Starfish Therapies

May 29, 2017

Transitional Movements

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

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

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

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

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

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

February 19, 2017

Using a Swing to Work on Jumping

We have recently had several kids who are struggling with jumping.  Sure, they clear their feet when they jump, but they are relying on using their hips to lift their feet, rather than push off through the toes.  And learning how to land so that they are primed to either jump again, or absorb the shock, has also proven challenging.

So we decided to brainstorm one day and one of the suggested ideas was to have the child lie on their back on a platform swing, move them forward so their feet are touching a wall, and have them push off.  As they swing back they will practice absorbing the shock and then pushing again.  By having them lie down, their body is in a similar position to if they were jumping in standing. We found the kids loved it.  We had to show them a couple of times what to do, and occasionally slow the return down while they were still getting the hang of it, but once they figured it out, they were self propelling themselves on a swing.  I don’t know about you, but a majority of our kids love to swing.

Of course, then we decided to get creative.  We had them sit at the end of the platform swing to do it.  We also used a typical playground style swing after the platform swing.  We still had them practice pushing off (and work on the components of jumping) but by having them sit up and hold onto the ropes, they also began to work on the idea of controlling their momentum and how to move their trunk so that it could carry over to swinging at the park.

If kids are working on single leg hopping, or leaping from one foot to the next, you can also do all of the above and have them work with only one leg, or alternate legs (and that sneaks in some coordination)! Also the repetition is great for strengthening their legs and core.

If your swing isn’t set up so that a child can push off a wall, you could also have someone hold a large therapy ball at the end and stabilize it so they could push off of that. Because it has a little more give, they won’t get the same force but it mimics the feel of a trampoline.

Has anyone else tried something along these lines?  Have you modified it in other ways? We’d love to hear from you!

February 25, 2016

Participation and Children with Coordination Challenges

A walk in the rain to dance class

I was recently at our Combined Sections Meeting for the American Physical Therapy Association and I sat in on a talk called ‘Developmental Dyspraxia: Sensory Considerations for Motor Skill Development’.  It was presented by a PT and an OT.  It was a great presentation and looked at some of the various types of dyspraxia that are out there and how they are similar and how they are different.

Here is the definition of Developmental Dyspraxia that they used: ‘the failure to have acquired the ability to perform age appropriate complex motor functions.’  The definition of Participation they used is: involvement in life situations and includes physical, social, and self-engagement in activities.’

What struck me most about this talk, and my biggest take-away was the fact that kids with Developmental Dyspraxia, or coordination challenges, can find a back door into Participation through social engagement.

We talked about Participation in a previous blog post but I wanted to revisit it for a second.  Participation is one of our main focuses when we work with kids.  We are helping them with various skills so that they can find a way to belong and contribute to their community throughout their development.

In this day and age, a lot of kids are enrolled in a plethora of after school and weekend activities. For a child who struggles with gross motor or other aspects of development, this may not be fun for them and they may feel isolated or left out, they may also not want to go or participate.  And this is why I loved the take-away I had from the talk.  If we alter the activity so that the child finds it enjoyable and they find a sense of belonging or community, they will enjoy participating in the community.  As they enjoy participating they will want to participate more, and they may even be willing to try activities that are challenging for them.  And now you have started to create a cycle of success.

An example could be: your family loves to go bike riding in the park but your middle child struggles to ride a bike and doesn’t want to do it.  What if you switched to taking a walk in the park as a family so that you were all able to participate and have fun?  If they enjoy it they are going to want to go the next time.  Maybe one of the times they will want to ride the bike for part of the time.  You have just helped them to enjoy being outside with your family, so they are active, even if it isn’t riding a bike, and through this enjoyment you are fostering their desire to continue to be engaged in this activity.

I’m not sure if I’m making sense. I’ll try again with another example.  You really want your child to be on the soccer team.  Whenever they play soccer they struggle to keep up and they end up sitting on the sidelines or they feel that their teammates get frustrated with them.  They start to push back when it comes time for practice and games until all of a sudden they just want to stay home.  What if you got them involved in brownies or cub scouts, or informal play groups, or maybe some type of martial arts?  They could develop a sense of belonging with a group/community that they enjoy belonging to.  With enjoyment they may be willing to try playing soccer with their friends or siblings just for fun.

The key is, we want kids to want to engage in their community and with their families and peers.  Finding social outlets to get kids involved can be a great step in this direction and then introducing the activities they find to be challenging.

I hope I didn’t make this too confusing, I was just so excited when I heard it that I wanted to share.  I would love to hear stories of how you have successfully navigated supporting your child to participate meaningfully in their community, however they define it.

March 31, 2014

Fun With Finger Play

Filed under: Developmental Milestones — Starfish Therapies @ 1:48 pm
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finger play
Our hands perform intricate movements that allow us to manipulate various objects around us. Our hands provide us with opportunities to interact with and learn from the environment. Hand function is dependent on several different factors. The large upper body muscles in the trunk, shoulder, and forearms provide strength and stability to push, pull, lift and hold. It is also important to develop strength in the small muscles of the hand in order to position our hands in precise and delicate ways.  Finger plays are a great way to promote improved hand skills. Some of the benefits of Finger plays include:
  1. Develop arches of the hand. The arches give the hand a rounded shape and help to position the fingers for accurate use.
  2. Develop finger isolation skills. The thumb, index and middle finger need to be able to be able to perform small accurate movements while the ring and small finger are tucked toward the palm. It is important to be able to move each finger individually in order to complete mature grasp patterns.
  3. Develop the web space. The web space is the space between the thumb and index finger. The web space is important because you have to keep it open and rounded (like an “ok” sign) to perform precise movements such as picking up small objects from the table.

 In addition to hand improved hand skills, finger skills facilitate improved ability to follow directions and improved imitation skills. Finger plays are a fun and exciting way to interact with your child while at the same time encouraging skill development.

Funny Bunny:

(Author unknown)

Here is a bunny (Raise two fingers.)
With ears so funny (wiggle raised fingers)
And here is a hole in the ground. (Make hole with fingers of other hand.)
At the first sound she hears,
She pricks up her ears (Straighten fingers.)
And pops right into the ground. (Put fingers in hole.)

Ten Fingers:  I have ten fingers    (hold up both hands, fingers spread)

And they all belong to me,  (point to self)
I can make them do things-
Would you like to see?

I can shut them up tight   (make fists)
I can open them wide    (open hands)
I can put them together   (place palms together)
I can make them all hide  ( put hands behind back)

I can make them jump high   (hands over head)
I can make them jump low  ( touch floor)
I can fold them up quietly   (fold hands in lap)
And hold them just so.

Three Balls:

Here’s a ball     (make ball with thumb and index finger )

And here’s a ball   (make ball with other thumb and index)
A great big ball, I see   (put arms up and touch fingers over head)

Shall we count them?
Are you ready?
One, Two, Three    (make all three balls in succession)

Open/Shut Them:

Open, shut them, (open and shut fists)
Open, shut them,
Give a little clap. (clap)

Open, shut them, (open and shut fists)
Open, shut them,
Put them in your lap. (place hands in lap)

Creep them, creep them (walk hands up body to chin)
To your chin.
Open your mouth,
But do not put them in.

Roll them, roll them, (make rolling motion with hands)
Roll them, roll them,
Roll them just like this.

Wave them, wave them, (wave)
Wave them, wave them,
Blow a little kiss! (blow a kiss)

Where is Thumbkin?:

Where is Thumbkin? (put both hands behind back)
Where is Thumbkin?
Here I am. (bring one thumb out front)
Here I am. (bring other thumb out front)

How are you today sir? (bend one thumb as if talking to the other)
Very well I thank you. (bend other thumb as if talking back)
Run away. (put first thumb behind back)
Run away. (Put other thumb behind back)

Repeat with: Pointer, Tall Man, Ring Man, Small Man.

February 19, 2014

Doing Two Things At Once

ring toss

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.

January 29, 2014

Spider Web Activity

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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?

August 9, 2013

The Un-Block

Filed under: Developmental Milestones — Starfish Therapies @ 7:00 am
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When we went to the American Occupational Therapy Association (AOTA) conference this year we saw this great toy that one of the vendors was selling.  It’s called the Un-Block.  I of course had to get it because I love any type of building toy and thought it looked like such a novel idea.  (Since I’m a PT, I was crossing my fingers that the OT’s would be able to use it.)  Luckily our OT’s have been using this toy and were able to give me some feedback on what they were using it for.

The biggest thing they said kids had a challenge with was motor planning how to connect the pieces.  Because it is a precise fit and the pieces slide together, many kids found this challenging and required hand over hand assist while working on the motor planning.  A lot of times they just wanted to snap them together (similar to legos) but they won’t connect that way.

Another challenge was lining the pieces up together in order to slide.  Currently the pieces are all the same color so it requires increased use of the visual system to get accurate alignment as well as precision.  Several kids would get it close and then keep attempting in the same spot, so they required assistance to problem solve and make adjustments so that the pieces would fit together.  We talked about that it would be great if the blocks were different colors or had the interlocking parts defined out by a color/boundary.  This is easy enough to add on your own if you think your kids would benefit from this.

This toy also allows kids to work on their grasps, such as the three jaw chuck or pincer grasp, when picking up the pieces and manipulating them such that they fit together.  In addition, the get to work on fine motor control, precision and coordination.

Lastly, they get to have fun with their imagination and build things!

While talking about the pieces being different colors we were also brainstorming that kids could do patterning, or create additional designs, or just get the visual assist that may be needed.

Have any of you played with this toy?  If so, how are you using it?

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?

December 10, 2012

Birthday Party Fun – Game Ideas

Filed under: Developmental Milestones — Starfish Therapies @ 4:49 pm
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party games party games1 party games2 party games3 party games5 party games6

One of my good friends was prepping for her daughter’s 8th birthday party so I went over to help so that we could spend some quality time together.  I loved the game ideas she had come up with for the kids and I think that in addition to birthday parties they are great ideas for working on other skills.

  1. Balloon Pop Spelling – We wrote individual letters on pieces of paper and folded them up and put one each inside of a blown up balloon (yes, I got to blow up almost 100 balloons – the things we do for spending quality time with friends)!  We did enough for four teams.  The object is for the kids to pop the balloons and look at the letters until they came up with the letters to spell her daughter’s name.  Now for kids who are sound sensitive you could use plastic easter eggs.  For kids who aren’t yet spelling you could put sight words in there and have them match them up or you could use colors or numbers or any variety depending on what you are working on.  You could also have each team try to spell a word using the most letters (kind of like a version of Boggle) and see who gets the longest word.
  2. Ball Toss – We got together buckets and some soft squishy balls and then the kids were going to be divided into groups of 3.  One child would put the bucket on their head (using hands to stabilize – I tried without hands and it didn’t work very well), one child would stand at the line and throw the balls trying to get them in the bucket and the 3rd would chase after the balls.  Each child gets 1 minute to get as many balls in as they can (you can change the time depending on the age group).  This is a great way to work on throwing skills and team work, plus it keeps the kids active with having to chase after the balls.
  3. Tissue Box and Ping Pong Balls – I have no idea what this one is called but basically you empty out tissue boxes and then you thread a belt through it so you can secure it around the child’s waist (with the tissue box in the back).  You then put several ping pong balls in the tissue box and they have to move around until they get all of the ping pong balls out of the the box.  They aren’t allowed to use their hands to help with shaking the balls out.  This is great because they have to get creative with moving in all different ways in order to facilitate getting the balls out of the box.
  4. M&M Transfer – Open up a bag of M&M’s and put some in one ball.  Give the child a straw and have them try to transfer all of the M&M’s into another bowl by sucking through the straw and securing the M&M to the end of the straw.  You could just have it as an activity or you could make it a race between several kids.  This is a great way to work on oral motor skills.

I believe there were going to be more games (as you can see from the pictures) as well as free time using tumbling mats but those were the only games I was lucky enough to help organize!

November 28, 2012

Weight Shifting for Kids with Coordination Challenges

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

We love using the Wii with our kids.  Its a novel way for them to work on specific skills such as weight shifting.  While using it we have noticed that several of our kids who have developmental coordination disorder or other coordination challenges have a really hard time motor planning how to weight shift.  We have used a hula hoop at their hips before to provide tactile and visual cues which has worked really well but even after trying it for a few weeks we didn’t see the carryover that we wanted to see.  So, we put our heads together and decided to try using Tog Rite (from TheraTogs).  You can also use something that is lycra or elastic (like a belt) to put around their hips.  When we did this after a few weeks we could see (check out the video) the carryover happening.   It was pretty exciting and we are hoping it continues to progress!

(Side note – since this was written, the caregiver has told us that this kiddo is spontaneously dancing at home now that they have figured out how to shift their weight through their hips)

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