Language Fix

5/15/2015 Assistive Technology in the Classroom  OTMommy Needs Her Coffee

5/16/2015 Effective Tiered Early Literacy Instruction for Spanish-Speakers Bilingual Solutions Guest blog on Speech Language Literacy Lab

5/17/2015 Helping with Attention and Focus in the Classroom   The Pocket OT

5/18/2015 Vocabulary Instruction  Smart Speech Therapy, LLC

5/19/2015 An SLP’s Role in RtI: My Story Communication Station: Speech Therapy, PLLC

5/20/2015 Incorporating Motor Skills into Literacy Centers   MissJaimeOT

5/21/2015 The QUAD Profile: A Language Checklist  The Speech Dudes

5/22/2015 Resources on Culturally Relevant Interventions  Tier 1 Educational Coaching and Consulting

5/23/2015 Language Goals Galore: Converting Real Pictures to Coloring Pages  Really Color guest blog on Speech Language Literacy Lab

5/24/2015 Lesson Pix: The Newest Must-Have Resource in your Tx Toolbox Speech Language Literacy Lab

5/25/2015 AAC & core vocabulary instruction Kidz Learn Language

5/26/2015 An RtI Alternative Old School Speech

5/27/2015 Intensive Service Delivery Model for Pre-Schoolers   Speech Sprouts

5/28/2015 RTI Success with Spanish-speakers     Speech is Beautiful

5/30/2015 The Importance of Social Language (pragmatic) Skills guest post on Speech Sprouts

5/31/2015 Sarah Warchol guest posts on Speech Language Literacy Lab

March 13, 2015

Multi-Purpose Sign-In

Filed under: Developmental Milestones — Starfish Therapies @ 9:47 pm
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At a recent staff meeting we were discussing a few of our kids who were having a challenge with regulating their emotions, such as frustration.  Our OT’s had tried discussing the zones of regulation with them but these were kids that were a little older and did not want to discuss how they were ‘feeling’ that day.  If colors were even introduced the kids would say ‘I don’t want to talk about colors.’

We decided to get creative about a way to start looking at how a child could tell us how they were feeling without us having to discuss it with them.  We decided to make a sign-in board for our kids.  We put it around the corner so they could sign-in once they were on their way to therapy and it wasn’t sitting out in the waiting room for all to see.

First we found a poster with various faces on it and we photocopied the poster onto different color construction paper.  The colors of the construction paper are the zones that most closely match the expression/emotion displayed on the face.  We then cut out each face and laminated it.  We used velcro on the back to have it stick to the surface (we may eventually go to magnets and a bigger surface but we used the supplies we had available at the time to trial this).

For kids that are open to talking about how they are feeling we use it as a tool to discuss their emotions and feelings.  We’ve had a few kids change their face throughout the session to match their changing mood.  For other kids, who aren’t as open to that discussion, we just ask them to pick a face to put by their name.  We are then noting what face they pick and seeing if it correlates with their mood that day.

Its not a complete solution but it gave us a tool to start working with some of the kids that were not as open to the topic of their feelings and emotions.  We’ll keep you posted as we adapt and grow it!

What tools do you use?

PS – In addition to working on regulation and emotions, kids are also working on their handwriting (they love to write their name on the board), as well as using two hands (including a stabilizing hand) to take the faces off and on.

February 24, 2015

Which Shoes Are Best?


As parents, you may wonder what is the best product or toy that will help your child meet their milestones or learn things quicker. I’m sure you’ve also wondered what type of shoe could be best for your new walker? There are so many shoes to choose from that will help make your child the most fashionable, but which one is going to be the best for the development of walking? There is not one right answer, but here are a few things to keep in mind when choosing a shoe that will be right for your child.

As children learn how to walk, their foot plays a huge role in their stability, shock absorption and momentum. The bottom of their foot allows them to feel where they are in space. Therefore, the type of shoe that is worn can determine their walking pattern and stability. Should your child go barefoot, wear a flexible shoe, or stiff shoe?

Some research shows (see below) that the best foot development occurs when a child is barefoot, so the best shoe would follow the barefoot model, meaning that the shoe should be flexible. Going barefoot allows the foot to feel the texture of the floor and gives them good sensory feedback to let them know where they are in space. A flexible shoe (soft material with a soft sole that allows for bending) can also allow for more sensory feedback, similar to going barefoot. However, a stiffer shoe can lead to greater stability compared to a very flexible shoe. It was seen that children keep their foot on the ground for a longer period of time when wearing stiffer shoes, possibly because they are not getting as much input and need that time to understand the environment that they are in. So if your child seems to be a little more unstable, a stiffer shoe may be best for them.

Depending on what type of shoe you decide to put your child in, they typically will adapt to it and change their walking pattern (amount of time they keep their foot on the floor, width of their feet, and speed of walking). Children are fast learners and are ‘flexible’ to any changes that come their way. As therapists, we are always trying to promote adaptability; so changing the type of shoes that they walk in can be a great way to teach them how to experience a new situation. As mentioned before, there is not one perfect shoe for all children and the need for flexibility vs. stability may need to discussed further depending on your child’s needs.

Keep in mind that the articles referred to focused on children who are developing motor skills typically, therefore, the amount of stability or flexibility may depend on the individual need of your child.

Buckland MA, Slevin CM, Hafer JF, Choate C, Kraszewski AP. The effect of torsional shoe flexibility on gait and stability in children learning to walk. Pediatr Phys ther. 2014; 26: 411-417.

Staheli L. Shoes for children: a review. Pediatrics. 1991;88:371

February 20, 2015

Doing Two Things at Once


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

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

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

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

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