The Value of 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?

Monkey Bars

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?

Playground Play

I was browsing through instagram a while ago and saw this great photo (above) of my friends’ son playing.  It immediately reminded me (not that I needed much reminding) why I love playgrounds for kids!

Besides just giving kids the opportunity to run around, play and explore, when I am working with a kiddo at a playground I am almost never at a loss for things to do.  Depending on their age and skill level, here are just a few things you can do with kids at a playground:

• Climbing –  There is climbing for all ages (even the non walkers).  You can use stairs to go up and down, although on a play structure its always easier to get kids to go up, much harder to convince them not to go down the slide!  Stairs can be crawled on or walked on.  For the walkers there are generally railings that allow early walkers to practice with some stability or for the more advanced they can try it without hands!  There are also almost always an array of ladders to climb.  What’s great about playground ladders is they come in all shapes and sizes.  There are standard ladders, there are twisty ones, there are rope nets, even ones I like to call rainbow ladders.  With this large variety kids get a chance to practice their motor planning and problem solving with regards to navigating the ladder.  To summarize, climbing is great for glut (tush muscles) and core strengthening, working on reciprocal movements and motor planning/coordination.
• Monkey Bars – Monkey bars or even the bar above the slide (like in the picture above) are great for hanging on!  Kids can work on their shoulder/shoulder blade strength and stability – which help improve their fine motor skills, as well as their core strength.  When they begin to traverse monkey bars they learn how to generate momentum and movement while maintaining stability.  It also gives kids an opportunity to play around with different grips and get immediate feedback for strength and control.  Lastly, kids can play with acrobatics and hang upside down and pull themselves up so they are sitting on the bars.  All of this helps body awareness, problem solving, coordination, etc.
• Swings – Swings are not only fun, they let your child increase their vestibular input, work on the coordination of their legs and trunk moving to keep the swinging motion going, and core strength.  Not only are kids excited when they learn how to make themselves swing, but it also means less time for you to stand around and push them!  In addition, just learning how to get onto the swing by themselves takes balance, coordination and problem solving.  For the little kiddos being pushed in the swing, they are getting opportunities to work on head control and trunk control during movement.

What are your favorite things about playground play?

Recipe for Playing Outside

I had the fun the other day of spending the day with a friend from high school and her children.  We spent the day outside and the kids played the entire time without prompting from us and didn’t want to leave when it was time to go.  Looking back, here are some things that I think worked.

1.  Novel environment – We went to a place that they had never been before.  Therefore they were excited to explore and play on the ‘new’ things (even though I’m sure they have seen many playsets before).  I know finding a brand new environment isn’t always possible but look for ways to switch up where you go with the kids outside.  Maybe its even as simple as taking turns with friends and neighbors to have the kids play in their back yards.  Other people toys are always so much more exciting than their own.  If you have parks nearby try out a new one that you don’t usually go to.

2.  Appropriate toys – Since we had a large area that they could play in the kids brought their bikes.  They were so excited to ride out ahead of us and then circle back to see what was taking us so long (we also brought dogs along so they had fun making the dogs chase after them).  If you are going to an area that has paths, bring kids bikes or scooter.  If you are going to the beach, bring sand toys.  If you are going to be at a grassy area, bring some ball games and maybe even a kite.  Plan ahead for what may engage your child where you are going to be.

3.  Have a playmate – If your child has a friend or a sibling that is fairly close in age it makes it easier to engage in play.  We were lucky that my friends kids had fun hanging out with each other this day.  I think part of it is that we had the above two factors going for us as well!  We found that when one started to lag behind or complain of being tired, they often only needed a minute before they realized the other one was still having fun playing and they were being left out.

4.  Don’t try to have their answers for them – We didn’t try to dictate how they played.  We let them come up with ideas and just made sure they were safe.  We would take many breaks from the bike riding to explore the leaves, or throw rocks into the lake or even play on the play structures.  The ideas they came up with for fun things to do were great when they were given the opportunity to use their imagination.

I am sure there are many great factors that can encourage playing outside but these were ones that I came up with when I looked back over what made this outing so much fun for the kids and so successful in terms of encouraging outdoor play!

I would love to hear any ideas you have that work.

Should We Wrap Kids in Bubble Wrap?

I know the trampolines they are talking about in the article are the outdoor ones but I don’t have a picture of one of those!

I recently read an article on Huffington Post about a new statement from the American Academy of Pediatrics (AAP) stating that kids should not jump on trampoline’s because its not safe.  Now I am sure they have looked at the numbers and seen how many injuries have occurred (its actually down in 2009 from 2004 according to the article) but have they looked at the other factors?  How many of those injuries were on a trampoline that was being used correctly?  How many had multiple kids on the trampoline, maybe even big and little kids together?  How many had the proper safety equipment that was recommended?  All of those factors can influence the information.

I’m not saying that there is no risk for injury if kids are being supervised and the equipment is being used properly but the risk most likely decreases.  (I hate to say it but as a child I hurt myself plenty of times when playing while my feet were planted on the ground)  When used properly trampolines can provide kids with cardiovascular exercise, strengthening for their muscles, sensory input, and the ability to explore movement.  With all the complaints of obesity in our youth and their overall sedentary lifestyle why take away something that when used properly can be fun and a great way for exercise?

I have talked about this before but I thought this article brought up an opportunity to reiterate the need for kids to have a chance to get sensory exploration and movement in their environment while engaging in active play.  How many school playgrounds have swings these days?  Or when was the last time you saw a merry-go-round on a playground.

Safety is extremely important but it is also important to let kids play and explore.  With proper supervision and use many ‘dangerous’ activities can actually have much lower risk.  (I made a similar point about the Bumbo chair recall)

What are your thoughts on this topic?

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?

Bringing Therapy Home

This is a short post to reference another article I had written that I wanted to make sure I shared here as well.

PediaStaff recently featured an article that I wrote about implementing PT at home for kids with Down Syndrome.  I realized as I wrote the article that although it was specifically related to kiddos with Down Syndrome, it also is applicable to kiddos with low tone.  In fact, many of the tips are applicable across the board to other therapies and for any child who is receiving therapy.

I think the biggest thing to remember is that if you have good communication with the families you work with you can work together to problem solve and create the best program for their child.  Here are some additional tips I thought I would add:

1. If you have other kids, create opportunities for the whole family to get involved
2. Make it a game (its amazing what kids will do if its a game)
3. Make it part of your routine
4. Pick one or two important things to work on consistently rather than trying to do a whole laundry list and not being able to get to any of them
5. Make it into quality time you get to spend with your kiddo, it can be time that’s just yours and theirs
6. Use play to work on skills such as at a playground

I hope you take the time to read the article and please share tips that you have heard from your therapists or that you tell your families to help make all the therapy homework a little less overwhelming!

Autism and Gross Motor Skills

In the most recent issue of Pediatric Physical Therapy there are three articles regarding autism/autism spectrum disorder and gross motor skills.  I was actually really excited to see this because I sometimes feel that gross motor skills get put on the lower end of the priority scale for kids who are diagnosed with autism, autism spectrum disorder, or PDD-NOS.  Now don’t get me wrong, I understand that there are only so many hours in a day and there are so many areas that you need to prioritize for your child’s development.  Gross motor is easy to overlook especially if they are walking and able to get around independently.

I just thought I would take a moment to highlight some of the benefits of working on gross motor skills with children who are diagnosed on the autistic spectrum.

• Strength and posture – Generally kids with this diagnosis have lower muscle tone.  This low muscle tone can cause them to fatigue quicker, have challenges with postural control, and make learning new tasks more demanding (which can make it harder).  Working on activities to develop core strength and overall muscle strength will help with these challenges which can aid them in paying attention in school because of improved posture, trying out new skills, playing longer with their peers during active play.  In addition, fine motor skills and speech skills can improve as a result of improved strength and muscular endurance as well as opportunities for active play.
• Coordination – Learning new skills can be challenging because of weakness and low muscle tone as mentioned above, however it can also be challenging if it is hard to organize all the pieces that make up a skill.  For example, jumping jacks involve jumping, arm movements, leg movements and timing/rhythm.  Just one of these components may be challenging so being able to practice breaking down the pieces of the task and then as they master the pieces putting them back together for the whole motion can help your child to achieve the skill in a more timely manner and with less frustration.
• Social skills – I have worked with several kiddos who are diagnosed as being on the autistic spectrum and concerns with families are often around their ability to interact with their peers and play.  Because learning new skills may be challenging that can make it harder to keep up with peers as they continually evolve their play and gross motor skills.  For example, jumping is a skill that kids love to do when they figure it out.  If your kiddo is having trouble jumping they may be missing out on valuable opportunities to relate to their peers in a play based way.  Same with bike riding or even being able to participate in PE or recess.
• Sensory – Depending on your child’s sensory needs, adding in gross motor play will allow your child the opportunity to get a variety of sensory experiences such as proprioceptive feedback to their joints (which can also help to keep low tone muscles ‘awake’), vestibular input to their inner ear from moving up, down and around, as well as tactile input from the various surfaces they may come in contact with during play.  Let’s Play and Get Messy! touches on some of the sensory aspects of play.

I am definitely not writing this to tell you to add one more thing onto your already busy and probably completely scheduled days, but just to help you look for opportunities to add gross motor practice into your day.  If your child is working with other professionals you can ask them to include some gross motor into their activities.  Or maybe find out from their teacher what their peers are doing on the playground or in PE so you can have ideas for active play in your household

My Child Can Walk – Now What?

 

First of all give your kiddo a high five!  Its great that they are walking.  I always laugh because I like to warn parents of kids that I work with that once their kiddo starts walking that’s all they want to do for the next several sessions.  That said, the challenge becomes how to direct and progress that walking!

I have been working with a kiddo who just made that final step (pun intended) to becoming a functional walker.  She now chooses it as her mode of locomotion.  She, for the most part, has mastered walking on a sturdy, flat surface that isn’t littered with obstacles.  The parents were looking for ways to continue to progress her walking (she still reverts to a mild high guard when something unexpected happens) that they could do.  Here were some of my suggestions:

Walking on different terrain – Since she has the living room and apartment mostly mastered I encouraged them to have her practice on different surfaces as well as practice walking from one surface to the next.  Some outdoor options are:  grass, tan bark, rubberized playground flooring, sand, and uneven terrain where it can have slight uphills and downhills (nothing you or I might notice but it could feel like a mountain to a novice walker).  For indoor practice you can use: carpet, really plush carpet, tumbling mats, mattresses, pillows, couch cushions, fluffy comforters, and yoga mats.  They may need a hand hold in the beginning but you can start to wean them off of it.  We started practicing with this little girl on her couch pillows (which are definitely way more challenging than plush carpet but it was the only option we had at hand at the moment).  First we had to convince her to stand on them so we had her stand on the pillow while playing with a toy she really liked at the couch.  Then we moved her away so that she had to walk to get to the toy she wanted to play with and over the next several trials we went from her having a death grip on my hand to her trying to push me away so she could do it by herself (of course she didn’t have the balance to do that so she promptly toppled).  Use things that really motivate them to get them used to standing on new and more challenging surfaces and to entice them to attempt walking across those same surfaces.  Once they start to get used to and master a surface its great to have them try to walk from a firmer surface to a softer or more uneven surface so that their body can begin to figure out how to react to the changes and thus improve their balance and overall walking proficiency.

Clearing obstacles – Another scenario we set up in the apartment we set up was having to step over things that get in their way.  We used one of her toys that has a long stick on the end of it and put the couch pillows on either end of it so she couldn’t avoid the stick.  I then put my ipad playing ‘Monster at the End of the Book’ on the other side and gave her my hand to help her with stepping over it.  She had a similar progression with as above in terms of going from the death grip to wanting to do it herself.  She was actually able to succeed doing it all by herself by the end.  We just kept moving the ipad from one side of the obstacle to the other so that she would keep practicing.  We started with something small and easy to step over but you can make it a little wider or a little higher to increase the challenge.  You could also make it into an obstacle course and have several in a row so that  there are more opportunities for practice.

Walking backwards – This skill is a slightly harder one to teach I think (I’m always open to suggestions though).  I generally use those toys that have a string on them so the kiddo can pull them along.  If it is an engaging toy they will want to watch what it does while it is moving so the only way they can pull it is to walk backwards.  I usually have to give them a little support while doing it so that they know they are supposed to move backwards.  For example, I can guide them from the shoulders with a slight backwards force to keep their feet moving that way.  If you have moveable furniture you can make a narrow pathway for them to pull the toy through making it harder for them to turn around to go forward.

These are just a few of the suggestions for what you can do with your kiddo once they are walking.  As always, I’d love to hear your ideas that work with your kiddos.

Top 10 Blog Posts of 2011

I love Top 10 lists!  Here is this years list of Top 10 Blog Posts:

10.  Core Muscles:  Building a Solid Foundation

9.  No Kid Left Inside – Benefits of Outdoor Play

8.  Having a Ball With Core Muscle Strength

7.  Gross Motor Development vs. Fine Motor Development

6.  Standing Straight and Tall

5.  A Glossary of Sitting

4.  Let’s Play!

3.  What is Protective Extension?

2.  Why is W-Sitting a Four Letter Word?

And the most read blog post by a landslide:

1.  Torticollis:  What Is It?

Thanks for everyone who reads and I look forward to the next year!