Starfish Therapies

June 1, 2015

Therapeutic Benefits of Swimming on MamaOT

Filed under: Developmental Milestones — Starfish Therapies @ 2:55 pm
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swimming

We are lucky enough to be participating in a series on the Therapeutic Benefits of Recreational Activities over on MamaOT.

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

May 5, 2015

Motor Groups and RTI

Motor Group

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

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

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

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

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

BLOGhoplogofrog

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

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

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

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

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

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

5/5/2015 Starfish Therapies

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

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

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

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

5/10/2015      Consonantly Speaking

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

5/26/2015 An RtI Alternative Old School Speech

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

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

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

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

February 3, 2015

Understanding Terminology: Ankle and Knee

Filed under: Developmental Milestones — Starfish Therapies @ 5:17 am
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legsOften in physical therapy, we use certain terminology to describe the position or alignment of the legs at rest or during activity.  You have probably seen these terms in your child’s evaluations or progress reports and they probably didn’t make much sense.  Even if your therapist explained the meaning to you, it still might not have made much sense. Hopefully this article can help clear up the meaning of these strange words and what they indicate.

FOOT/ANKLE:

Kids Advnetures
Pronation – This is a term used to describe the sum of three different motions that together cause the heel to slant inward, the arch to collapse toward the floor, and the foot to turn outward during standing and walking.  A certain amount of pronation is normal during the walking cycle. However, if there is an excessive amount present it can lead to stress on ligaments and muscles and can cause other alignment issues throughout the rest of the leg over time.  Excessive pronation is most common in individuals with low muscle tone but can also occur individuals with high muscle tone.
supinationSupination – This term is used to describe the sum of three different motions that together cause the foot to point downward and turn inward. This foot position is common in individuals with increased muscle tone and in certain diagnoses such as Cerebral Palsy.
Pronation and supination can be present during standing or during isolated times of the walking cycle.
KNEE:
Genu Valgum (knock knees)- This term describes knees that are touching or close to touching while the lower leg is bent outwards and the ankles are separated more than normal (see picture below). This alignment is a normal part of development around 2-3 years of age and in most cases will naturally straighten out by 5-6 years of age. However, it may persist when other impairments are involved.  It is often seen in combination with ankle/foot pronation described above. Very severe cases may require surgical intervention.
Genu Varum (bow legs) – This term describes the opposite of genu valgum.  The knees are separated while the ankles come closer to the midline of the body (see picture below).  This alignment is normal in infants and during the first year but should decrease as weight is introduced through the legs with standing and walking.
From infancy to childhood, a typically developing child should progress from genu varum during the first year of life to a relatively straight position with the onset of walking and then into genu valgum around 2-3 years.  The legs should then again realign themselves into a relatively straight position by around 5-6 years.  Females will tend to have slightly more genu valgum than males due to the greater width of the pelvis.
genu valgum and varum
From left to right, the pictures represent genu valgum (knock knees), normal alignment, and genu varum (bow legs).

December 31, 2014

Top Ten Posts of 2014

Starfish_Star_NewYears

Happy New Year everyone!  Thank you for continuing to enjoy our blog as much as we enjoy producing it.  Here are the ten posts that were the most popular over 2014.  We can’t wait to see what 2015 produces!

10.  Encouraging Rolling – From Back to Stomach

9.  What Does Low Tone Mean?

8.  Core = More Than Just Abs

7.  My Child Isn’t Rolling Over:  Should I Be Concerned?

6.  Easter Egg Hunt for Motor Skills

5.  A Glossary of Sitting

4.  Having a Ball with Core Muscle Strength

3.  A Multi-Tasking Activity

2.  Motor Learning:  Stages of Motor Learning and Strategies to Improve Acquisition of Motor Skills

And the number one post this year was this amazing Guest Post from the folks over at Milestones and Miracles!

1.  Avoiding the ‘Container Shuffle’ with your Baby

November 11, 2014

Avoiding the ‘Container Shuffle’ with your Baby

Filed under: Developmental Milestones — Starfish Therapies @ 4:24 pm
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movement exploration  IMG_1734  problem solving3

Guest post by: Nicole M Sergent, MPT

As a new parent, I was there. Giddy excitement over the news of a baby on the way followed by showering love from family and friends in the form of gift, and gifts, and more gifts. At the time I was touched (and am still forever grateful for their generosity) but shortly after the baby came I quickly fell into a routine many new moms do. As a physical therapist, I like to call it, “the container shuffle.”

“The container shuffle” goes something like this. Sleep (crib), eat (highchair), play (exercsaucer), calm down (bouncer seat), sleep (crib), eat (highchair), play (positioning seat), calm down (swing) etc. As a mother, I related to the thoughts many of my patients’ parents have. Everyone buys us all this stuff…and baby likes them and is happy…so why not use them? As a therapist, I’d like to tell you why.

I can’t tell you how many children I have assessed with general motor delays without significant medical histories or orthopedic or neurologic impairments. These babies are very stable in an upright static position. They often even sit really well, without ever rolling, crawling, creeping, kneeling, or standing. After I have carefully assessed to make sure, nothing more significant is going on, I’ll delicately share my diagnosis: CONTAINER SYNDROME.

I realize it is not rocket science but think of it this way. When a baby plays on the floor, he/she has the ability to wiggle, squirm, and move. Each tiny movement that may seem insignificant is actually exercise. They are beautiful diagonally directed movements. And they are needed. Because our moving transitions from one position to another (floor to sit, sit to stand), require that motion. How can we expect a baby to be able to move and explore if we always have them strapped in a container? Research tells us that babies who spend less time on their tummies on the floor, have delayed motor skills in the first year of life.

In addition to the ability to practice motor coordination, allowing a child to play outside of a “container,” has additional benefits. Play on a baby’s tummy, aids in digestion, assists with hand eye coordination, and promotes typical skeletal development. The hips have the ability to develop into a more stable, mature position and the skull, free from pressure from resting against a surface, has freedom to develop typically. Did you know that 20% of all infants now have plagiocephaly (flattened appearance of the head/face)? While free play time may not prevent all of those cases, I believe the increase in “container syndrome,” plays a significant role.

I once attended a continuing education lecture, where the OT speaking suggested that infants should spend 80% of waking hours on the floor. As a therapist, I could see the benefit of this time well spent. As a mother, I felt myself slumping with guilt. My daughters did not spend that much time on their tummies, especially my youngest that had severe acid reflux. A practical balance must exist for families. And while I realize “containers” are helpful with a fussy baby and so that one can actually shower, I recommend promoting floor time throughout the day. I tell the parents of my patients, “If you find yourself going to put your baby down, choose the floor or pack-n-lay first.”

Many of those children I have evaluated that had delays with mobility and transition skills that I felt came from “container syndrome,” ended up catching up to typically expected gross motor milestones in just a few short weeks by allowing more free play time on the floor. It can be argued that it is not rocket science. My mother (and yours) might argue it is common sense and “what we did with you.” But in a commercialized world where more = better, maybe we do need a dash of common sense to help keep our infants happy and healthy as they develop and grow.

Nicole M. Sergent, MPT is a pediatric physical therapist and co-owner of Milestones & Miracles, LLC. She co-authored a unique developmental tool for therapists and parents that pairs detailed development with interactive play skills, called 1-2-3 Just Play With Me. It is available in digital and print and can be found at www.milestonesandmiracles.com, Amazon.com, and select retailers. Follow Milestones and Miracles online for developmental support & fun

 

 

September 2, 2014

Accessible Beaches

Filed under: Uncategorized — Starfish Therapies @ 9:08 pm
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surf chair 1 surf chair 2

I was recently back in my home town in NJ and spent the day on the beach.  I was impressed as I saw multiple people being pushed down in ‘surf chairs’.  I thought it was great that so many families took the time to get chairs that would allow their loved ones to access the beach.  Imagine my surprise and delight when at the end of the day I was packing my stuff up and saw that these chairs were provided by the beach!  I went home and looked it up and not only does the beach provide them, but they are free of charge.  Its just recommended that you make a donation.

I would love to hear about other beaches in other parts of the country that have programs like this.

August 11, 2014

Tummy Time – More Than Just a Buzz Word (A Blog Hop)

Filed under: Developmental Milestones — Starfish Therapies @ 10:00 am
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Tummy Time Therapy Blogger Blog Hop

Is Tummy Time Important A Therapy Blogger Blog HopBelow you will find all the posts in the Tummy Time therapy blogger blog hop. So many great ideas and thoughts on tummy time from Occupational Therapist and Physical Therapists.

The Importance of Tummy Time for Babies – Golden Reflections Blog

Tummy Time & Baby’s First Year – The Recycling OT

How to Use a Therapy Ball to Make Tummy Time Easier and More Fun for Baby – Mama OT

5 Awesome Toys for Tummy Time! – The Inspired Treehouse

Terrific Tummy Time Positions – Your Kids OT

Tips For Tummy Time From A Physical Therapist – Pink Oatmeal

Tummy Time : The Basics – Therapy Fun Zone

Tummy Time: Developmental Consequences & Future Implications – Tools to Grow, Inc.

Tummy Time Tips – Pedatric OT Tips

Tummy Time Just Isn’t For Babies – Your Therapy Source

Tummy Time – More Than Just A Buzz Word – Starfish Therapies

Tummy Time Never Gets Old – Playapy Platform

Tummy Time has become a common phrase in the last decade or so as a result of the NICHD Back to Sleep Campaign.  Prior to this time most parents put their children to sleep on their stomachs so Tummy Time was never an issue.  Now, with children sleeping on their backs they are spending 12 or more hours a day (if a parent is lucky and their child sleeps that much) on their backs which used to be devoted to time on their stomach.

And, in my opinion, another factor is the rise of innovative baby equipment that has been produced to make some aspects of parenting easier.  I know as a baby sitter I loved having the car seat that clicked into the car and then clicked into the stroller, or even the bouncy seats.  As a therapist I now see how all that equipment was taking away from time the child could have been equipment free, exploring their body and environment.

I’m not saying get rid of all equipment or put your child to sleep on their stomach, but I think its important to make sure you are balancing things out.  For instance, if you went to the gym and lifted weights, and only used your right side, you would be disproportionately strong on one side.  This is the same for infants.  When they are on their back, they are working the muscles on the front side of their body (abs, neck flexors, hip flexors) and learning how to lift them against gravity so that they are getting stronger.  However, the muscles on the back side of their body are getting forgotten about.  Those include their back extensors, neck extensors and gluts (tush muscles).  The muscles on both sides of their body are important to their gross motor development as they learn new skills and move through the developmental milestones.

Some of the benefits of Tummy Time are:

  • Improved head control – ability to hold their head stable so that they can observe the world
  • Improved trunk control – ability to hold their body stable so they can begin to sit on their own and develop balance reactions
  • Stretching – After 9 months in the womb, babies have tight muscles on the front of their body and by being on their stomach they are naturally stretching out so that they can begin to balance out the front and back of their bodies.  In addition, the more time they spend in carriers and other pieces of equipment, it keeps them in a slightly flexed position.
  • Decreased chance of developing plagiocephaly – This is when they develop a flat spot on their head.  Some babies get it in the back or on the side of their head.  This is because the back of their skull is still ‘soft’ and when they have decreased neck strength to move their head, they often lie with their head in one position so it flattens out in that area.  When spending time on their belly, the facial muscles are firm and less likely to flatten out/deform.  It also gives the back of their head a break from constant contact with a surface.
  • Hip development – When babies are born their femurs (thigh bones) are rotated.  Natural development allows a derotation to happen as their gluts get stronger and place a pull on their bones.  While on their belly, they are naturally developing their glut strength by activating their trunk and leg muscles against gravity.  This promotes the natural development that is supposed to occur!
  • Arm strength – While on their tummy, babies begin to experiment with pushing up on their arms which develops their upper extremity strength as well as eventually leads into rolling over and further exploration of their environment and movement.  This is also a precursor to crawling as they learn how to coordinate their arm use.

Tummy Time

These are just a few of the reasons why I like tummy time.  I know it isn’t easy to find time in busy days but I also look at it as ways to get down on the same level as your baby and interact with them.  You can even get some good ‘face time’ in!

TummyTime

 

April 3, 2014

The Ins and Outs of Pencil Grips

child at desk

A pencil grip can be a quick and easy fix for an awkward grasp. There is such a huge variety of them out there, but how do you know what ones to choose. Here’s some quick tips on how to choose a pencil grasp for your child.

The Simpler the Better: If your child needs a pencil grip, they are most likely having difficulty planning how to hold the pencil in the first place. Keep it simple so the grip doesn’t become as frustrating as the pencil initially was to hold. It will also make it easier to transfer from pencil to pencil if needed and recall how to hold it correctly each time.

Look at the concerns: The type of pencil grasp that your child will use is going to depend on what the areas of concern are when they are holding the pencil. Here are some common concerns, along with which direction to possibly take:

  • Low tone (fine motor weakness): This can be observed one of 2 different ways. One such way is when your child is holding the pencil too loosely and often resorts to an awkward grasp to compensate. The other way is they will look like they are actually applying too much force when writing and are using it as an over-compensation for the weakness. Thicker or jumbo grips are usually easier for these kiddos to hold onto and can cut back on some of the force when writing concerns. Weighted pencils or grips can also help in some cases, so the child doesn’t feel the need to push down the pencil so hard when writing.
  • Motor Planning: This is when your child just can’t seem to get the motor patterns correct for holding the pencil. These are the kids that the more simple the grip the better. Single grips or crossover grips would be most beneficial for these kids.
  • Kinesthetic feedback: These kids usually grip the pencil with a tight fisted grasp or barrel grasp. They’re looking for input when writing in order to fill a sensory need, as well as give them some proprioceptive feedback to assist with guiding the pencil. Wider or jumbo pencil grips or textured ones may be most beneficial for these kids.

Make it Fun: There’s different colors, shapes and even grips with glitter. You want to get the right type of grip, but you want your child to be excited about using it as well. Let them choose colors or other features of the pencil grip as long as it doesn’t impede overall function of what you wanted it to do originally.

It’s not forever: Pencil grips are just to encourage the use of an appropriate grasp for the time being and not to use as a permanent fix. It should assist your child in making the grasp more of a habit and you should be able to eventually end up with no use of no grasp at all. Just another helpful trick along the way.

March 5, 2014

Muscle Memory and Movement

Filed under: Developmental Milestones — Starfish Therapies @ 7:00 am
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skiing

I recently spent a week skiing after almost two years off.  And while I wouldn’t say I was a superstar, I was amazed at how easily the movements came, and how little thought had to go into me successfully completing the basics of skiing.  At some point and time, my body had committed the movements to it muscle memory.  Now, add massive amounts of fresh powder and I was glad for that muscle memory because powder is not my strong point (I learned to ski on the east coast) so I had to think about how to build on the basics so that I could successfully get down the mountain.

How is this pertinent?  Well when your child is learning a new movement they practice it over and over so that their body can commit the movement to its muscle memory.  Once this happens, its an automatic movement and you can start adding in variations to the movement.  For instance, a baby learning to crawl will practice on flat ground over and over until they are the crawling masters.  Once they get that down they can start experimenting with crawling on different surfaces, such as cushions, or crawling over obstacles, or up stairs.  These variations will be more work for them because they have to expand on their movement bank and think about how to be successful.  Eventually with practice these will become automatic as well.

When muscle memory happens, a person can go a while without doing a skill and when they try it again, they will need to practice a bit but it will come back that much faster than if they were learning it for the first time.  I know when I teach someone to use crutches, it is that much easier for a person who has used them before.  This is an example of a skill that isn’t used every day but once its learned, it comes back that much faster when the skill is needed again.

So, the premise of this is repetition is important when kids are learning new skills because they are committing the movement to their muscle memory so that they can expand on that movement and continue to progress to higher level skills.  So the next time you wonder why your child who is just learning a skill does it over and over again, its because they are committing it muscle memory.  For kids that need extra help to learn movements its essential that repetitions are built in to their learning.

 

February 12, 2014

Straighten Up: Helpful Hints for Posture at School

IMG_2908

It’s at least halfway through the school year and a great time to think about posture!  More often than not, children tend to pay little attention to their posture while focusing on something else such as school work, television, or video games. Most commonly, you will see them slouching forward, leaning to one side, propping on one or both elbows, propping their head in their hands or even lying their head on the desk while writing or drawing. They may appear unaware of this  when corrected because unlike adults, most kids do not experience back and neck pain related to poor posture. It is also difficult to help them why good posture matters in order to prevent habits that could potentially cause problems later in life.

Tips to Improve Your Child’s Posture:

  • Lead by Example: Draw attention to your own posture and show your child what sitting up tall looks like.
  • Mirror: Using a mirror is a great way to show your child what their posture looks like or what it should look like.  Specifically, having them stand sideways can making slouching more apparent.
  • Chair: The chair your child uses can make a huge difference in their posture.  It is important for their feet to rest flat on the floor and that their knees are bent roughly 90 degrees.  It is also important to look at the length of the seat.  If the back of the chair does not touch your child’s back while their feet are on the ground place a pillow in between the space for support.  If the only chair you have to use is so high that your child’s feet are dangling in the air, place a stool or wooden block underneath for their feet to rest flat on.
  • Desk:  The height of the desk is also important.  It should hit slightly above your child’s belly button in the middle of their trunk.  If it is too low, your child will slouch forward to reach their work.  If it is too high, your child will have to elevate their shoulders towards their ears raise their arms up to reach what they are doing and will therefore, be overusing certain neck and shoulder muscles.  If your child is too low at the table, you can place pillows or cushions under their bottom but then again may need to place something under their feet so they do not hang.
  • Set Limits:  It is important to set time limits on computer/television/video game sessions.  Try limiting bursts of these activites to 20 minutes at a time.  After 20 minutes, encourage your child to get up and move around for a while.

If you have been working on your child’s posture and do not see improvement or if your child complains of pain or seems unable to sit still for periods of time, they may have some underlying muscle tightness or weakness that makes a good, neutral posture very difficult to achieve and they may need some targeted strengthening or stretching.

How do you work on your kiddo(s)’ posture?

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