Starfish Therapies

June 18, 2017

Pop Goes the Bubble

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

April 8, 2017

Fun with Balance Beams

Filed under: Developmental Milestones — Starfish Therapies @ 11:39 pm
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balance beam 1

I don’t know about you but balance beams are one of our staples to use with kids. As I was writing this post, I looked around and realized just how many different ones we have, and we actually use them all!

Clearly having a kid walk on a balance beam will work on their balance.  If forces them to narrow their base of support which challenges their balance. You can make it as easy or as difficult as you want.

balance beam 2

Some things to take into consideration when you are selecting which beam to use:

  • Wider is less difficult than narrow
  • Firm is less difficult than soft and squishy
  • Straight is less difficult than curved or zig zag
  • Lower to the ground is less difficult than higher off the ground

That being said, there are times we will use one that is more challenging than you would think appropriate for the child. We might use a higher one, even though the child is still struggling with one low to the ground. This could be because when it is low to the ground they try to go too fast, or step off too easily.  When its higher they may slow down and take more deliberate steps.

balance-beam-3.jpg

I’ve been asked why we don’t just use some tape on the ground. Well we do, but that doesn’t have the same effect as being elevated off the ground. When the child is off the ground, most times, they have a sense of it and are more cautious. It can work on their confidence for novel situations, or even help with their fear of falling as they practice being successful over and over.

We have several kids who like to move, and use movement to find their stability. They actually have a harder time doing things that require them to be still. By giving them a balance beam to walk on, they are challenged and most often have to slow down which can help work on their static stability.

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Now walking is the easiest way to use a balance beam. Its the most common way we use it, but that doesn’t mean its the only way. Some of the other ways we have used balance beams are:

  • Side stepping – Have the child take sideways steps to the left and the right to cross the beam. This works best if they are going out and back so they get both sides, but if they are only going one way, just have them switch the direction they are facing as they walk each time.
  • Blindfolded – This helps to work on their awareness of their bodies and decreases their ability to use vision to help their balance. Check out our post on using animal masks to work on balance!
  • Squats – As the child walks along the beam they can squat down to pick up treasure in front of them, or they can turn to the side to pick up treasure on the floor.  Usually treasure is a bean bag or a puzzle piece or a Squigz or whatever has captured their fancy that session!
  • Catch – Have the child stand on the balance beam and play catch with them. If there isn’t anyone spotting them make sure they are in a safe place if they lose their balance
  • Backwards – Walking backwards is another challenge to balance and body awareness. A fun way to incorporate it is to have the child go through the ‘adventure’ backwards. Anything novel usually captures their attention for a short period of time!
  • Jumping – We have jumped on them like bunnies, jumped over them like obstacles, and used them to practice side to side jumping.

vision-free-balance

What are other ways you have used balance beams?

 

April 1, 2017

Today I Sat Up

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I love having friends and family who have little ones who are growing and moving through their milestones.  And I especially love when they say I can use their pictures and videos.

When I saw this video of this little one sitting up, I thought it was great. He is a fairly new sitter and you can see him working on exploring his movement. He shows rotation, and reaching outside his base of support, and coming back up to the middle, and propping for some extra support. As you can hear in the video, he found a new limit. He was able to reach a little further and return to the middle without falling down. But it was all the times of reaching and falling down that helped him to gain the skills to know his limits and to know what muscles he needed to turn on to keep himself from falling over.

As he feels more confident with his sitting he begins to release his degrees of freedom. So when he rotated to reach for something he was relaxing his trunk because he didn’t need to hold it rigid to stay upright. He is able to begin picking and choosing the muscles he needs to be successful, rather than turning them all on and having limited movement.

If you get a chance watch some little ones as they begin to master a new movement and you will see them slowly relax and be able to have fluid movement rather than tightening up all their muscles to try to maintain control.

February 12, 2017

Eccentric Abs (and no I don’t mean odd!)

eccentric-abs

Our abdominal muscles (or Abs) play a big part in our core muscles.  They aren’t the only part but they are a piece that makes up the whole.  It requires coordination of each of the different muscle groups to help create a stable foundation so that we can move our arms and legs effectively.

What do I mean by eccentric abs?  Well when a muscle contracts it can do it a few ways.  One of those ways is eccentrically.  This post about squatting helps to explain the difference between eccentric and concentric muscle control.  But basically, eccentric contractions, or slow lengthening of the muscle, helps to give us control.

When we do sit ups we are asking our abs to perform concentrically, or to shorten.  When we do planks, we are asking them to perform isometrically, or to stay the same length to hold us stable.  So when do we work on them eccentrically, and why is this important?

Well we use our abs eccentrically also.  We use them to help us control our movements. Think about balance.  If you get bumped and your top half is moving backwards, you want your abs to be slowing that movement down until they can use a concentric contraction to bring you back up to midline. When I started thinking about this, I started wondering how I could help kids practice eccentric control.  For our quads (leg muscles) its easy, we practice slowly sitting down in a chair, or do squats, or slowly step down from a step.  If we ask people to slowly lower down from a sit up position, they will definitely work on it some, but chances are they are going to use their hip flexors (the front of their hip) to help control.  Especially, if its a child and they need us to stabilize their legs.

So, how do we focus on the abs and not get primarily the hip flexors? Well one way we came up with was doing a ball pass.  This can be done in sitting, standing, high kneeling, half kneeling, or whatever position you want to try where the trunk is upright.  Make sure the child is guarded properly to maintain safety, and then have them reach back over their head with both hands to get a ball from someone behind them.  They can then throw the ball at a target in front of them.  After you do a bunch of repetitions this way, have them start with the ball in their hands and then lean back to try to drop in in a basket behind them.  Not only will this engage their abs, but they will also get to work on balance in whatever position you have them in.

January 8, 2017

Righting Reactions

What are righting reactions you may ask.  Righting reactions are the reactions that help bring our head, trunk, and body back to midline so we can keep our balance.  They help us to be able to stand on a boat, or a moving train.  They help us to regain our balance after we catch our toe on something, or to be able to walk across an unstable surface.  Basically they are pretty important.

Righting reactions start to develop right away.  That’s what head control is all about.  When a baby can hold their head stable, their righting reactions are easier.  That’s because their inner ear sends messages to the rest of the body about where it is in space.  If it’s not where its supposed to be, the body is able to begin the correction process it to bring it back to where it should be.

After head control, trunk control follows.  This allows your baby to sit up and not fall over.  Initially they are like that house of cards you may have built, they have to be in exactly the right position and you can’t even breathe on them or everything might topple.  But as they learn to react to the messages being sent about their position, and their muscles get stronger and react faster, they are able to play and pivot and reach and do all sorts of things in sitting.

Standing follows sitting (yes, there are other places that righting reactions work such as hands and knees but for this purpose we will move on to standing).  In addition to the head and trunk control there are three general reactions to help keep you in a standing position: ankle, hip, and stepping.  The ankle reaction is when you have a slight instability and sway just a bit at the ankle to find your middle again.  The hip reaction is for a slightly bigger and faster balance disturbances and you bend forward or backwards at your hips to keep yourself standing.  And lastly, the stepping strategy happens when you need to adjust your base of support (foot position) so that you can stay upright.

Hopefully this gives you a general idea of what our bodies do to keep us upright and what your child is working on as they begin to navigate through the developmental milestones.

 

 

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.

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?

March 16, 2014

A Few Examples of the Importance of Postural Control

Filed under: Developmental Milestones — Starfish Therapies @ 9:09 pm
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platform swing

JR is 5-year-old boy and can’t sit in a chair or on the floor for more than 1 or 2 minutes at a time. He’s in constant motion and if he focuses on sitting still he can’t listen or pay attention to anything else. When in a chair he’s sitting on his feet, standing up and down, or moving in his chair so much it’s actually moving the chair itself. When on the floor he is either bumping into his friends or rolling around.

KC is a 5-year-old little girl that can sit in a chair or on the floor, although always seems extremely tired. When at the table she is slouched forward in her chair, or leaning forward and resting her head in her hands or laying her head on the table. When seated on the floor you may see her using a “w” sit or sitting with her legs forward but having to support herself with her hands in back of her to remain in this position.

Both of these kids seem to be at the opposite ends of the spectrum in how they act both seated in a chair and when on the floor, but in actuality could be both experiencing the same postural control issues. They each have their own way to deal with weakened postural control, but may also have other underlying issues that influence the way they act in addition. Postural control allows us better control of our distal extremities (arms and legs) and can also assist in helping us attend to someone or something better when we need to.

In order to compensate for his weakened postural control JR moves excessively. The movement helps him in remaining upright, but can lead to increased distractibility and difficulty in attention. This movement keeps him alert and at an increased arousal level. KC allows her postural control to take over for her instead and she is notably experiencing a lower arousal level when seated. She allows her body to sink back into things and depends on her upper extremities for support in a lot of cases to keep her upright. This lower arousal can lead to inattention as well at times, and she can tune out others around her.

Postural control is extremely important not only in a child’s attention and focus, but also in fine motor. In both JR and KC’s cases, their fine motor abilities can be affected depending on how they are able to sit down. Good postural control is also important in our balance and in helping us navigate our different environments appropriately and safely. There are many ways to work on postural control that are fun and exciting for kids. Here are some to check out.

Great Postural Control Activities:

Kids Yoga

Swimming

Karate

Yoga ball exercises

Animal Walks

Climbing

January 29, 2014

Spider Web Activity

IMG_3226 IMG_3194 IMG_3195 IMG_3196

One of our PT’s used this great game around Halloween time (I know, I’m a little late publishing it but better late than never)!  The idea came from ‘No Time for Flash Cards’.  The object is to walk along the tape lines and pick up all the spiders that are in the ‘web’.  Not only did the kids love playing this game but it also worked on some great skills such as:

  • Balance and Body Awareness – by having to keep their feet on the tape lines they are working on maintaining balance with a significantly narrowed base of support and maintaining awareness of where their feet are.  (For kids who can’t manage that small of a line you could have them either keep one foot on the line or double up the tape lines to make them wider)
  • Squatting – when the kids reach an area that has a spider they will have to stay on the line, squat down (while maintaining their balance), reach for the spider and then return to standing.  For kids that need some extra help you could put the spiders closer to the lines so they don’t have to reach as far.  You could also use bean bags if kids don’t have the fine motor dexterity to pick up the small spiders (to change it up some you could give them tweezers or clothespins to try to pick the small spiders up with).  You could also put the spiders on step stools so that kids don’t have to squat as far down if they are still working on this skill.
  • Motor Planning/Executive Functioning – the kiddo has to figure out how to get to each spider (by walking the lines of the spider web) which involves planning out their path.  They also need to work on once they are there how they stay on the line while still picking up the spider.

Who else has done an activity similar to this one?

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