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?


May 5, 2015

Motor Groups and RTI

Motor Group

May is Better Hearing and Speech Month and Speech Language Literacy Lab has organized this blog hop with multiple professionals to discuss RTI.

Being a physical therapy provider in the school district does not always provide the opportunity to become involved in Response to Intervention (RTI).  We were lucky enough to be involved in with a school district that allowed us to get involved to help address the motor needs of children at the pre-school level.  We were finding that there were a lot of referrals to physical therapy because some kiddos were not at the same gross motor level as their peers.  While a lot of the teachers implemented gross motor time, they often felt unsure if what they were offering was optimal for the kids they had in their class.  We were able to go in and support them with gross motor groups in the classroom, where the teacher is actively involved and can ask questions about why we are doing different activities, how they can carry those activities over, what else we would recommend for common challenges they were noticing with their kids, and it allowed us to have eyes on all the kids and offer suggestions to the classroom as a whole if we noticed certain skills were at various levels of mastery for the kids.

What has been great with this is the teachers are feeling empowered and supported when they do motor groups every other day of the week that we are not there.  They also have a person to talk to for their questions about motor development and if something is concerning or not.  Most importantly it opens a line of communication between the teachers and us as the physical therapists.  My experience in the school system has been that if a service provider and the teacher and teaching staff can have great lines of communication, the children benefit even more.

Besides these benefits as a therapist and teacher, the students get one extra set of eyes on them as they move through a period of time in their life that is ripe with gross motor development.  At that age, play is where they do their learning and interacting with their peers that sets them up for each successive school year.  While it may not look important whether or not a kiddo is able to keep up with his peers in play, it is a critical part of each child’s development and by implementing structured motor groups, we are setting the teachers and the students up for success.

On a different note, in terms of actual physical therapy services provided for kids, we have found that it has cut down on the number of referrals that were occurring just because the teachers weren’t sure how to help the child.  For children like this we were finding that some education to the teaching staff on how to best support the child would make the difference and they were able to continue to progress with their peers.  The motor group allows us to be proactive in providing teaching staff this support so that the children benefit sooner!


Please be sure to check out the other blogs that have participated in the Blog Hop on RTI for May’s Better Hearing and Speech Month:

Here is The Schedule (Links may take you to the author’s site as opposed to directly to their blog since this post is being published at the beginning of the month):

5/1/2015 Kick Off to Better Hearing and Speech Month!

5/2/2015 RTI for the R sound! Badger State Speechy

5/3/2015 Response to Intervention in High School– A Journey from Abject Frustration to Collaboration and Student Success Stephen Charlton Guest blogs on Speech Language Literacy Lab

5/4/2015 Technology and RTI  Building Successful Lives Speech & Language

5/5/2015 Starfish Therapies

5/6/2015 Orton Gillingham Approach & RTI  Orton Gillingham Online Academy

5/7/2015 Evidenced-based writing that works for RTI & SPED SQWrite

5/8/2015 RTI/MTSS/SBLT…OMG!  Let’s Talk! with Whitneyslp

5/9/2015 RtI, but why?  Attitudes are everything!  Crazy Speech World

5/10/2015      Consonantly Speaking

5/11/2015 Universal benchmarking for language to guide the RTI process in Pre-K and Kindergarten      Speech Language Literacy Lab

5/12/2015 Movement Breaks in the Classroom (Brain Breaks)   Your Therapy Source

5/13/2015 How to Write a Social Story   Blue Mango LLC

5/14/2015 Some Ideas on Objective Language Therapy    Language Fix

5/15/2015 Assistive Technology in the Classroom  OTMommy Needs Her Coffee

5/16/2015 Effective Tiered Early Literacy Instruction for Spanish-Speakers Bilingual Solutions Guest blog on Speech Language Literacy Lab

5/17/2015 Helping with Attention and Focus in the Classroom   The Pocket OT

5/18/2015 Vocabulary Instruction  Smart Speech Therapy, LLC

5/19/2015 An SLP’s Role in RtI: My Story Communication Station: Speech Therapy, PLLC

5/20/2015 Incorporating Motor Skills into Literacy Centers   MissJaimeOT

5/21/2015 The QUAD Profile: A Language Checklist  The Speech Dudes

5/22/2015 Resources on Culturally Relevant Interventions  Tier 1 Educational Coaching and Consulting

5/23/2015 Language Goals Galore: Converting Real Pictures to Coloring Pages  Really Color guest blog on Speech Language Literacy Lab

5/24/2015 Lesson Pix: The Newest Must-Have Resource in your Tx Toolbox Speech Language Literacy Lab

5/25/2015 AAC & core vocabulary instruction Kidz Learn Language

5/26/2015 An RtI Alternative Old School Speech

5/27/2015 Intensive Service Delivery Model for Pre-Schoolers   Speech Sprouts

5/28/2015 RTI Success with Spanish-speakers     Speech is Beautiful

5/30/2015 The Importance of Social Language (pragmatic) Skills guest post on Speech Sprouts

5/31/2015 Sarah Warchol guest posts on Speech Language Literacy Lab

March 19, 2014

Independent Exploration with Power Mobility

Filed under: Developmental Milestones — Starfish Therapies @ 9:00 am
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Independent exploration is an important part of a child’s development.  Power mobility is one way kids with limited mobility can begin to independently explore their environment.  Here is some information on one way to encourage early power mobility in an inexpensive way.

Did you know that there is emerging research on the benefits of early power mobility for high-risk infants? Yes, that’s right, Cole Galloway, PT, PhD and his team of therapists and engineers at the University of Delaware have been converting toy power cars into low-tech power mobility devices for infants and toddlers to begin exploring early mobility through space and are getting some great results. The best part is, with an appropriately sized toy power car, a switch your child can access, some PVC pipe, pool noodle, kick boards, and a little knowledge of power tools and electrical wiring, not to mention the instructions on their website, you can customize a car at a relatively low cost to meet your child’s unique needs. In addition to their first power car design, Mater (see above), the team at University of Delaware is brainstorming new creative ideas to promote motor skills like developing toy power cars that encourage standing by moving forward when the child stands up and power assisted walking by removing the weight bearing surface on their stand up cars to allow the child to take steps.

While only a few case reports have been published to date looking at the benefits of early power mobility with these modified toy power cars, early data suggests that they can improve a child’s social skills, cognitive function, teach spatial awareness, improve communication skills, and provide a functional and age appropriate means of transportation in a home or preschool environment that the child’s peers will love!

We have recently used one of these cars with a kiddo in their school environment.  While they needed some support to use this device, they were able to play with their peers on the playground.  The kids were pretending that they were a train and the kiddo in the car was the engine and the rest of them were the various cars of the train.  All children involved loved it!


For more information check out the GoBabyGo! website. 


  1. Huang HH, Ragonesi CB, Stoner T, Peffley T, Galloway JC. Modified Toy Cars for Mobility and Socialization: Case Report of a Child With Cerebral Palsy. Pediatr Phys Ther. 2013 Nov 20. [Epub ahead of print]
  2. Huang HH, Galloway JC. Modified ride-on toy cars for early power mobility: a technical report. Pediatr Phys Ther. 2012 Summer;24(2):149-54.
  3. Ragonesi CB, Galloway JC. Short-term, early intensive power mobility training: case report of an infant at risk for cerebral palsy. Pediatr Phys Ther. 2012 Summer;24(2):141-8.

October 2, 2012

Using the Penguin Shuffle to Teach Turn Taking

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 pm
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So, Penguin Shuffle is a board game by Milton Bradley from 1995 that is no longer in production.  Our therapist loved it so much she bought it off of ebay and wants to start a campaign to get Milton Bradley to begin making it again (feel free to let us know if you want to join her campaign).  What she loves about it is that it is set up for practicing taking turns.  First one person tries to get their penguin down the shoot onto the carousel and then the other takes their turn.  Depending on the child you may need to provide cues such as verbally saying whose turn it is, or pointing, or shaking the penguin slightly as a reminder that its not the child’s turn.  Ideally you start to wean down off of the cues until they recognize when it is their turn.  Usually you will see two things happen, a child will try to keep going, without waiting for the other person to have a turn, or they will sit there and not realize its their turn.  Its especially hard for the child to wait with this game if their penguin doesn’t make it in the slot and slides off the iceberg because their tendency is to want to try again immediately.  You can even keep track of how many times you need to cue the child during the course of a game and see if it decreases or they types of cues decrease as they get more practice with it.  Of course you then want to see if you can generalize it out to other activities but this is a great game for setting the building blocks of taking turns.

In addition to taking turns, it also can help a child to work on object manipulation to get the penguin standing on his feet in the chute and it can work on visual motor for timing the best time to let your penguin begin his shuffle down the shoot in the hopes of landing on the iceberg carousel.

I know I said this game isn’t available by the manufacturer any longer but has anyone used this game, or a game similar to it that you can also inherently work on taking turns?

May 23, 2012

Water Squirt Toys – Some Colorful Ideas!

image retrieved from:

With the weather getting nicer and nicer, I love to come up with ideas that can be done outside.  One of our OT’s actually thought of this idea and I loved it (and added a few twists).

There are a plethora of squirt toys out there for kids and one of the great things is that they really work on hand strengthening.  You can use squirt bottles, water guns, and those little toys that suck up water and you squeeze them and water shoots out of their ‘mouth’ (sorry, no idea what they are called), to name a few.  As fun as this can be you can add some twists to it by using colored water (with food coloring added in or washable paint added to the water) and the opportunities are endless!

The first idea I had was making targets and seeing how accurate kids could be by trying to hit the center of the target or even certain pictures on the target (by using white paper the colored water will show up).  You can use the different squirt toys and see which can generate the longest stream by measuring how far away the kids can stand and still hit the paper.  This is great work for visual attention and hand-eye coordination.  You could even play around with if they are more accurate standing up, sitting down, kneeling, standing on one foot, etc.

Another idea would be to play ‘tag’ with the squirt bottles and each kiddo gets one filled with a specific color (of washable color) and they all wear white t-shirts.  You can make it a small playing area or a large playing area.  You can make teams of one color or have it all individual.  See who can get the most hits on the t-shirt while the kids run around.  This generates activity, awareness of other kids in their surrounding area, hand-eye coordination, visual attention and hand strengthening to name a few things.

You could even create an adventure with an outdoor obstacle course and have it be a scavenger hunt where they have to go through the course and squirt certain pictures as they go.  For instance have a picture of a star or a circle or a leaf and they get points for each one they are able to squirt.

What are some other ideas you have used for outdoor fun with squirt toys?

May 22, 2012

Gross Motor Ideas for the Park

Now that nice weather is upon us its time to get outside and play with the kids!  Parks are a great place for kids to effectively ‘burn off’ their energy while working on gross motor skills and socialization.  Here are some of the great things about parks:

  • There are other kids around to play with.  They may not even know them but if they are sitting next to each other playing in the sand conversations can start up and they make a new friend.  For kids that need to practice social skills there are lots of opportunities to encourage play and socializing.
  • Kids can climb.  There are climbing opportunities for kids of almost every level.  There are usually changes in height on the ground that little ones can practice climbing up and down.  The stairs that go up and down the play structures offer opportunities for walking or crawling up and down stairs.  Ladders come in all shapes and sizes with different patterns that offer opportunities for motor planning and problem solving.  Also they let kids work on climbing down which can offer its own challenges.  Lastly there are usually climbing walls, fake climbing rocks, chain link nets to climb or arches to go up.
  • Lots of different surfaces to walk or run on to practice balance.  Sand, grass, tan bark, wiggly bridges are just a few of the surfaces that can provide opportunities for challenging balance.  If you take kids shoes off these same surfaces provide great sensory input opportunities.
  • Slides can work on core when kids are learning to go down sitting up, they provide vestibular input, work on depth perception and awareness of height as well as different sensory input depending on if it is straight, curved, steep, in a tunnel, etc.  And if its okay at the park kids can practice climbing up slides (one of my favorite things to do when I was little).
  • Swings are a great place to get vestibular input as well as work on head and trunk control.  If kids are old enough to start self propelling its also a great core workout and opportunity for motor planning and coordinated movement as they figure out how to lean back and bring their legs up and then pull themselves forward while bending their knees all while timing it with the movement of the swing.  Another one of my favorite activities as a kid was to see how high I could swing and then jump off.  We had contests to see who could go the furthest!  You may want to have them practice that on a smaller scale first.
  • Lots of space can be found at parks which is great for running races, games of tag, riding bikes, throwing and catching balls, soccer, frisbees, kites.  All of these activities are great for gross motor development.
  • I also forgot the little ride on toys that bounce back and forth which are fun and provide sensory input as well as problem solving for climbing on and off, and core strength to keep it moving!
  • I almost forgot monkey bars.  This is great for upper extremity and core strength.  You can practice having kids hold on to one bar with both hands or stagger their hands across two different bars.  Make sure you change which hand they are leading with.  And, you can help them learn to traverse the monkey bars.  A great way to work on visual attention with a task as well.

What are some of your favorite activities to do at the park?

March 16, 2012

Beyond the First Jump

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 pm
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I love working with kiddos on learning how to jump.  And then they finally master their first jump all by themselves and I want to jump with them (I usually do).  I get so excited that I forget there can be so much more to jumping.  Don’t get me wrong, jumping all by themselves opens up a world of possibilities for kids.  It can help them with peer interaction, it can assist with self regulation, it can show when they are excited, it can provide them proprioceptive feedback and it can strengthen their legs as well as help to get the wiggles out of them.

Once they are able to jump up into the air with two feet leaving the ground they are on their way to becoming jump masters.  I know it seems like jumping up in the air should be all it takes but there are jumps beyond this basic jump that you probably haven’t even stopped to think about.  I’ll name a few below:

  • Jumping multiple times in a row
  • Jumping forward
  • Jumping backwards or sideways
  • Jumping in a circle
  • Jumping up for an object overhead
  • Jumping off of a height (like a step, curb, chair, etc)
  • Jumping onto a height (like a step, curb, etc)
  • Jumping over something
  • Jumping open and close (like in jumping jacks)

I’m sure there are plenty of others that I am forgetting but these are plenty to get you started with your jumper!  With each new task your kiddo has to go through a different set of motor planning, as well as mental readiness before they can do the jump that is needed.  What I do now is I just start adding in scenarios for kids to practice different types of jumping (once they are able to jump with two feet – although sometimes I will start a few of these while they are still learning to jump).  For instance, for jumping off of things, if I am having them practice the stairs or a balance beam or stepping stones, I will usually hold their hands and have them jump off with my help.  This way jumping off of things becomes routine.  Jumping up for something is the one that always surprises me as being more challenging than I would have thought.  I will usually use things like the stacking cups and hold them up in the air so the kiddo will jump while trying to reach for them.  Or I will use suction cup balls on a wall/window/mirror and have the kiddo jump up to try to pull them off the surface.  Jumping forward works really well with colored spots or using a hopscotch board because you get great visuals.  We also work on numbers at the same time.  If I make the pieces into a straight line so its a number path from 1-10 we start with jumping on each number and then we switch to jumping only on evens and then only on odds.  I usually have to give a hand hold assist to help them get the clearance.  I also use hopscotch boards to work on jumping open and close.  I love the boards that let you move the numbers around!  Jumping onto things I start with something that’s barely elevated.  I use these foam colored spots that we have that are maybe a little over a quarter of an inch and I have the kiddo jump onto the spot.  Then I may have them jump onto the mat (which is maybe a little over an inch high).  By doing it this way they often don’t realize they are jumping up onto something and don’t have time to mentally psych themselves out.  Same with jumping over something I start with something little like a line and then I may have them jump over my leg and slowly increase the height until they aren’t even thinking about it.

These are just a few ideas for progressing jumping.  I’d love to hear other ideas you have or any questions you have about different jumping tasks!

March 2, 2012

Easter Egg Hunt for Motor Skills


Ok, now don’t judge, but the original inspiration for this idea came from a ski trip I took with some college friends (a year or two after graduation) over Easter weekend.  Two of our friends arranged an ‘adult’ easter egg hunt with jello (of the adult variety) in each Easter egg.  Well we were all like big kids because of course we each had certain colors (and flavors) we wanted to find!

Now, translate this to a kids Egg hunt and here are some ideas:

  • You can fill each egg with a different motor skill you want the kid to do and you could have numbers on the egg for number of reps or that could be included on the paper with the skill.  I would also add in fun ones such as ‘play a game on the wii’ where they are still working but think they are playing!
  • You can put pictures of different skills or games in the eggs so the kiddo has to go find the object/game or perform the skill.
  • You can put different sensory materials in each egg and the kiddo can explore the textures.
  • If you put finger paint in each one they could use the paint to add to their picture (of course you would have to wipe their hands off after each egg)
  • Make it into a treasure hunt for direction following.  Each egg gives a clue as to where the next egg is hidden.  For instance they could have to hop down the hallway to find the blue egg and then that egg would give the next set of directions. The final egg could lead them to something fun!
  • Fill them with beans or rice or sand and have the kids have to shake them to guess what is inside, and to make music!
  • Ask the kiddo to find a certain number of each color so they get to work on color recognition and numbers.
  • You can also mix and match the colors and then when the kids come back they have to put the correct colors together as a group or individual.
  • And, the best part is that opening the eggs works on fine motor skills!

What other ways have you found to use an Easter egg hunt?

PS- Try the adult egg hunt too, its lots of fun!

February 24, 2012



Since I just took an extended holiday weekend and went skiing, I for some reason couldn’t turn off my PT brain and I found myself analyzing what I was doing (other than falling) as I made my way down the slopes.

I can tell you right off the bat that your quads get an amazing work out.  Not only were they burning as I was going down the slopes but they are still sore and I can feel them every time I stand up or go up and down the stairs.

My other sore muscles are my calves and that’s because being on skis encourages you to shift your weight forward so your calves are working to keep you from falling flat on your face.  This is the same way your calves (and quads) are used when you go down the stairs, they slowly elongate to keep you from falling.

When you are shifted forward on your skis going down hill you could stay in that one position but I can pretty much guarantee you will go speeding straight down the mountain.  In order to control your speed you need to weight shift from side to side as well as turn your skis slightly (or drastically) back and forth.  This is great practice for weight shifting which is important for walking.

When you are shifting forward and side to side, you need to keep your head and trunk upright and looking down the hill which helps to develop righting reactions as well as trunk rotation (for when you turn your skis side to side).

By looking down the hill or to your next target (especially if you are doing moguls) you get to work on maintaining visual focus despite other things going on around you.  You also get to anticipate what you are going to do next and work on your anticipatory balance reactions.

And believe me, skiing will work on your balance all around!

There are plenty of other things that go into skiing but that is the basic breakdown.

Now, when kids (or adults) first start out they learn how to maneuver with skis on their feet.  I remember practicing with a kiddo who was going to go skiing for the first time.  We were practicing on dry land so that she would have some idea of what to expect and thereby feel more comfortable with this new activity.  We practiced moving our feet from ‘pizza’ (pointing inwards) to ‘french fries’ pointing straight ahead. I would give the command and she would react.  This gave her the opportunity to work on reaction time, motor planning and coordination.  Lastly we practiced falling.  The main purpose for that was so that when she fell she wouldn’t get discouraged and would stand up and ‘brush it off’ or ‘shake it off’.  I was so excited to hear that her first skiing opportunity was not only a success but she wanted to do it again!  Ski school is a great chance for your kids to learn with their peers and work on social skills while they all learn a new activity.

For kids that have more involved needs there are some amazing adaptive skiing programs out there.  This family talks about their discovery of skiing and the upside of going downhill!  I also work with a kiddo who participates in adaptive skiing and he loves it.  The smile he gets on his face when you ask him about it says all you need to know about the benefits of this activity that is ‘typical’ among his peers.  Here are some of the adaptive ski programs I know about but please feel free to add to the list.

February 10, 2012

Balloon in the Air


In our group this week we decided to challenge the kids a bit and add in hitting a balloon back and forth to each other.  We even felt a little ambitious and had a second balloon ready to go just in case we could add two into the mix!  Boy were we over ambitious on that thought!  I had realized some of the benefits of hitting a balloon with your hand back and forth (or even just with you trying to get it) but it wasn’t until I watched these kiddos try to grasp the concept that I saw all the skills they were working on.

Visual Tracking – The kiddos had to follow where the balloon was going so they could be ready if it came to them.  This involves following the balloon with their eyes to see where it was going.  We often had to provide extra cues to help with this.  We would say their name and we would point to the balloon as it was coming to them.  When one of the adults hit the balloon we would say the kiddo’s name that we were hitting it to to try to help them follow it and be ready.

Hand Eye Coordination – This was challenging.  They had to not only follow the balloon by visually tracking it, they then had to time and motor plan how to hit the balloon when it came to them so that their hand actually connected with the balloon.  We found that many of the kids had a hard time with the idea of batting it with their hand because they wanted to catch the balloon (this is when it may be handy to use a fly swatter or tongue depressor attached to a paper plate).  And when they did make contact with the balloon they had to try to bat it back into the air and towards one of their friends.

Motor Planning – I already mentioned the motor planning involved with batting the balloon with their hands but they also have to plan out how to move their bodies so they can get to the balloon and hit it up in the air again.  This involves timing, balance and body awareness.

Balance – For some of the kids they got to practice their ability to anticipate a movement and maintain their balance before, during and after the movement.  With one of the kiddos who has a hard time maintaining standing balance when asked to do a task, we practiced it a few times and he went from losing his balance every time he hit the balloon to being able to remain standing!  For one of our older kids that we work with we actually used it as a balance activity and had her stand on an unstable surface while she had to hit the balloon back and forth with another person.

‘Ball’ Skills – All of the younger kids initially wanted to catch the balloon and then throw it.  We had to spend some time breaking down the task and ‘teach’ them to hit the balloon with their hand when it was coming towards them.  This was a whole change for them because usually they are asked to catch a ball which is a different set of skills than hitting it away with their hands.

Counting – We decided to make it a ‘game’ to keep their interest so we were trying to see how many hits we could get before the balloon hit the ground.  During this game the adults tended to hit the balloon more but the kids were all counting out loud with each hit, allowing them to work on 1:1 number association.

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