Top Ten Blog Posts of 2017

It’s been a few years since we did a top ten list at the end of the year (that may be because for a few years we weren’t very consistent with posting). Since we managed to get out a post every week of this year (yes, we are patting ourselves on the back) we thought we would take a look back and see what posts were the most read by you our readers!

Here are our top 10 overall from 2017:

10.  Encouraging Rolling From Back to Stomach

9.  What Does High Tone Mean?

8. Easter Egg Hunt For Motor Skills

7.  Having a Ball with Core Muscle Strength

6.  Avoiding the ‘Container Shuffle’ with Your Baby

5.  My Child Isn’t Rolling Over:  Should I Be Concerned?

4.  A Multi-Tasking Activity

3.  A Glossary of Sitting

2. What Does Low Tone Mean?

1.Motor Learning: Stages of Motor Learning and Strategies to Improve Acquisition of Motor Skills

Interestingly enough, all of these were published prior to 2017, so I decided to dig a little deeper and find out our top ten that were published in 2017. Those are:

10. Halloween Inspired Gross Motor Games

9. Single Leg Stance

8. Transitional Movements

7. 10 Things You Didn’t Know a Pediatric PT Could Help With

6. Crossing Midline

5. Taking the Vision out of Balance

4. Core Workout: Hungry Hippos Meets Wreck it Ralph

3. Eccentric Abs (and no, I don’t mean odd!)

2. Ideas to Target the Core

1.Righting Reactions

Happy New Year, thanks for a great 2017 and we look forward to seeing you in 2018!

Using a Treadmill for Walking Quality

In last week’s post we talked about weight shifting and trunk elongation to help walking quality and energy efficiency. This week we are going to look at using a treadmill.

For some kids who are working on walking quality and efficiency foot placement can be a big deal. How they take that first step can affect everything else that goes up the chain to the hips, the trunk, and the head. By using a treadmill you can slow down the speed so they have time to think about what they are doing and get in a lot of practice and repetition (remember: repeat, repeat, repeat…). We also added tape down the middle to help provide a visual cue for foot placement to help decrease scissor stepping (when feet cross over midline while walking instead of going straight in front).

We also provided a wooden dowel in front to provide some balance assist (but with only 1-2 fingers resting lightly so they aren’t leaning on it). With some verbal cues for heel to toe foot placement, and the light support at the wooden dowel to help keep the trunk upright, it also helps to prevent other compensations that can occur from underlying hip weakness such as internal rotation at the hip to lock out the joint and create stability. But it also creates a crouching pattern that decreases efficiency and energy conservation with walking.

We are lucky enough to have access to a treadmill that can start at really low speeds. We did 2-3 minute increments of walking, over 4 different speeds, twice at each speed. As we were building up occasional manual cues were provided to assist with weight shifting, as well as pelvic and trunk rotation. After we got up to the highest speed we were going to, we went back down to the slowest, and repeated 2 sets at that speed without any manual cues. Afterwards, we went to overland walking. Since it still isn’t automatic (remember it takes lots of repetition to make it automatic) there were lots of verbal cues to slow down the walking rather than go back into the habitual walking pattern that automatically arises when they aren’t thinking about each step they take.

How have you guys used a treadmill to help walking quality?

Weight Shifting and Trunk Elongation

 

We have been working on walking with some kids that are working on improving their weight shifting and all the mechanics that go with that. Many of them have hip weakness which we are addressing but we are also looking at other areas to address as well. With the hip weakness you can often see a trendelenberg pattern (when their hip drops on the leg they pick up to take a step with). One way kids counteract this is to lean their trunk towards the side that they are standing on when they pick up their other foot to take a step. This provides them some hip stability but it decreases their efficiency and increases their energy utilization because they now are actively moving their trunk side to side with every step. It also makes it harder to fix on a target when walking and can cause path deviation.

So, we decided to help them work on elongating their trunk while weight shifting onto the stance side. To do this, we used a balance board to simulate the weight shifting. As their hip strength and overall balance improves we can take the balance board away and have them shift into single leg stance but for now we decided to only add one new challenge to the task and let them keep both feet on a support surface. We placed a target above their right side and their left side that was just high enough for them to reach when they reached overhead.

Once we were set up, we asked them to shift over to one side and at the same time reach overhead to hit the target. This resulted in them lengthening their trunk on the side they were shifted to (as opposed to shortening their trunk because they were leaning to that side). Once they hit the target they shifted over to the other side and repeated the process over there. We did this in sets of 10. After that we did some overland walking with light tactile cues at their hips and verbal cues to reach overhead when they were on their stance leg.

Did it miraculously change their walking? No, but it started to introduce a new motor pattern that will require a lot of repetitions to become second nature, and it will require continued strengthening of the hips. But it is another component to helping with a more energy efficient walking pattern! Just remember, it takes lots and lots of repetitions to change a motor pattern – repeat, repeat, repeat…

What ideas have you tried?

Dribbling a Ball

We were recently working on ball dribbling skills with some kiddos. They had been practicing them off and on for a while but were still finding it hard to dribble the ball while walking down the hallway. So, we decided to spend one whole session devoted to bouncing the ball and progressing this skill. To do this we looked back at the how motor learning occurs and started with blocked practice of the basic skill and slowly added to it to get to the skill we wanted. The best part was that at the end of the session the words ‘that was easy’ were actually spoken – this was so great because when we first said we were going to go out and dribble down the hallway that same child said ‘oh no, that’s hard.’

1. Using a spot on the ground and the wall behind the child we started with bouncing the ball in place on the spot. The wall was used to help provide a cue to stay up tall as there is a tendency to bend at the waist and get closer to the ball rather than bouncing the ball hard enough to come back up high enough. We let the child choose how they wanted to bounce the ball and it usually started with both hands bouncing the ball and then catching it and then bouncing it again.
2. Next, using the same props/cues, we progressed to bouncing it with two hands up to 3 bounces. This way they were working on continuous bouncing and not bounce and catch. Once 3 was mastered we slowly progressed until we got to 10 successful bounces.
3. Next, using the same props/cues, we repeated the above step but by bouncing with one hand. We continued to progress this until we got up to 10 successful bounces with one hand.
4. At this point we moved into the hallway (and this is when the words ‘oh no, that’s hard’ were spoken). We had them dribble the ball while walking for up to 3 bounces. Most used two hands and we let them. Again we slowly progressed until we got to 10 successful bounces while walking.
5. Next we decreased to one hand and repeated the above steps until we got to 10 successful bounces while walking. This was when it was declared ‘that was easy.’

At this point the child began dribbling the ball the full length of the hallway. What was fun to see was that there was control of the ball. Even when it bounced slightly to the left or the right, they were able to maintain control and keep dribbling forward!

Now, in subsequent sessions we will have to continue to practice this but ideally we can begin to decrease the number of steps and then begin to generalize the skill and introduce different games that involve dribbling.

How have you worked on dribbling with kids?

Fun with Painter’s Tape

Looking for easy and fun activities for your kiddos to do at home? All you need is painter’s tape and a little imagination! Here are four different gross motor activities with simple set ups to work on balance, strength, motor planning, coordination, and body awareness.

1. Weaving through spider web:  Use a hallway to span tape from one wall to the next in a varied pattern as seen in the picture. Have your kiddo step over, army crawl under, and crouch through to get to the other side. Giving them a chance to problem solve how to get from one end to the other works on motor planning and being able to adjust their body and avoid contact with the tape challenges their awareness of their body in space. Here are some posts on painter’s tape spider webs, and jungle vines (just adapt for painters tape)!
2. Walk the line: walk forwards, backwards, sideways:  The beauty of painter’s tape is that it can easily be applied and removed from so many surfaces. Regardless of your floor type, you can create patterns on the ground for your kiddo to walk across. This challenges their balance and ability to move with a narrower base of support. You can also have them hop on one foot down the line or hop back and forth between lines to build strength and power. You can add more variety by having your child walk backwards or sideways! Here are some other post on similar ideas such as balance beams, more balance beams, and jumping paths – just adapt and use painter’s tape!
3. Spider web walking:  In addition to lines, you can create a spider web out of tape and challenge your child to walk on the line to get different critters within the boxes or you can have them jump from box to box to avoid touching the spider web! Here is a longer post on this idea!
4. Tic tac toss:  Take the tic tac toe game off the paper and turn it life-size by taping a grid on the ground. Use two different color bean bags to duel it out amongst family members or friends. If you want to add more physical challenge you can incorporate similar concepts to what is explained above including walking heel to toe to your chosen box or hop from square to square to drop it in rather than tossing.

Now grab some tape and let the fun begin!

Jungle Vines

 

We love taking students for their clinical internships. They often bring fresh ideas to our treatment plans. This is an exercise that our most recent student came up with, and of course we have all found a reason to use it with our kids! Feel free to change the name of it, this is the name we use when it is part of an Adventure for one of our kids.

We take our climbing net and we string it up parallel above the floor in our Universal Exercise Unit. The height can vary depending on the skill of the child. For some kids, having it lying flat on the floor will be challenging enough. You can also use an agility ladder for this activity, or create a grid with tape. (we have done a similar activity with tape across a hallway but made it more of a maze)

Because we like to get in multiple repetitions we usually have a toy with many pieces (such as a puzzle or animal bean bags). Then the child can ‘rescue’ friends, or a monster, or whatever they feel like.

It works really well for working on single leg stance as the child usually takes some time when lifting their foot up to clear the obstacle and then place it in the next hole. It also works on balance (one foot and two feet) while they plan their next move and use precision to make it through the jungle. Of course there is motor planning and coordination as they pick their path through the jungle and figure out how they need to move to get to the other side, and then actually execute the plan.

What other ways have you done activities like this?

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?

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

It’s All About Motivation

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?

 

Crossing Midline

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.