Starfish Therapies

August 22, 2012

Role Models = Inspiration and Motivation

image retrieved from:

I was one of the many who were inspired by Oscar Pistorius during the Summer Olympic Games just recently.  I have seen several blog posts by others who were inspired as well.  He helped to provide hope to people that they too may not be seen as different and that they can strive for something that may not be the norm at this point and time.

My favorite inspirational story surrounding this amazing athlete is that he has become a role model for one of the boys I work with and have talked about often in my blog posts.  He is a 7 year old with spastic quadriplegia cerebral palsy and he is learning how to walk without his canes.  This is an amazing feat because of the amount of energy it takes for him to take each step and maintain his balance.  Motivation has been a challenge because who as an almost 8 year old wants to work that hard every day to learn how to walk?  Well he saw Oscar Pistorius run in the Olympics and has decided he wants to be like him.  He has found his inspiration and motivation to help him take each step.  Don’t get me wrong, he still has his moments of whining but he has an internal motivation that we have sought to provide for him and have not always been successful.

The other similarity in this story is that the little boy I work with, just like Oscar, has never once seen himself as disabled….
Who are your kids role models and inspirations?

August 16, 2012

TV Teacher – Another Handwriting Tool

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 pm
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image retrieved from:

I just wanted to share another great handwriting tool for people to put into their bag of tricks.  Sarah, one of our OT’s reviewed The TV Teacher for PediaStaff in this post.  Just like in her review of Callirobics she talks about it in relation to a kiddo she was working with and give her perspective on ways the program can be beneficial for various kids as well as things to watch out for.

Has anyone else used this program?  What are other programs or tools you use?

August 14, 2012

Home Exercise Programs – Ideas to Increase Compliance

Filed under: Developmental Milestones — Starfish Therapies @ 9:00 am
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Starfish Therapies: Home Exercise Programs - Ideas to Increase Compliance

Well I am almost 3 weeks status post my hip surgery and I am swamped in my home exercise program. This post surgery protocol is almost a full time job.  I am lucky that I am able to devote the time to completing it because I’m not able to do patient care currently and my admin work allows for flexible hours.  I don’t know how I would complete it without this luxury of a flexible work schedule.  As a PT I understand a lot of what they want me to do but even still I needed to create a chart (see photo above) so that I could understand and follow the complex information they gave me and make sure I completed the correct exercises and progressed them appropriately each week.  Again, a bit ridiculous I think.

I know that as a PT I have given many home exercise programs, or suggestions of things for families to work on with their children.  I try to make sure that I also provide them with ways to fit it into their lifestyle because a home exercise program is only good if it is completed.  It doesn’t matter if I have created the doctoral dissertation of all home exercise programs because if it doesn’t get done its just a waste of paper and time.  I contributed to another blog where I talked about my thoughts on home exercise programs and how to make them effective for families.  I thought I would take a moment and make some suggestions now based on my new found personal experience. My thoughts are still the same but I have found some ideas for maybe making sure it gets completed.

  1. Figure out how much time you can devote to physical therapy exercises each day or week and share it with your therapist so they can help to select the priority for exercises/activities you should focus on
  2. Let your therapist know what your other therapies are giving you for ‘homework’ because there may be overlap and you can ‘kill 2 birds with 1 stone’
  3. As ridiculous as it sounds make a chart for each week so you can check things off.  Put the chart in a place where you will see it so it will be a reminder of what you need to do.  (I love charts and lists because I love checking and crossing off)  For older kids you can use sticker charts so they buy into practicing the things they need to work on.  I talk about ways to motivate kids in another blog post I did.
  4. Make it a part of your day as best as you can.  There are many things that therapists give you to work on that can easily be incorporated into your daily routine.  In my case, in a few weeks I am going to need to start standing on one leg (my surgical leg) and what I will do is stand on one foot while brushing my teeth, doing the dishes and other opportunities like that.  Ask your therapist for ways you can include their exercises into day to day activities, usually they’ll surprise you with what they can come up with.
  5. Ask why.  I know for myself I am more likely to do something if I understand why I am doing it.  Believe me, I woke up this morning and didn’t want to do my exercises.  I gave myself a figurative kick in the behind and reminded myself that I had this surgery for a reason and I wanted it to be a success and that these exercises were getting me one step closer to having a hip that worked correctly again.  If you aren’t sure why your therapist is suggesting an exercise or an activity as them why they are recommending it, we usually have a good reason for the things we do and its good to make us explain it every once in a while!

I would love to hear other suggestions people have for making home exercise programs compliance more likely whether you are a therapist or a parent or a patient yourself.  I love new ideas and maybe even some motivation for myself! (Luckily I have had the Olympics to keep me occupied during this time and provide motivation for doing my exercises as well)

May 28, 2012

A Simple Shift in Perspective

Filed under: Developmental Milestones — Starfish Therapies @ 4:38 pm
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A photo from one of our previous ‘Fun Fridays’

Sometimes I’m amazed at how much I can learn from the kids I work with.  On Friday I was chatting with one of the kiddos about his day and he informed me that he got to play all day at school today.  So I asked about after school (when he came to therapy).  He answered yes.  When I dug deeper and asked about PT (which we were currently doing) he said that yes he was getting to play because today was ‘Fun Friday’ which means he gets to have fun.  I loved his perspective on this because we were doing the same type of exercises as we always do this current Friday (we do occasionally do fun activities on Fridays) but just because we call Friday’s ‘Fun Friday’ in his mind it meant he was playing.

I don’t think I processed the whole conversation at the time but later when I was thinking back on it, I realized how simple it is to change our outlook sometimes.  I think I am going to try to practice the ‘Fun Friday’ lesson more often.

May 17, 2012

Spots – Multiple Fun Uses!

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 pm
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I love when I find an unexpected treasure (and in the $ bin no less)!  This morning I stopped at our local Rite-Aid to stock up on soda (not healthy I know but sometimes that’s what it takes to keep up with the kids) to feed our addictions at work and I was meandering through the store and I found these frog and ladybug circle pads that are made of foam and look just like the spots that we used to buy from Ikea (which they no longer carry).  I love the fact that they have animals on them because the kids love using our bean bags that are shaped like turtles and frogs and bugs, so having spots with animals gives them one more cue as to where we want them to be.  What do we use spots for you may wonder?  Well the list is endless but here are a few of our top things:

  • We make paths with our spots for having kids jump along the path, hop on one foot along the path, and skip over spots while jumping or hopping.  It creates a great visual cue when you are able to tell them a color or animal to jump to next.  Its great for beginning jumpers as well as for jumpers that you are working on getting consecutive jumps out of.
  • They provide a great visual for a kid to stand on.  I use them all the time when I want the kiddo to be standing ‘still’.  For instance when playing catch or bean bag toss or basketball, they often want to move closer and I can ask them if they are on their circle and they generally immediately go back to it.  We use them in group for circle games so the kids have an idea of where their space is.
  • They are great targets for the stomp rocket or throwing things.  You can have the kids work on aiming for the spot, especially with bean bags or flat discs since they don’t roll.
  • We use them on the stairs to provide a visual cue for which foot to place down next.  This is great for working on alternating feet as well as giving a clear visual target for where to place your foot.
  • Also when they are in a path it can be used to work on narrowing a kiddo’s base of support by having them stay on the circles or for increasing their step length by having them place one foot on each circle.
  • You can have kids balance them on their head for posture and body awareness while standing or walking.
  • We use them in obstacle courses so that at each spot they have a new task/skill that starts such as standing on one foot, lifting the heavy ball, doing jumping jacks, etc.
  • They are also great visual cues for early jumping jacks skills by placing them in a sequence of 1-2-1-2 to begin working on jumping open, then jumping together.  It is also great for early hopscotch of one foot, two feet.

What are some of the things you use spots for?

May 15, 2012

Stickers – So Simple, Yet So Effective

When working with kids motivation is the key.  Depending on the day, the hour or the child that motivation could look different.  One of the simplest yet so effective methods of motivation are stickers.  Kids love them!  Not only are they great motivation but they actually work on skills and the child doesn’t even realize it (that’s my favorite kind of motivation)!

I’ve talked about using sticker charts before and we make use of them in many ways.  We have some kids who have ongoing ones that will result in something once it is all filled up.  One of these uses is where they have to earn a sticker each day for behavior/participation/etc.  Others have an ongoing one with tasks they are working on and each session they do the skill/task they earn a sticker until the whole chart is full.  Others have sticker charts for each session where they write down their tasks or they have a goal for a certain number of stickers and they get to put one on every time they accomplish what they were supposed to.  We also just hand out stickers at the end of the session sometimes and they love to wear it proudly on their hand or shirt or forehead occasionally!

Other than motivation you may be wondering what else the kiddo is working on.  Well here are a few things:

  • Bilateral Coordination – If they are peeling the sticker off they need to stabilize the paper with one hand while manipulating the sticker with the other hand.  Also for precision of placing the sticker they need to use a stabilizing helper hand as well.
  • Mature Grasp Patterns -In order to effectively peel off the sticker it works best with a pincer grasp.  They may evolve to this and you may need to help them by starting with larger stickers first and then working your way down to smaller stickers.  Also, in the beginning the more you start the peel for them the easier it will be for them to get it but eventually you want them to be able to manipulate the sticker off the paper by themselves.
  • Fine Motor Control – This goes along with both of the above points but it also takes control to put the sticker on the surface that they want, especially if they want it in a certain location.
  • Visual Motor -If you have a square on a chart or they are making a picture with stickers they get to work on visual motor skills and precision by placing the sticker in the correct spot.  To encourage success, start with larger areas and work your way down to smaller areas for them to place the sticker in.
  • Body Awareness -You can have the kiddo place the sticker on a specific body part for increased body awareness.  Its always interesting to see where the stickers end up when you say something like ‘place the sticker on your forehead’!
  • Counting/Reading – For the kids who are working on charts they always want to know how many they have or how many more they need so its a great opportunity to work on counting and one to one association because they will have to point to the sticker or empty space while they count.  Also if you have specific tasks/skills written down they can work on locating the word(s) for where to put the sticker.
  • Choices/Decision Making – We will also use letting the kiddo pick out their own sticker as another whole type of motivation.  Sometimes we pick it out for them but on some ‘special’ occasions we let them pick it out.  The thought process that goes into what sticker is pretty amazing and you can see them weighing the pros and cons of their sticker choice as they go through the sheets of stickers and decide yes/no/maybe for that sheet to narrow it down and then making the final decision.  Sometimes its based on what they like and sometimes its based on what is already on their chart and wanting just the right mix of stickers.

How do you use stickers?

May 3, 2012

The Power of Kids to Influence Us!

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 pm
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So, I am always amazed at what good enrollers kids are.  They do it naturally.  Yes, we have our agenda that we want to get through to them however their agenda always manages to sneak in as well.  For instance, I use a lot of different motivation techniques, especially for my 5-7 year olds and as a result I now find myself hooked on Smurf Village and Zombie Takeover (not from my choosing but because its what works with our kids).  As if I didn’t have enough to do on my ‘off’ hours, I am now monitoring Zombies and Smurfs because if I didn’t the kids would notice.  For instance, I walked into the clinic today and the first question out of my 7 year old kiddo’s mouth was ‘Did you get the Zombie Cheerleader yet?’.  We also have intense discussions about what crops we should plant on the Smurf Village based on time left in the session.  I know these sound like silly games but they are amazingly motivating for the kids.  You’d be amazed at what a child will do in order to harvest the next crop or feed a zombie.

In addition to being motivating for the kids it also works on finger isolation and precision for pointing.  They get to learn limits (they are not allowed to spend Smurf Berries) and we can talk about do we want to earn more XP’s to get to a higher level faster or more coins to be able to add things to the village.  In addition we work on standing balance, cross body reaching while having them tap on the screen, and visual attention while doing gross motor tasks to name a few.  They also get to talk about strategy in terms of what is most important to do first and prioritize on each game, its great to see their reasoning skills.

I am sure there are a ton of other games out there like these although I don’t know if I want to know about them because I don’t think I can handle overseeing another set of creatures on a daily basis – my Smurfs and Zombies are keeping my hands full!

April 27, 2012

Suction Cup Balls

Suction cup balls are one of our favorite toys to play with.  We can usually find them in the party favor section at Target but they also sell them on Amazon.  We use them to work on many skills such as:

  • Throwing:  By having the kids throw the balls at a window or mirror they get to work on not only throwing in general but also throwing at a target and throwing with increased force so that the balls will stick to the surface.  You can work on throwing distance by slowly moving them further away from the target as they are more successful with getting the balls to stick.  You can also work on accuracy by making tape boxes or circles on the window or mirror and having the kiddos try to throw them in the target.  You can even make a mini ‘darts’ game!
  • Hand Grip Strength:  You can have the kiddos work on pulling the balls off of the mirror or the window.  In order to do this they need to be able to have a strong enough grip to hold onto the ball while pulling.  You can encourage using the other hand by having them stabilize on the support surface while pulling with the other hand.
  • Tip Toes: By putting the suction cup balls on a window or mirror just out of the kiddos reach you can have them practice going up onto their toes to reach overhead for the balls.  As they get better at going onto their toes you can make it more challenging by not letting them lean on or use their hands on the support surface.  Have them try to get the balls off without touching anything but the balls.
  • Jumping Up:  Jumping up for an object is a skill we often don’t think about but it can be hard to elicit.  Just because a kiddo can jump up, doesn’t mean they can jump up while reaching for an object.  If you put the suction cup balls even higher on the window/mirror you can have them jump up to grab them.  Start with them closer so the kids can have some success but then slowly move them higher.
  • Motivation in General:  You can also use them just as general motivation.  I have had kids reach up with two hands while lying on their belly over a therapy ball to encourage trunk extension strength.  By having them use two hands they are less likely to push up with their arms, thereby having to use their extensor muscles.  You can also use them for reaching in various directions and then letting the kiddo throw them afterwards.  Pretty much anything novel makes great motivation for a kiddo!

What else have you used suction cup balls for?

March 30, 2012

‘Melting’ Drawing/Letters


(this activity was melt the monster)

Here’s something that is really simple that the kids get a kick out of and can spice up drawing, handwriting, coloring, etc.  We have them ‘melt’ their letters or drawings after it is completed by using a spray bottle or a pipet with water.  The kids love the idea of doing it and usually ask if they can ‘melt’ their letters which gives us a great motivator to get them to work on their letters.  In addition if they are using a spray bottle or pipet they are working on hand strengthening and fine motor skills so its a double bonus! (I like the melting from the spray bottle a little bit better but the pipet works just as well in a ‘pinch’)

March 27, 2012

Pre-Crawling: Problem Solving and the Desire to Move

This post probably should have come before last weeks post about pivoting and reversing but they are still all part of the same idea for kiddos who are learning how to figure out a new movement such as commando crawling.  You can see in the video that he sees a toy or toys that he wants to get to and then he uses every part of his body to figure out how to move forward to get there.  This can also include incorporating rolling from side to side in an effort to produce forward movement.  Kids are amazing at how they will figure out to get what they want.  The first thing that is important is the desire to move.  Some kids develop this on their own and some kids need to be shown that moving is fun.  That could look like engaging them with a toy and then moving it slightly further away (still within reach but they have to work for it).  Then keep moving it just a bit further and help them get to it so they can learn that moving will get them to places and things that they want.  In this video I just let the kiddo figure out how to move on his.  In some upcoming videos you will see me help him work on figuring out how to coordinate his arms and legs, but the fact that he is working so hard to get to where he wants to go is really important for the development of his motor planning and coordination.  He gets important feedback regarding what works and what doesn’t work.  You will also notice that he can’t keep his head up and move the rest of his body at the same time.  He comes up to check for his target and then his head goes right back down again while he tries to push with his legs.  He is using his head the same as he would an arm or a leg and at this point he can’t coordinate head and neck extension with movement in the rest of his body.  Same with his legs, they are very symmetrical which is normal.  They move together and do the same thing.  You will notice in last weeks post (which was videoed chronologically later than this one) that he is able to move his legs separately and have them do things differently.  This is appropriate developmentally.  He is working out how to be efficient.  Keep watching/reading for more on pre-crawling and progressing to commando crawling!

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