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.
In honor of Super Bowl 50 being in the San Francisco Bay Area next weekend, and the Broncos playing in the game, I thought I would share a football activity one of our therapists came up with. She used this as a motivating activity for one of our kids who is really into football and wanted his therapy activities to be meaningful. I thought she did a great job of incorporating his age appropriate interests into something that was therapeutic and fun.
As you can see from the picture a football field was created along with goal posts. This child was working on dynamic standing and sitting balance as well as walking, transitioning between sitting and standing, and squatting to pick things up from the ground.
With this set up his goal was to get it through the uprights. He got a certain number of points based on various criteria
Was he sitting or standing while he threw the ball
Did it go through the uprights
Did it land on the ‘field’
How far away from the target did it land
Clearly if he threw it standing and it went through the uprights he got the most points and then they were graded lower after that. He had a target number of points that they kept on a white board (also allowing him to work on his math skills!).
After he threw the ball he had to walk to where it landed (or to the accessible place the therapist moved it to) and squat down to pick it up and then return to the bench and sit before he threw the ball again.
You could easily do this with bean bags or a soccer ball and goal or any other activity. The part that was fun for us was all the skills he could work in a meaningful and fun way for him! And, football was a regular discussion with regards to players, positions, teams, divisional standings, etc.
What ways have you made activities meaningful for your kids you work with?
I wrote a post a while back describing low tone so I thought I would try to do the same with high tone. Tone is the resting state of your muscles. When someone has high tone it means that their muscles are getting more input than is necessary, even when they are at rest. Where kids with low tone tend to melt into you, these kids tend to be on the ‘stiffer’ side. One thing I often hear from parents is that their child likes to stand all the time (even before standing is a milestone they should be hitting) and they don’t like to sit. (PS- for these kids it is not better to put them in an exersaucer alot because it doesn’t help them learn how to use their muscles differently) This is because it is easier for their muscles to work all together. When they are standing they are able to use extension all together, they can keep all of their muscles turned on at the same time. When they are sitting they are asking their muscles to do different things. They need to keep their trunk muscles turned on without turning on their gluts (tush muscles) at the same time.
Many people think that kids with higher tone are stronger because they are able to keep their muscles turned on. This is a common misconception and these kiddos often have the same amount of weakness as kids with low tone. The just look strong when they are able to do a task like standing when all their muscles are on. If you ask them to sit or go onto hands and knees they often have a more challenging time because they have to isolate their muscles to have them do different things. When a child goes onto hands and knees they need to keep their head, neck and trunk extensor muscles turned on but they need to relax their gluts/hip extensor muscles so that they can bend at the hips and again at the knees. Often they will hold this position for a short period of time before they turn their gluts back on and come up into high kneeling. This is because its easier for them to maintain head, neck and trunk extension with hip extension then it is to have hip flexion with their head, neck and trunk being extended. Just like in sitting they need to keep their trunk upright while keeping their legs bent at their hips and knees.
Its important to remember that these kids need to strengthen individual muscles so that they become more efficient at isolating out movement and don’t need to rely on using all their muscles doing the same thing at the same time. The earlier they start developing isolated muscle strength the easier it will be as they progress through their milestones where they need to be able to use each muscle differently. In addition, as they grow or have growth spurts you may see some ‘stiffness’ return because their muscles have just been stretched and need to adapt to the new length. Maintaining isolated strengthening will help your child to move through these growth spurts with increased ease.
I know this is a hard topic to explain so I hope I made it a little more understandable for you. Please don’t hesitate to ask any questions that this may have raised and I will do my best to answer.
Postural control is a term used to describe the way our central nervous system regulates sensory information from other systems in order to produce adequate motor output or muscle activity to maintain a controlled, upright posture. The visual, vestibular, and somatosensory systems are the main sensory systems involved in postural control.
The visual system contributes to postural control by delivering information from the retina to different areas in the brain that allow for object identification and movement control. Therefore, if your child has a visual impairment, it may be affecting their ability to control their posture and balance especially during movement.
The vestibular system, which consists of organs located in the inner ear, contributes by interpreting changes in movement, direction and velocity or speed of movements. This information is sent to the brain stem, which then creates a response that allows your postural muscles to activate and increases your body awareness. The vestibular system can be affected in children with various syndromes and disabilities.
The somatosensory system contributes by relaying information about body position to the brain, allowing it to activate the appropriate motor response or movement. Specific receptors or gauges called proprioceptors are located in our muscles, tendons, and joints. These are the receptors that are able to tell our brain whether our knee is bent or straight, whether we are bearing weight or not, and which muscles are contracting and which are relaxing at any moment. Inadequate somatosensation will affect postural control as well.
So you can see that all three of these systems play an important role in maintaining postural control and balance. To ensure proper postural control, the sensory information from these three systems must be regulated by the central nervous system in order to produce an appropriate motor response. So what does proper postural control look like? This is when an individual is able to engage in various static and dynamic activities, such as sitting, standing, kneeling, quadruped, crawling, walking, and running with the ability to contract the appropriate muscles required for a controlled midline posture, as well as the ability to make small adjustments in response to changes in position and movement, without the use of compensatory motions. If even one of the mentioned systems is not working the way it is supposed to it can affect postural control and balance. However, when one system is affected the other two can be trained to compensate. If more than one system is affected in combination with central nervous system involvement postural control will be more greatly affected. Talk with your therapist for ways to assist your child achieve improved postural control.
It recently made the news that the Bumbo chair has been recalled because of the potential for skull damage to infants. The recall will provide safety straps to the chair to potentially prevent injury. Since this recall has been announced several pediatric therapists have taken the time to put their thoughts down. One of these therapists is an old classmate of mine from PT school and I thought she had some great points in her blog post ‘In Defense of the Bumbo‘. Another great post was by Kendra Ped PT ‘More Trouble for the Bumbo‘ where she discusses her thoughts on the Bumbo chair as well as reminders about proper use for all infant equipment. We have also posted about the use of infant equipment in the past as well. Although I did not in the post mention the therapeutic benefits of using the Bumbo chair. Therapy Fun Zone has also posted on the Bumbo seat as a product review and how they have used it therapeutically.
I think that all of these blogs make great points. The other thing that I would add is that many people tend to use the Bumbo too early with their kids. If your child isn’t able to hold their head or back up on their own, or even with you holding them at the hips, then they should not be left in the Bumbo chair. If you need to leave them in a seat for extended time there are other products that will provide them with the support that they need. If your child is having trouble with head and trunk control and you are using it to help them work on this skill, you wouldn’t be leaving them in it unsupervised for extended periods of time. It would be during a supervised session of you engaging them so they are actively working to lift their head and trunk and thereby learn to become more independent with sitting skills.
Hopefully these posts will help you to figure out great ways to use the Bumbo chair appropriately and effectively for your child.
Posture is always an interesting topic. As adults we are often trying to improve our posture because we have started discovering that poor posture can cause other problems like pain. These are things we don’t think of when we are younger and don’t always think about for our kids. Posture is something that can and should be worked on from when kids are little so that they can hopefully avoid long term problems as they get older. I have to thank one of our readers for coming up with this idea!
Here are some tips and ideas for exercises/playing that can also work on posture:
Make sure kids hamstrings stay flexible. Its a lot easier to keep them flexible than to stretch them later. When hamstrings are tight it can tip our pelvis backwards so that it flattens our low back spine. To help with keeping hamstrings flexible have kids avoid w-sitting and long periods of kneeling as these will both shorten the hamstrings. They should sit in a variety of positions such as ‘criss cross’ or with their legs straight out in front of them. Here are some different sitting positions.
Core strength is really important. Some of my favorite ways to improve core strength for kids other than having them do sit ups are:
Lots and lots of climbing. Since its getting nicer out this should be easier because parks are lots of fun. The more unstable the climbing surface the more they will have to work their stabilizers and abdominals. I love climbing nets or climbing domes. Even ladders work well for this.
Animal walks are a lot of fun and really challenge the core. Some of our favorites are bear walking (hands and feet) or crab walking or dog/cat walking (straight crawling). You can have animal parades or animal races. You can change the terrain by going over uneven surfaces such as cushions or you can go up and down hills. You can make animal obstacle courses where they have to be the animal and go around cones, over obstacles and through tunnels.
Use a therapy ball. Have your kids sit on it and move it around in all directions with fast and slow motions. Or have them bounce on it. Try to give as little stabilization as possible (try for just the legs) and make sure they aren’t using their hands to hold on. If you can get them to engage their hands in play such as clapping or touching their head or reaching to the sky it automatically encourages more upright posture. I will also have kids reach for items such as bean bags and then throw them for a target while sitting on the ball.
Try sitting on an unstable surface. There are wedges or core discs that are out there that can provide the ability to wiggle while sitting and allow kids to keep their core active and engaged. You need to try it out though because sometimes it can be too challenging and they will just sink into a slumped posture. Also if you can make a sitting surface a little higher than normal so their feet still hit the ground it can encourage an upright posture more than sitting at 90/90. Or if you have a therapy ball that they can sit on with their feet on the ground while watching tv or doing other things it really works to keep the core active. You have to make sure that they are safe while doing this though.
Swinging at the park especially when they are self propelling naturally engages the postural muscles such as the scapular retractors and the abs. In addition they get some great vestibular input.
Bike riding is really fun and great for core strength and endurance. If you really want to get the core working ride up slight inclines and hills, they will have to use their arms and abs to generate power from their legs.
Reaching in sitting will also encourage upright posture. Have them sit in a variety of positions or on a variety of surfaces and play games where you make them reach up and in front or to the side. Watch their posture to make sure they are engaging their core muscles.
I probably have a ton of other ideas but this is a start. What are some of your favorite ‘exercises’ for encouraging improved posture with kids?
When kids are learning to sit up one of the ways they do it is to go from their belly into sitting. Just like other new movements, sometimes they need to be shown how to do the movement. Once the kiddo is able to push up on their arms, they can usually begin to learn how to sit up. By giving them a little help to bend at the hips, it shifts their weight backwards. With their weight going backwards they can move their hips over one leg toward the ground. If you help them to move slowly they can use their hands to support their trunk and begin to walk their hands backwards. By doing this and using their trunk muscles to lift up, they move into a sitting position. With your help in the beginning they have increased time to figure out how to motor plan how to use their hands and trunk muscles while moving their hips back and towards the ground. The more they have success with the movement the more they will want to practice moving. Also if they are able to access a toy or something they like once they are sitting its even more motivating to practice the movement.
In order to be able to do things in sitting, kiddos need to be able to reach and move without falling over. Reaching in sitting works with balance and being able to anticipate how the movement is going to affect them and turn the correct muscles on so that they don’t topple over. Some ways to work on reaching are to have things on the ground in front of, to the side of and in various positions so they get practice moving in different directions. Its fun to watch them figure out how far they can reach without falling and still be able to return to sitting. Sometimes they have to take some practice runs until they figure out exactly how their muscles are going to react. The less support you can provide and still have them be safe during these activities will really help them to use their whole body in a coordinated way. In addition to having items on the ground, you can also hold them up and have them reach. Change positions here as well so they get to use one or two hands, and switch between right and left. You’ll also start to see more trunk rotation developing and cross body reaching as they feel more stable. You can watch the kiddos find ways to create stability, whether holding one arm in a high guard position or using an arm to prop on the ground, they are figuring out their bodies. Have fun watching them develop!
Babies these days are getting really good at sitting. The invention of the Bumbo seat has definitely helped with this (although it is a great tool for kids who need extra help with sitting to develop other skills). Its also a lot easier to pick your baby up and sit them down. What I am proposing, once they start to develop movement and some trunk control, is to take an extra few seconds and help them get into sitting. By practicing transitional movements earlier, they develop their motor planning abilities, improve their coordination, and develop the strength they will need to achieve higher level motor skills. Transitional skills such as learning how to get into sitting will also help your child further develop independent movement which promotes exploration and cognitive skills. It allows your child a chance to initiate when they want to change their perspective from being on the ground to sitting up. It gives them a whole new world to explore and can further increase their motivation to move and develop. This video will show you some ways to help your baby transition from lying on their back to getting into sitting. As you watch the trunk muscles activate you can also see how it is a great core exercise. At the last part you see him learning how to modulate his movement so he doesn’t overshoot his target, as well as how to problem solve to accomplish the task. Transitional movements are a great learning opportunity for your baby. Check out Developing Sitting Balance for ideas on how to work on sitting balance.
As kids begin to sit up they need to figure out how to maintain their balance. As you can see in the video it doesn’t just happen, there is lots of ‘figuring it out’ involved!
With the invention of the Bumbo seat more and more people (yes I am generalizing) are putting their kids in it to have them sit up sooner. Now don’t get me wrong, it has its uses and is good for short bursts but kids need their whole bodies to develop sitting balance. The Bumbo seat provides them extra stability at their legs and hips which allows them to work on their trunk and how to react to stay upright but it doesn’t give them the opportunity to coordinate all of the components that go into sitting.
To help a kiddo develop sitting balance you want them to have some trunk control first. If they don’t have trunk control then you want to give them extra support at the hips or even at the belly area so they can start to learn how to keep their head and upper trunk upright in a sitting position. If they can hold themselves up then you can start to wean away the support. If you notice in the video I keep my hands close by but I’m not holding on tight. By keeping my hands close by I am provide limits so that the kiddo can maintain success. This way if they start to topple they won’t have to pick themselves back up from the ground, but rather from wherever my hands are. This requires less work against gravity. It also provides a chance for kids to work on figuring out when they have to turn their muscles on and off as their trunk moves around over their base of support.
I’m going to try to outline some of the things that go into developing and maintaining sitting balance:
(it can help to have something that is really engaging in front of them so they are using their visual attention to help with staying upright)
As kiddos start to lose their balance (or move their trunk too far outside their base of support) one of the first things they need to do is recognize that they are no longer balanced or upright.
Once this happens they need to send a message to their muscles to turn on and try to correct things so that they can be upright again and not fall over. Usually when this happens in the beginning the message gets there a little too late and they fall over. This is why if you give limits so they don’t go all the way to the floor they still get to figure out what muscles to turn on. With repeated practice they start to get the message in time and begin to activate their muscles when they notice a change in head and trunk position.
In the beginning their muscles tend to overshoot the target (sometimes they undershoot too). This means that they over compensate and use too much force so they go too far in the opposite direction. When this happens it takes practice for them to quickly get the message and switch the muscles that they are using. Sometimes I feel like kids learning to sit are little weeble wobbles!
If you notice in the video the legs are coming into play a lot. This is how they begin to use their legs for stability. If they can ground their legs and keep a stable base they have more mobility in their trunk and arms and can do more things in sitting. The grounding and stability begins with them activating their legs to try to counter balance the change in their trunk. That’s why you see them lifting their legs into the air as they try to regain a sitting position. If you are holding on too tight or they are spending all their time sitting in stabilizing chair, they miss out on the opportunity to develop this.
With practice kids fine tune their timing and their reactions so that they barely have to do anything to keep themselves up when they are just sitting there. The next step comes when they get bumped or are doing active sitting (such as playing with a toy).
When they are bumped their body has to react to the change in balance so it is a similar process to learning to sit and stay upright. The challenge is usually figuring out how much they need to react and how quickly they need to do it. Its usually easier to start with slow and small ‘bumps’ whereas the faster and harder ones are more challenging.
When they are playing with toys they have to use anticipatory balance reactions. That means they need to recognize that if they move to reach for something, or if they pick up a toy they are going to need to counter balance that move so they don’t fall over. They turn on their muscles in anticipation of the action or activity that they are about to participate in. Just think about if you’ve ever gone to the Cheesecake Factory and you go to pick up their water glass. You expect a heavy glass and so you adjust your force to that, well it turns out its plastic and you end up almost drenching yourself in water! The second time you go to pick it up though your body has adapted and you use just the right amount of force. This is similar to anticipatory balance control.
I know the video was a little longer than normal this week but I thought the dancing was so cute that I just had to share more!
Starfish Therapies 