Using a Swing to Work on Jumping

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

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

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

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

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

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

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

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

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

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

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

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

Encouraging Independent Exploration

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

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

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

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

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

 

 

 

Growth Spurts

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

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

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

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

Righting Reactions

‘Oh no, my head’s too far back’

‘And now it’s back to the middle!’

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

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

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

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

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

 

 

Tummy Time – Not Just For Babies

Tummy time is a common activity that babies participate in while they grow and develop. Spending time on their tummy allows babies to help build neck and back strength. Being on their stomach gives babies an opportunity to spend time in a different position while they explore their surroundings. As babies grow up and become toddlers and children they tend to spend less and less time on their stomachs.

Tummy time is also a great position for older children and adults to use. As children start attending school they spend a large portion of their day sitting in chairs at a desk. Adults too tend to spend the majority of their time in a seated position. Spending a large portion of the day sitting can cause the muscles in the front of their hips to become tight; this is also very common in adults. When children spend some time on their stomach it can aid in stretching those muscles on the front of their hips and can help strengthen muscles of their back and neck.

Here are a few positive reasons to get your child to spend some time on their stomachs:

–       Can help improve flexibility of hip flexor musculature

–       Can improve back, neck, and scapular strength

–       Allows children to play and explore in a different position

Tummy time can become an activity that the whole family can participate in! Have the whole family spend some time on their stomach while reading a book, playing a game, or while watching a show on television. You do not have to have your child spend large amounts of time on their stomach’s to gain some of the great benefits of being in this position. Start with a few minutes a day until your child is able to maintain this position for a prolonged period of time. Try to aim for your child to stay in this position for the length of a short book or while playing a board game. Added benefit of playing a game is they are also working on weight shifting, upper extremity strength, hand-eye coordination, to name a few.

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Developmental Playgroup – Self-Help (Part 1)

This past week we looked at Self-Help skills during our developmental playgroups.  Here is a brief overview of some of the things discussed.  We will provide more detail in coming weeks!

Birth- 4 months:

• Express the need for food by crying
• Signal the need for diaper changes
• Express pleasure when placed in warm water (bathing)
• Will eventually begin to help by using their own hands to guide the nipple

4-8 months:

• Show interest in feeding activities
• Can pull off their own socks
• Can velcro closures on clothing

8-12 months:

• Begin to hold their own cup and drink
• Begin to eat finger foods
• Begin to pull off soiled or wet diaper
• Begin to sleep until 6 or 8 am.

12-24 months:

• Use a spoon to some degree to feed themselves
• Have good control of a cup
• Begin to try and wash themselves
• Begin to help with dressing
• By age 2 they may begin to gain control of bowels and bladder

24-36 months:

• Increasingly able to feed self and use cup/glass
• Can generally undress themselves
• Show signs of being ready for toilet training

Activities/ Things to remember when teaching or promoting self help skills:

• Decreasing amount of assistance given during activities (ie less assistance with silverware during mealtimes)
• Establish a routine/create a daily schedule
• Focus on the learning instead of the length of time to finish the task
• Rewards are best when naturally occurring in the environment

 

7 Self-Care Milestones to Look Forward To:

As the sense of self increases, so will your child’s achievements in self-care. He’ll naturally develop and fine-tune his motor skills over the next three years to master:

1. Using a fork and spoon: Some toddlers start wanting to use utensils as early as 13 months, and most children have figured out this all-important skill by 17 or 18 months. By age 4, your child will probably be able to hold utensils like an adult and be ready to learn table manners.
2. Undressing: While the ability to take his own clothes off may lead to lots of naked-toddler chase sessions, it’s a key accomplishment. Most children learn to do it sometime between 13 and 24 months.
3. Toothbrushing: Your child may start wanting to help with this task as early as 16 months, but probably won’t be able to handle a toothbrush skillfully until sometime between her third and fourth birthdays. Even then, dentists say, kids can’t do a thorough job on their teeth until much later.
   • Pediatric dentists recommend that parents do a thorough brushing of their kids’ teeth every night until school age or later. As a compromise, if your child is eager to brush, let her do the morning brushing herself. Or let her brush first, and then you finish up.
4. Washing and drying hands: This skill develops at 24 months or so and is something kids should learn before or at the same time as using the toilet – you don’t want your child spreading germs.
5. Getting dressed: Your little one may be able to put on loose clothing as early as 24 months, but he’ll need a few more months before being able to manage a T-shirt, and another year or two after that before he’ll really be able to get dressed all by himself. Also at 24 months, he’ll probably be able to pull off his shoes.
6. Using the toilet: Most kids aren’t physically ready to start toilet training until they’re at least 18 to 24 months old. Two key signs of readiness for a child include being able to pull her pants up and down by herself and knowing when she has to go before it happens.
7. Preparing breakfast: Toddlers as young as 3 may be able to get themselves a bowl of cereal when they’re hungry, and most kids can do it by the time they’re 4 1/2. If your child wants to give this a whirl, make it easy by leaving kid-size containers of cereal and milk in the cupboard and fridge.

References:

1. http://www.floridahealth.gov/AlternateSites/CMS-Kids/providers/early_steps/training/itds/module1/lesson1_3.html
2. http://www.earlychildhoodnews.com/earlychildhood/article_view.aspx?ArticleID=676
3. http://www.childcarequarterly.com/summer08_story2.html
4. http://www.babycenter.com/0_toddler-milestone-self-care_6503.b

Developmental Playgroup – Cognition (Part 1)

Cognition was the most recent topic at the Developmental Playgroups this past week.  It is broken down into: Cause and Effect, Spatial Relationships, Problem Solving, Imitation, Memory, Number Sense, Classification, Symbolic Play, Attention Maintenance, and Understanding of Personal Care Routines.  Because it covers such a wide range, for the purposes of the blog, we will break it into smaller components.  This post covers Cause and Effect, and Spatial Relationships.

Cause and Effect:  Cause and Effect looks at a relationship between actions/events and what the reslt is.  This concept helps infants/children to develop an understanding of object properties, relationships between and event and the consequences, and patterns of human behavior. By developing an understanding of this concept, infants/children are able to build their abilities to solve problems, make predictions, and understand the impact their behavior has on others.

• Examples: crying and being picked up, shaking a toy and hearing it make noises, pushing a button on a toy and having music play.

Some milestones/age appropriate activities for this concept are:

• 4-7 months:
  • Hear a loud noise and turn head in the direction of the noise
  • Explore toys with hands and mouth
  • Move body in a rocking motion to get the infant care teacher to continue rocking
• 8 months: Children perform simple actions to make things happen, notice the relationships between events, and notice the effects of others on the immediate environment.
  • Shake toy, hear the sound and shake it again
  • Watch someone wind up a toy and then touch the toy trying to make it go off again
  • Push button on toy to watch it light up/something pop out.
• 9-17 months:
  • Bang two blocks together
  • Keep turning objects to find the side that works (mirror or nesting cup)
  • Cry and anticipate someone to come help them
  • Continuously drop an item to have someone come pick it up
  • Watch someone perform an action and then try to imitate- squeeze water toys.
• 18 months: Children combine simple actions to cause things to happen or change the way they interact with objects and people in order to see how it changes the outcome.
  • Attempt to wind up the toy after not getting the lid to open
  • Drop various objects from different heights to observe how they fall – what noise they make
  • Making tower of blocks and knocking them over
• 36 months:
  • Demonstrate an understanding of cause and effect by making predictions about what could happen and reflect upon what caused something to happen
  • Communicates that they miss someone/cries after they leave
  • Make a prediction about what will happen next in the story
  • Ask what happened if they see a band aid

Spatial Relationships: Spatial Relationship looks at how an object is located in relation to a reference object.  Understanding this concept helps infants/children gain a better understanding of numbers as they get older as well as how things move and fit in space.

• Examples: exploring objects with their mouths, tracking objects and people visually, squeezing into tight spaces, fitting objects into openings, and looking at things from different perspectives (Mangione, Lally, and Signer 1992).

Some milestones/age appropriate activities for this concept are:

• 4 to 7 months:
  • Look and explore their own hand
  • Reach for nearby items
  • Explore toys with hands and mouth
• 8 months: Children move their bodies, explore the size and shape of objects, and observe people and objects as they move through space.
  • Use vision or hearing to track the path of someone walking by
  • Hold one stacking cup in each hand
• 9-17 months:
  • Roll a car back and forth on the floor
  • Dump toys out of a container
  • Move over and between cushions and pillows on the floor
  • Put the circle piece of a puzzle into the round opening, after trying the triangle opening and the square opening
• 18 months: Children use trial and error to discover how things move and fit in space.
  • Go around the back of a chair to get the toy car that rolled behind it instead of trying to follow the car’s path by squeezing underneath the chair
  • Use two hands to pick up a big truck, but only one hand to pick up a small one
  • Put a smaller nesting cup inside a larger cup after trying it the other way around.
• 19 -35 months:
  • Complete a puzzle of three separate cut-out pieces, such as a circle, square, and triangle
  • Turn a book right-side up after realizing that it is upside down
  • Fit four nesting cups in the correct order, even if it takes a couple of tries

We will go over the remaining concepts in some follow up posts!

References:

http://www.cde.ca.gov/sp/cd/re/itf09cogdev.asp#sr

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdcsr.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdps.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdimit.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdmem.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdclas.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdpers.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdattm.asp

https://www.healthychildren.org/English/ages-stages/baby/Pages/Cognitive-Development-8-to-12-Months.aspx

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Developmental Playgroup – Communication

We relaunched our Developmental Playgroup this week and we broke it into smaller groups so that we could better direct our education and play activities.  The first group is pre-crawlers and the second group is pre/early(new)-walkers.  With our playgroup we spend time on a different developmental domain each week and this week’s topic was communication.

I wanted to share the information we gathered so that it can be passed along and shared!

6 stages of language development:

1. Prelinguistic stage/ Pre-speech phase: first year of life.
   1. Development Aspects: development of gestures, making adequate eye contact, sound repartee between infant and caregiver, cooing, babbling and crying. Babbling is followed by jargon phrases- unintelligible strings of sounds with a conversation tone.
   2. Five stages of babbling:
      1. Phonation stage- 2mo: Cry, cough, grunt, sneeze- vocal cords are not vibrating with a smooth speech like quality yet. Vowel sounds.
      2. Gooing Stage- 2-3 mo: primitive movements of articulators (tongue and lips) become more coordinated- results in consonant like sounds- not fully formed. Start to coordinate sounds with eye contact. Start to take turns making sounds with caregiver.
      3. Expansion Stage- 4-5mo: ear fully resonant vowel sounds, explore pitch and intensity with squealing, yelling, growling, whispering and raspberries. Laughter emerges.
      4. Canonical Babbling- 6-7 mo: articulators, resonance and voice become coordinated resulting in real syllables. Quick to interpret this as attempts at words- Ba-Ba.
      5. Integrative/Jargoning 10-15 mo: complex babbling with a few real words thrown in. Intonation: gibberish with sound of comments, questions and commands. Well coordinated with gestures, body language and eye contact.
2. Holophrase/ one word: 10-13 months
   1. One word can mean several different things- Dada (where is dada, dada come here, dada pick me up, etc)
3. Two word sentence: 18 months
   1. Sentences are now a noun and a verb.
   2. Declarative: Doggy Big
   3. Interrogative: Where ball
   4. Negative: Not egg
   5. More milk: imperative
4. Multiple Word Sentences: 2 and 2 ½ yrs
   1. Can use more prefixes/suffices, predicates in their sentences to change tense or meaning. Very common to have tense/grammar errors.
   2. Doggy is big, where is ball, this is not egg, I catched it, I falling.
5. More complex grammatical structures: 2 ½ and 3 yrs
   1. Conjunctions, prepositions.
   2. Read it, my book, Where is Daddy, I can’t play, Take me to the shop.
6. Adult like Language structures: 5 to 6 yrs
   1. Concepts such as ask/tell, promise, order in which words properly go in a sentence.

Milestones:

Year one

• Recognizes name
• Says 2-3 words besides mama, dada
• Imitates familiar words
• Understands simple instructions
• Recognizes words as symbols for objects: car- points to garage, cat- meows
• Understands no- 12-18 months

Activities: respond to child’s coos, gurgles, babbling, talk to your child throughout the day, read colorful books, tell nursery rhymes and sing songs, teach child names of everyday items and familiar people/label items, play peek a boo, pat a cake.

Between one and two:

• Understands no
• Uses 10-20 words, including names
• Combines two words (dada bye bye) – telegraphic speech
• Waves goodbye
• Makes the sounds of familiar animals
• Gives toy/item when asked
• Makes wants known- states more
• Can point to her toes, eyes and nose
• Brings objects from another room when asked.

Activities: reward/encourage early efforts of saying words, talk to baby about things that you are doing, talk simply, clearly and slowly, talk about new situations before, during and after, look at your child when they are talking to you, describe what your child is doing/feeling/hearing, listen to music.

Between two and three:

• Identifies body parts
• Carries on conversation with self and dolls
• Asks what that and where’s my
• Makes plurals- adding s
• 450 word vocabulary
• Gives first name and uses fingers to tell age
• Combines nouns and verbs- mommy go
• Understands simple concepts- last night, tomorrow
• Refers to self as me rather than name
• Tries to get adults attention- watch me
• Likes to hear the same story repeated
• May say no when they mean yes
• Talks to other children and adults
• Solves problems through words not hitting/crying
• Answers where questions
• Names common pictures/things
• Short sentences- me want more, me want cookie
• Matches 3-4 colors, knows big and little

Activities: repeat new words over and over, play games with following directions- touch your nose, go on trips and talk about what you see before, during and after the trip, let your child tell you the answers to simple questions, read books everyday make it a part of your routine, listen to your child, describe what you doing, have your child deliver simple messages mommy needs you daddy, carry on a conversation with your child, ask questions to get your child to think/talk, show the child you understand by answering smiling and nodding your head, expand what the child says- dog big- that is a big brown dog.

Language development supports your child’s ability to communicate, and express and understand feelings. It also supports thinking and problem-solving, and developing and maintaining relationships. Learning to understand, use and enjoy language is the critical first step in literacy, and the basis for learning to read and write.

Interactive Reading: ask questions, use dramatic inflections, let them guess what will happen next, point to pictures and describe them- ask your child to do the same.

References:

1. http://raisingchildren.net.au/articles/language_development.html

2. https://childdevelopmentinfo.com/child-development/language_development/

3. http://www.asha.org/public/speech/development/language_speech/

4. http://www.asha.org/public/speech/development/01/

5. http://www.asha.org/public/speech/development/12/

6. http://edubloxtutor.com/language-development/

7. http://www.ldonline.org/article/6313

8. http://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=35:admin&catid=2:uncategorised&Itemid=117

9. http://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=34:ages&catid=11:admin&Itemid=117

10. http://www.sentinelsource.com/parent_express/pregnancy_babies/understanding-the-stages-of-baby-babble/article_611d18f4-a11d-11e1-8120-0019bb2963f4.html

Why Your Child’s Inner Ear is Important for More Than Hearing

Imagine learning to stand for the first time, but everything around you appears to move. You can’t stabilize your gaze and everything sort of spins. Now imagine learning to walk for the first time, except you can’t focus on an object for balance. Either would be tough for anyone, especially a child.

That ability to focus your sight – That’s what’s called your vestibular system – and it’s not a part of your eye. It’s actually in your inner ear. It plays a large role in balance, telling you where your head is in space. In turn, your body responds to what you vestibular system is telling you.

But the vestibular system also plays a part in stabilizing your gaze. Try looking at an object in the room. While keeping the object in focus, shake your head from left to right – are you a little dizzy? Maybe… But were you able to keep that object in focus? Probably. That’s because, while you were shaking your head from side to side, your vestibular system was communicating with little muscles around your eye, telling them to respond, which allows you to keep your focus (known as the vestibular ocular reflex, or VOR).

And if you weren’t able to keep the object in focus? Well, it makes balance and development that much more difficult.

What could be a sign that your child’s vestibular system isn’t working properly? Some children may have trouble standing without holding onto a surface, and even fall when standing at a table without reacting to the fall (think of a falling tree). Others may have trouble walking without holding on to an adult or surface, with a tendency to rely too heavily on that support, at times appearing as an impulsive movement.

If you notice or are concerned about your child’s vestibular function, it’s a good idea to discuss it with your child’s pediatrician. They can make a good assessment or help refer you to a specialist.