Starfish Therapies

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!)


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
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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!

March 10, 2016

Priming the Muscles

 I was giving a presentation the other night on Strength Training for Children with Developmental Coordination Disorder and it led to an interesting conversation with the attendees.  It was actually a really great conversation because it was a collaboration amongst a mix of pediatric and adult therapists.

We were discussing children who have hypotonia (low muscle tone), and how they have a harder time turning their muscles on and keeping them on.  Strengthening helps them to be more efficient with turning their muscles on but their low tone never goes away.  It came up that they often become tired easily, and this can show up in school, because they have to focus on their posture (staying in their seat) as well as whatever activity they are doing.

One therapist shared a great story about a child she was working with who was struggling with a specific test that he had to take every week at school because he was focusing on staying in his chair, writing on his paper, and answering the questions in a timed fashion.  His scores were not very good.  They came up with a strategy (that the school approved) for him to do a modified plank on his knees before the test.  Immediately his test scores started to improve because he was priming his muscles to turn on during the activity.  It was easier for him to keep himself in his chair because he reminded his muscles that they need to work.  A few weeks later, the teacher reported that all of the kids wanted to do this and started doing the modified plank with him (so now he doesn’t look any different than his peers).  I thought this was a great example of how to support education through physical activity.

I know myself, when I do a 10 minute yoga routine I put together, my posture is better (without me thinking about it) for the rest of the day.  This is because I have reminded my posture muscles that they are supposed to be working.

So how can we use this?  For kids that have lower muscle tone, we might want to consider giving them a physical activity at the start of their day that can prime their muscles.  This could be modified plank or bear walking or some simple yoga poses.  Or if not at the beginning of their day maybe before a test at school or before they start their homework or before PE or other physical activity.

I know families who have kids with low tone who have been able to move on from physical therapy and get their kids involved in martial arts, swimming, or gymnastics (to name a few).  This is great because these activities help with whole body muscle activation as well as provide a social way to keep active.

I’d love to hear other ideas you have for ‘priming the muscles’!

March 1, 2016

Power vs Control (or why going up stairs is different than going down stairs)

Filed under: Developmental Milestones — Starfish Therapies @ 3:30 am
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Power vs control

Muscles can work in several ways: they can get shorter, they can lengthen, and they can stay the same length.

Generally when a muscle shortens it is generating power.  For instance, when you ‘make a muscle’ you are bending your elbow and moving your hand closer to your shoulder.  Your biceps is getting shorter to make this happen.  It is generating power so that you can lift your hand (or a weight if you were holding one).  That is why it looks like you are ‘making a muscle.’

When a muscle lengthens it is producing control.  For instance when you are carrying a sleeping baby and you want to slowly lower them into their crib so they aren’t jostled, and they stay asleep you are moving your hands further away from your shoulder.  Your biceps (and other muscles) are getting longer and they control how quickly they lengthen to help to make it a smooth transition and landing so your baby continues to sleep.

When a muscle stays the same it is usually holding something static or still.  The muscle has to stay partially contracted so that it can keep your body part in the same position.  If you have ever carried a grocery bag by the handle, with your arm partially bent, you have probably experienced this.  I know my arm is screaming for relief by time I get back to my apartment!

I want to focus on the shortening and the lengthening, also known as power and control (at least in the way I describe them).  We often have families who ask us why their child can go up the stairs without a problem but they still want to scoot or crawl down the stairs, or just want to be carried.

Going up the stairs requires the generation of power from their legs.  When they step up, they are shortening their calves, quadriceps (thigh muscles) and their gluts (bum muscles) so that they can lift their body weight up to the next step.

Going down the stairs requires control.  The calves, quadriceps and the gluts are slowly lengthening so that they are controlling the body weight for the foot will land on the next step.  If there is no control, the muscles just release and the foot/body drops down onto the next step.  This is especially scary for kids going down stairs because they see all the stairs in front of them that they might fall down.  A great way to work on this is to break it into one or two step chunks so it is more manageable for them.  You will also often see kids turning sideways to lower down to the next step.  This does not require as much control as going forward down the stairs as you don’t have to move your leg over your foot so the calf does not have to do as much work.  Going down a step backwards also takes out some of the control needed by the calves so you may see kids using this as an alternative method.

And, as kids grow, strength, power, and control will change with each growth spurt and the muscles will need to get used to the new dimensions of the body and get caught back up again!

I’m not sure if anyone else out there has ever started working out again and your thigh (quadricep) muscles are really sore.  If you try to sit down gracefully in a chair, it is not pretty, but standing up out of the chair, while sore and painful, doesn’t look nearly as bad.  That is because sitting down requires control and standing up is power.  (My legs feel like this at this very moment…)

February 15, 2016

Low Tone and Growth Spurts

Low Tone Growth Spurt

We frequently have children of all ages in the clinic who have been diagnosed with low muscle tone (hypotonia).  This can often be confusing for parents and difficult to explain to others so we wrote ‘What Does Low Tone Mean?’ to help with that explanation.

Recently, my coworkers and I were talking about a few babies/children who we were seeing who have low tone and how we could see the progress they were making but it was often hard for the parents to not only see but to understand why it might possibly be taking ‘so long’ or longer than other children.

As a sidebar, I love having other therapists around to discuss the kids we are lucky enough to work with.  By discussing the kids, we are able to help pull the pieces of information and ideas we have in our head and synthesize them into something that makes sense and we can explain to others! What came out of our discussion is:

When a child has low tone, we have already acknowledged that they have to work harder to engage their muscles and keep them turned on to complete activities.  As the child uses their muscles they are helping to get them stronger so that they can generate more force and maintain that force generation for longer periods of time (endurance).  For instance, when a baby is working on tummy time they have to turn their muscles on to lift their head up off the support surface – to do that they need to be able to generate enough force so that their muscles can turn on and lift the head.  Once they have their head lifted up, they need to be able to keep that force turned on long enough so that they can look around.  With practice it gets easier to lift their head and they can do it for longer periods of time.

That is until they grow.  A child in their first year of life is in a constant growth spurt for the most part.  Not only is their body changing, but they are constantly learning new skills for their development.

If you think back to when you were a child in elementary or middle school and you hit a growth spurt (or to other children you have seen if you can’t remember yours!), it was as if you woke up with a whole new body.  You were probably a little bit clumsy (in my case a lot clumsy since I was already clumsy to begin with) and your movements were not very coordinated.  I often visualize a baby lamb or horse or giraffe taking their first steps when I think of young kids going through growth spurts.

Now, put that same awareness on a little baby who is changing every day.  Especially if that baby has low muscle tone.  Our muscles learn to work in a certain way and they get really efficient at it.  If you change their length or change the weight that they have to move, all of a sudden they are a little less efficient.  For kids with low tone, they are playing a constant game of catch up.  They are working hard each day to get stronger and become efficient but then someone goes and changes the parameters of the game on them.  Now they have to learn how to work at a new length with a new weight, and very often a new activity.

And, each time they grow or are faced with a new developmental task, they need to find their stability again before they can work on their mobility.  For instance, its very hard to reach for a toy in sitting, if they are having trouble generating the strength to hold themselves in sitting, or its hard to crawl if they can’t hold themselves in a hands and knees position.  So, with each growth spurt, they will need to relearn how to find stability before they can go back to working on their mobility.

Hopefully I helped to explain things a little and didn’t just make it more confusing!

February 8, 2013

Marbles and Water

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 pm
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I was perusing Facebook the other day and I saw my friend post that she put some marbles in her son’s bath and it resulted in hours (ok maybe an exaggeration but probably lots) of fun.  I loved it as soon as I saw it and in fact told her I would probably use it for a blog idea.  She said that she had gotten the idea for the marbles from one of my previous blog posts (I love when life happens like that).

If you are doing this you need to make sure you are supervising the marble and tub time with your kids.  Just think of the sensory input they are getting.  They can feel around for the marbles with their hands or their toes (as mentioned in my post).  They can try to pick up as many as they can or just one at a time.  You could also have funnels or other containers that they can practice putting them into and then pouring them out of.  You can use different colors and have them search for the colors and sort them, or have them count a certain number of marbles and see if the can do it faster with their hands or their feet or their right or their left.

Who else has used marbles in the tub and what did you notice in the process?

January 14, 2013

What does High Tone mean?

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 pm
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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.

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