Using a Hula Hoop for Weight Shifting

photo retrieved from transum.org

We are seeing several kiddos who have developmental coordination disorder and/or similar motor planning challenges and discovered that when we play weight shifting games on the Wii they are not able to motor plan the weight shift.  I will try to paint a visual for you – they will attempt to shift their weight to the right (or left) and in response to this they then bend their trunk so their head is going to the left (or right).  All this does is equalize out the weight on their feet again so no weight shifting occurs and nothing happens on the game.

I had tried having them weight shift on this small monkey balance board that we have and they were able to do it while keeping their head upright but as soon as I brought them back down to level ground, the compensatory trunk movements came back.

One day I was at a kiddo’s house and I saw a hula hoop lying there.  I decided what the heck, maybe this would help (also it changed things up just enough that she was intrigued by the idea).  I had her stand in the hula hoop and I held it stable at hip level for her with it resting lightly against her tush.  I then visually demonstrated (with sound effects) that I wanted her to move her hips side to side and ‘bump’ into the hula hoop.  She needed to look at the hula hoop to do it initially in order to have the visual and tactile feedback but eventually she was able to do it without looking.

When I told one of my other therapists that this had worked she used the same technique with her kiddos.  She was able to have success with it on flat ground and then keep the hula hoop in position while they played a game on the Wii and not only did the quality of movement improve for the weight shifting, but so did the scores on the game!  When she removed the hula hoop they weren’t able to maintain the improvement after only one session of practicing it.  Clearly we will need to do a mini experiment to see how many sessions it would take for carryover to happen (sorry, just another idea that popped into my head).

We did try it with one kiddo who has visual impairment and did not have the same results so we realized that the hula hoop definitely provides visual input as well as some tactile input from resting on the hips.

I’d love to hear if anyone has tried anything like this and how it has worked for you!

Ideas for Weight Bearing – Arms

I usually spend a lot of time thinking about legs and weight bearing and weight shifting because I’m often working with kids on walking or balance or other skills that require them to use their legs.  Well sometimes we need to work on weight bearing through their arms as well.  This could be to work on shoulder girdle (the shoulder blade area) stability, core strength, weight shifting, or encouraging the use of one arm if it is a little weaker to name a few of the reasons.  Here are some ideas that we have used:

• crawling, bear walking, crabwalking – over level ground or uneven ground or cushions.  This will help with weight shifting as well as strengthening.
• push ups – to make it fun for kids I will often help them out by stabilizing them at the hips and using bean bag bugs and have them try to ‘kiss’ the bugs
• wheelbarrow walking – to make it easier hold the kiddos closer to the hips and level to the ground, to make it harder hold them closer to the feet and at a bigger angle to the ground
• bean bag toss (or other throwing game) – have the kiddos lie over a bolster, peanut, cushion or some other item so that they have to hold themselves up by the arms.  Then they can try to throw bean bags at a target or make a pyramid with cups and have them try to knock those over or even set up bowling pins and roll balls at it.  For best results have the kiddos switch hands so they will work on weight bearing on both sides.
• bombardment – a game we made up that has the kiddo in the same position as the previous activity and then roll balls towards them and have them try to stop them and roll them back to you.  You can create points and everything.
• ball on a wall – I don’t have a real name for this one but I will have kids keep a ball on the wall with their arm fully extended.  They have to try to roll it around and keep it in a 12″ x 12″ square for a certain amount of time.  You can change the size and weight of the ball to make it easier or more challenging.  You can also have them try to coordinate a ball with both arms at the same time.
• steamroller – Have your child lie on a foam roller, bolster, peanut, or small therapy ball and have them use their hands to walk their body out as far as they can.  You can have tape lines on the floor to see how far they can make it without collapsing, and then of course walking back.  You can also have a toy out in front so then they have to weight shift onto one arm to use the other arm.

That’s just a few of the ideas that we’ve used.  I’m sure more will come to me later but I would love to hear the things you have done for weight bearing on the arms!

Skiing

     

Since I just took an extended holiday weekend and went skiing, I for some reason couldn’t turn off my PT brain and I found myself analyzing what I was doing (other than falling) as I made my way down the slopes.

I can tell you right off the bat that your quads get an amazing work out.  Not only were they burning as I was going down the slopes but they are still sore and I can feel them every time I stand up or go up and down the stairs.

My other sore muscles are my calves and that’s because being on skis encourages you to shift your weight forward so your calves are working to keep you from falling flat on your face.  This is the same way your calves (and quads) are used when you go down the stairs, they slowly elongate to keep you from falling.

When you are shifted forward on your skis going down hill you could stay in that one position but I can pretty much guarantee you will go speeding straight down the mountain.  In order to control your speed you need to weight shift from side to side as well as turn your skis slightly (or drastically) back and forth.  This is great practice for weight shifting which is important for walking.

When you are shifting forward and side to side, you need to keep your head and trunk upright and looking down the hill which helps to develop righting reactions as well as trunk rotation (for when you turn your skis side to side).

By looking down the hill or to your next target (especially if you are doing moguls) you get to work on maintaining visual focus despite other things going on around you.  You also get to anticipate what you are going to do next and work on your anticipatory balance reactions.

And believe me, skiing will work on your balance all around!

There are plenty of other things that go into skiing but that is the basic breakdown.

Now, when kids (or adults) first start out they learn how to maneuver with skis on their feet.  I remember practicing with a kiddo who was going to go skiing for the first time.  We were practicing on dry land so that she would have some idea of what to expect and thereby feel more comfortable with this new activity.  We practiced moving our feet from ‘pizza’ (pointing inwards) to ‘french fries’ pointing straight ahead. I would give the command and she would react.  This gave her the opportunity to work on reaction time, motor planning and coordination.  Lastly we practiced falling.  The main purpose for that was so that when she fell she wouldn’t get discouraged and would stand up and ‘brush it off’ or ‘shake it off’.  I was so excited to hear that her first skiing opportunity was not only a success but she wanted to do it again!  Ski school is a great chance for your kids to learn with their peers and work on social skills while they all learn a new activity.

For kids that have more involved needs there are some amazing adaptive skiing programs out there.  This family talks about their discovery of skiing and the upside of going downhill!  I also work with a kiddo who participates in adaptive skiing and he loves it.  The smile he gets on his face when you ask him about it says all you need to know about the benefits of this activity that is ‘typical’ among his peers.  Here are some of the adaptive ski programs I know about but please feel free to add to the list.

• Alpine Meadows in Tahoe, CA
• Vermont Adaptive Skiing
• Adaptive Ski and Sport Programs (nationwide list)
• Catamount in conjunction with STRIDE in Hillsdale, NY
• National Abilities Center in Park City, UT
• Adaptive Sports Center in Crested Butte, CO

When all things aren’t equal – Legs

I recently had a parent ask about ideas to help her child who has weakness on one side of her body more than the other side.  I figured I would write about some of the ideas that I use although please be aware that there are a ton of ideas and it depends on the developmental stage your child is at and specifically what skills they are working on.  For this case I am going to give ideas for kids that are working on skills such as walking or stair climbing.  I’m going to look at ideas for encouraging the use of both legs more equally. (In order to differentiate the legs I will talk about them as the weaker and stronger leg, hopefully this does not offend anyone)

Climbing – I love having kids crawl up and down steps.  This is a great way to work on both sides of the body together but still encourage them to activate the side that is weaker.  It works on developing reciprocal activity (which is needed for walking and crawling) as well as motor planning, coordination and leg strength (especially the butt muscles).  Make sure your kiddo is switching legs as they try to crawl up, using one knee on the next step up and then shifting their weight onto that leg as they bring the other leg up.  Make sure they are shifting their weight onto the leg that is leading so that they are practicing weight shifting as well as taking maximal advantage of the opportunity to develop leg strength.  They may need a little help especially if it is the weaker side.  Make it motivating by putting a favorite toy a few steps above them or using a toy with multiple pieces that they need to go up and down to get all the pieces (i.e. puzzles).

Up and Down Hill – Walking up and down inclines can also work to help your kiddo develop strength equally on both sides.  Especially on the way up they have to engage their butt muscles in order to keep their balance and on the way down they need to maintain control so they don’t crash.  You can have them walk or crawl up and down the hills.

Step Ups and Downs – If your child is standing and walking already then working on step ups and downs is a great activity.  I like to use smaller stairs and encourage the kiddo to go up leading with their weaker leg and come down leading with their stronger leg.  This way the leg that isn’t as strong gets to develop strength and power as it lifts the kiddo up to the next step and it develops control as it lowers the kiddo down onto the next step.  If your kiddo can ‘cheat’ while on the stairs then find a few phone books you can tape together or a step stool that is at a height that is challenging but they can have success (usually with a little support).  When I work on these kind of skills I pretend we are going over a mountain and usually I have bean bag animals or puzzle pieces on one side and their ‘home’ on the other side so that they think they have a purpose in going over the step over and over.  Same rules apply, stepping up you put the weaker leg on the step and going down you leave the weaker leg on the step.

Single Leg Stance – Now this can be challenging if your kiddo can’t fully stand or balance on one leg by themselves yet.  Here are some ideas to help that skill evolve as well as work on keeping their weight on the weaker leg.  You can have your kiddo stand with the stronger leg up on a slight height like a phone book or a step stool and play with them.  If they have challenged balance you may need to stand close by.  You could have them stand like this while playing with magnets on the refrigerator, drawing at an easel, playing games on an ipad, etc.  Just make sure they aren’t leaning on the support surface too much!  Another way to encourage single leg stance and shifting onto their weaker leg is to use a stomp rocket.  The stomp rocket is a toy that is so much fun!  Have them use their stronger leg to stomp on it which makes them have to stand on their weaker leg.  As they get better at this you can have them hold their foot up for a count of (1,2,3,etc) before they are allowed to stomp.  Depending on how good their balance is you may have to give them a slight hand (not too much support) while they balance before stomping.

Kicking a ball – Have them practice kicking a ball.  You can have the ball be standing still or it can be rolling towards them (depending on their level).  In order to pick their foot up to kick the ball they will need to balance on their weaker leg.

The above ideas all can help with stability and strength on their weaker leg.  If you are looking to have them work on lifting their foot more with things like walking then you can reverse some of the activities I listed or you can also try some of the ideas I talked about for improving foot clearance.

Please share other ideas!

Shift, Shift, Shift – Ideas to Encourage Standing Weight Shift

Website for this Image:  4colorrebellion.com

I have a kiddo who has cerebral palsy who is working so hard to walk independently and he’s getting there one step at a time (actually we’re up to lots of steps just with long pauses in between!).  One of the things he is having a hard time with is coordinating his weight shift so he can pick up his foot and take a step.  Part of this is because his balance is challenged when he’s on two legs so its even more challenged if he tries to rely on one leg, and the other part is that he is trying to figure out how to shift at the hips.  He’s really good at leaning his trunk to the side to take the weight off the side he wants to step with, but this doesn’t make his balance any better.  In order for him to get even more efficient with his walking we’re trying to teach his body how to shift from the hips so that his head and trunk can stay upright (not tip over!).  We’ve found a few techniques that have helped so I thought I would pass them along.

Wii Fit Plus – I love this program (although if you ask my coworkers I am not very Wii savvy – I usually have to get the kids to help me figure out what to click on next!).  There are a bunch of games under the ‘Training’ section that are fun and challenge balance and encourage weight shifting.  The kids love it because they are playing a video game and I love it because they are working on the skills I want them to.  By using the visual cues of the game he is able to work to get his weight from one side to the other.  We’ve even been successful with shifting our weight forward several times which is a challenge.  So that the focus is kept on the balance and weight shifting I usually have the kiddo work the board that you stand on and I work the controller (if both are required).  It makes for great teamwork and we’ve been able to progress from me shouting out ‘left’, ‘right’ to him being able to see which direction he needs to shift on his own.  Its a fun and motivating way to work on skills for a longer period of time.

Reaching Overhead – Despite the fun and allure of the high tech therapy, I do have to switch back to good old fashioned low tech too.  When my kiddo gets too excited he attempts to reach his arms all the way to one side to shift his weight to that side, or as I mentioned earlier lean his head and trunk to the side.  Since we are working on shifting at the hips and keeping an upright head and trunk he has to figure out how to elongate his trunk on the side we are shifting to.  We’ve been doing this by simply having him reach overhead on the side I want him to shift to.  I put the toy or object just a little out of reach almost directly above his shoulder on the side he is going to weight shift to and I ask him to reach for it.  Its been great because in addition to working on weight shifting at the hips he is elongating his trunk on that side and he is working on his balance.  The first time we did it he couldn’t even reach to his ear level without losing balance.  Now he can stretch his arm above his head and grab the object with only the occasional loss of balance!  I will alternate between asking him to do several on one side or alternating back and forth.

Step Up – This can be adjusted depending on the level of the child you are working with.  For this kiddo he is just attempting to lift his foot to place it on an Ikea circle (so approximately 1/2″-3/4″ height).  Just the lifting his foot enough to precisely place it requires a ton of concentration and control because he can’t just move his foot to any old spot, he has to get the whole foot onto the circle.  Because he is paying attention to where his foot is going, and usually looking directly at the circle, he has a harder time leaning his head and trunk or using his arms to generate the weight shift so he has to do a controlled weight shift.  Once he gets his foot on the circle he will hang out for a short period and work on maintaining his balance here.  This also encourages a maintained weight shift onto the foot that stayed on the ground because his other foot is slightly elevated.  This also lets him practice adjusting his trunk so that the stance side is elongated.  I will usually let them watch a page or two of a book on the ipad while standing here so they get some reward and motivation while being kept entertained.