Strong Outer Hips (aka abductors)

One of the muscles we focus on when we are working with kids, or young adult (or even ourselves if we’re being honest) is the hip abductor, or the outer hip muscle. This muscle may be on the smaller side but it is mighty!

When this muscle is strong it helps to stabilize your hips for every day activities like walking, standing, running, climbing stairs, crawling, and on and on and on. If you have a strong hip abductor and you pick up your foot to take a step it will hold your hips level so that you have a nice smooth walking pattern. If your hip abductor is weak, it will not be able to keep your hips level and when you take a step a few things could happen. Two of the most common things are:

1. when you pick your foot up, your hip on that side will drop down as compared to the hip on the other side, or
2. when you pick your foot up, you will lean your head and trunk away from that foot so that you are creating a counter balance to help keep you stable.

So why is this a problem? Here are a few reasons:

• For a little one first learning to walk, if they don’t have the stability at their hips it makes it harder to take those independent steps and they will want to hold on to support surfaces longer
• For a little one first learning to crawl, they may have finally mastered getting on to their hands and knees, but they don’t have the stability to lift one of their legs to bring it forward, and every time they try they collapse back down on to their belly
• For someone who may have spasticity or higher muscle tone in their inner hip muscles (adductors), they may scissor their legs when they walk (cross them in the middle rather than stepping straight in front). If their abductors are strong they can help to counteract the scissoring pull and make walking a bit more efficient.
• For anyone working on running, your hips will do the same thing as with walking if its weak, except you are putting more stress on your knee with every step you run. This can lead to overuse injuries and knee problems that can cause pain and lead to limited physical activity.

So what can you do? Here are a few ideas for exercises:

• Sidestepping – depending on the age and skill of the child, this can look like cruising back and forth at a support surface, or it can be walking sideways down a hallway, or even adding resistance tubing/banding while walking sideways (make sure to lead with each foot)
• Bridging – depending on the age and skill of the child, this can look like lying on their back with their knees bent and their feet flat on the floor and having them lift up their bottom (you can make it fun by driving cars under the ‘bridge’ or rolling balls under), or it can be holding the bridge position for longer periods of time, or while you are in the bridge position lifting one foot off the ground and then the other, or just doing one leg bridges, or even adding a resistance band around your thighs to push against while doing two leg bridges
• Climbing – depending on the age and skill of the child, this can look like crawling up and down stairs (or couches), climbing on ladders at the park, using a climbing wall (even better is to traverse side ways on a climbing wall or park climbing structure)

What are some ways you have worked on the abductors?

Ideas for ‘Weight’-Training at Home

Weight training is not usually the first thing that comes to mind for pediatric therapy but its a big part of it.  We are big believers in strength/weight training for our kiddos to help improve their function.  It helps them to more efficiently activate their muscles, improves muscle isolation, helps movement to be more efficient and cuts down on compensatory movements and strategies.  For some of the kiddos we see in the clinic based setting we are able to use the Universal Exercise Unit to help promote strengthening, however not all of our kids come to the clinic or are able to use this piece of equipment so I have had to get creative on ways to strengthen that is still fun for the kids.  Here are some of the exercises we do for strengthening:

Leg Press – To get a good leg press I like to use resistance tubing.  I have bought one that has handles already built in that work great.  I have the child lie down on the ground and wrap the tubing around a stable object at their head (a table leg can often work).  I then put their foot in the handles and I control their leg while they push out (making sure that they don’t hyper extend their knees).  Its easiest to do this one leg at a time.

Hip and Knee Flexion – To do this one, I just reverse the above exercise.  I have them lie down with their feet facing towards the table and put one foot in the handle (the band should be resting taut) and then have them pull their foot up by bending their hip and knee.  Again, make sure you control their leg to avoid and torque at the knee.

Scapular (shoulder blade) Retraction – Take the same resistance tubing as above and tie it around a door knob (make sure the door is shut). You can also hold it for them (like in the pictures).  Then have the child stand (or sit) across from it. They are going to hold one end in each hand and slowly pull back while squeezing their shoulder blades together.  Make sure they keep their elbows bent at approximately 90 degrees the whole time.  Once they have pulled back, then they are going to slowly bring their arms forward again.Their body should be staying still during all of this, and the only movement should be from the arms and shoulders.

Weighted Squats – You can use a weighted ball, heavy cans of food, a bag of flour, or anything else that your child may consider to be heavy.  Have them squat down to pick it up off the floor and then stand up and place it in your hands or on a table or other surface.  If you’re using a ball, my favorite way to get them to do more is to have them give it to me and then pretend I drop it and ask them to pick it up again.  They generally think its funny that I can’t hold onto it!

 

 

Working on Control (How to Squat)

I recently wrote a post on Power vs Control and afterwards I had someone reach out asking how they could help their kiddo learn how to squat or sit down easier so I decided to write some of my ideas down and share them with all of you.  Hopefully you find them helpful!

For kids that are having a harder time than others developing control so that they can easily lower themselves into a chair, or attain a squatting position to play, or go down the stairs fluidly, you want to remember that it is still a component of strength.  That means, you still want them to work on strengthening their leg muscles that help them do the opposite, i.e. stand up from a chair, get up from the ground, go up the stairs, etc.  Overall strength will help them with the control.

Next you want to remember that they are probably nervous to bend their knee because they don’t know that they can control what they are doing and might fall.  Now if you ask them this, I am not sure that they would be able to tell you that is what they are thinking, but it is what their body is feeling.  A way for you to possibly relate is this: have you ever tried to do a push up and get your body down really close to the ground before you push back up?  That means you are bending your elbows almost all the way to a 90 degree angle.  If you are really good at push ups this won’t mean anything to you.  If you are like me, you can only bend your elbows just a little bit because if you try to go further you don’t have the strength to support your body weight and you lose control and crash to the ground!

So, we covered that strength is important.  What’s next is you want to help them start to feel comfortable ‘unlocking’ or bending their knees.  What you might also see is when they do bend their knees they go from straight to all the way down super fast without any control.  If they were trying to sit it would look like they are ‘plopping’ in their chair.  So here are my ideas:

1. Sitting onto an elevated surface – If you have a bench or chair or surface that you can pile up with pillows so they can only have to bend their knees a little bit to sit down they will only have to bend a little and be successful.  As they experience more success you can lower the surface.  You can also give them something to hold onto to give them more confidence.  If the support surface is slightly unsteady they will have to depend on their legs more.  If it is more stable they will use their arms more.  A fun thing to do would be make a big pile of cushions and have them practice sitting back into that.  It won’t hurt if they ‘crash’ and they will have to work a little harder to stand back up!
2. Picking toys up off the floor – If you have a shape sorter or a puzzle or anything with lots of pieces that they are interested in you can scatter them around the floor, or on slightly elevated surfaces, such as step stools, so that they have to bend down to pick them up in order to use them.  You will need to play with the height because they may be able to just hinge at the waist and hips but your goal is to get them to bend their knees.  You can make it close to a coffee table or couch so they can hold on while they reach down to get it.  To make it even more challenging you can have them on a slightly elevated surface and the toy on the floor so they have to really bend their knees to get it.  Just remember a mini squat or a deep squat is going to be the easiest, getting them to bend their knees to the mid range (90 degrees) will be the hardest.
3. Step downs – get some step stools or cushions or other raised surfaces and have them around on the floor and make a game out of walking around and having to climb up and down each of them.  Make sure they are switching feet so they get to work on both the left and right side going up and down.  You may need to give them a hand at first to be successful but try to wean the support away.  Pairing things with a song or a toy with lots of pieces always helps with motivation.

I’d love to hear other ideas that you have!

Football Fun

  

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?

Therapeutic Benefits of Swimming on MamaOT

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!

The Ins and Outs of Pencil Grips

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.

Rope Climb – With a Lycra Swing Twist

A great way to work on core and upper body strength, as well as bilateral hand use is to put your climbing rope in a lycra swing.  Its really hard to get any traction/stability from your feet and you get to rely on upper body and core strength to get yourself up high enough to rescue the monkey!

The kids find it to be hard work and are often exhausted after doing this activity but they get a great workout with it.

What are some variations that you can think of?

Boot Camp Ball

We are constantly looking for ways to keep things fresh for some of the kids we see here so we were excited when Your Therapy Source did a post on Beach Ball Ther-Ex Games.  Our therapists took that idea and came up with Boot Camp Ball.  There are a few ways you can use it, as there are numbers, shapes and colors involved but we kept it simple and just used the numbers.

First, they came up with a list of activities that were numbered (see photo).

Next, the kiddo would pick which hand would be the ‘magic’ hand

Then, they would catch the ball (in standing for this kiddo because we were working on standing balance and bilateral hand use).  Whatever number was under the ‘magic’ hand is the activity that they would do based on the corresponding number on the activity list.

Then they would repeat.

By calling it boot camp we were able to keep the pace moving and they thought it was great when there were activities like sit-ups on the list.

There are lots of ways to modify this depending on what you are working on with your kids.  For instance:

• You could have them point to a number on the ball and touch it with one finger if you are working on finger isolation
• you could use shape/color combinations for kids that are working on recognizing them, or to provide more combinations
• By doing the shapes, numbers and colors  you could make a really fun flow chart that would mean they would have to match up which variables were present to find out their activity
• You could do catching sitting down if standing up was too challenging, or standing on one foot if it wasn’t challenging enough

The big thing is, its another opportunity to make doing the same activities over and over again FUN!

How have you used this idea, or an idea similar to it?

Guest Post from Denmark – Olympic Game Day

I’m a pediatric physical therapist from Denmark and I paid Starfish Therapies a short visit last fall. I have always thought that it is very exciting and inspiring to see how other PT’s work and luckily Stacy and the Starfish Therapies team were very kind and showed me around and answered all my questions.  I especially like the idea of having a blog where you can reach out to parents, caregivers, teachers and colleagues and exchange knowledge and ideas. And now I’m very excited because Stacy has asked me to do a guest blog.

I want to tell you about an Olympic game day that was arranged at my current workplace Borneterapien – a Danish Pediatric Rehabilitation Centre (www.borneterapien.dk). In pediatric rehabilitation we believe that it is important to identify local networks for families with disabled children. In Borneterapien we have experienced that the parents need information about opportunities for recreational activities and social participation. We think that participation in activities and sports is a great way for children to form friendships and develop skills.

So basically we wanted to create a context in which children with disabilities and their parents were able to network with equals. We thought that an Olympic game day would be a splendid way to accomplish that.

On September 7, 2011 the first Olympic game day took place. Thirty-eight children aged 1½ – 14 years and their parents participated. We divided the children in a preschool group and school group. In each group children were allocated in subgroups of 3-6 children according to their functional and intellectual abilities. The activities included horse riding, relays, 100m run, orienteering race, pulling car, obstacle courses, swimming etc. All children participated in 2-3 activities. Afterwards we had a medal ceremony and all children, parents and therapists had lunch together.

The Olympic game day turned out to be a really great success. All parents expressed that the event was a good experience for both children and adults and they felt that it had been very rewarding to meet other children and their parents. The parents especially liked to see their child being happy and excited. All the children expressed that the event had been very good and that it had been very much fun to meet the other children. The top three experiences stated by the children were: 1) To pull car; 2) To receive a medal and 3) To compete in relays.

What started out as a onetime thing has now become an annual tradition that the children, parents and therapists look forward to with joy.

How have you tried to facilitate networking between children and parents? Any ideas?

Best wishes,

Michelle

 

About Michelle Stahlhut:

Michelle graduated from Metropolitan University College, Denmark with her Bachelor in Physical Therapy and from University of Lund, Sweden with her Master in Medical Science. She has worked in preshcool and school settings as well as a rehabilitation setting. Michelle has primarily worked with children with cerebral palsy, developmental delay, developmental coordination disorder, autism and Down syndrome.

Michelle believes that it is essential for the pediatric physical therapist to create opportunities for the children to participate and interact with their environment. With mutual respect and presence she feels that the therapy truly makes a difference.

Guest Blog at Embrace Your Chaos on Obstacle Courses

I’m so excited to be a guest blogger at Embrace Your Chaos today.  The post is about all the great ways to play using Obstacle Courses.  Please hop on over and check it out!

What are your favorite obstacle courses?