Starfish Therapies

March 26, 2017

Free Wheelin: What Does Your Child Need to Learn to Ride a Bike?

Bike 2

Learning to ride a bike is a major childhood milestone for most kids providing a sense of freedom and increased independence. While the ultimate goal of self-propelled locomotion is no doubt thrilling, developing the skill can be tedious and frustrating. Fear not! Here are some tips for you to help your kiddo coast right through the learning stage and on to their free wheelin’ days ahead!

The very first thing your kiddo needs is the appropriate equipment both for size and safety. The staff at your local bike shop can help you with choosing the appropriate sized bike for your child’s age and size but it’s important to know some of the basics making adjustments as your child grows. Your child should be able to stand over their bike with both feet planted flat on the ground with 1-2 inches of clearance. Their seat height should allow a small bend in the knee when the pedals are at their lowest position. The handlebars should be at an appropriate distance to where there is a slight bend in their elbow to allow them to turn the wheel fully side to side without being overstretched. For safety a well-fitted helmet which sits across the middle of their forehead is required. For more information on sizing, fit, and safety tips check out the US Consumer Product Safety Commission’s guidelines!

Now that we have the right equipment, let’s look at skills! Bike riding requires a combination of balance, strength, power, and coordination. For most learner’s the first big obstacle is balance! It can be much easier for your child to learn to start their bike once they have the balance to keep it upright! A good place to start working on balance is to remove the pedals and practice pushing the bike with their feet and coasting. You can make it fun by joining them and “racing” or picking a song to sing and see how far into the song you can get!

Next it’s time to practice steering, turning, and awareness. Start with wide turns and slowly progress to smaller, tighter turns. You can create an obstacle course with cones for your kiddo or narrate an “adventure!” Giving them a target encourages them to look ahead and be aware of their surroundings for safety while biking!

Starting and stopping their bike independently is often the last hurdle for kiddos and takes practice, practice, practice! Be there to steady your child with a hand on the back of their seat or at the side of a handlebar but let them learn how to feel the balance and correct themselves. Soon family bike rides will be a favorite weekend activity!

Here is an old blog post of ours on bike riding!

March 19, 2017

What is the Vestibular System?

Vestibular_Swing
The vestibular system is made up of fluid filled organs that are located in the inner ear.  It is one of the essential components of balance and helps provide us information about our body’s movement.  The vestibular system responds to gravitational pull in order to send signals to our brain about the direction and speed at which we are moving.  It is also responsible for allowing us to stabilize our eyes during movement and helps us maintain our head in an upright position.

 

A properly working vestibular system is essential for all activities! Some essential tasks the vestibular system helps your child complete include: scanning words in a book to read, following a ball as it travels towards them through air, maintaining their balance during playtime activities, and maintaining an upright posture.

 

If a child’s vestibular system is not properly functioning, they may be under or over reactive to movement input.  If your child has an under reactive vestibular system, they may constantly attempt to seek out vestibular input-such as enjoying spinning in fast circles, swinging, or running fast and crashing down.  They may also appear more unbalanced or “clumsy.” Over reactive signs may include being more sedentary, fearful of fast movements, or being overly sensitive to fast or sudden movements.

 

Some additional common signs and symptoms of inadequate vestibular function include: dizziness, unsteadiness, vertigo, and trouble reading or reporting dizziness when reading, occasional stumbling/falls, or reports of the room spinning around them.

 

Even a fully developed and normally functioning vestibular system can be impacted by traumatic events. For example, vestibular dysfunction is often seen following concussion.  The vestibular system, does; however, have great potential for rehabilitation. Specific treatment techniques have been shown to re-train and enhance vestibular function.

 

There are many ways to help activate and develop your child’s vestibular system-and many of these activities you may already be doing on a daily basis.  Going to the park provides endless opportunities for vestibular system stimulation, including swings, slides, ball play, monkey bars, and running! Spinning and jumping activities are also very stimulating for the vestibular system.

March 12, 2017

Development of Refined Movement

I recently saw a video a friend posted of her son learning to commando crawl.  I immediately asked if I could use the video because I thought it was so great.  Luckily she said yes and you can see the video in this post!

What I loved about it is that with almost every move forward, he almost topples to the side.  He then has to bring his head and trunk back up to the middle for the next pull forward.  But because he hasn’t refined his movement yet, he goes too far and topples to the other side.  What’s great though is that every time this happens, his body is storing the information on how much effort he needed and it will begin to give him feedback to limit his movements so that he stays more in the center.  You can see in the next video clip (only 5 days later) how much less he falls to the side and how much faster his movements have become. And then in the next one (only another 5 days later), he is a commando crawling master!

We have all experienced this.  When we are learning a new skill, we are like the first video clip.  Our movements are clumsy and unrefined.  We use bigger, less efficient motions than what is required.  But each time we practice we refine our skills a little more so that soon we are efficiently performing the new skill.

It is for reasons like this that it is important to give babies and all kids, opportunities to explore their movement.  They are learning how their body works and creating new pathways that give them just the right feedback.  If they are never given the opportunity to practice it takes them longer to develop skills.   By overshooting over and over, they are learning from each movement to make the next one even better. This carries over to almost any new movement we are learning, whether we are a baby, a toddler, a teenager, and even possibly an adult!

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
Tags: , , ,
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’!

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