Starfish Therapies

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?

April 8, 2017

Fun with Balance Beams

Filed under: Developmental Milestones — Starfish Therapies @ 11:39 pm
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balance beam 1

I don’t know about you but balance beams are one of our staples to use with kids. As I was writing this post, I looked around and realized just how many different ones we have, and we actually use them all!

Clearly having a kid walk on a balance beam will work on their balance.  If forces them to narrow their base of support which challenges their balance. You can make it as easy or as difficult as you want.

balance beam 2

Some things to take into consideration when you are selecting which beam to use:

  • Wider is less difficult than narrow
  • Firm is less difficult than soft and squishy
  • Straight is less difficult than curved or zig zag
  • Lower to the ground is less difficult than higher off the ground

That being said, there are times we will use one that is more challenging than you would think appropriate for the child. We might use a higher one, even though the child is still struggling with one low to the ground. This could be because when it is low to the ground they try to go too fast, or step off too easily.  When its higher they may slow down and take more deliberate steps.

balance-beam-3.jpg

I’ve been asked why we don’t just use some tape on the ground. Well we do, but that doesn’t have the same effect as being elevated off the ground. When the child is off the ground, most times, they have a sense of it and are more cautious. It can work on their confidence for novel situations, or even help with their fear of falling as they practice being successful over and over.

We have several kids who like to move, and use movement to find their stability. They actually have a harder time doing things that require them to be still. By giving them a balance beam to walk on, they are challenged and most often have to slow down which can help work on their static stability.

balance-beam-4.jpg

Now walking is the easiest way to use a balance beam. Its the most common way we use it, but that doesn’t mean its the only way. Some of the other ways we have used balance beams are:

  • Side stepping – Have the child take sideways steps to the left and the right to cross the beam. This works best if they are going out and back so they get both sides, but if they are only going one way, just have them switch the direction they are facing as they walk each time.
  • Blindfolded – This helps to work on their awareness of their bodies and decreases their ability to use vision to help their balance. Check out our post on using animal masks to work on balance!
  • Squats – As the child walks along the beam they can squat down to pick up treasure in front of them, or they can turn to the side to pick up treasure on the floor.  Usually treasure is a bean bag or a puzzle piece or a Squigz or whatever has captured their fancy that session!
  • Catch – Have the child stand on the balance beam and play catch with them. If there isn’t anyone spotting them make sure they are in a safe place if they lose their balance
  • Backwards – Walking backwards is another challenge to balance and body awareness. A fun way to incorporate it is to have the child go through the ‘adventure’ backwards. Anything novel usually captures their attention for a short period of time!
  • Jumping – We have jumped on them like bunnies, jumped over them like obstacles, and used them to practice side to side jumping.

vision-free-balance

What are other ways you have used balance beams?

 

August 1, 2016

Developmental Playgroup – Self-Help (Part 1)

Filed under: Developmental Milestones — Starfish Therapies @ 5:33 pm
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drinking2

This past week we looked at Self-Help skills during our developmental playgroups.  Here is a brief overview of some of the things discussed.  We will provide more detail in coming weeks!

Birth- 4 months:

  • Express the need for food by crying
  • Signal the need for diaper changes
  • Express pleasure when placed in warm water (bathing)
  • Will eventually begin to help by using their own hands to guide the nipple

4-8 months:

  • Show interest in feeding activities
  • Can pull off their own socks
  • Can velcro closures on clothing

8-12 months:

  • Begin to hold their own cup and drink
  • Begin to eat finger foods
  • Begin to pull off soiled or wet diaper
  • Begin to sleep until 6 or 8 am.

12-24 months:

  • Use a spoon to some degree to feed themselves
  • Have good control of a cup
  • Begin to try and wash themselves
  • Begin to help with dressing
  • By age 2 they may begin to gain control of bowels and bladder

24-36 months:

  • Increasingly able to feed self and use cup/glass
  • Can generally undress themselves
  • Show signs of being ready for toilet training

Activities/ Things to remember when teaching or promoting self help skills:

  • Decreasing amount of assistance given during activities (ie less assistance with silverware during mealtimes)
  • Establish a routine/create a daily schedule
  • Focus on the learning instead of the length of time to finish the task
  • Rewards are best when naturally occurring in the environment

 

7 Self-Care Milestones to Look Forward To:

As the sense of self increases, so will your child’s achievements in self-care. He’ll naturally develop and fine-tune his motor skills over the next three years to master:

  1. Using a fork and spoon: Some toddlers start wanting to use utensils as early as 13 months, and most children have figured out this all-important skill by 17 or 18 months. By age 4, your child will probably be able to hold utensils like an adult and be ready to learn table manners.
  2. Undressing: While the ability to take his own clothes off may lead to lots of naked-toddler chase sessions, it’s a key accomplishment. Most children learn to do it sometime between 13 and 24 months.
  3. Toothbrushing: Your child may start wanting to help with this task as early as 16 months, but probably won’t be able to handle a toothbrush skillfully until sometime between her third and fourth birthdays. Even then, dentists say, kids can’t do a thorough job on their teeth until much later.
    • Pediatric dentists recommend that parents do a thorough brushing of their kids’ teeth every night until school age or later. As a compromise, if your child is eager to brush, let her do the morning brushing herself. Or let her brush first, and then you finish up.
  4. Washing and drying hands: This skill develops at 24 months or so and is something kids should learn before or at the same time as using the toilet – you don’t want your child spreading germs.
  5. Getting dressed: Your little one may be able to put on loose clothing as early as 24 months, but he’ll need a few more months before being able to manage a T-shirt, and another year or two after that before he’ll really be able to get dressed all by himself. Also at 24 months, he’ll probably be able to pull off his shoes.
  6. Using the toilet: Most kids aren’t physically ready to start toilet training until they’re at least 18 to 24 months old. Two key signs of readiness for a child include being able to pull her pants up and down by herself and knowing when she has to go before it happens.
  7. Preparing breakfast: Toddlers as young as 3 may be able to get themselves a bowl of cereal when they’re hungry, and most kids can do it by the time they’re 4 1/2. If your child wants to give this a whirl, make it easy by leaving kid-size containers of cereal and milk in the cupboard and fridge.

References:

  1. http://www.floridahealth.gov/AlternateSites/CMS-Kids/providers/early_steps/training/itds/module1/lesson1_3.html
  2. http://www.earlychildhoodnews.com/earlychildhood/article_view.aspx?ArticleID=676
  3. http://www.childcarequarterly.com/summer08_story2.html
  4. http://www.babycenter.com/0_toddler-milestone-self-care_6503.b

July 25, 2016

Developmental Playgroup – Cognition (Part 1)

Under

Cognition was the most recent topic at the Developmental Playgroups this past week.  It is broken down into: Cause and Effect, Spatial Relationships, Problem Solving, Imitation, Memory, Number Sense, Classification, Symbolic Play, Attention Maintenance, and Understanding of Personal Care Routines.  Because it covers such a wide range, for the purposes of the blog, we will break it into smaller components.  This post covers Cause and Effect, and Spatial Relationships.

Cause and Effect:  Cause and Effect looks at a relationship between actions/events and what the reslt is.  This concept helps infants/children to develop an understanding of object properties, relationships between and event and the consequences, and patterns of human behavior. By developing an understanding of this concept, infants/children are able to build their abilities to solve problems, make predictions, and understand the impact their behavior has on others.

  • Examples: crying and being picked up, shaking a toy and hearing it make noises, pushing a button on a toy and having music play.

Some milestones/age appropriate activities for this concept are:

  • 4-7 months:
    • Hear a loud noise and turn head in the direction of the noise
    • Explore toys with hands and mouth
    • Move body in a rocking motion to get the infant care teacher to continue rocking
  • 8 months: Children perform simple actions to make things happen, notice the relationships between events, and notice the effects of others on the immediate environment.
    • Shake toy, hear the sound and shake it again
    • Watch someone wind up a toy and then touch the toy trying to make it go off again
    • Push button on toy to watch it light up/something pop out.
  • 9-17 months:
    • Bang two blocks together
    • Keep turning objects to find the side that works (mirror or nesting cup)
    • Cry and anticipate someone to come help them
    • Continuously drop an item to have someone come pick it up
    • Watch someone perform an action and then try to imitate- squeeze water toys.
  • 18 months: Children combine simple actions to cause things to happen or change the way they interact with objects and people in order to see how it changes the outcome.
    • Attempt to wind up the toy after not getting the lid to open
    • Drop various objects from different heights to observe how they fall – what noise they make
    • Making tower of blocks and knocking them over
  • 36 months:
    • Demonstrate an understanding of cause and effect by making predictions about what could happen and reflect upon what caused something to happen
    • Communicates that they miss someone/cries after they leave
    • Make a prediction about what will happen next in the story
    • Ask what happened if they see a band aid

Spatial Relationships: Spatial Relationship looks at how an object is located in relation to a reference object.  Understanding this concept helps infants/children gain a better understanding of numbers as they get older as well as how things move and fit in space.

  • Examples: exploring objects with their mouths, tracking objects and people visually, squeezing into tight spaces, fitting objects into openings, and looking at things from different perspectives (Mangione, Lally, and Signer 1992).

Some milestones/age appropriate activities for this concept are:

  • 4 to 7 months:
    • Look and explore their own hand
    • Reach for nearby items
    • Explore toys with hands and mouth
  • 8 months: Children move their bodies, explore the size and shape of objects, and observe people and objects as they move through space.
    • Use vision or hearing to track the path of someone walking by
    • Hold one stacking cup in each hand
  • 9-17 months:
    • Roll a car back and forth on the floor
    • Dump toys out of a container
    • Move over and between cushions and pillows on the floor
    • Put the circle piece of a puzzle into the round opening, after trying the triangle opening and the square opening
  • 18 months: Children use trial and error to discover how things move and fit in space.
    • Go around the back of a chair to get the toy car that rolled behind it instead of trying to follow the car’s path by squeezing underneath the chair
    • Use two hands to pick up a big truck, but only one hand to pick up a small one
    • Put a smaller nesting cup inside a larger cup after trying it the other way around.
  • 19 -35 months:
    • Complete a puzzle of three separate cut-out pieces, such as a circle, square, and triangle
    • Turn a book right-side up after realizing that it is upside down
    • Fit four nesting cups in the correct order, even if it takes a couple of tries

We will go over the remaining concepts in some follow up posts!

References:

http://www.cde.ca.gov/sp/cd/re/itf09cogdev.asp#sr

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdcsr.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdps.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdimit.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdmem.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdclas.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdpers.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdattm.asp

https://www.healthychildren.org/English/ages-stages/baby/Pages/Cognitive-Development-8-to-12-Months.aspx

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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.

April 15, 2016

To Flip-Flop or Not

Filed under: Developmental Milestones — Starfish Therapies @ 8:08 pm
Tags: , , ,

Flip Flops 3

So, you’re in the department store shopping for your kid, because they seem to be growing every week! They are in dire need of new shoes and it’s summer, which means it’s flip flop weather, right?!

Not so fast! Although, I love the cute sandals they have for kids now a days – I think it’s important to look at how sandals may be effecting your child’s walking.

When you think about how a tennis shoe is secured to your child’s foot and then think about how a sandal is secured to your child’s foot – they are very different. When you’re wearing a tennis shoe you don’t have to think about keeping the shoe on your foot, which allows your walking pattern to be similar to how you would walk barefoot.

Now, when you’re wearing flip-flops, you have to secure the shoe on to your foot by gripping your toes into the sandal. This creates some confusion for your body. As you’re swinging your leg through, your hip is moving up/forward, but your toes are pushing down trying to keep the flip-flop onto your foot – do you see the confusion? Not only is your body confused, but by gripping your toes onto the sandal it places pressure and tension onto parts of your lower leg and foot that were not intended for that purpose.

But it’s hot out and my child and I need summer shoes! Consider a shoe that is secured to the foot – something that cups the heel. It can have straps and openings, but when the shoe isn’t secured to the foot such as flip-flops and slippers – it places abnormal pressure and tension on your child’s body.

Just some things to think about as you are buying your next pair of summer shoes!

April 8, 2016

Hip Dysplasia

Filed under: Developmental Milestones — Starfish Therapies @ 7:41 pm
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swaddle

As parents of babies or young children you may have heard the term hip dysplasia or you may remember your pediatrician moving your little ones hips around at all those check-ups during the first year.  They are feeling and listening for clicks or clunks which, when felt may indicate hip dysplasia.

Hip dysplasia is the term used to describe a hip joint that is not properly formed so that either the hip can be dislocated and relocated with passive movement or is already in a dislocated position. The term developmental dysplasia of the hip (DDH) is used when the condition is present in a newborn or develops sometime around birth, usually in the first year of life. As physical therapists, we know that most of the time DDH is present at birth and can be attributed to the baby’s position in the womb. Specifically, the breech position is found to be a cause for DDH present at birth. While the exact cause of DDH in other cases is not known, there is an increased likelihood with a positive family history as well as in the female gender, with girls being 4-5 times more likely to have hip dysplasia than boys. However, we also know that DDH can develop over time in otherwise healthy hip joints or can further the amount of hip dysplasia in a mild case that is maybe yet to be diagnosed. Read the tips below so will know the signs of hip dysplasia as well as how to prevent it from developing or worsening by understanding how to position baby with swaddles, carriers, etc.

1. Signs of hip dysplasia that you can take note of and tell your doctor about:

  • Asymmetry of skin folds: when your baby is lying on his or her tummy, the gluteal and thigh folds should be symmetrical at the same height.
  • Loud, audible clicking or clunking felt during diaper changes
  • Limited range of motion available at one or both hips

2. Swaddling

  • Swaddles should be loose around the hips and thighs to allow for baby’s natural hip position (flexed and externally rotated). Baby should have free movement from the waist down.
  • Swaddles should not hold baby’s hips extended or close together.

3. Baby carriers

  • Baby carriers should support baby underneath the buttock and thighs and allow the legs to spread apart with flexion at the hips.
  • Baby’s hips are more at risk when they are allowed to dangle straight down or are held close together in a sling type carrier.

For more information as well as images that demonstrate proper hip positioning during swaddling, use of baby carriers and car seats, visit the International Hip Dysplasia Institute website here. If you have questions about specific products out there, let us know!

March 31, 2016

Educational vs Medical Based Physical Therapy

Filed under: Developmental Milestones — Starfish Therapies @ 5:00 pm
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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’!

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