Starfish Therapies

February 12, 2017

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


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



Yoga ball exercises

Animal Walks


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?

February 19, 2013

Using a Mobility Harness

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 pm
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When we were at our conference recently we purchased a small harness from Wingman Multi-Sport that looked like it had a lot of potential for use at work.  Well its only been two weeks and so far our favorite use is for helping with bike riding.  The handle on the back saves our backs (which is always a bonus) and it allows us to take our hands off the bike without compromising the safety of the child.

Another use we’ve found for it is to attach it to the weights in our Universal Exercise Unit so that the kiddos can climb up the cargo net against resistance and further strengthen their muscles while doing a functional activity.

There are a ton of other ideas we’ve had for using it such as assisting with crawling (to decrease weightbearing), providing assist with walking (so that we don’t actually have to have our hands on the child) and roller blading/skating.  We just haven’t had kiddos that are appropriate for these activities yet so we will have to wait until that happens to trial our other ideas!

February 13, 2013

‘Peter Pan’ Scavenger Hunt

peter pan game

Okay, so the title may be confusing but this is what our therapist and her kiddo called it.  I loved the idea.  They took these awesome carpet squares that we had found at ScrapSF and spread them out across the carpet and mat.  They then had some clothes pins on one side of the room and a cut out shape in the middle of the crash pad.  The child had to start on the side with the clothespins and pick up one and then hop from carpet square to carpet square (without touching the mat or carpet) all the way to the crash pad where they got to crash and then put their clothespin on the cut out shape.  They then would make their way back across the carpet square path to get their next clothespin.

Now this was brilliant in several ways.

  1. They got to work on fine motor control and strengthening by using the clothespins.
  2. They had to plan out which path they wanted to take so they had to sequence as well as judge distances and their ability to hop across the distance without touching the ground between the squares.
  3. Each time they hopped (leading with one foot) from one square to the other the square had some slight sliding movement and they had to work on their static standing balance so that they wouldn’t fall.  In addition, after they realized that the square would be moving they were able to start relying on some anticipatory postural control so that they were prepared for the slight movement.
  4. There was lots of repetition of all pieces of the task, especially if they touched the ground because they started over again!
  5. They got the proprioceptive sensory input of jumping into the ‘crash pad’.
  6. There was practice of gross motor skills for hopping/leaping from target to target.
  7. They worked on visual scanning as they picked the next target to hop/leap to.

What ways could you modify this to work on the skills you wanted?

October 23, 2012

A Multi-Tasking Activity

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

One of our OT’s was so excited last week to show us the new activity she was doing with a few of her kiddos.  She had just started it so she hasn’t had time to embellish it for pictures and make it look pretty!  Also, we had to wrangle one of our other OT’s in for the picture because no kiddos with photo rights were available at that time.

Basically she has a few kiddos who are working on balance, visual motor control and letter recognition.  So, in order to combine all three she has them standing on a spot (their feet aren’t allowed to leave the spot) and throwing the ball at whatever letter she calls out.  She currently has capitol and lower case letters because the kiddo this set up was for is working on being able to tell the difference.

When she showed me, I immediately loved the idea and came up with all different variations.  As the kiddos’ balance improves you can have them stand on one foot, or on a balance board or a balance disc.  You can have them work on maintaining stability in other postures such as high kneeling (like pictured) or half kneeling or staggered stance.  I also thought it could be used for numbers or colors as well and the ‘pictures’ on the wall could be adjusted depending on the child’s visual needs.  For instance, the white on white may be too challenging for some kids.

In addition to the learning and balance, it also helps kids with throwing and eye-hand coordination.  They have to be able to throw the ball (you can have them do overhand, underhand, two handed overhead, chest pass) and they have to be accurate with their throws.  It also assists with auditory processing because as the therapist calls out the target they have to figure out what they are hearing and then translate it to what is in front of them.

Another variation of this could be letter bowling.  You could have bowling pins with letters/numbers/colors on them and the child would have to work on rolling (which can be a hard skill to learn) the ball to knock over the correct pin or hit the correct target taped low to the ground.

How else have you used this idea and what skills have you worked on?

October 19, 2012

Some Fun Ideas for Encouraging Activity

I was browsing through the newest Family Fun magazine and I have to say I was quite impressed with the items they had that encouraged kids and families to be active.  Not only that, several of them also encouraged learning as well.  I thought I would share some of the activities in case you would like to try them, and I would love to hear any variations of these activities that you have tried!

1.  The first one (on page 36 of the November 2012 issue) is simple, it involves using a therapy ball for fitness.  They recommend a 45 cm ball but you want to make sure it is the right size so that if your child is sitting on it their hips and knees are bent to approximately 90 degrees.  The fuller the ball is the harder it is to balance.  They then go on to show exercises that work on core and leg strength.  They give them great names such as ‘On top of the world’, ‘Do you know squat’, and ‘Hand walking the plank’.  On top of the world has your child sit on the ball and lift one leg a few inches off the floor for 10 seconds while holding their balance and then switch.  This will work on your child’s balance and core strength.  Do you know squat has them do a squat while holding the ball against a wall with their back.  Have them try to hold the squat for as long as they can.  This will work on their core and leg strength.  The last one, Hand walking the plank has them lie on their stomach on the ball and walk their hands out as far as they can in front of them while maintaining their balance on the ball and then walk them back in.  This will also strengthen the core and their arms.  What other ball exercises do your kids do?  I know I sit on the ball while I watch tv so at least I am doing something healthy while my brain takes a vacation!

2.  In the spirit of Thanksgiving they introduced the idea of 21 Turkeys on page 33.  This game has people line up across from each other and throw a football back and forth (you can use little footballs or other balls for smaller kids).  If they can throw it right to their chest so its an easy catch they get 2 points.  If they have to reach for it or move to catch it, they get 2 point and if they miss its 0 points.  This will also allow the kids to work on adding and counting as well as throwing and catching.

3.  On page 40 they describe calculator hopscotch.  I love this idea.  Set up a calculator with sidewalk chalk (see photo) and you can play a few different ways.  You can have one person pick out a math problem by hopping from square to square and the other person jump on the answer (depending on your kiddo’s math ability you may want to just practice hopping on a number or recognizing how many of something there are and then jumping on the number).  You can also toss a stone onto a number and then in one minute come up with as many equations as you can that equal that number.  Or you can do the last one as a group activity and see how many equations you can find before moving on to the next answer.

4.  A great relay race on page 55 has you divide into teams and each team gets a bag of plain popcorn.  The first runner puts a cup attached to a rubber band around their shoe so the cup sits on top of their shoe.  Fill them with popcorn and then cross to the opposite side of the room/yard and empty the cup into the box.  Go back and pass the cup to the next team mate.  Continue this until the bag of popcorn is gone!
Has anyone played these games or do you have any other variations?

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