Starfish Therapies

May 22, 2017

The Power of the Calves

star jumps

I don’t know about you, but I have had many children over the years that really struggle to use their calf muscles in an efficient and effective way. This could be due to many reasons but there is probably some underlying weakness and coordination challenges. I have seen this a lot in my kids who are toe walkers. Now I’m sure some of you are saying ‘wait but they walk on their toes, doesn’t that mean they use their calf muscles and they should be nice and strong?’

Not necessarily. Because they tend to walk on their toes (this may look like they are up high on their tip toes or it may look like a shuffling walk with the foot mostly flat but never getting a heel strike first) they aren’t moving through the full range of motion at their ankles and so their calves are only working in a very small range. For the kids up on their tip toes they are really strong in that one position but they would fatigue pretty quickly if you were to ask them to do multiple heel raises in a row. For kids whose feet look flatter but they are still not hitting with their heels first, they are tending to constantly stop a ‘fall’ forward by catching themselves on their foot and then ‘falling’ forward onto the next foot. They aren’t using their calves to help them push off to lead into the step, but rather ‘falling’ into the step.

So as you can see calves work in two ways, they help to control your step forward by supporting your body weight as the muscle slowly lengthens, and they also help to push off by shortening the muscle to give you power to go into the next step. These are also helpful for jumping and running activities to name a few.

Hopefully all this is making sense. I really started this post to give you some ideas for how to work on the calf muscle to help your kiddos use them more effectively and efficiently!

  • Scooter Board Push – I was inspired when I came across this post. I have a few kids that I have been trying to get creative on ways to work on their calves. I actually tried this one out and the kiddo I was working with loved it! He loves to do puzzles so we put the puzzle pieces on one side of the room and were assembling it on the other side of the room so he had to push me back and forth to get all the pieces. Because of the size of the room we had some extra challenges because he had to turn a corner as well causing him to work on his motor planning. In the beginning he had some trouble and would try to go down on his knees to push or I would help him too much so he was just walking and not pushing through his feet but he eventually got it and was so excited when we would get going fast and when we could turn the corner without running into the crash pad! I completely recommend this activity. Just an FYI, carpet causes them to work harder!
  • Wall Push Offs – You can do this one on a scooter or a swing. With a scooter you can have competitions to see how far you can push each time and if you can get further than your last time. Or you can set up bowling pins that when they push off the wall they have to try to knock them over and see how many tries it takes before they’ve knocked them all over. You could also use an exercise ball and have them push off of that and see how many pushes it takes to get down the hallway, and then try to get fewer pushes on the way back! Obviously you would have to move the exercise ball to them each time and hold it stable while they push.
  • Furniture Gliders – With the smooth side down on the furniture gliders, have them put their hands on the top side. Then create a course with painters tape and have them push their hands all along the path. The key is to make sure they are pushing with their feet and not dropping down onto their knees. You can change up the course and make it straight lines, curved lines, zig zag lines, or have it be a treasure hunt/maze where they have to follow the lines to get to bean bags or puzzle pieces and then they bring them out of the maze before going back in to collect the next one! If you don’t have furniture gliders you could do this with bear walking but its definitely more fun with being able to push yourself around! You could also try putting their hands on a scooter and pushing that way if you don’t have furniture gliders!
  • Step Downs – Stepping down slowly really helps to work on having the calves control the body weight as it lowers down. That being said, this is often hard for kids to control. We have tried putting a stomp rocket on the ground below the step so they have to step onto the stomp rocket to get it to go. If possible I recommend doing this without rails. You can change the height of the step to make it easier or harder. And the kids love to shoot the stomp rocket. We generally have targets that we aim for. You can give points to each target and have them try to get a certain number of points by hitting them with the rocket.

What are some ideas you have for calf strengthening with kids?

May 14, 2017

Ideas to Target the Core

wheelbarrow

bridging

modified plank

I don’t know about you, but I know my core muscles (abdominals, back extensors, shoulder girdle, and hips) can always stand to be stronger. This also goes for our kids, typically developing as well as kids with a neuromuscular challenge. While there are lots of ideas for targeting specific muscle groups, sometimes its good to do exercises that get a bigger bang for their buck. There are some exercises that can target multiple areas of the core at the same time. Here are a few:

  • Planks – Planks are great for getting all areas of the core. Of course they are not easy, especially if you want to maintain good form. For those just starting out with a plank you can go on your hands and knees and bring your hips in a straight line with your trunk. To make it harder to you can move to your hands and toes (or forearms and toes) and keep your whole body in a straight line. To make it even easier, you can use a bench or a table and put your hands on there so you are at an incline. The goal is to be able to hold your body in a straight line without having your belly sag or your hips sticking up in the air. Find the level of difficulty that lets you maintain that straight body. And start small. If you can hold it for 15 seconds then do that. Slowly increase your time and then increase the difficulty!
  • Wheelbarrow Walking – This also targets multiple areas, the hips don’t get as much work unless you are being supported by the ankles, but its still great for the shoulders and trunk. You can use a scooter board and sit on it and hold them by their trunk, or their hips, or their thighs, or their ankles (the further out you hold them, the harder it is). Use a hallway and have something fun like a book or a puzzle at the end that they get to do something with each time they get down there. You can also use a rolling stool. This changes the angle and makes it harder. Even harder is you just standing and walking while supporting them. Again, the goal is to hold the body straight so find the level of support that allows them to do this and gradually work your way out towards their ankles and up to you standing!
  • Walk Outs – Use an exercise ball or a peanut ball or even a foam roller (the exercise ball will be the hardest because it can move in multiple directions). Place a puzzle and its pieces a little out of reach and have them lie on their stomach on the ball and then slowly walk out their hands as far as they can go while maintaining a straight trunk and hips. Then put a piece in the puzzle and walk their hands back. Keep repeating until all the pieces are done. You can also use beanbags, or other toys that involve multiple pieces.
  • Bridging – This one really targets the hips but also works on the trunk. I’ve talked about ways to work on this in other posts. You can get creative with how to make it fun, such as balls or cars going underneath. You can also make it harder by putting one foot on an elevated surface and the other one on the floor, or both feet on an exercise ball or peanut (or other unstable surface). You could just do one leg and keep the other leg up in the air. You can do reps of up and down, or you can go up and hold it for longer and longer periods of time.

What are some of your favorite ways to work on the whole core?

May 7, 2017

I Won’t Stand for That! (unless I learn how)

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 am
Tags: , , , ,

sitting down

Pull to stand

Learning to pull to stand can come naturally for some kids, and for others it can require a bit of work. This video is one where it came naturally (please note the emerging balance reactions at the end of the video – I love to see kids getting to experiment with this). As he was learning to crawl and explore he naturally began experimenting with pushing or pulling up to stand. This may have started with your legs, a coffee table, an oversized bin, the couch, or a chair. Basically anything that is off the ground and their hands can reach. When they get to it, their natural curiosity has them try to see what’s up there, or what’s on the other side. They become successful at it when the ability of their muscles matches their curiosity!

For those kids that require a little more help, here are some ideas you can try:

  • Sit to Stand – If your child can already sit independently, have them sit on a small stool really close to the couch or an activity table or a chair. Have a preferred toy or activity on the support surface. Help them to put their hands on the support surface and move into standing. Let them play for a bit and then bring them back down into sitting and repeat again. This helps them to strengthen their leg muscles, as well as learn that if they move into the new position, there might be something they like there!
  • Playing at Support Surfaces of Various Heights – When your child can crawl, or even kneel, create an environment where they have different heights to explore on. This could be the couch, the coffee table, an activity table, an overturned storage bin, a foot stool, etc. Put toys or activities that are motivating to the them on the support surfaces, and be there to engage as well. They may begin to experiment with pushing or pulling up onto extended legs. You can also line them up near each other. For instance, have the activity table touching the couch and a little bit away have an overturned bin touching the couch so that you have made a U of activities at various heights. Let them start at the lowest height and then make them aware of the activities or toys at the higher height. They can use the lower height to help them problem solve how to reach the higher height. This can also help them learn how to lower back down to the ground because they may want to get back to the toy or activity at the lower height again.
  • Crawling Over Obstacles – Learning to crawl over obstacles helps kids to develop their total body strength as well as have to problem solve how to get to where they want. This can involve pushing up onto extended legs before they go over the obstacle, or even just crawling right over. It engages their curiosity about what is ‘on the other side’ and if you use toys that are motivating, they can crawl back and forth along the same obstacle path for many repetitions! Use your legs, couch pillows, piles of blankets or towels, small upside down storage containers, etc.
  • Manual Assistance – And sometimes you just have to give them the extra support and take them through the motions. So if you are at a support surface, and they are on their knees with their hands on the surface, help them bring one leg forward so their foot is resting on the floor (half kneel) and then give them a little boost at the hips to go all the way up into standing. Take turns with which side you help them with so they get to develop strength in both legs, as well as so that each leg learns that it can push without the other leg right next to it!

What are other ways you have taught kids to pull to stand?

April 30, 2017

Strong Outer Hips (aka abductors)

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 am
Tags: , , , , ,

bridgingside step hip abduction

One of the muscles we focus on when we are working with kids, or young adult (or even ourselves if we’re being honest) is the hip abductor, or the outer hip muscle. This muscle may be on the smaller side but it is mighty!

When this muscle is strong it helps to stabilize your hips for every day activities like walking, standing, running, climbing stairs, crawling, and on and on and on. If you have a strong hip abductor and you pick up your foot to take a step it will hold your hips level so that you have a nice smooth walking pattern. If your hip abductor is weak, it will not be able to keep your hips level and when you take a step a few things could happen. Two of the most common things are:

  1. when you pick your foot up, your hip on that side will drop down as compared to the hip on the other side, or
  2. when you pick your foot up, you will lean your head and trunk away from that foot so that you are creating a counter balance to help keep you stable.

So why is this a problem? Here are a few reasons:

  • For a little one first learning to walk, if they don’t have the stability at their hips it makes it harder to take those independent steps and they will want to hold on to support surfaces longer
  • For a little one first learning to crawl, they may have finally mastered getting on to their hands and knees, but they don’t have the stability to lift one of their legs to bring it forward, and every time they try they collapse back down on to their belly
  • For someone who may have spasticity or higher muscle tone in their inner hip muscles (adductors), they may scissor their legs when they walk (cross them in the middle rather than stepping straight in front). If their abductors are strong they can help to counteract the scissoring pull and make walking a bit more efficient.
  • For anyone working on running, your hips will do the same thing as with walking if its weak, except you are putting more stress on your knee with every step you run. This can lead to overuse injuries and knee problems that can cause pain and lead to limited physical activity.

So what can you do? Here are a few ideas for exercises:

  • Sidestepping – depending on the age and skill of the child, this can look like cruising back and forth at a support surface, or it can be walking sideways down a hallway, or even adding resistance tubing/banding while walking sideways (make sure to lead with each foot)
  • Bridging – depending on the age and skill of the child, this can look like lying on their back with their knees bent and their feet flat on the floor and having them lift up their bottom (you can make it fun by driving cars under the ‘bridge’ or rolling balls under), or it can be holding the bridge position for longer periods of time, or while you are in the bridge position lifting one foot off the ground and then the other, or just doing one leg bridges, or even adding a resistance band around your thighs to push against while doing two leg bridges
  • Climbing – depending on the age and skill of the child, this can look like crawling up and down stairs (or couches), climbing on ladders at the park, using a climbing wall (even better is to traverse side ways on a climbing wall or park climbing structure)

What are some ways you have worked on the abductors?

April 25, 2017

The Value of Peer Play

peer play

I was recently at a school working with a kiddo. This child has made huge gains and is now easily able to access her school environment. The one area that is still a slight struggle is the play structure. She is able to do all points of access on all the play structures in her school. The challenge is that she doesn’t want to. And she doesn’t want to because she thinks she can’t. Even after doing it successfully she will still not want to do certain ladders. The other challenge is that if I push her, there is a potential for a meltdown. So I have walked the fine line between challenging and stepping back, in order to boost her confidence on the various ladders of the play structure. Now don’t get me wrong, she will do the stairs, the slide, and most standard ladders. Its just when they look a little different that she doesn’t want to do them.

So, back to my story. This day, while we were heading out to the play yard for recess after doing some work in the motor room, her friend from her class ran up and asked her to come play. They usually play together but it generally involves running around and trying to tag each other. This time her friend wanted to go on the play structure. She went with him and she climbed up the stairs and then I could see him coaxing her to do the ladders with him. He got her to climb down one ladder and then patiently brought her to each ladder and stayed with her the whole way up, encouraging her and showing her how he did it. There were times she would only go up about two steps and then come back down and run away. He was able to run up to her and bring her back in a way that she was still having fun and laughing, that I wouldn’t have been able to do. She didn’t realize he was making her work, she just saw it as playing with her friends.

Its moments like this that I love being able to step back and observe the kids I work with interacting with their peers. This interaction was just as, if not more important, than the time I spent with her.

What are ways you encourage peer play and then step back and let them go?

April 17, 2017

Hand and Foot Play

Hand and foot play is an important part of a child’s development.  So is bringing the feet to their mouth (unfortunately I didn’t get a good picture of that!).  So what are some of the reasons it is so important?

  1. Hamstring stretches – They just spent 9 months cramped up in the ‘fetal’ position. This means their knees were flexed and in close to the body. By reaching for their feet they are beginning to perform hamstring stretches that will help to lengthen the muscle.
  2. Core strength – By lifting their feet up and reaching with their hands, they are working their abdominal muscles which will help to develop their core strength. You try lifting both your feet up and reaching with your hands. Its not easy work on those abs!
  3. Midline – You can see in the pictures that they can bring their hands and/or feet to midline which helps to increase their awareness of where midline is.
  4. Body awareness – Hand and foot play allows your baby to explore their body and the various parts of their body. They begin to realize that their feet are attached to them and that their hands and feet can work together.
  5. Exploration – Once they are participating in hand and foot play, you will probably see them putting their feet in their mouth. This is how babies explore. They put everything in their mouth, including their own toes!
  6. Movement – As you can also see in the photos lots of movement is happening. He isn’t just lying flat on his back holding his feet. He is rocking back and forth, dropping one foot, picking it back up again, etc. This helps to create building blocks for movement and cause and effect. If they end up on their side, what do they have to do next?
  7. Self-soothing – When they are engaged in play with their feet, or putting their toes in their mouth, they are also able to self-soothe. This can help with sensory regulation.

If your child isn’t doing this, you can help to encourage them.  Gently bring their feet up towards their hands. Maybe help them to put their hands on their feet and try to grasp them. You can make a game out of it by playing peek-a-boo behind their feet so that their feet are in midline when you are ‘hiding’. You could also do ‘This little piggy’ while you have their feet up in the air and count each toe. You can play ‘patty-cake’ while holding their hand and feet together and bringing them to midline for each ‘clap’.

What are other ways you have encouraged hand and foot play?

April 8, 2017

Fun with Balance Beams

Filed under: Developmental Milestones — Starfish Therapies @ 11:39 pm
Tags: , , , ,

balance beam 1

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

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

balance beam 2

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

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

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

balance-beam-3.jpg

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

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

balance-beam-4.jpg

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

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

vision-free-balance

What are other ways you have used balance beams?

 

April 1, 2017

Today I Sat Up

IMG_3552

I love having friends and family who have little ones who are growing and moving through their milestones.  And I especially love when they say I can use their pictures and videos.

When I saw this video of this little one sitting up, I thought it was great. He is a fairly new sitter and you can see him working on exploring his movement. He shows rotation, and reaching outside his base of support, and coming back up to the middle, and propping for some extra support. As you can hear in the video, he found a new limit. He was able to reach a little further and return to the middle without falling down. But it was all the times of reaching and falling down that helped him to gain the skills to know his limits and to know what muscles he needed to turn on to keep himself from falling over.

As he feels more confident with his sitting he begins to release his degrees of freedom. So when he rotated to reach for something he was relaxing his trunk because he didn’t need to hold it rigid to stay upright. He is able to begin picking and choosing the muscles he needs to be successful, rather than turning them all on and having limited movement.

If you get a chance watch some little ones as they begin to master a new movement and you will see them slowly relax and be able to have fluid movement rather than tightening up all their muscles to try to maintain control.

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.
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