Starfish Therapies

May 21, 2012

Ideas for Helping Kids Develop Better Posture

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 pm
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Posture is always an interesting topic.  As adults we are often trying to improve our posture because we have started discovering that poor posture can cause other problems like pain.  These are things we don’t think of when we are younger and don’t always think about for our kids.  Posture is something that can and should be worked on from when kids are little so that they can hopefully avoid long term problems as they get older.  I have to thank one of our readers for coming up with this idea!

Here are some tips and ideas for exercises/playing that can also work on posture:

  • Make sure kids hamstrings stay flexible.  Its a lot easier to keep them flexible than to stretch them later.  When hamstrings are tight it can tip our pelvis backwards so that it flattens our low back spine.  To help with keeping hamstrings flexible have kids avoid w-sitting and long periods of kneeling as these will both shorten the hamstrings.  They should sit in a variety of positions such as ‘criss cross’ or with their legs straight out in front of them.  Here are some different sitting positions.
  • Core strength is really important.  Some of my favorite ways to improve core strength for kids other than having them do sit ups are:
  1. Lots and lots of climbing.  Since its getting nicer out this should be easier because parks are lots of fun.  The more unstable the climbing surface the more they will have to work their stabilizers and abdominals.  I love climbing nets or climbing domes.  Even ladders work well for this.
  2. Animal walks are a lot of fun and really challenge the core.  Some of our favorites are bear walking (hands and feet) or crab walking or dog/cat walking (straight crawling).  You can have animal parades or animal races.  You can change the terrain by going over uneven surfaces such as cushions or you can go up and down hills.  You can make animal obstacle courses where they have to be the animal and go around cones, over obstacles and through tunnels.
  3. Use a therapy ball.  Have your kids sit on it and move it around in all directions with fast and slow motions.  Or have them bounce on it. Try to give as little stabilization as possible (try for just the legs) and make sure they aren’t using their hands to hold on.  If you can get them to engage their hands in play such as clapping or touching their head or reaching to the sky it automatically encourages more upright posture.  I will also have kids reach for items such as bean bags and then throw them for a target while sitting on the ball.
  • Try sitting on an unstable surface.  There are wedges or core discs that are out there that can provide the ability to wiggle while sitting and allow kids to keep their core active and engaged.  You need to try it out though because sometimes it can be too challenging and they will just sink into a slumped posture.  Also if you can make a sitting surface a little higher than normal so their feet still hit the ground it can encourage an upright posture more than sitting at 90/90.  Or if you have a therapy ball that they can sit on with their feet on the ground while watching tv or doing other things it really works to keep the core active.  You have to make sure that they are safe while doing this though.
  • Swinging at the park especially when they are self propelling naturally engages the postural muscles such as the scapular retractors and the abs. In addition they get some great vestibular input.
  • Bike riding is really fun and great for core strength and endurance.  If you really want to get the core working ride up slight inclines and hills, they will have to use their arms and abs to generate power from their legs.
  • Reaching in sitting will also encourage upright posture.  Have them sit in a variety of positions or on a variety of surfaces and play games where you make them reach up and in front or to the side.  Watch their posture to make sure they are engaging their core muscles.

I probably have a ton of other ideas but this is a start.  What are some of your favorite ‘exercises’ for encouraging improved posture with kids?

February 6, 2012

When all things aren’t equal – Legs

I recently had a parent ask about ideas to help her child who has weakness on one side of her body more than the other side.  I figured I would write about some of the ideas that I use although please be aware that there are a ton of ideas and it depends on the developmental stage your child is at and specifically what skills they are working on.  For this case I am going to give ideas for kids that are working on skills such as walking or stair climbing.  I’m going to look at ideas for encouraging the use of both legs more equally. (In order to differentiate the legs I will talk about them as the weaker and stronger leg, hopefully this does not offend anyone)

Climbing – I love having kids crawl up and down steps.  This is a great way to work on both sides of the body together but still encourage them to activate the side that is weaker.  It works on developing reciprocal activity (which is needed for walking and crawling) as well as motor planning, coordination and leg strength (especially the butt muscles).  Make sure your kiddo is switching legs as they try to crawl up, using one knee on the next step up and then shifting their weight onto that leg as they bring the other leg up.  Make sure they are shifting their weight onto the leg that is leading so that they are practicing weight shifting as well as taking maximal advantage of the opportunity to develop leg strength.  They may need a little help especially if it is the weaker side.  Make it motivating by putting a favorite toy a few steps above them or using a toy with multiple pieces that they need to go up and down to get all the pieces (i.e. puzzles).

Up and Down Hill – Walking up and down inclines can also work to help your kiddo develop strength equally on both sides.  Especially on the way up they have to engage their butt muscles in order to keep their balance and on the way down they need to maintain control so they don’t crash.  You can have them walk or crawl up and down the hills.

Step Ups and Downs – If your child is standing and walking already then working on step ups and downs is a great activity.  I like to use smaller stairs and encourage the kiddo to go up leading with their weaker leg and come down leading with their stronger leg.  This way the leg that isn’t as strong gets to develop strength and power as it lifts the kiddo up to the next step and it develops control as it lowers the kiddo down onto the next step.  If your kiddo can ‘cheat’ while on the stairs then find a few phone books you can tape together or a step stool that is at a height that is challenging but they can have success (usually with a little support).  When I work on these kind of skills I pretend we are going over a mountain and usually I have bean bag animals or puzzle pieces on one side and their ‘home’ on the other side so that they think they have a purpose in going over the step over and over.  Same rules apply, stepping up you put the weaker leg on the step and going down you leave the weaker leg on the step.

Single Leg Stance – Now this can be challenging if your kiddo can’t fully stand or balance on one leg by themselves yet.  Here are some ideas to help that skill evolve as well as work on keeping their weight on the weaker leg.  You can have your kiddo stand with the stronger leg up on a slight height like a phone book or a step stool and play with them.  If they have challenged balance you may need to stand close by.  You could have them stand like this while playing with magnets on the refrigerator, drawing at an easel, playing games on an ipad, etc.  Just make sure they aren’t leaning on the support surface too much!  Another way to encourage single leg stance and shifting onto their weaker leg is to use a stomp rocket.  The stomp rocket is a toy that is so much fun!  Have them use their stronger leg to stomp on it which makes them have to stand on their weaker leg.  As they get better at this you can have them hold their foot up for a count of (1,2,3,etc) before they are allowed to stomp.  Depending on how good their balance is you may have to give them a slight hand (not too much support) while they balance before stomping.

Kicking a ball – Have them practice kicking a ball.  You can have the ball be standing still or it can be rolling towards them (depending on their level).  In order to pick their foot up to kick the ball they will need to balance on their weaker leg.

The above ideas all can help with stability and strength on their weaker leg.  If you are looking to have them work on lifting their foot more with things like walking then you can reverse some of the activities I listed or you can also try some of the ideas I talked about for improving foot clearance.

Please share other ideas!

January 27, 2012

More Great Songs for Therapy

After my last post on fun songs to use in therapy my coworkers suddenly started remembering songs that they frequently use in therapy so I thought I’d share some more ideas.

If You’re Happy and You Know It

This is a great song because you get to insert your own action.  You could pick skills that you are working on such as: jump up and down, stand on one foot, stand on tip tiptoes, jumping jacks, etc.  I also use it when we are on the ball and I am trying to keep the kiddo from using their hands to stabilize so I will often insert actions like:  clap your hands, reach to the ceiling, touch your ears, touch your head, reach to the sides, wiggle your fingers, touch your shoulders, say hooray (and reaching arms up overhead).

Hokey Pokey

Just by following the words of the song the kiddos get to work on motor planning and balance (and single leg stance for left and right foot).  To spice it up a bit you can have them jump (or hop on one foot) at the end instead of clapping.  You can also use the words ‘Touch the ground, stand back up, touch the ground and shake it all about’ to work on squats.  You could have the kids pretend they are dogs or cats and they can put their ‘paws’ and ‘tails’ in to work on crawling and balance in quadraped.  You can also just change animals for every turn so if they are frogs they hop in and hop out, or butterflies tip toe in and tip toe out.

I’m a Little Tea Pot

This is another fun song to use on the ball.  You can work on postural control while singing the song and then when you get to the ‘tip me over’ part you tip the kiddo backwards so they have to do a sit-up to get back up.

Old MacDonald

Great song for getting repetition of activities in.  If you are using an animal puzzle or play animals it works even better and the kids get to work on animal recognition because they get to select the animal that is on Old MacDonald’s Farm!  Usually we use this type of song for working on things like walking on a balance beam or going up and down the stairs.  Activities where they need lots and lots of repetition for mastery but may not be that exciting to do over and over again.

Winnie the Pooh

I only use the first lines from this song when it says ‘When I up,down,touch the ground it puts me in the mood.  Up, down, touch the ground in the mood for _____‘.  This can be a fun one to get a kiddo ready to do something.  You can have them squat up and down and then change what they are in the mood for.  It could be jumping, walking, running, crawling, spinning, etc.  (You just have to be okay if the rhyming is off!)  And it works even better if you do a big dramatic pause before you give the action!

More of Our Own!

  • Mr. Helper (to the tune of Frere Jacques) – Mr. Helper, Mr. Helper, – Hold, Hold, Hold, – Hold, Hold, Hold, – Hold the paper steady, – Hold the paper steady, – Helping hand, Helping hand.  Great Song to use when trying to teach a kiddo to use their secondary hand for stabilization or to ‘help’ with the task.
  • This is the Way We Wash Our Hands – I’ve adapted this one to go with gross motor tasks such as This is the way we (climb the stairs, jump around, skip along, stomp our feet, crawl away, run around, cross the bridge [for balance beam walking], bend our knees [squatting], walk on our toes, walk on our heels, etc).  Also lets the kids work on changing tasks because they have to switch what they are doing as the words in the song change!

January 18, 2012

Core = More Than Just Abs

I tend to be guilty of thinking of abs and core as being synonymous.  So I often have to remind myself that there is a lot more to the core than just those abdominal muscles that I’m personally awful about exercising (I definitely hate doing ab work).

So what is the core if its not just abs?

Your core pretty much encompasses from your neck to your hips.  This means it includes front, back and sides of your mid section.  It includes your shoulder and shoulder blade muscles.  It includes your gluts and other hip muscles.  Basically your core is the foundation that the rest of your movement occurs off of.  Think of it as the cornerstone of your body.

When kids work on their core aren’t trying to develop a six pack but rather improve the endurance and coordination of the muscles that fall within the core.  You don’t just want your child’s core to turn on when they want to do a sit up or a side bend, you want them to turn on so that your child can sit up straight throughout the day while they try to learn in school.  You want their core to work while they are trying to play or to eat.  If their core is strong they have better use of their hands and arms for fine motor skills and better use of their feet and legs for gross motor skills.

So, when working on core muscles, its not just about overall strength, its about their ability to stay turned on for long periods of time (endurance) or their ability to cooperate with the other muscles around them (coordination) as well as their ability to react to what is happening in a split second (help maintain balance/upright position).

Working on the individual muscle strength is important so don’t get rid of those sit ups or trunk extensions but its important to make sure you are working the core as a whole.

How you may ask?  Well here are some ideas:

  • Using a ball or core work is fun for the child and can work on the muscles activating together  and reacting quickly, as well as keeping them turned on for longer periods of time to build their endurance.  There are a lot of resources out there for ball work ideas and here are two, ‘Having a Ball with Core Muscles Strength‘, and ‘Therapy Ball Exercise Ideas
  • Having kids perform a plank and some variations are great ideas also – you can have them turn on their right or left side for a plank or face down.
  • Animal walking is a great way to develop dynamic cores strength as well as make it fun and work on kids imaginations!
  • Wheelbarrow walking
  • Climbing is a great way to also work on core muscles strength.  Anything from a climbing wall to a ladder to a climbing net to crawling up and stairs.  The more dynamic the surface (such as a net) the more challenge your core will get.  It also involves the hips and shoulders.  If your child needs lots of help then start with something really stable like crawling up stairs (also a great way to develop hip and glut strength).
  • The sit-n-spin is also a fun way to work on the trunk while having fun!
  • Here are some other fun suggestions for core exercises

I also mentioned that your core involves shoulders and hips.  This is important to remember because if your child doesn’t have muscles that can stabilize their shoulder blade it makes using their arms a lot harder.  Can you imagine trying to form your letters correctly when handwriting if your shoulder area wasn’t strong?  Any of the exercises that are listed above that involve weight bearing through the hands and arms will work on shoulder girdle stability such as:  wheelbarrow walking, crawling, bear walking, push ups, and plank.  In addition here are some other gross motor ideas that can strengthen the core and have a direct effect on handwriting and fine motor skills.  Another idea is to have the kiddo use some thera-band and try to pull you up by pulling on the thera-band and pulling their arms back.  They think its hysterical that you are ‘stuck’ and need help!

Lastly, a lot of times when I am working on posture with a kiddo or having them sit on a ball they tend to slouch from their shoulders all the way to their hips.  There can be a few reasons for this such as weakness or tight hamstrings but the reason I want to look at is challenges with coordinating the trunk muscles so that they can tilt their pelvis forward and get that nice straight posture that helps with learning and attention.  If you spend just a little bit of time working on this with kids they start to pick it up pretty quickly.  If it gets overlooked, it can contribute to tight hamstrings and ongoing poor posture that is harder to correct as they get older.

What I generally do to teach coordination of the trunk muscles for an anterior pelvic tilt is I work on reaching with the kiddo.  The easiest is to have the child sitting on a firm surface (or even a slightly downhill surface) on the floor or a chair.  If you have two people its even easier.  Find things they want to reach for whether its toys or an ipad app and hold it in front and above them.  If you stabilize their hips while they are reaching (with both hands) and give them some cues at their low back they will start to tilt their pelvis forward while reaching.  Its important for them to reach using both hands in the beginning while they are working on getting the coordination of their flexors and extensors so that they stay symmetrical.  Also watch for if they keep their chin tucked or if they really extend their head and neck to try to stabilize.  I usually remind them to put their chin down and use their eyes to look up.  Once they get the coordination down you can start to challenge them by having them reach off to one side or add a dynamic surface such as a therapy ball, disc or peanut.

What are other ideas you use for core muscle control and upright posture?

December 22, 2011

Obstacle Course Fun!

Do your kids ever get tired of the same activities during therapy or even while playing?  Well one of the ways I’ve tried to spice things up is by adding in obstacle courses.  Generally I take the same skills we’ve been working on and put them all together.  For the older kids I let them help me create the order and the items that are in the course.  The great thing is you can put as many or as few items as you want in it and if the kids are helping you they will most likely pick an activity that you regularly work on!  In addition to working on the individual skills it also helps them work on sequencing and transitioning from one task to the next.  Add in a stop watch and you can make it a lot of fun!  Usually the first effort is the slowest because they are figuring out what’s next and how to do each skill so they generally ‘beat’ their time on the next round.  You can really spice it up by using dice to see how many times they have to do the entire course and/or how many times they have to do each item in the task.  We have made indoor and outdoor obstacle courses and sometimes a combination of both!

Here are some ideas that I have used recently:

Outdoors – ride bike a certain distance, run to the play structure, traverse the monkey bars (after climbing up the ladder), climb up the climbing wall/ladder, go down the slide, walk on the ledge separating the grass from the bark (balance beam), and skip back to the bike.

Indoors – hopping on right foot on dots, jump rope, hopscotch one way, jumping jacks, animal walk out and back (bear, cat, snake, frog, etc), hopscotch back, jump rope, hop on left foot on dots

Some indoor variations – add in knee walking (I have them pretend they are a choo choo train), set up cones and have them heel walk while zig zagging one direction and toe walk while zig zagging back, step up onto a step stool and step down or hop up and hop down, do a forward roll, crawl through a tunnel, climb over a stack of cushions, hop like a bunny, step from one step stool to the next or one phone book to the next, walk on a tape line, and many more

Some outdoor variations – bounce a ball in place or moving, kick a ball (for distance or into a goal/target), walk backwards on a curb/ledge, climb down a ladder, crawl in the grass, ride a scooter instead of a bike or ride a tricycle, carry a plastic egg on a spoon, hop in a potato sack (you can buy fun kid ones now or you can use extra large pillow cases), run zig zag through cones

Another idea is a fine motor obstacle course or a combination of both.  You can create fine motor stations and they have to do gross motor activities to get between each one!

These are just a few of the ideas I have used.  I would love to hear some of your ideas!

January 19, 2011

Pretend Climbing

Climbing is a great way for kids to not only develop strength but also to work on motor planning and coordination. Ladders and cargo nets and stairs are all great ways to work on climbing as well as rock climbing walls. If you don’t have these things available to you, have no fear you can still work on climbing right on the floor and you get to exercise your imagination as well!

Have your child lie on their belly and get into a commando crawling position.  This is when one leg and one arm is bent and the others are straight.  For example, the right leg is bend up to your side and the right arm is bent down so the hand is around shoulder level while the left arm and leg are straight out.  Have your child use flat hands and pull with their hands while pushing with their legs to propel themselves along.  Many kids may want to bring both hands to shoulder level before pulling however help them to keep their hands staggered.  Once they have propelled have them switch sides and push and pull with the other side.  Once they get the hang of this and are using flat hands in a staggered position and keeping their bellies on the ground you can even have races with them.  You can pretend that you are race cars going around a race track or spiderman climbing up a wall.

What a great way to have fun with your child while working on strength, coordination and motor planning!

January 3, 2011

Top 10 Blog Posts of 2010

Its the end of the year and its time for my Top 10 Blog Posts of 2010.  Based on readership these were the posts that got the most views this past year.  If you want to compare to last year check out Top 10 Blog Posts of 2009!

10.  Repetition and the Beauty of ‘Redo’

9.  Standing Straight and Tall

8.  Climbing:  The Catch-22

7.  Having a Ball With Core Muscle Strength

6.  Why is W-Sitting a Four Letter Word?

5. Buns of Steel

4. Strategies for Tummy Time

3.  Do Video Games Promote of Hinder Child Development?

2.  Glossary of Sitting

1.  Sensory Exploration in Today’s Society

There you have it, the Top 10 for 2010!  If you have any ideas for 2011 please share them, I always look forward to ideas for new posts!  Happy Holiday Season to everyone!

October 21, 2010

Imagination Play

Do you ever feel like you are in a rut or play the same things over and over with your kids?  Or maybe you start to run out of ideas of things to do to help them stay active.  Well one solution is to let them come up with ideas.  I am always amazed at what the kids will come up with when I let them use their imagination.  Sometimes, they can be a little rusty but questions and guiding rather than telling can get their imagination sharpened pretty quick.  Even the little ones you can let them choose a toy and then guide them to lead the play.

When I was home for Christmas last year my nephew was there and he was ready to play.  He didn’t care that I had just gotten off a red-eye flight and wanted some much needed sleep.  He was ready for us to be pirates and fight the bad guys and we couldn’t step on the lava (the carpets covering the hard wood floors).  One minute we were on the same side and the next I was the bad guy and then we were friends again.  We made it to the boat (his bed) but unfortunately it was broken so he needed to use his tools to fix it.  At this point I was able to close my eyes (especially since I was on the bed) and informed him that I was guarding the prisoners (my two dogs who were coerced onto the bed with us – a twin bed I might add).  It was amazing to see his imagination run away with only a few words or questions from me.  And, we did climbing and running and hopping and crawling and tiptoeing and rolling during our adventures as pirates.

Now, you can definitely start simpler than that.  For example a little girl I work with and I go on an adventure each week while we practice bike riding.  It involves going over mountains (bumps in the sidewalks) and going over rivers (streams from sprinklers).  I suggest the adventure but I let her lead and I ask questions like ‘what do you think we’ll see on the other side of the mountain’.  Sometimes our adventures lead us to the park and we get to pretend on the play structure.

If you can’t make it outside use the cushions from your couch or even just the couch and the floor and a toy and let your child’s (and your) imagination run wild.  I bet you’ll surprise yourself with how much fun you will have and you can work on their gross motor skills at the same time!

I would love to hear your stories of imaginative play and activities with your kids – please share your great ideas.


September 21, 2010

Motor Smart Toys and Tips

Ball Pit: One of the greatest ideas we have received, from a parent, is how to make a sturdy ball pit.  If you have a pack and play that you are no longer using or you are still using but you want to spice it up a little, get a bunch of balls and put them in the pack and play.  It is a great way for your child to work on body awareness, core muscle strength, motor planning and having fun!  You can even hide stuffed animals or bean bags in there and have them find them.

Crash Pad: This is a great tool for kids of all ages.  Take a duvet cover and fill it with high density foam scraps.  If you have a foam shop near you, call them for their scraps (this is a less expensive route) or you could go to a store and buy high density foam (this is more expensive and time consuming) and cut it into smaller pieces.  Other options are getting old cushions from couches and cutting them up.  Fill the duvet cover with the foam and then let your kids have fun.  They can ‘crash’ on it, or crawl over it, or walk over it, or make up new games.  The crashing is great for those kids who seek proprioceptive input and the crawling is great for core strengthening.  Walking works on balance and coordination.  All in all, the kids get to have fun – its kind of fun for adults too!

June 28, 2010

Consistency and Carryover

walking outside

When we are working with kids in therapy we are often asked by parents what they can do to help their children make improvements towards their goals. My answer is to be consistent and to carryover what they are learning.  I have said in the past that one of the biggest factors for kids is their motivation and curiosity and willingness to explore, and this holds true.  However, from a parent or caregiver standpoint consistency and carryover are extremely important.

Look at it this way, if your child is getting 1 hour of therapy a week, that means that there are 167 more hours in that week.  Now I know that some of them are devoted to sleeping but the other hours are great opportunities for you to help your child progress.  This doesn’t mean that you have to become the therapist but you can create opportunities to work with your child during your day to day tasks.  One of the challenges is that often our schedules are rushed and its a lot faster to just do it for your child rather than to let them do it for themselves.

For example, if you are working on teaching your child to use a fork and spoon to eat, it will take longer to help them to eat than if you just did it for them.  Maybe you can make a compromise though.  Pick one food that they will feed themselves and then you help them with the rest.  And even them doing it themselves may involve you ‘helping’ them by holding their hand with the utensil.

Another example is teaching a child to sit up.  Its a lot more convenient to just pick them up and put them in sitting than to encourage and help them to sit up on their own.  Just think, if every time you wanted them to sit up you helped them to go through the steps rather than do it all for them.  How much faster do you think they would be at learning how to sit up?

I could go on like this for hours with examples, hopefully you are starting to get my drift!  What I would encourage you to do is talk to your therapist about how you can incorporate the skills they are working on into your day to day life so that your child will maximize their therapy and make faster gains.  You just have to be willing to take the time and be vigilant in not ‘doing it for them’!

This also goes for higher level skills like playing with a ball.  If your child can kick a ball then play with them with a ball and kick it back and forth so they become better at it.  If you don’t do this consistently you can’t expect them to be able to play soccer!  Same goes with play structures.  Teach them how to climb but then expose them to different structures so they can utilize climbing in a variety of different environments.

YOU can be the biggest influence in your child’s development and can have a great impact by being consistent with practicing and carrying over the skills they are learning.

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