Starfish Therapies

August 6, 2017

Feed the Woozle

Another game I have never played, but one of my therapists found a really fun way to use it to motivate one of our kiddos to work on stairs, and more specifically stairs while carrying things. You can take the general idea and use it for other activities you are trying to get kids to do!

We put the Woozle at the top of the stairs. At the bottom of the stairs the kiddo gets to roll the dice and figure out how many pieces of food he gets to take up to the Woozle (1, 2, or 3). [Note – also working on counting and numbers]

Once that has been determined he picks the food (which have amazing names – a favorite is the Lemon Flavored Underpants) and puts them in a cup (we use stacking cups). [Note – also working on fine motor skills]

He then carries the cup up the steps to the Woozle to feed him. The trick is that in order for the Woozle to know that its the kiddo approaching to feed him, and not a ‘bad guy’, he has to step on the taped x’s. Which of course encourage reciprocal stepping (occasionally the x’s get missed and we use our judgement if we want to repeat or let them go, especially if they are doing reciprocal anyway). [Note – and visual processing, coordination, motor planning, balance]

Once to the top, he feeds the Woozle and then comes back down the stairs holding the empty cup to fill back up with more food. [Note – also works on floor to stand and stand to floor each time, or squatting]

I don’t know about your kids, but ours think this is hysterical and love picking out which food they are going to give him, and they find it funny when he only gets one piece of food. Little do they realize that means they have to do more reps to get rid of all the food!

What other ways have you used Feed the Woozle?

July 30, 2017

Jumping Path

jumping path

As I was browsing through Facebook the other morning while trying to get my morning started (yes, this has become my new snooze button), I saw a video someone had shared of kids using a jumping path. I thought is was so great that I took a screen shot of the video and brought it into work so that we could recreate it. Luckily, we have cut out feet that we had purchased at a conference a few years ago so this project didn’t involve much planning.

It is such a simple idea yet so great in that it works on many skills. A few of those skills are:

  • Jumping – This one is pretty obvious. However, we have kids that struggle to keep both feet together while jumping (they do more of a staggered jump), and we are always looking for new ways to get more repetitions of jumping in. This is an easy way. Even if all of the feet were facing the same direction (forward, or backward, or to the right, or to the left) they would still get jumping repetitions in.
  • Motor planning – The child has to look at where their feet are, look at where the next feet are, and plan how they are going to get there.
  • Spatial/body awareness – The child has to understand where they are in space in relation to where they want to be
  • Coordination – Getting their body to move in the way they have now figured out they need to move to get to the new set of feet
  • Balance – It can be a little more challenging to jump and land on a precise location and stay there than to just jump forward and land wherever you want

Has anyone else tried this activity? Do you have any variations? I did figure out that you can make it easier or more complex by how you place the feet.

  • Having the feet all pointing the same direction is the easiest.
  • Next would be having them pointing at 90 degrees from each other (forward, right, forward, right)
  • Clearly having a pattern of only two directions (see above) is easier than multiple directions
  • The hardest would be a completely random path with 90 to 180 degree turns throughout and going in all directions

July 23, 2017

It’s All About Motivation

Adventure

Many times I get asked about what kinds of activities we do with the kids, or how we get them to do what we want them to do when it may be hard work for them. The answer is always the same, it’s all about motivation. If you can make an activity into something that a child wants to do, then they will work hard at it, and usually repeat it multiple times.

I had written two posts a while ago about when we used songs to motivate kids that you might find interesting.

Well one of our other ways is to use obstacle courses, which we have talked about before. But how we make those obstacle courses fun is what this post is about! Here are a few ideas!

  • American Ninja Warrior Junior – I’ll be honest, I’ve never watched American Ninja Warrior. That being said, I’ve noticed a lot of our kids have, and they love it! We have been able to get more leverage from that show for motivating kids. We have done it in obstacle course format where we time them on the course (but they lose points if the quality isn’t there, so they don’t just rush through). We have created training programs for it so that the kids do exercises that will help them be American Ninja Warriors and then they get to create a course at the end of the session for fun. But the ‘training’ is where they put in the work. Although, even the courses they create are pretty challenging and work on the things that we would want them to work on.
  • Adventures – Some kids like to go on adventures. This could involve crossing a bridge (balance beam), climbing mountains (stepping stones), navigating the swamp or quicksand (crash pads), traversing lily pads (spots), rescuing friends (climbing up and down stairs), going into the dungeon (stepping up and down a ‘curb’ type step), setting off the flare for the support team (stomp rocket), using the magic key to open the secret door (making a basket with the basketball while standing on a balance board), crossing the forbidden forest (walking over a yoga mat with obstacles underneath to make it uneven), and the list could go on and on. Usually we have friends we rescue (a puzzle with animals, bean bag animals, stuffed animals) or we go collect treasure (a puzzle with different shapes) and the child gets to choose which we are doing on that adventure. That way they also have to go through multiple times.

What are some fun ways you have motivated kids?

 

July 2, 2017

Crossing Midline

twister yoga

Crossing midline is the ability for your hands, feet, and eyes to move across your body. Being able to cross midline is an important skill for children to develop as it is needed to complete everyday tasks such as, putting on shoes, reading, writing, and ball skills. Crossing midline includes visually tracking. Visually tracking includes your child’s ability to move their eyes across midline without moving their head, which is an important skill for reading. Being able to cross midline allows for your child’s brain to make connections from one side of their brain to the other. Children who have difficulties crossing midline typically do not have a dominant hand, may often lose their place while reading, and may have difficulties throwing and catching a ball.

Here are some fun activities that you can incorporate into your child’s playtime to encourage crossing midline:

  • Popping bubbles: Blow bubbles and encourage your child to reach across their body to pop the bubbles. Make sure that your child pops bubbles with both hands.
  • Drawing figure eights: You can have your child draw figure eights on a piece of paper or for some added fun have them draw figure eights in shaving cream
  • Bean bag games: Have your child reach across their body to grab a bean bag and then throw the bean bag at a target. Make sure your child is using both hands to grab bean bags.
  • Windmills: Have your child stand with their feet a bit wider than shoulder width, have them try to bring their opposite hand down to touch their opposite foot. Repeat this exercise 10 times on each side.
  • Play twister: This is a great game to encourage your child to reach across midline with both their hands and their feet.

June 18, 2017

Pop Goes the Bubble

Filed under: Developmental Milestones — Starfish Therapies @ 12:03 am
Tags: , , , , , ,

Who doesn’t love bubbles? A lot of the kids we work with do! Here are some things that you can work on with bubble play:

  • Reaching – You can do this in almost any position.
    • Sitting – For little ones just learning to sit you can start by blowing bubbles all around them and having them move their arms towards them. As they get a little more stable you can blow the bubble and catch it on the end of the wand and hold it further away from them so they have to reach outside their base of support. You can have them reach up, forward, to the side, across the body, diagonal, pretty much any direction! For kids who are sitting in chairs you can do this as well. Make it even more difficult by putting them on a bench where their feet don’t touch, or on an unstable surface like a peanut, therapy ball, or dynamic sitting cushion. If you want to control the challenge, you can have them sit on a therapy ball and change their position while they try to reach. This can really work on the core muscles.  Make a game out of it, see how many bubbles they can pop in a minute. Then you get some counting in too!
    • Standing – All the same ideas as above except in a standing position. You can use spots to help them keep their feet in place so they have a smaller base of support, or you can use more than one spot so you are changing their foot position while they reach. Maybe even use a twister board and have them change their foot position and each time they have to pop a bubble. You can make it more challenging by having them stand on a balance board, a bosu, a dynamic disc, on top of stepping stones, on a balance beam, the possibilities are endless. You could also have them stand in more challenging positions such as tandem stance or single leg stance while reaching.
    • Kneeling  – The same ideas apply to kneeling. You can do short kneeling, tall kneeling, half kneeling. Change the surface, change the leg position, etc.
  • Single Leg Stance – What better way to pop bubbles than with your feet? Bubbles are a great way to get kids to stomp and when they are purposefully stomping they are generally holding their foot up a little bit longer than if they are just walking. Also because they are trying to stomp on the bubble they are more deliberate and trying to find their balance. You can have them go one bubble at a time (possibly holding it on the end of the wand) or you can blow a whole bunch and have them stomp through the bubble fields. You can make it more challenging by having varied surfaces that the bubbles are on so they have to stomp up onto a step or onto a mat, or down onto the ground from a slightly elevated position.

  • Squatting – Great time to get in squatting practice, or floor to stand/stand to floor practice. If you blow the bubbles towards the floor they may attempt to get to them with their hands. Then the next time you blow them up high and have them stand up for them. As long as they are entertained, you can get a lot of reps in this way! If the bubbles aren’t going where you want then you just need to catch it on the wand and hold it down low or up high for them to try to pop.
  • Other – There a ton of other things too such as oral motor control from blowing the bubbles, and breath control for the same reason. Visual motor, Fine motor control, and coordination for dipping the wand into the bubble juice and bringing it to their mouth.

What are some of the things you work on with bubbles? What are your favorite activities?

 

June 7, 2017

Apps for PT and Kids

jump jump froggy
Its always fun to find new apps to use with kids. They like the variety and its nice to challenge and engage them in different ways. Here are a few that our therapists have found recently! We’d love to hear what apps you have been using!
Physical Therapy For Kids (By Preferred Mobile Applications LLC) $6.99
The Physical Therapy For Kids App was created by a yoga instructor and a Physical Therapist to aid pediatric physical therapists in working with their patients. This app has fun images to provide as visuals for 56 different exercises that help kids practice gross motor strength, balance, and coordination activities. Select a picture and tap it repeatedly to see the animation of the exercise.
Recommended for children ages 3-12
Jump Jump Froggy (By Timothy Charoenying) Free
This app features four fun activities: Jump up, 30-second speed hopping challenge, sit-ups, and push-ups. Fun animations come to life with each activity; the on screen action is a direct result of the player’s engagement in the activity. Kids can play to beat their high score and there is a multi-player mode so kids can compete with their friends and family.
Recommended for children of all ages
Super Stretch Yoga (By The Adventures of Super Stretch LLC) Free
This fun app created for kids provides an interactive experience for doing yoga.
Using storytelling, animation and video examples, kids can practice 12 different yoga poses (there are videos of children performing each pose). You can go through all the poses at once or choose 1 pose to do at a time and repeat as often as you like.
Recommended for children 3 and up
Toca Dance Free (By Toca Boca AB) Free
This is a fun app help kids practice motor planning and coordination. It is available as a free version. In this app you dress your dancers and choreograph a dance.  Then a video is made of the completed dance.  Kids can watch and learn the dance created and can pause the video or repeat parts to practice at their own pace.
You can even choreograph movements like squatting, jumping or crossing midline to work on certain PT goals.
Recommended for children ages 6 and up

May 14, 2017

Ideas to Target the Core

wheelbarrow

bridging

modified plank

I don’t know about you, but I know my core muscles (abdominals, back extensors, shoulder girdle, and hips) can always stand to be stronger. This also goes for our kids, typically developing as well as kids with a neuromuscular challenge. While there are lots of ideas for targeting specific muscle groups, sometimes its good to do exercises that get a bigger bang for their buck. There are some exercises that can target multiple areas of the core at the same time. Here are a few:

  • Planks – Planks are great for getting all areas of the core. Of course they are not easy, especially if you want to maintain good form. For those just starting out with a plank you can go on your hands and knees and bring your hips in a straight line with your trunk. To make it harder to you can move to your hands and toes (or forearms and toes) and keep your whole body in a straight line. To make it even easier, you can use a bench or a table and put your hands on there so you are at an incline. The goal is to be able to hold your body in a straight line without having your belly sag or your hips sticking up in the air. Find the level of difficulty that lets you maintain that straight body. And start small. If you can hold it for 15 seconds then do that. Slowly increase your time and then increase the difficulty!
  • Wheelbarrow Walking – This also targets multiple areas, the hips don’t get as much work unless you are being supported by the ankles, but its still great for the shoulders and trunk. You can use a scooter board and sit on it and hold them by their trunk, or their hips, or their thighs, or their ankles (the further out you hold them, the harder it is). Use a hallway and have something fun like a book or a puzzle at the end that they get to do something with each time they get down there. You can also use a rolling stool. This changes the angle and makes it harder. Even harder is you just standing and walking while supporting them. Again, the goal is to hold the body straight so find the level of support that allows them to do this and gradually work your way out towards their ankles and up to you standing!
  • Walk Outs – Use an exercise ball or a peanut ball or even a foam roller (the exercise ball will be the hardest because it can move in multiple directions). Place a puzzle and its pieces a little out of reach and have them lie on their stomach on the ball and then slowly walk out their hands as far as they can go while maintaining a straight trunk and hips. Then put a piece in the puzzle and walk their hands back. Keep repeating until all the pieces are done. You can also use beanbags, or other toys that involve multiple pieces.
  • Bridging – This one really targets the hips but also works on the trunk. I’ve talked about ways to work on this in other posts. You can get creative with how to make it fun, such as balls or cars going underneath. You can also make it harder by putting one foot on an elevated surface and the other one on the floor, or both feet on an exercise ball or peanut (or other unstable surface). You could just do one leg and keep the other leg up in the air. You can do reps of up and down, or you can go up and hold it for longer and longer periods of time.

What are some of your favorite ways to work on the whole core?

May 7, 2017

I Won’t Stand for That! (unless I learn how)

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

sitting down

Pull to stand

Learning to pull to stand can come naturally for some kids, and for others it can require a bit of work. This video is one where it came naturally (please note the emerging balance reactions at the end of the video – I love to see kids getting to experiment with this). As he was learning to crawl and explore he naturally began experimenting with pushing or pulling up to stand. This may have started with your legs, a coffee table, an oversized bin, the couch, or a chair. Basically anything that is off the ground and their hands can reach. When they get to it, their natural curiosity has them try to see what’s up there, or what’s on the other side. They become successful at it when the ability of their muscles matches their curiosity!

For those kids that require a little more help, here are some ideas you can try:

  • Sit to Stand – If your child can already sit independently, have them sit on a small stool really close to the couch or an activity table or a chair. Have a preferred toy or activity on the support surface. Help them to put their hands on the support surface and move into standing. Let them play for a bit and then bring them back down into sitting and repeat again. This helps them to strengthen their leg muscles, as well as learn that if they move into the new position, there might be something they like there!
  • Playing at Support Surfaces of Various Heights – When your child can crawl, or even kneel, create an environment where they have different heights to explore on. This could be the couch, the coffee table, an activity table, an overturned storage bin, a foot stool, etc. Put toys or activities that are motivating to the them on the support surfaces, and be there to engage as well. They may begin to experiment with pushing or pulling up onto extended legs. You can also line them up near each other. For instance, have the activity table touching the couch and a little bit away have an overturned bin touching the couch so that you have made a U of activities at various heights. Let them start at the lowest height and then make them aware of the activities or toys at the higher height. They can use the lower height to help them problem solve how to reach the higher height. This can also help them learn how to lower back down to the ground because they may want to get back to the toy or activity at the lower height again.
  • Crawling Over Obstacles – Learning to crawl over obstacles helps kids to develop their total body strength as well as have to problem solve how to get to where they want. This can involve pushing up onto extended legs before they go over the obstacle, or even just crawling right over. It engages their curiosity about what is ‘on the other side’ and if you use toys that are motivating, they can crawl back and forth along the same obstacle path for many repetitions! Use your legs, couch pillows, piles of blankets or towels, small upside down storage containers, etc.
  • Manual Assistance – And sometimes you just have to give them the extra support and take them through the motions. So if you are at a support surface, and they are on their knees with their hands on the surface, help them bring one leg forward so their foot is resting on the floor (half kneel) and then give them a little boost at the hips to go all the way up into standing. Take turns with which side you help them with so they get to develop strength in both legs, as well as so that each leg learns that it can push without the other leg right next to it!

What are other ways you have taught kids to pull to stand?

April 30, 2017

Strong Outer Hips (aka abductors)

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

bridgingside step hip abduction

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?

April 25, 2017

The Value of Peer Play

peer play

I was recently at a school working with a kiddo. This child has made huge gains and is now easily able to access her school environment. The one area that is still a slight struggle is the play structure. She is able to do all points of access on all the play structures in her school. The challenge is that she doesn’t want to. And she doesn’t want to because she thinks she can’t. Even after doing it successfully she will still not want to do certain ladders. The other challenge is that if I push her, there is a potential for a meltdown. So I have walked the fine line between challenging and stepping back, in order to boost her confidence on the various ladders of the play structure. Now don’t get me wrong, she will do the stairs, the slide, and most standard ladders. Its just when they look a little different that she doesn’t want to do them.

So, back to my story. This day, while we were heading out to the play yard for recess after doing some work in the motor room, her friend from her class ran up and asked her to come play. They usually play together but it generally involves running around and trying to tag each other. This time her friend wanted to go on the play structure. She went with him and she climbed up the stairs and then I could see him coaxing her to do the ladders with him. He got her to climb down one ladder and then patiently brought her to each ladder and stayed with her the whole way up, encouraging her and showing her how he did it. There were times she would only go up about two steps and then come back down and run away. He was able to run up to her and bring her back in a way that she was still having fun and laughing, that I wouldn’t have been able to do. She didn’t realize he was making her work, she just saw it as playing with her friends.

Its moments like this that I love being able to step back and observe the kids I work with interacting with their peers. This interaction was just as, if not more important, than the time I spent with her.

What are ways you encourage peer play and then step back and let them go?

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