Starfish Therapies

March 26, 2017

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

Bike 2

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

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

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

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

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

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

March 19, 2017

What is the Vestibular System?

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

 

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

 

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

 

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

 

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

 

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

March 12, 2017

Development of Refined Movement

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

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

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

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

March 5, 2017

Monkey Bars

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 am
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We get a lot of kids who want to get better at monkey bars. Its something that their friends and classmates are doing with ease and they are struggling back at the first monkey bar, or having to have someone help them across.  Here are some ways we have found to help them:

  1. Get used to swinging/holding onto one bar. This could look like holding onto the first monkey bar and letting their feet swing once, twice, three times, or more.  Or have them hold onto an overhead bar for a count of X before they drop down to the support surface.  This gets their hands and arms used to gripping onto the bar and supporting their weight, as well as the feeling of having their feet unsupported
  2. Use a trapeze. We have a small trapeze that we let our kids swing on.  Some of them struggle with the core strength to pick their feet up off the ground to swing.  We have remedied that by putting the trapeze close to a wall and using a large therapy ball or peanut.  We have them hold onto the trapeze and help them get their feet onto the ball.  They then get to push off and swing back and forth as many times as they can.  They begin to start trying to get their own feet on the ball which supports their core strengthening.
  3. Knee walking or walking. We are lucky enough to be able to recreate monkey bars indoors and we have a treatment table that we can put under it.  We could also use a balance beam or any other elevated surface so that their feet are supported while they traverse the monkey bars.  We then have them work on reaching through with their hands so that only one hand goes onto each bar.  This lets them practice the coordinated movement of reaching through with their hands, and looking at the next bar, without the added strain of supporting their own body weight.
  4. Swing through. I know reaching through to the next bar so that only one hand is on a bar at a time may seem harder, but we have found it to help the kids we work with.  When they get two hands onto the same bar their tendency is to turn off their core.  This stops any momentum they have going and have to generate the energy all over again to move to the next bar.  By swinging through and only putting one hand on each bar they are working on the efficient use of momentum and keeping their core engaged which decreases the work on their hands and arms.
  5. Practice, practice, practice. Lots and lots of repetitions of all of these techniques as well as just going across the bars.

I don’t want you to think we forgot about core and upper extremity strengthening, because we didn’t.  We focus on those areas as well, but I limited this post to working on the actual monkey bars.

What are ways you have successfully worked on monkey bars with kids?

February 19, 2017

Using a Swing to Work on Jumping

We have recently had several kids who are struggling with jumping.  Sure, they clear their feet when they jump, but they are relying on using their hips to lift their feet, rather than push off through the toes.  And learning how to land so that they are primed to either jump again, or absorb the shock, has also proven challenging.

So we decided to brainstorm one day and one of the suggested ideas was to have the child lie on their back on a platform swing, move them forward so their feet are touching a wall, and have them push off.  As they swing back they will practice absorbing the shock and then pushing again.  By having them lie down, their body is in a similar position to if they were jumping in standing. We found the kids loved it.  We had to show them a couple of times what to do, and occasionally slow the return down while they were still getting the hang of it, but once they figured it out, they were self propelling themselves on a swing.  I don’t know about you, but a majority of our kids love to swing.

Of course, then we decided to get creative.  We had them sit at the end of the platform swing to do it.  We also used a typical playground style swing after the platform swing.  We still had them practice pushing off (and work on the components of jumping) but by having them sit up and hold onto the ropes, they also began to work on the idea of controlling their momentum and how to move their trunk so that it could carry over to swinging at the park.

If kids are working on single leg hopping, or leaping from one foot to the next, you can also do all of the above and have them work with only one leg, or alternate legs (and that sneaks in some coordination)! Also the repetition is great for strengthening their legs and core.

If your swing isn’t set up so that a child can push off a wall, you could also have someone hold a large therapy ball at the end and stabilize it so they could push off of that. Because it has a little more give, they won’t get the same force but it mimics the feel of a trampoline.

Has anyone else tried something along these lines?  Have you modified it in other ways? We’d love to hear from you!

February 12, 2017

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

eccentric-abs

Our abdominal muscles (or Abs) play a big part in our core muscles.  They aren’t the only part but they are a piece that makes up the whole.  It requires coordination of each of the different muscle groups to help create a stable foundation so that we can move our arms and legs effectively.

What do I mean by eccentric abs?  Well when a muscle contracts it can do it a few ways.  One of those ways is eccentrically.  This post about squatting helps to explain the difference between eccentric and concentric muscle control.  But basically, eccentric contractions, or slow lengthening of the muscle, helps to give us control.

When we do sit ups we are asking our abs to perform concentrically, or to shorten.  When we do planks, we are asking them to perform isometrically, or to stay the same length to hold us stable.  So when do we work on them eccentrically, and why is this important?

Well we use our abs eccentrically also.  We use them to help us control our movements. Think about balance.  If you get bumped and your top half is moving backwards, you want your abs to be slowing that movement down until they can use a concentric contraction to bring you back up to midline. When I started thinking about this, I started wondering how I could help kids practice eccentric control.  For our quads (leg muscles) its easy, we practice slowly sitting down in a chair, or do squats, or slowly step down from a step.  If we ask people to slowly lower down from a sit up position, they will definitely work on it some, but chances are they are going to use their hip flexors (the front of their hip) to help control.  Especially, if its a child and they need us to stabilize their legs.

So, how do we focus on the abs and not get primarily the hip flexors? Well one way we came up with was doing a ball pass.  This can be done in sitting, standing, high kneeling, half kneeling, or whatever position you want to try where the trunk is upright.  Make sure the child is guarded properly to maintain safety, and then have them reach back over their head with both hands to get a ball from someone behind them.  They can then throw the ball at a target in front of them.  After you do a bunch of repetitions this way, have them start with the ball in their hands and then lean back to try to drop in in a basket behind them.  Not only will this engage their abs, but they will also get to work on balance in whatever position you have them in.

February 5, 2017

Encouraging Independent Exploration

mater

As a pediatric physical therapist, one of the things we hear the most from parents is, ‘I want my child to walk’. And this is completely understandable.  Its how we get around, how we explore the world. However, what if walking limits the child’s independence?  I’m not here to say what is the right way to do things and the wrong way to do things but just to raise some things for families to ponder as they continue to support their child’s growth and development.

Children are always interacting with the environment.  When they are really little they are limited with their abilities.  Mostly its what is brought to them or what they can see from their current position.  As they grow and get stronger, most kids start to develop some independent movement.  That could be rolling, getting into sitting, scooting, crawling, pivoting, standing, cruising, walking, etc.  Each change in movement and ability changes their perception of their environment and how they interact with that environment as well as the people around them.  For the first time they can see something and figure out how to get there if they want to learn more about it.  Its amazing how resourceful kids can be when they want to be.

For kids who have delays, for whatever reason, independent exploration can be hard for them. They are often dependent on others to get them from one place to another, or to bring the world to them.  What if we could work hand in hand with them to discover alternative methods of having the independence to explore their environment or move without anyone’s hands on them, while at the same time continuing to promote their gross motor abilities.  There are some great tools out there that can increase mobility for kids, from an early age.  While I know using assistive devices or wheeled mobility is not for every child or family, it is an option to give them that independence while their other skills are still developing.

I’ve linked to some resources above, but one of my favorites is the work of Go Baby Go and their use of powered kid cars that have been adapted with increased support as well as switches to make them go.  The kids love them!

I would love to hear from people about their experiences with using early mobility to increase independence vs focusing only on gross motor milestone development.

 

 

 

January 29, 2017

Growth Spurts

When working with kids, growth spurts are always something we have to take into account.  I can remember as a child feeling like I had these arms and legs that weren’t connected to me making me even clumsier than I already was.  On top of that I think I was hungry all the time too.  Almost all kids go through growth spurts at various times during their developmental years so I just wanted to take a moment to point out some things to consider during these times.

For all kids, when they grow rapidly their bones change lengths, their muscles have to adjust and as a result their ability to sense where they are in space has to alter.  It doesn’t happen overnight (hence me feeling like my arms and legs weren’t attached) and during the time when their bodies are adjusting to these new proportions they may be a little on the clumsy side.  Just think for a second of your house and your daily routine.  I bet you know exactly where everything is and can almost go through your morning routine in your sleep.  Now imagine that someone came in during the night and moved everything around.  I bet it would throw you off for a few days while you adapted to the new layout.  That’s how kids have to adapt to their ‘new’ body.

When a child has low muscle tone or high muscle tone there are other things to consider.  For a child with low muscle tone, they are working hard to maintain strength and stability.  Their muscles get good at working at a certain length and they begin to progress their skills.  Now they grow suddenly and their muscles are longer and all of a sudden they aren’t as efficient and their endurance is decreased.  They will show some weakness and have a harder time with postural stability and overall functional skills.  This is their period of adaptation to their new size.  It just may take them a little longer, and they may look like they have regressed.  You may have to give them a little more help or a little more time for a short period, but the good news is, they get back to their previous abilities much faster than the first time around when they were just learning the skill.  That’s because their body already knows what to do, they just have to figure it out at this new size.

Hopefully this helps explain some of what you may see as your child is growing and they appear to change over night, don’t worry, its not permanent!

January 15, 2017

Ideas for ‘Weight’-Training at Home

Weight training is not usually the first thing that comes to mind for pediatric therapy but its a big part of it.  We are big believers in strength/weight training for our kiddos to help improve their function.  It helps them to more efficiently activate their muscles, improves muscle isolation, helps movement to be more efficient and cuts down on compensatory movements and strategies.  For some of the kiddos we see in the clinic based setting we are able to use the Universal Exercise Unit to help promote strengthening, however not all of our kids come to the clinic or are able to use this piece of equipment so I have had to get creative on ways to strengthen that is still fun for the kids.  Here are some of the exercises we do for strengthening:

Leg Press – To get a good leg press I like to use resistance tubing.  I have bought one that has handles already built in that work great.  I have the child lie down on the ground and wrap the tubing around a stable object at their head (a table leg can often work).  I then put their foot in the handles and I control their leg while they push out (making sure that they don’t hyper extend their knees).  Its easiest to do this one leg at a time.

Hip and Knee Flexion – To do this one, I just reverse the above exercise.  I have them lie down with their feet facing towards the table and put one foot in the handle (the band should be resting taut) and then have them pull their foot up by bending their hip and knee.  Again, make sure you control their leg to avoid and torque at the knee.

Scapular (shoulder blade) Retraction – Take the same resistance tubing as above and tie it around a door knob (make sure the door is shut). You can also hold it for them (like in the pictures).  Then have the child stand (or sit) across from it. They are going to hold one end in each hand and slowly pull back while squeezing their shoulder blades together.  Make sure they keep their elbows bent at approximately 90 degrees the whole time.  Once they have pulled back, then they are going to slowly bring their arms forward again.Their body should be staying still during all of this, and the only movement should be from the arms and shoulders.

Weighted Squats – You can use a weighted ball, heavy cans of food, a bag of flour, or anything else that your child may consider to be heavy.  Have them squat down to pick it up off the floor and then stand up and place it in your hands or on a table or other surface.  If you’re using a ball, my favorite way to get them to do more is to have them give it to me and then pretend I drop it and ask them to pick it up again.  They generally think its funny that I can’t hold onto it!

 

 

January 8, 2017

Righting Reactions

What are righting reactions you may ask.  Righting reactions are the reactions that help bring our head, trunk, and body back to midline so we can keep our balance.  They help us to be able to stand on a boat, or a moving train.  They help us to regain our balance after we catch our toe on something, or to be able to walk across an unstable surface.  Basically they are pretty important.

Righting reactions start to develop right away.  That’s what head control is all about.  When a baby can hold their head stable, their righting reactions are easier.  That’s because their inner ear sends messages to the rest of the body about where it is in space.  If it’s not where its supposed to be, the body is able to begin the correction process it to bring it back to where it should be.

After head control, trunk control follows.  This allows your baby to sit up and not fall over.  Initially they are like that house of cards you may have built, they have to be in exactly the right position and you can’t even breathe on them or everything might topple.  But as they learn to react to the messages being sent about their position, and their muscles get stronger and react faster, they are able to play and pivot and reach and do all sorts of things in sitting.

Standing follows sitting (yes, there are other places that righting reactions work such as hands and knees but for this purpose we will move on to standing).  In addition to the head and trunk control there are three general reactions to help keep you in a standing position: ankle, hip, and stepping.  The ankle reaction is when you have a slight instability and sway just a bit at the ankle to find your middle again.  The hip reaction is for a slightly bigger and faster balance disturbances and you bend forward or backwards at your hips to keep yourself standing.  And lastly, the stepping strategy happens when you need to adjust your base of support (foot position) so that you can stay upright.

Hopefully this gives you a general idea of what our bodies do to keep us upright and what your child is working on as they begin to navigate through the developmental milestones.

 

 

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