Starfish Therapies

February 5, 2017

Encouraging Independent Exploration

mater

As a pediatric physical therapist, one of the things we hear the most from parents is, ‘I want my child to walk’. And this is completely understandable.  Its how we get around, how we explore the world. However, what if walking limits the child’s independence?  I’m not here to say what is the right way to do things and the wrong way to do things but just to raise some things for families to ponder as they continue to support their child’s growth and development.

Children are always interacting with the environment.  When they are really little they are limited with their abilities.  Mostly its what is brought to them or what they can see from their current position.  As they grow and get stronger, most kids start to develop some independent movement.  That could be rolling, getting into sitting, scooting, crawling, pivoting, standing, cruising, walking, etc.  Each change in movement and ability changes their perception of their environment and how they interact with that environment as well as the people around them.  For the first time they can see something and figure out how to get there if they want to learn more about it.  Its amazing how resourceful kids can be when they want to be.

For kids who have delays, for whatever reason, independent exploration can be hard for them. They are often dependent on others to get them from one place to another, or to bring the world to them.  What if we could work hand in hand with them to discover alternative methods of having the independence to explore their environment or move without anyone’s hands on them, while at the same time continuing to promote their gross motor abilities.  There are some great tools out there that can increase mobility for kids, from an early age.  While I know using assistive devices or wheeled mobility is not for every child or family, it is an option to give them that independence while their other skills are still developing.

I’ve linked to some resources above, but one of my favorites is the work of Go Baby Go and their use of powered kid cars that have been adapted with increased support as well as switches to make them go.  The kids love them!

I would love to hear from people about their experiences with using early mobility to increase independence vs focusing only on gross motor milestone development.

 

 

 

January 29, 2017

Growth Spurts

When working with kids, growth spurts are always something we have to take into account.  I can remember as a child feeling like I had these arms and legs that weren’t connected to me making me even clumsier than I already was.  On top of that I think I was hungry all the time too.  Almost all kids go through growth spurts at various times during their developmental years so I just wanted to take a moment to point out some things to consider during these times.

For all kids, when they grow rapidly their bones change lengths, their muscles have to adjust and as a result their ability to sense where they are in space has to alter.  It doesn’t happen overnight (hence me feeling like my arms and legs weren’t attached) and during the time when their bodies are adjusting to these new proportions they may be a little on the clumsy side.  Just think for a second of your house and your daily routine.  I bet you know exactly where everything is and can almost go through your morning routine in your sleep.  Now imagine that someone came in during the night and moved everything around.  I bet it would throw you off for a few days while you adapted to the new layout.  That’s how kids have to adapt to their ‘new’ body.

When a child has low muscle tone or high muscle tone there are other things to consider.  For a child with low muscle tone, they are working hard to maintain strength and stability.  Their muscles get good at working at a certain length and they begin to progress their skills.  Now they grow suddenly and their muscles are longer and all of a sudden they aren’t as efficient and their endurance is decreased.  They will show some weakness and have a harder time with postural stability and overall functional skills.  This is their period of adaptation to their new size.  It just may take them a little longer, and they may look like they have regressed.  You may have to give them a little more help or a little more time for a short period, but the good news is, they get back to their previous abilities much faster than the first time around when they were just learning the skill.  That’s because their body already knows what to do, they just have to figure it out at this new size.

Hopefully this helps explain some of what you may see as your child is growing and they appear to change over night, don’t worry, its not permanent!

January 15, 2017

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!

 

 

April 23, 2016

Why Your Child’s Inner Ear is Important for More Than Hearing

Standing Vestibular

Imagine learning to stand for the first time, but everything around you appears to move. You can’t stabilize your gaze and everything sort of spins. Now imagine learning to walk for the first time, except you can’t focus on an object for balance. Either would be tough for anyone, especially a child.

That ability to focus your sight – That’s what’s called your vestibular system – and it’s not a part of your eye. It’s actually in your inner ear. It plays a large role in balance, telling you where your head is in space. In turn, your body responds to what you vestibular system is telling you.

But the vestibular system also plays a part in stabilizing your gaze. Try looking at an object in the room. While keeping the object in focus, shake your head from left to right – are you a little dizzy? Maybe… But were you able to keep that object in focus? Probably. That’s because, while you were shaking your head from side to side, your vestibular system was communicating with little muscles around your eye, telling them to respond, which allows you to keep your focus (known as the vestibular ocular reflex, or VOR).

And if you weren’t able to keep the object in focus? Well, it makes balance and development that much more difficult.

What could be a sign that your child’s vestibular system isn’t working properly? Some children may have trouble standing without holding onto a surface, and even fall when standing at a table without reacting to the fall (think of a falling tree). Others may have trouble walking without holding on to an adult or surface, with a tendency to rely too heavily on that support, at times appearing as an impulsive movement.

If you notice or are concerned about your child’s vestibular function, it’s a good idea to discuss it with your child’s pediatrician. They can make a good assessment or help refer you to a specialist.

March 31, 2016

Educational vs Medical Based Physical Therapy

Filed under: Developmental Milestones — Starfish Therapies @ 5:00 pm
Tags: , , ,

Desk

If my child is receiving medically based physical therapy, why don’t they get physical therapy at school?

This is a question we are asked all the time. While some children may have both an educational and a medical need for physical therapy the answer comes down to the purpose of services.

When a physical therapist recommends services medically this is based on the child’s health and rehabilitating a prior level of function or a need for therapy in order to achieve something that will improve their health and decrease their need to access other medical services.

For a physical therapist to recommend services at school, the therapist has to document that the child needs to do something at school to be safe or access their school curriculum that require the services of a skilled therapist to achieve. When a child is on an individual education plan (IEP) this is driven by needing the services of a skilled therapist to meet the goals identified for them to indicate adequate educational progress. When a child is on a 504 plan, this means that in order to progress with their current group of peers, they require the support of a skilled therapist to meet educational standards.

This means that once a child is safely able to move around their classroom, the campus, and use the playground on site safely and as independently as they will able to given other factors like age, cognition, or behavior they frequently are found to not need educationally related physical therapy as they are successful in that environment. While this does not mean they’ve met their maximum motor abilities or that in a different model of service delivery, like the medical model, they would not have a need for the services of a physical therapist, it does mean that there mobility skills are no longer limiting their education.

We frequently try to explain it in the simplest ways, physical therapy in the educational environment is to support the student safely accessing their education.  In school, gross motor development generally falls under physical education.

This is just to help with a basic understanding of the difference in the models.  It would be easy to go further in depth but we wanted to help answer a question we get a lot of times.

March 19, 2016

Sport Specialization in the Young Athlete

Filed under: Developmental Milestones — Starfish Therapies @ 9:10 pm
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Sport Specialization
It seems that children are being forced to specialize in one sport at a younger and younger age. There are various travel teams and summer leagues that you, as a parent, might feel the pressure for your child to join, because this will give them a leg up on the competition. It will get them seen by the right recruiters and your child will be given a scholarship for college.
Well… not necessarily.
Children who specialize in one sport are 70-93% more likely to be injured than those who participate in multiple sports. They are also more likely to burnout from stress and are often the first ones to quit. Most college athletes actually come from a multi-sport background.
So when should a child specialize and how much time should be spent in a single sport? Here’s what the research says:
  • Before 12 years old – 80% of time should be spent in different sports or deliberate/free play
  • Between 13 to 15 years old – 50% of time should be spent in a single sport and the other 50% of time in different sports or deliberate/free play.
  • 16 years old and up – 20% of the time should be spent in different sports or deliberate/free play.

Get more information about sport specialization here

March 10, 2016

Priming the Muscles

 I was giving a presentation the other night on Strength Training for Children with Developmental Coordination Disorder and it led to an interesting conversation with the attendees.  It was actually a really great conversation because it was a collaboration amongst a mix of pediatric and adult therapists.

We were discussing children who have hypotonia (low muscle tone), and how they have a harder time turning their muscles on and keeping them on.  Strengthening helps them to be more efficient with turning their muscles on but their low tone never goes away.  It came up that they often become tired easily, and this can show up in school, because they have to focus on their posture (staying in their seat) as well as whatever activity they are doing.

One therapist shared a great story about a child she was working with who was struggling with a specific test that he had to take every week at school because he was focusing on staying in his chair, writing on his paper, and answering the questions in a timed fashion.  His scores were not very good.  They came up with a strategy (that the school approved) for him to do a modified plank on his knees before the test.  Immediately his test scores started to improve because he was priming his muscles to turn on during the activity.  It was easier for him to keep himself in his chair because he reminded his muscles that they need to work.  A few weeks later, the teacher reported that all of the kids wanted to do this and started doing the modified plank with him (so now he doesn’t look any different than his peers).  I thought this was a great example of how to support education through physical activity.

I know myself, when I do a 10 minute yoga routine I put together, my posture is better (without me thinking about it) for the rest of the day.  This is because I have reminded my posture muscles that they are supposed to be working.

So how can we use this?  For kids that have lower muscle tone, we might want to consider giving them a physical activity at the start of their day that can prime their muscles.  This could be modified plank or bear walking or some simple yoga poses.  Or if not at the beginning of their day maybe before a test at school or before they start their homework or before PE or other physical activity.

I know families who have kids with low tone who have been able to move on from physical therapy and get their kids involved in martial arts, swimming, or gymnastics (to name a few).  This is great because these activities help with whole body muscle activation as well as provide a social way to keep active.

I’d love to hear other ideas you have for ‘priming the muscles’!

March 1, 2016

Power vs Control (or why going up stairs is different than going down stairs)

Filed under: Developmental Milestones — Starfish Therapies @ 3:30 am
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Power vs control

Muscles can work in several ways: they can get shorter, they can lengthen, and they can stay the same length.

Generally when a muscle shortens it is generating power.  For instance, when you ‘make a muscle’ you are bending your elbow and moving your hand closer to your shoulder.  Your biceps is getting shorter to make this happen.  It is generating power so that you can lift your hand (or a weight if you were holding one).  That is why it looks like you are ‘making a muscle.’

When a muscle lengthens it is producing control.  For instance when you are carrying a sleeping baby and you want to slowly lower them into their crib so they aren’t jostled, and they stay asleep you are moving your hands further away from your shoulder.  Your biceps (and other muscles) are getting longer and they control how quickly they lengthen to help to make it a smooth transition and landing so your baby continues to sleep.

When a muscle stays the same it is usually holding something static or still.  The muscle has to stay partially contracted so that it can keep your body part in the same position.  If you have ever carried a grocery bag by the handle, with your arm partially bent, you have probably experienced this.  I know my arm is screaming for relief by time I get back to my apartment!

I want to focus on the shortening and the lengthening, also known as power and control (at least in the way I describe them).  We often have families who ask us why their child can go up the stairs without a problem but they still want to scoot or crawl down the stairs, or just want to be carried.

Going up the stairs requires the generation of power from their legs.  When they step up, they are shortening their calves, quadriceps (thigh muscles) and their gluts (bum muscles) so that they can lift their body weight up to the next step.

Going down the stairs requires control.  The calves, quadriceps and the gluts are slowly lengthening so that they are controlling the body weight for the foot will land on the next step.  If there is no control, the muscles just release and the foot/body drops down onto the next step.  This is especially scary for kids going down stairs because they see all the stairs in front of them that they might fall down.  A great way to work on this is to break it into one or two step chunks so it is more manageable for them.  You will also often see kids turning sideways to lower down to the next step.  This does not require as much control as going forward down the stairs as you don’t have to move your leg over your foot so the calf does not have to do as much work.  Going down a step backwards also takes out some of the control needed by the calves so you may see kids using this as an alternative method.

And, as kids grow, strength, power, and control will change with each growth spurt and the muscles will need to get used to the new dimensions of the body and get caught back up again!

I’m not sure if anyone else out there has ever started working out again and your thigh (quadricep) muscles are really sore.  If you try to sit down gracefully in a chair, it is not pretty, but standing up out of the chair, while sore and painful, doesn’t look nearly as bad.  That is because sitting down requires control and standing up is power.  (My legs feel like this at this very moment…)

February 15, 2016

Low Tone and Growth Spurts

Low Tone Growth Spurt

We frequently have children of all ages in the clinic who have been diagnosed with low muscle tone (hypotonia).  This can often be confusing for parents and difficult to explain to others so we wrote ‘What Does Low Tone Mean?’ to help with that explanation.

Recently, my coworkers and I were talking about a few babies/children who we were seeing who have low tone and how we could see the progress they were making but it was often hard for the parents to not only see but to understand why it might possibly be taking ‘so long’ or longer than other children.

As a sidebar, I love having other therapists around to discuss the kids we are lucky enough to work with.  By discussing the kids, we are able to help pull the pieces of information and ideas we have in our head and synthesize them into something that makes sense and we can explain to others! What came out of our discussion is:

When a child has low tone, we have already acknowledged that they have to work harder to engage their muscles and keep them turned on to complete activities.  As the child uses their muscles they are helping to get them stronger so that they can generate more force and maintain that force generation for longer periods of time (endurance).  For instance, when a baby is working on tummy time they have to turn their muscles on to lift their head up off the support surface – to do that they need to be able to generate enough force so that their muscles can turn on and lift the head.  Once they have their head lifted up, they need to be able to keep that force turned on long enough so that they can look around.  With practice it gets easier to lift their head and they can do it for longer periods of time.

That is until they grow.  A child in their first year of life is in a constant growth spurt for the most part.  Not only is their body changing, but they are constantly learning new skills for their development.

If you think back to when you were a child in elementary or middle school and you hit a growth spurt (or to other children you have seen if you can’t remember yours!), it was as if you woke up with a whole new body.  You were probably a little bit clumsy (in my case a lot clumsy since I was already clumsy to begin with) and your movements were not very coordinated.  I often visualize a baby lamb or horse or giraffe taking their first steps when I think of young kids going through growth spurts.

Now, put that same awareness on a little baby who is changing every day.  Especially if that baby has low muscle tone.  Our muscles learn to work in a certain way and they get really efficient at it.  If you change their length or change the weight that they have to move, all of a sudden they are a little less efficient.  For kids with low tone, they are playing a constant game of catch up.  They are working hard each day to get stronger and become efficient but then someone goes and changes the parameters of the game on them.  Now they have to learn how to work at a new length with a new weight, and very often a new activity.

And, each time they grow or are faced with a new developmental task, they need to find their stability again before they can work on their mobility.  For instance, its very hard to reach for a toy in sitting, if they are having trouble generating the strength to hold themselves in sitting, or its hard to crawl if they can’t hold themselves in a hands and knees position.  So, with each growth spurt, they will need to relearn how to find stability before they can go back to working on their mobility.

Hopefully I helped to explain things a little and didn’t just make it more confusing!

January 21, 2016

Superhero Fun

Filed under: Developmental Milestones — Starfish Therapies @ 10:53 pm
Tags: , , , ,
IMG_9493
Who doesn’t love pretending to be a superhero? We had a Superhero week at the clinic, and as a result thought it would be fun to list some gross motor activities that we came up with that your child could practice while pretending to be their favorite superhero!
1. Imitating various animals, such as a spider, while pretending to be Spiderman. By imitating various animals, children can work on coordination of their arms and legs, improve their motor planning, learn how to move their body in space, and improve their overall strength. Some animals to try include: bear, crab, spider, snake, horse, and frog.
2. Practicing jumping forwards, in place, down from a step or hopping while pretending to be Batman jumping from skyscraper to skyscraper trying to catch the foes and save the day! By practicing jumping and hopping skills, a child is working to improve their coordination, standing balance, and strength of their leg musculature.
3. Practice running “faster than a speeding bullet” like Superman does on both even and uneven surfaces. Running can help improve a child’s cardiovascular and muscular endurance, improve leg  strength as well as improve coordination. For younger children working on floor mobility skills, have your child pretend to fly like Superman, lifting their head, arms and legs off of the floor, which will help to improve the strength of their neck and trunk muscles.
Be creative and allow your child to use their imagination to come up with activities that their favorite superhero might do!
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