Starfish Therapies

June 11, 2017

Kneeling: Exploring New Heights

High kneel 3

Kneeling is a great position to help progress developmental milestones, as well as a way to work on strengthening hips and core. Depending on the activity it can also be a great way to work on arm strength.

Getting into kneeling allows kids to work on transitional movements, provides a new way for sitting, lets them explore balance and balance reactions, is a precursor for activities like climbing and pulling to stand, and it lets them see whats on a level above the floor providing them a different way to engage with their environment and toys.

Here are some ideas for kneeling:

  • Unstable – Use something that isn’t stable such as a cylindrical toy, a foam roller, a ball, or even a push toy. All of these will vary in their instability and you can also create some stability by holding it still while they get used to it. This allows them to play with flexing and extending their hips, weight bearing through their arms, activating their core for balance reactions as they try to find midline or a place of stability by moving the object forward and backwards. A toy like this one also has the added fun of sound!
  • At a higher surface – You can find a surface that is not too high and not too low. It can provide stability to allow them to play with their toys or even bang on the surface. With this they are learning balance also. Every time they lift their hand or engage with their toy they need to find a way to stay stable or they run the risk of toppling over and not being able to play. Once they start to learn that toys and fun are up off the floor this can lead to exploring and figuring out how to get into kneeling!
  • Transitions – Kneeling is also a great position to be able to transition into various positions. As you can see in the pictures kids can use kneeling as a way to play and to move into other positions. Set up toys around your child that they have to manipulate or move and weight shift to be able to access. Let them explore their movement and problem solve how to best interact with the toys. You can help them by showing them how to get into a kneeling position and see what they do from there.

     

There are lots of ways to modify these activities (and tons more that I’m sure I’ll think of as soon as this goes live!). I would love to hear how you incorporate kneeling into your child’s play!

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?

April 30, 2017

Strong Outer Hips (aka abductors)

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

March 5, 2017

Monkey Bars

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

February 19, 2017

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!

February 12, 2017

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

eccentric-abs

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.

January 15, 2017

Ideas for ‘Weight’-Training at Home

Weight training is not usually the first thing that comes to mind for pediatric therapy but its a big part of it.  We are big believers in strength/weight training for our kiddos to help improve their function.  It helps them to more efficiently activate their muscles, improves muscle isolation, helps movement to be more efficient and cuts down on compensatory movements and strategies.  For some of the kiddos we see in the clinic based setting we are able to use the Universal Exercise Unit to help promote strengthening, however not all of our kids come to the clinic or are able to use this piece of equipment so I have had to get creative on ways to strengthen that is still fun for the kids.  Here are some of the exercises we do for strengthening:

Leg Press – To get a good leg press I like to use resistance tubing.  I have bought one that has handles already built in that work great.  I have the child lie down on the ground and wrap the tubing around a stable object at their head (a table leg can often work).  I then put their foot in the handles and I control their leg while they push out (making sure that they don’t hyper extend their knees).  Its easiest to do this one leg at a time.

Hip and Knee Flexion – To do this one, I just reverse the above exercise.  I have them lie down with their feet facing towards the table and put one foot in the handle (the band should be resting taut) and then have them pull their foot up by bending their hip and knee.  Again, make sure you control their leg to avoid and torque at the knee.

Scapular (shoulder blade) Retraction – Take the same resistance tubing as above and tie it around a door knob (make sure the door is shut). You can also hold it for them (like in the pictures).  Then have the child stand (or sit) across from it. They are going to hold one end in each hand and slowly pull back while squeezing their shoulder blades together.  Make sure they keep their elbows bent at approximately 90 degrees the whole time.  Once they have pulled back, then they are going to slowly bring their arms forward again.Their body should be staying still during all of this, and the only movement should be from the arms and shoulders.

Weighted Squats – You can use a weighted ball, heavy cans of food, a bag of flour, or anything else that your child may consider to be heavy.  Have them squat down to pick it up off the floor and then stand up and place it in your hands or on a table or other surface.  If you’re using a ball, my favorite way to get them to do more is to have them give it to me and then pretend I drop it and ask them to pick it up again.  They generally think its funny that I can’t hold onto it!

 

 

March 25, 2016

Working on Control (How to Squat)

Filed under: Developmental Milestones — Starfish Therapies @ 4:46 pm
Tags: , , ,

Sitting

I recently wrote a post on Power vs Control and afterwards I had someone reach out asking how they could help their kiddo learn how to squat or sit down easier so I decided to write some of my ideas down and share them with all of you.  Hopefully you find them helpful!

For kids that are having a harder time than others developing control so that they can easily lower themselves into a chair, or attain a squatting position to play, or go down the stairs fluidly, you want to remember that it is still a component of strength.  That means, you still want them to work on strengthening their leg muscles that help them do the opposite, i.e. stand up from a chair, get up from the ground, go up the stairs, etc.  Overall strength will help them with the control.

Next you want to remember that they are probably nervous to bend their knee because they don’t know that they can control what they are doing and might fall.  Now if you ask them this, I am not sure that they would be able to tell you that is what they are thinking, but it is what their body is feeling.  A way for you to possibly relate is this: have you ever tried to do a push up and get your body down really close to the ground before you push back up?  That means you are bending your elbows almost all the way to a 90 degree angle.  If you are really good at push ups this won’t mean anything to you.  If you are like me, you can only bend your elbows just a little bit because if you try to go further you don’t have the strength to support your body weight and you lose control and crash to the ground!

So, we covered that strength is important.  What’s next is you want to help them start to feel comfortable ‘unlocking’ or bending their knees.  What you might also see is when they do bend their knees they go from straight to all the way down super fast without any control.  If they were trying to sit it would look like they are ‘plopping’ in their chair.  So here are my ideas:

  1. Sitting onto an elevated surface – If you have a bench or chair or surface that you can pile up with pillows so they can only have to bend their knees a little bit to sit down they will only have to bend a little and be successful.  As they experience more success you can lower the surface.  You can also give them something to hold onto to give them more confidence.  If the support surface is slightly unsteady they will have to depend on their legs more.  If it is more stable they will use their arms more.  A fun thing to do would be make a big pile of cushions and have them practice sitting back into that.  It won’t hurt if they ‘crash’ and they will have to work a little harder to stand back up!
  2. Picking toys up off the floor – If you have a shape sorter or a puzzle or anything with lots of pieces that they are interested in you can scatter them around the floor, or on slightly elevated surfaces, such as step stools, so that they have to bend down to pick them up in order to use them.  You will need to play with the height because they may be able to just hinge at the waist and hips but your goal is to get them to bend their knees.  You can make it close to a coffee table or couch so they can hold on while they reach down to get it.  To make it even more challenging you can have them on a slightly elevated surface and the toy on the floor so they have to really bend their knees to get it.  Just remember a mini squat or a deep squat is going to be the easiest, getting them to bend their knees to the mid range (90 degrees) will be the hardest.
  3. Step downs – get some step stools or cushions or other raised surfaces and have them around on the floor and make a game out of walking around and having to climb up and down each of them.  Make sure they are switching feet so they get to work on both the left and right side going up and down.  You may need to give them a hand at first to be successful but try to wean the support away.  Pairing things with a song or a toy with lots of pieces always helps with motivation.

I’d love to hear other ideas that you have!

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