This is a short post to reference another article I had written that I wanted to make sure I shared here as well.

PediaStaff recently featured an article that I wrote about implementing PT at home for kids with Down Syndrome.  I realized as I wrote the article that although it was specifically related to kiddos with Down Syndrome, it also is applicable to kiddos with low tone.  In fact, many of the tips are applicable across the board to other therapies and for any child who is receiving therapy.

I think the biggest thing to remember is that if you have good communication with the families you work with you can work together to problem solve and create the best program for their child.  Here are some additional tips I thought I would add:

1. If you have other kids, create opportunities for the whole family to get involved
2. Make it a game (its amazing what kids will do if its a game)
3. Make it part of your routine
4. Pick one or two important things to work on consistently rather than trying to do a whole laundry list and not being able to get to any of them
5. Make it into quality time you get to spend with your kiddo, it can be time that’s just yours and theirs
6. Use play to work on skills such as at a playground

I hope you take the time to read the article and please share tips that you have heard from your therapists or that you tell your families to help make all the therapy homework a little less overwhelming!

As babies develop they will often engage in hand and foot play, even bringing their feet to their mouth.  This may seem odd to parents but it actually serves a purpose and has several benefits for your child.  Some of these benefits/purposes are:

• Bringing their feet up to their hands and even their mouth allows the child to start stretching out their hamstrings.  After approximately nine months in the womb they have really tight hamstrings from being in the ‘fetal’ position.
• By lifting their feet up in the air and attempting to get them with their hands they are working on their core strength as well as developing anti gravity strength in their flexor muscles in both their abs and their head and neck.
• Grasping their feet allows them to develop their grasping skills which can carryover into fine motor tasks.
• Reaching for their feet encourages reaching with both hands as well as one hand.  It also can work on reaching to the same side of the body as well as to the opposite side of the body.
• Assymetric reaching can also lead to the development of skills such as rolling.
• The practice of attempting to grab their feet in either one or both hands, and either one or both feet allows them to develop motor learning and motor exploration so they can figure out what their bodies and muscles do.
• Also, hand and foot play, as well as putting their feet in their mouth shows they are developing body awareness as well as gives them opportunities to continue to develop this.

You can encourage hand and foot play as well as foot to mouth by gently bringing their feet up to where they can reach them.  Never force this motion because some kids may be tighter than others.  By exposing them to their feet, they will begin to be interested and attempt to reach for their feet to explore and play.

In our group this week we decided to challenge the kids a bit and add in hitting a balloon back and forth to each other.  We even felt a little ambitious and had a second balloon ready to go just in case we could add two into the mix!  Boy were we over ambitious on that thought!  I had realized some of the benefits of hitting a balloon with your hand back and forth (or even just with you trying to get it) but it wasn’t until I watched these kiddos try to grasp the concept that I saw all the skills they were working on.

Visual Tracking – The kiddos had to follow where the balloon was going so they could be ready if it came to them.  This involves following the balloon with their eyes to see where it was going.  We often had to provide extra cues to help with this.  We would say their name and we would point to the balloon as it was coming to them.  When one of the adults hit the balloon we would say the kiddo’s name that we were hitting it to to try to help them follow it and be ready.

Hand Eye Coordination – This was challenging.  They had to not only follow the balloon by visually tracking it, they then had to time and motor plan how to hit the balloon when it came to them so that their hand actually connected with the balloon.  We found that many of the kids had a hard time with the idea of batting it with their hand because they wanted to catch the balloon (this is when it may be handy to use a fly swatter or tongue depressor attached to a paper plate).  And when they did make contact with the balloon they had to try to bat it back into the air and towards one of their friends.

Motor Planning - I already mentioned the motor planning involved with batting the balloon with their hands but they also have to plan out how to move their bodies so they can get to the balloon and hit it up in the air again.  This involves timing, balance and body awareness.

Balance – For some of the kids they got to practice their ability to anticipate a movement and maintain their balance before, during and after the movement.  With one of the kiddos who has a hard time maintaining standing balance when asked to do a task, we practiced it a few times and he went from losing his balance every time he hit the balloon to being able to remain standing!  For one of our older kids that we work with we actually used it as a balance activity and had her stand on an unstable surface while she had to hit the balloon back and forth with another person.

‘Ball’ Skills – All of the younger kids initially wanted to catch the balloon and then throw it.  We had to spend some time breaking down the task and ‘teach’ them to hit the balloon with their hand when it was coming towards them.  This was a whole change for them because usually they are asked to catch a ball which is a different set of skills than hitting it away with their hands.

Counting – We decided to make it a ‘game’ to keep their interest so we were trying to see how many hits we could get before the balloon hit the ground.  During this game the adults tended to hit the balloon more but the kids were all counting out loud with each hit, allowing them to work on 1:1 number association.

The newest pinterest project used in OT around here was making an owl out of torn paper.  It was posted from this blog that has a ton of crafts on it.  After completing the project, the feedback our OT gave on its benefits is below:

• the cutting provides scissor skills practice as well as practice with visual motor skills and bilateral hand use (to hold the paper while cutting)
• tracing the shapes works on pencil skills as well as grasp and more visual motor
• having the kiddos put the eyes and beak on can work on body awareness and eye-hand coordination
• tearing paper works on bilateral coordination of hands, motor planning and mature grasp

With the paper tearing what she really noticed is that some kids can have a really challenging time doing opposing motions with their hands.  Some of the kids just tried to pull their hands straight away from each other and had a hard time figuring out how to move one hand forward and the other hand backwards to create a tear.  Also by pulling their hands straight apart they were using an immature grasp whereas the opposing hand motions encourages a more mature pincer grasp.  Think of the fun your kids can have tearing paper!

I’ve already addressed rolling in a previous post, as well as if you should be concerned if your child isn’t rolling yet, but I wanted to provide a video for some visuals on ways to encourage rolling in your child.  This video addresses helping your child to roll from their back onto their stomach.  Its important that your child learn to activate their flexor muscles (abs) to assist with rolling as opposed to throwing their head back to use extension to initiate rolling.  Using a toy or object that your child is interested and engaged in will encourage them to track it visually which they will follow with their eyes, head and then body as you move it to just over their head.  They will also try to reach for it which will further bring their abs into it as well continue the motion in the direction of the roll.  They also need to bring their leg and hip over which can complete the motion onto their belly.  In the beginning they usually need some extra help at the hip to guide them towards their belly, as well as to prevent them from falling right back onto their backs.  Don’t help too much at the hip because they need to start figuring out how much muscle activity they need as well as how far to continue the action (so they don’t fall back) and how to stabilize.  All of the trial and error is great opportunities for them to develop motor planning and work on movement exploration.  Once they are on their belly often their arm can get stuck under their body. If you tickle at their pecs (front of the shoulder) sometimes you can encourage them to pull their arm out.  Often they will figure out ways to maneuver their body until they can get the arm out from underneath them.

One final thing, make sure you help them practice rolling to both the left and the right so that they can maximize their mobility as well as develop their strength equally on both sides.

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!

After my last post on fun songs to use in therapy my coworkers suddenly started remembering songs that they frequently use in therapy so I thought I’d share some more ideas.

If You’re Happy and You Know It

This is a great song because you get to insert your own action.  You could pick skills that you are working on such as: jump up and down, stand on one foot, stand on tip tiptoes, jumping jacks, etc.  I also use it when we are on the ball and I am trying to keep the kiddo from using their hands to stabilize so I will often insert actions like:  clap your hands, reach to the ceiling, touch your ears, touch your head, reach to the sides, wiggle your fingers, touch your shoulders, say hooray (and reaching arms up overhead).

Hokey Pokey

Just by following the words of the song the kiddos get to work on motor planning and balance (and single leg stance for left and right foot).  To spice it up a bit you can have them jump (or hop on one foot) at the end instead of clapping.  You can also use the words ‘Touch the ground, stand back up, touch the ground and shake it all about’ to work on squats.  You could have the kids pretend they are dogs or cats and they can put their ‘paws’ and ‘tails’ in to work on crawling and balance in quadraped.  You can also just change animals for every turn so if they are frogs they hop in and hop out, or butterflies tip toe in and tip toe out.

I’m a Little Tea Pot

This is another fun song to use on the ball.  You can work on postural control while singing the song and then when you get to the ‘tip me over’ part you tip the kiddo backwards so they have to do a sit-up to get back up.

Old MacDonald

Great song for getting repetition of activities in.  If you are using an animal puzzle or play animals it works even better and the kids get to work on animal recognition because they get to select the animal that is on Old MacDonald’s Farm!  Usually we use this type of song for working on things like walking on a balance beam or going up and down the stairs.  Activities where they need lots and lots of repetition for mastery but may not be that exciting to do over and over again.

Winnie the Pooh

I only use the first lines from this song when it says ‘When I up,down,touch the ground it puts me in the mood.  Up, down, touch the ground in the mood for _____‘.  This can be a fun one to get a kiddo ready to do something.  You can have them squat up and down and then change what they are in the mood for.  It could be jumping, walking, running, crawling, spinning, etc.  (You just have to be okay if the rhyming is off!)  And it works even better if you do a big dramatic pause before you give the action!

More of Our Own!

• Mr. Helper (to the tune of Frere Jacques) - Mr. Helper, Mr. Helper, – Hold, Hold, Hold, – Hold, Hold, Hold, – Hold the paper steady, – Hold the paper steady, – Helping hand, Helping hand.  Great Song to use when trying to teach a kiddo to use their secondary hand for stabilization or to ‘help’ with the task.
• This is the Way We Wash Our Hands – I’ve adapted this one to go with gross motor tasks such as This is the way we (climb the stairs, jump around, skip along, stomp our feet, crawl away, run around, cross the bridge [for balance beam walking], bend our knees [squatting], walk on our toes, walk on our heels, etc).  Also lets the kids work on changing tasks because they have to switch what they are doing as the words in the song change!

In the most recent issue of Pediatric Physical Therapy there are three articles regarding autism/autism spectrum disorder and gross motor skills.  I was actually really excited to see this because I sometimes feel that gross motor skills get put on the lower end of the priority scale for kids who are diagnosed with autism, autism spectrum disorder, or PDD-NOS.  Now don’t get me wrong, I understand that there are only so many hours in a day and there are so many areas that you need to prioritize for your child’s development.  Gross motor is easy to overlook especially if they are walking and able to get around independently.

I just thought I would take a moment to highlight some of the benefits of working on gross motor skills with children who are diagnosed on the autistic spectrum.

• Strength and posture – Generally kids with this diagnosis have lower muscle tone.  This low muscle tone can cause them to fatigue quicker, have challenges with postural control, and make learning new tasks more demanding (which can make it harder).  Working on activities to develop core strength and overall muscle strength will help with these challenges which can aid them in paying attention in school because of improved posture, trying out new skills, playing longer with their peers during active play.  In addition, fine motor skills and speech skills can improve as a result of improved strength and muscular endurance as well as opportunities for active play.
• Coordination – Learning new skills can be challenging because of weakness and low muscle tone as mentioned above, however it can also be challenging if it is hard to organize all the pieces that make up a skill.  For example, jumping jacks involve jumping, arm movements, leg movements and timing/rhythm.  Just one of these components may be challenging so being able to practice breaking down the pieces of the task and then as they master the pieces putting them back together for the whole motion can help your child to achieve the skill in a more timely manner and with less frustration.
• Social skills – I have worked with several kiddos who are diagnosed as being on the autistic spectrum and concerns with families are often around their ability to interact with their peers and play.  Because learning new skills may be challenging that can make it harder to keep up with peers as they continually evolve their play and gross motor skills.  For example, jumping is a skill that kids love to do when they figure it out.  If your kiddo is having trouble jumping they may be missing out on valuable opportunities to relate to their peers in a play based way.  Same with bike riding or even being able to participate in PE or recess.
• Sensory – Depending on your child’s sensory needs, adding in gross motor play will allow your child the opportunity to get a variety of sensory experiences such as proprioceptive feedback to their joints (which can also help to keep low tone muscles ‘awake’), vestibular input to their inner ear from moving up, down and around, as well as tactile input from the various surfaces they may come in contact with during play.  Let’s Play and Get Messy! touches on some of the sensory aspects of play.

I am definitely not writing this to tell you to add one more thing onto your already busy and probably completely scheduled days, but just to help you look for opportunities to add gross motor practice into your day.  If your child is working with other professionals you can ask them to include some gross motor into their activities.  Or maybe find out from their teacher what their peers are doing on the playground or in PE so you can have ideas for active play in your household

Ever since I discovered Pinterest I have been bombarding my OT’s at work with ideas that look really fun and purposeful.  The idea I was the most excited about was the marble painting from Play Based Learning, so when one of the OT’s decided to try out this activity for a kiddo to encourage bilateral hand use because he doesn’t like to use 2 hands I was so excited to hear about it and see the final result!  Luckily it was a success as you can see from his finished art work.  And, even better the OT was able to realize other great skills this activity provided the opportunity to practice.  I thought I would share them:

• It worked on visual motor because he was tracking the marble as he moved it about the paper
• It worked on his ability to use a utensil because he was so excited to spoon the marble out of the paint onto the paper that he was actually willing to use a spoon – something that was not the norm
• It worked on grading movement because if he moved the bin to fast or made too large a movement the marble came flying out
• It also worked on variable movement because the tendency was for the child to want to move the box back and forth in one directional plane but then all he would get is a line on his paper.  This activity allowed them to work on diagonal and horizontal and vertical and circular motions to name a few.

Overall though, the best part was that the kiddo loved doing the activity and couldn’t wait to show his parents and didn’t want to let go of the project once it was complete!

After the completion of our first group class I shared some of our ideas in ‘Kids Games:  New Twists on Old Favorites‘.  Well, we’ve now started another group class with a focus on sports, ball play, gross motor skills and social interaction.  Since we have a bit more diversity of abilities in this group so we had to get creative again on adapting games to maximize everyone’s participation and skills practice.  Here are some of the ideas we came up with:

Mother May I

We start with one of the adults being ‘mother’ but then we make sure each child gets to take a turn as well.  We aren’t attempting to have them race across to see who gets there first, we are more focused on their gross motor skills and peer interactions.  The kiddo whose turn it is gets to ask to move across the floor.  Instead of saying ‘mother’ they say the person’s actual name.  We had the kids use hopping, jumping, skipping, galloping, tip toe walking, backwards walking, bear walking, crab walking, somersaulting (forward rolling) and crawling to name a few.  We were pretty amazed at the requests they came up with themselves without our prompting!  The kiddo who was playing ‘mother’ responded back ‘yes (kids name) you may!’  They had a blast checking out the different ways to get across the room as well as loving the fact that they got to request what they were doing.

T-Ball

We set up a t-ball stand and got a large bat and a foam ball and had the kids try to hit the ball.  This was great practice for crossing midline, using two hands, hand eye coordination, trunk rotation and standing balance.  Once they hit the ball they got to ‘run’ around the bases.  Of course we mixed it up so that each time they were up they had to use a different method to get around the bases (similar to the ideas mentioned in Mother May I).  While they were going the other kids got to cheer for them and then when they made it back to home plate they each gave the runner a high five!

Bear Hunt

This is a favorite amongst the kids for some reason.  They request it every single time!  We basically recreate the parts of the song by putting actions in.  Here are the lyrics and actions we have used (but there are lots of options for lyrics so pick and choose the ones you like best)

We march in place for the ‘going on the bear hunt’ line.   For the wheat field we do more marching and attempt to walk over the crash pad.  At the tree we climb up our stairs and jump into the ball pit.  At the cave we crawl through a tunnel.  For the bridge we walk across a balance beam. And, for the river we crawl back across the crash pad.  The kids especially love when you go back through everything really fast again!

Statue Dancing

We kind of made this one up ourselves by combining two different games.  We took freeze dancing where the kids get to dance around and then freeze when the music turns off and combined it with a different version that has the kids fall down when the music turns off.  So what we do is have the kids freeze when the music shuts off and then they all have to count to 3 and then blow each other over so they all fall down.  Then they stand up and start over when the music starts again.  I couldn’t believe how much they laughed throughout the entire song.  They couldn’t wait until they got to fall over!  Its been great on working on body awareness and where other people are around you in addition to helping with practicing floor to stand transitions!

With the rainy season beginning to hit us I was inspired to pull out my kid persona and go play in the rain (or the puddles)!  You’d be amazed at how motivated kids get to go in a puddle.  As long as the parents are okay with us going outside and we have the proper gear puddles are fun.

For some of my kids who are working on bike riding I use a little reverse psychology and tell them ‘Whatever you do, don’t get my bike wet’.  They immediately head toward the puddle.  This is really fun for a kiddo who uses an adapted tricycle and we are working on continuous motion such as pedaling.  It amazing how many times he can pedal in a row without stopping when he’s heading toward the puddle.  We actually finish our bike ride in almost 1/2 the time because there’s so much motivation and tons of puddles.

You can also work on jumping skills!

• jumping forward into the puddles
• jumping over the puddles
• jump up and down multiple times in a row in the puddle
• hop on one foot through the puddle
• do spinning jumps in the puddle (see who can make it all the way back facing forward in just one jump)
• leap from puddle to puddle to practice push off and spring

Stomping skills are great too!

• stomp in the puddle to see who makes the biggest splash (to work on putting your foot down with force)
• works on single leg stance if you have them pause for a count of (however long you want) before they get to try to splash you with their stomp
• works on foot clearance and hip flexion by exaggerating the lift up in order to get a bigger splash (you can experiment with if splashes are bigger if the foot starts higher or lower in the air)

Balance skills with puddles are a hit too!

• get out some stepping stones or stepping stools and create a path for the kiddo to walk over so they don’t fall into the puddle
• you can put a string across the puddle and pretend it is a tightrope so they don’t fall into the lake below
• or bring out a 2×4 and make a bridge across the lake

Some other ideas are:

• racing to see who can get to the puddle first (using running, skipping, galloping, etc)
• tip toe through the puddle trying not to splash
• try to step over the puddle without stepping in it to work on step length

What are your ideas for rainy day PT and puddle fun?

One of our OT’s adapted this animal book into an OT activity for her kids.  She took the book and photocopied and laminated each page and then added velcro to them so they would match up.  Just to warn you it makes the book much harder to close once all of the pictures are in there so you may want to store them in a separate bag to help preserve the life of the book.  When I asked our OT what she used the book for she quickly listed off the following reasons:

• bilateral skills to stabilize the book with a helper hand and try to take the picture on or off
• hand and upper extremity strengthening for the kids that have a hard time separating the velcro pieces
• visual perception/processing for matching the correct pictures to each other

I am sure there are other great uses as well from an OT standpoint but I wanted to figure out a way to work it into my session!

Obviously I could use it like a toy with multiple pieces and have them repeat whatever task I am having them do while they get each animal picture to put back in the book.  I decided to use it for an animal walk and imagination game.  I took out all of the pictures and turned them upside down on the carpet.  The little girl had to pick one and then she had to go around the room doing her best imitation of that animal.  I’ll tell you we had to get creative for some animals.  We collectively decided that the guinea pig liked to roll around like a roly poly and that fish slithered along the ground (we were pretending to swim).  It was a great way for her to work on motor planning, strengthening and her imagination!

Although I’m not a speech therapist I would imagine that you could use this tool for encouraging sounds (since we had to make the noise of each animal as well) and for matching, site words and picture identification.  I would also love to make it into a memory game so that whatever page the book opened to you had to try to remember where that card was in the rows of turned over cards!

What every day items have you adapted into a game or tool that serves multiple purposes?

Relay races or even just relays are really fun ideas that can work on gross and fine motor skills as well as teamwork, cooperation and social skills.  All this while the kids are active and playing!  Depending on the skill level of the kids involved you may need to modify these but they can be used for groups of kids or for one kid at a time (that’s the beauty of using a timer – they get to ‘race’ against the clock).

Egg and Spoon Race – You can use a typical plastic or metal teaspoon with a plastic egg filled with beans or sand. Or, for younger kids or kids who need a little more help with their stability or balance you could use a bean bag with a plastic serving spoon (the large ones).  You can keep it simple by having the kiddo walk straight across without having the egg fall off the spoon or you can have them weave in and out of cones or walk backwards or sideways.  You could also play pass the spoon down the row if you have a bunch of kids!  If you have a scooter or rolling chair you could incorporate hamstring strengthening by having the child sit on the scooter/chair and use their legs to ‘walk’ themselves to the other side or you could get some teamwork going and have another kiddo push the one on the scooter/chair.  All this without letting the egg fall off the spoon!

Three Legged Race – You can get some bandanas or use thera-band or any material that you can tie two legs together.  The kids have to work together to get from one side to the other.  You can make it more challenging by having them have to hold something or bend down and pick up things from the ground as they cross.  One kid can hold the container while the other kiddo picks the item (i.e. bean bag or smaller if you are working on fine motor skills) up and places it in the bag/container.  Talk about teamwork and balance skills!  If its just one kid you are working with you can partner up with them or get a sibling involved!

Potato Sack Race – This one can be done with store bought potato sacks or with oversize pillow cases or actual potato sacks.  Have the child get in and hop across to the other side.  If they are much higher level have them hop on one foot over and the other foot back.  For kiddos still developing jumping skills you can give them some hand hold assist while they hop their way across to the other side.

Over and Under – A great activity for teamwork and sequencing as well as balance and coordination.  Get a line of kids all facing forward (using a tape line for them to stand on or individual spots may help with the chaos that could ensue).  Give the first child a ball or a bean bag (or a water balloon if you are outside and its summer time) and have them reach over head to hand it to the person behind them.  Once that kiddo has the ball then they pass it between their legs to the child behind them.  The kids take turns alternating over and under until it reaches the end of the line and then they reverse it to get the ball back to the first person.

Magic Hat Race – You can put a bunch of options into a ‘magic hat’ and then draw out a piece of paper to see what they are going to do for that turn.  Some options are:  running, hopping, skipping, walking backwards, twirling, walking on tiptoes, crawling, bear walking, crab walking, etc.  You could do this as many times as you want and get in lots of practice for skills.  Its also interesting for kiddos who have difficulties with motor planning and coordination to see how they do when they feel like they need to move faster.  It will give you an idea of what skills you still need to practice at slower speeds or by breaking them down into components.

Wheelbarrow - This is really fun when its two kids working together but even if its you and a kid its a great way to work on core and upper extremity strengthening.  Depending on the strength of the child you may need to get on your knees because the higher you hold their legs the harder it can be for them.  Same with holding them by the hips or all the way out by the feet (hips is easier than feet).

Tightrope Walk – Put a piece of tape along the ground and have the kids pretend they are walking on a tight rope and if they ‘fall’ off they have to start over.  You can have them do it taking giant steps, baby steps, on their tip toes, sideways or even backwards to mix it up.

Logroll – Kids lie on the ground and roll from one side to the other.  Its amazing to see if they can stay on track.  If you have more than one kiddo have them lie down head to head and hold hands and try to roll together across the room without letting go of each others hands.  I highly recommend you try it with the kiddos too – its lots of fun!

What ideas do you have or have you used??

I tend to be guilty of thinking of abs and core as being synonymous.  So I often have to remind myself that there is a lot more to the core than just those abdominal muscles that I’m personally awful about exercising (I definitely hate doing ab work).

So what is the core if its not just abs?

Your core pretty much encompasses from your neck to your hips.  This means it includes front, back and sides of your mid section.  It includes your shoulder and shoulder blade muscles.  It includes your gluts and other hip muscles.  Basically your core is the foundation that the rest of your movement occurs off of.  Think of it as the cornerstone of your body.

When kids work on their core aren’t trying to develop a six pack but rather improve the endurance and coordination of the muscles that fall within the core.  You don’t just want your child’s core to turn on when they want to do a sit up or a side bend, you want them to turn on so that your child can sit up straight throughout the day while they try to learn in school.  You want their core to work while they are trying to play or to eat.  If their core is strong they have better use of their hands and arms for fine motor skills and better use of their feet and legs for gross motor skills.

So, when working on core muscles, its not just about overall strength, its about their ability to stay turned on for long periods of time (endurance) or their ability to cooperate with the other muscles around them (coordination) as well as their ability to react to what is happening in a split second (help maintain balance/upright position).

Working on the individual muscle strength is important so don’t get rid of those sit ups or trunk extensions but its important to make sure you are working the core as a whole.

How you may ask?  Well here are some ideas:

• Using a ball or core work is fun for the child and can work on the muscles activating together  and reacting quickly, as well as keeping them turned on for longer periods of time to build their endurance.  There are a lot of resources out there for ball work ideas and here are two, ‘Having a Ball with Core Muscles Strength‘, and ‘Therapy Ball Exercise Ideas‘
• Having kids perform a plank and some variations are great ideas also – you can have them turn on their right or left side for a plank or face down.
• Animal walking is a great way to develop dynamic cores strength as well as make it fun and work on kids imaginations!
• Wheelbarrow walking
• Climbing is a great way to also work on core muscles strength.  Anything from a climbing wall to a ladder to a climbing net to crawling up and stairs.  The more dynamic the surface (such as a net) the more challenge your core will get.  It also involves the hips and shoulders.  If your child needs lots of help then start with something really stable like crawling up stairs (also a great way to develop hip and glut strength).
• The sit-n-spin is also a fun way to work on the trunk while having fun!
• Here are some other fun suggestions for core exercises

I also mentioned that your core involves shoulders and hips.  This is important to remember because if your child doesn’t have muscles that can stabilize their shoulder blade it makes using their arms a lot harder.  Can you imagine trying to form your letters correctly when handwriting if your shoulder area wasn’t strong?  Any of the exercises that are listed above that involve weight bearing through the hands and arms will work on shoulder girdle stability such as:  wheelbarrow walking, crawling, bear walking, push ups, and plank.  In addition here are some other gross motor ideas that can strengthen the core and have a direct effect on handwriting and fine motor skills.  Another idea is to have the kiddo use some thera-band and try to pull you up by pulling on the thera-band and pulling their arms back.  They think its hysterical that you are ‘stuck’ and need help!

Lastly, a lot of times when I am working on posture with a kiddo or having them sit on a ball they tend to slouch from their shoulders all the way to their hips.  There can be a few reasons for this such as weakness or tight hamstrings but the reason I want to look at is challenges with coordinating the trunk muscles so that they can tilt their pelvis forward and get that nice straight posture that helps with learning and attention.  If you spend just a little bit of time working on this with kids they start to pick it up pretty quickly.  If it gets overlooked, it can contribute to tight hamstrings and ongoing poor posture that is harder to correct as they get older.

What I generally do to teach coordination of the trunk muscles for an anterior pelvic tilt is I work on reaching with the kiddo.  The easiest is to have the child sitting on a firm surface (or even a slightly downhill surface) on the floor or a chair.  If you have two people its even easier.  Find things they want to reach for whether its toys or an ipad app and hold it in front and above them.  If you stabilize their hips while they are reaching (with both hands) and give them some cues at their low back they will start to tilt their pelvis forward while reaching.  Its important for them to reach using both hands in the beginning while they are working on getting the coordination of their flexors and extensors so that they stay symmetrical.  Also watch for if they keep their chin tucked or if they really extend their head and neck to try to stabilize.  I usually remind them to put their chin down and use their eyes to look up.  Once they get the coordination down you can start to challenge them by having them reach off to one side or add a dynamic surface such as a therapy ball, disc or peanut.

What are other ideas you use for core muscle control and upright posture?

This is a continuation of Motor Tips for Parents – Part 1 where I try to summarize the answers to questions and pointers I’ve given to my friends who have become parents in recent years.

1. Less Equipment, More Floor Time – I know its a challenge in this day and age to avoid the plethora of equipment that is available for kids and babies because they make parents lives easier and can keep kids contained and occupied.  However, this limits their chances for movement, sensory and environmental exploration.  Equipment such as exersaucers and bumbo chairs, while not bad when used in moderation or for therapeutic purposes with kiddos who need extra support, can get in the way of movement development if used excessively.  Kids benefit from practicing figuring out sitting and standing through trial and error, not to mention they develop their motor planning by figuring out what works and what doesn’t work as they not only try to maintain sitting and standing but also work to get into those positions.  By just putting your kiddos in bumbo chairs and exersaucers all day long (okay exaggeration there to help my point) they are getting extra stability and support that they wouldn’t normally have when trying to explore the motion on their own.  Now I’m not saying don’t use equipment but be aware of how much time your child gets for floor time.
2. Practice, Repetition, Consistency – A lot of times parents, or my friends have questions about how to teach their child a new skill.  Obviously depending on the skill there are going to be different techniques involved but a big factor is that to master a new skill kids (and adults) need lots of practice, repetition and consistency.  If you want your child to learn how to get off the couch without diving head first then every time you get them off the couch help them to turn around and go down feet first (it even helps if you add a consistent phrase to the activity).  If you pick them up and set them down on the floor every time it doesn’t give them any frame of reference.  Same for a kiddo learning to sit up on their own.  If they are lying down and you want to get them into sitting, help them move through the motions of getting into sitting rather than picking them up and placing them in a nice sitting position.  In the beginning you will probably have to help them a lot but they will start to get the hang of it and figure it out on their own.  Feel free to apply this concept to almost any skill your child is working to develop!

The Pirate Song

This new favorite song of ours.  One of my coworkers started using it and we have all picked it up.  Its great for ball or balance board work.  Its especially great if you add a dramatic pause after the line ‘the captain said to me…’ because the kids love the anticipation of what comes next and it usually results in a great giggle!  I love it because I can switch it up.  I can move the child slowly on the ball during parts of the songs, I can hold them for slightly longer so they have to work on various trunk muscles, and then I can speed it up when it comes to ‘We’ll go this way and that way and forwards and backwards’.  I mean the song helps you out with trunk control right in the verse!  I usually add in some bouncing too.  Its great for the kids to come up with items that rhyme with the numbers and to pick up the vocals at different parts.  Definitely 2 thumbs up for this song from us and our kiddos!

The Ants Go Marching

This is a great one for working on walking or crawling or knee walking or wheelbarrow walking.  I loved it when I used to do treadmill training with the kiddos.  I don’t have access to a treadmill anymore but I still use it when I am gait training a kiddo using an assistive device or where I have to manually help them.  It provides a nice steady rhythm to go with walking and it engages the kiddos while they work on a harder skill.  I also use this for ball work as well because the kids love to bounce during the ‘boom, boom, boom’ part!

The Wheels on the Bus

This is a classic favorite.  Depending on what I am doing or how long I want the activity to last I add in my own verses.  I’ll share a few of mine but feel free to make up your own.  I was trying to keep a kiddo entertained and she loves Disney characters so while we were slowly commando crawling across the floor I pulled every Disney character out of my memory and added them as riders onto the bus.  Let your creativity and imagination run wild and I bet your kiddos will love it!  See who they come up with too, you might be surprised!

• The parrot on the bus says ‘Polly want a cracker’
• The pirate on the bus says ‘walk the plank’
• The baker on the bus says ‘have some cake’
• The genie on the bus says ‘your wish is my command’
• The butterfly on the bus says ‘flutter, flutter, flutter’
• The Winnie the Pooh on the bus says ‘where’s my hunny’
• The ballerina on the bus says ‘twirl, twirl, twirl’
• The Dorothy on the bus says ‘there’s no place like home’
• Use animals too and have them make whatever sound you usually have them make

Ok, I think you get the idea.  We’ve also adapted it for bike riding so it can be the wheels on the bike.  This way the feet can ‘pedal, pedal, pedal’ and the hand can ‘steer, steer, steer’.  Hope you enjoy the adaptations as much as we do!

Ten Little Monkeys

Another favorite that can be used for gross motor play or for ball work again.  It can be used while working on jumping on the trampoline or across the floor.  My favorite line is the last one when there are no monkeys jumping on the bed and when mom calls the doctor the doctor says ‘put those monkeys back in bed’! (see Kids Games – New Twists on Old Favorites for a gross motor idea for this song)

Where is Thumbkin

We use this one on the ball to keep a kiddos hands occupied with a task or just sitting down and working on posture or from a fine motor standpoint, working on finger isolation or imitation.  Its a fun one!

Creating My Own Version

I have a kiddo who I work with whose mom is amazing at coming up with lyrics to well known tunes or just making up her own tune.  Her child responds really well to songs and will do any activity if there is a song to it.  Well I have been able to practice a bit with this and I’m not nearly as talented as her but I’m getting better with practice (well at least the kiddos don’t mind my attempts, my coworkers continue to giggle at me)!  Here are a few that I have added in to work on the skills we are doing (I will try to keep it to tunes that are already in existance):

• Five Little Ducks – We are working on climbing a climbing net and to get multiple repetitions involved we are putting bean bag animals at the top for the kiddo to rescue.  On the way up we use the words: ‘5 little friends went out to play, up the net and far away, (kiddo’s name) said ‘hey where are you?  I’m coming to rescue you’, up the net he went to them, left foot right foot and two hands.‘  (If it takes him longer than this to get to the top I have to get creative so it changes on a weekly basis)  On the way down we sing: ‘down the net he went once more, left foot right foot to the floor, over and over he climbed back down, until his feet were on the ground.‘ (same deal for if it takes him longer).  We then repeat with one less friend for the next time.
• Farmer in the Dell – Ok, I had to get really creative on this one because we were working on standing from the ground using a half kneel (not something any kid really wants to practice over and over).  Since I was using a farm puzzle to help with the repetions, I adapted Farmer in the Dell to the following words: ‘There’s a (kiddo’s name) on the ground, there’s a (name) on the ground, hi ho the dairy oh, there’s a (name) on the ground.’  Next verses I will just give the first line, hopefully you get the idea: ‘(name) takes a sheep (or whatever animal piece you want them to pick up)‘ next verse ‘There’s a (name) on his knees‘ next verse ‘And, (name) stands up‘.  Hopefully you could follow that, believe me I’m a novice at this song writing stuff!

I’d love to hear any of your favorite songs to use.  I generally use any song that has lots of verses from the pre-existing kids songs but I also would love to hear any creative adaptations!

First of all give your kiddo a high five!  Its great that they are walking.  I always laugh because I like to warn parents of kids that I work with that once their kiddo starts walking that’s all they want to do for the next several sessions.  That said, the challenge becomes how to direct and progress that walking!

I have been working with a kiddo who just made that final step (pun intended) to becoming a functional walker.  She now chooses it as her mode of locomotion.  She, for the most part, has mastered walking on a sturdy, flat surface that isn’t littered with obstacles.  The parents were looking for ways to continue to progress her walking (she still reverts to a mild high guard when something unexpected happens) that they could do.  Here were some of my suggestions:

Walking on different terrain – Since she has the living room and apartment mostly mastered I encouraged them to have her practice on different surfaces as well as practice walking from one surface to the next.  Some outdoor options are:  grass, tan bark, rubberized playground flooring, sand, and uneven terrain where it can have slight uphills and downhills (nothing you or I might notice but it could feel like a mountain to a novice walker).  For indoor practice you can use: carpet, really plush carpet, tumbling mats, mattresses, pillows, couch cushions, fluffy comforters, and yoga mats.  They may need a hand hold in the beginning but you can start to wean them off of it.  We started practicing with this little girl on her couch pillows (which are definitely way more challenging than plush carpet but it was the only option we had at hand at the moment).  First we had to convince her to stand on them so we had her stand on the pillow while playing with a toy she really liked at the couch.  Then we moved her away so that she had to walk to get to the toy she wanted to play with and over the next several trials we went from her having a death grip on my hand to her trying to push me away so she could do it by herself (of course she didn’t have the balance to do that so she promptly toppled).  Use things that really motivate them to get them used to standing on new and more challenging surfaces and to entice them to attempt walking across those same surfaces.  Once they start to get used to and master a surface its great to have them try to walk from a firmer surface to a softer or more uneven surface so that their body can begin to figure out how to react to the changes and thus improve their balance and overall walking proficiency.

Clearing obstacles – Another scenario we set up in the apartment we set up was having to step over things that get in their way.  We used one of her toys that has a long stick on the end of it and put the couch pillows on either end of it so she couldn’t avoid the stick.  I then put my ipad playing ‘Monster at the End of the Book’ on the other side and gave her my hand to help her with stepping over it.  She had a similar progression with as above in terms of going from the death grip to wanting to do it herself.  She was actually able to succeed doing it all by herself by the end.  We just kept moving the ipad from one side of the obstacle to the other so that she would keep practicing.  We started with something small and easy to step over but you can make it a little wider or a little higher to increase the challenge.  You could also make it into an obstacle course and have several in a row so that  there are more opportunities for practice.

Walking backwards – This skill is a slightly harder one to teach I think (I’m always open to suggestions though).  I generally use those toys that have a string on them so the kiddo can pull them along.  If it is an engaging toy they will want to watch what it does while it is moving so the only way they can pull it is to walk backwards.  I usually have to give them a little support while doing it so that they know they are supposed to move backwards.  For example, I can guide them from the shoulders with a slight backwards force to keep their feet moving that way.  If you have moveable furniture you can make a narrow pathway for them to pull the toy through making it harder for them to turn around to go forward.

These are just a few of the suggestions for what you can do with your kiddo once they are walking.  As always, I’d love to hear your ideas that work with your kiddos.

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.

Some benefits are the enhancement of:

Spatial/Body Awareness and Sensory Exploration:  When kids explore their environment in a variety of ways such as rolling, running, going up-side down, sliding on their tummy, etc. it helps them with learning and experiencing where their body is in comparison to their environment.  Using messy play, especially with tactile input (grass, sand, tan bark, water, bubbles, etc) helps to increase this awareness when their bodies are in different positions.  When your child is allowed to fall, roll around and rough-house they are increasing their balance, coordination, motor planning and overall safety, by getting to know their body and how it moves.

Creativity and Imagination:  When kids get to explore things that are messy (finger paint, shaving cream, a jumble of toys, pieces of ‘junk’ they find, etc) and they can manipulate, create and interpret them the way they want to, they are  building their imaginations and exercising their creativity muscles.

Health:  Now you may be asking, how letting my child make a mess could possibly keep them healthy?  Just pause and think about it in this way, the child that is outside making mud pies and sliding down the slide into the puddles is getting a lot more movement than the child in front of the tv or the computer.  Not that those things are bad, but good old-fashioned play shouldn’t be a lost art.  And, Keeping kids active and engaged in active play is one of the best ways to counteract the obesity epidemic that is prevalent in this day and age.

Self-Regulation:  When kids get to run, jump in puddles, dig in the sand, etc. they are able to increase their overall self-regulation during the day.  Also, the more movement they engage in during the day, the better they sleep, eat and learn.  By not restricting their play and allowing them to get dirty or messy, as long as it’s safe of course, will encourage them to continue seeking out the movement that they need to keep themselves regulated as they go through their day.

Problem Solving Skills:  If kids are cleaned up immediately, every time they get dirty and/or they are kept from opportunities to experience making a mess and being messy, they are missing out on chances and experiences to build upon their problem solving skills.  Letting them explore in messy play builds upon problem solving and motor planning skills. They get to figure out things like:  How messy can I get? What happens when I put it in my hair? Can I wipe it off with my hand? Does my friend like it when I touch them with messy hands? They begin to figure out things on their own and form their own answers to their questions. It can also aide in learning appropriate social cues as well over time.

We all remember how much fun it was to get messy as a kid and why wouldn’t we want our children to experience the same thing? So remember to put aside those remotes and keyboards every now and then and go get messy!  (As an added bonus you can also teach them the ‘joys’ and value of cleaning up!)

Spinners -Recently I have been using a spinner to help with activity selection.  The high tech version that I started using was the Spinnerz app that Your Therapy Source talked about in one of their blogs.  I downloaded it and have been shouting its praises until my coworker went to download it and it wasn’t in the app store.  I’m hoping this is a temporary thing and they bring it back but I think you can apply the ideas to other electronic customizable spinners or even make your own low tech ones (great use for old game board spinners).  The beauty of this is you can add whatever tasks you want the child to work on.  I have made indoor activity lists and I have made outdoor activity lists.  We got a little fancier and added a second spinner that counted 1-10 so that after the exercise was chosen the child then spun the ‘how many’ spinner to find out.  Its amazing.  If I had asked the child to do 10 reps of push-ups there would have been lots of whining, with the spinner its became fun!  It gets even easier if you let them help you come up with the tasks on there.  (Just think of the possibilities – you could put your kids chores on a spinner and see what they are going to have to do that day!)

Dice – A great tool I’ve found for selecting how many reps and sets are a pair of dice.  You can use an iphone app (there are a lot out there, some even simulate rolling real dice) for a high tech set if your kiddo has a hard time with hand use or if they just really like tech things, or you can use two dice.  I have been using a dry erase board where we come up with activities for the day and then for each activity we will roll two dice.  One will tell us how many reps and one will tell us how many sets.  This way the kiddo feels like they are part of the decision making process.  They also love crossing the items off the dry erase board when they are finished!  Another use for dice would be to make some cardboard dice or to put stickers on real dice and write the various activities you want to accomplish on each side.  The second one can be for determining how many.

Sticker Charts - When I was having a really tough time with a kiddo I started using a sticker chart.  The kiddo and I sat down together and listed the activities that we had been working on that needed to be practiced and came up with a list of about 7 items with one of the items being ‘extra activity’.  I then drew columns next to each activity and if we did that activity that session at the end we got to put a sticker next to it. Our agreement is that once all the squares on the sticker board are filled in we will have a ‘fun’ day.  The best part about this is that our ‘fun’ day will still work on skills that I want.  Our options were – using the Wii, dance party, or going to the clinic (I see this kiddo at home and there is definitely an aura of magic about the clinic!).

Jenga – So, I’ve mentioned this idea before but I thought I’d add it to this post.  We have revamped our Jenga set so that most of the pieces have a colored shape on them.  Some of them are still blank.  Depending on the age and the skill level of the child you can have them actually play Jenga (works on fine motor control and finger isolation) or you can just have them pick a block out of a bucket.  I showed my kiddo the shapes and colors ahead of time and we used the dry erase board to make a chart.  We assigned activities to the shapes and number values to the colors.  When I asked what we should do about the blank ones we decided to just assign a set activity to them (in this case it was to do 3 jumping jacks).  Part of the fun is wondering what activity is going to come up.

Those are just a few of the ideas I have come up with.  I’m sure I will have to continue to stretch my creative powers to continue to keep up with these kids that are so savvy at negotiation!  Please feel free to share ideas you have come up with.

Over the last few years many of my friends and relatives have had kids of their own.  As a result I often get questions from them regarding what their baby or child should be doing.  I understand that advice and opinions can be taken with a grain of salt and everybody does things differently but I thought I’d share with you, over several posts, the top pieces of advice I’ve given as a result of all the questions.

1. Tummy Time, Tummy Time and More Tummy Time:  This is my number one piece of advice to all new parents.  I’ve been to a lot of baby showers and some of them have you offer an anonymous piece of advice to the new mom, well mine’s never anonymous because it usually always reads ‘Lots of Tummy Time!’.  I just think (and research has shown) that this position is the building block of movement.  It helps the baby to begin to develop their head control, strengthen their arms and shoulder girdles, begin activating their gluts which will help to facilitate their hip and femur bony development, and stretch out the front of their body which has been squished into flexion for the last 9 months to name a few.  It also gives them some control of their environment.  If they are lying on their backs they are waiting for toys to be brought to them, on their tummy they can begin to figure out how to move or pivot to get to what they want.  Also, it helps to facilitate them getting into a sidelying position which is really important for trunk development.  With the implementation of the Back to Sleep program and the busier lifestyles of families and the conveniences that have been developed (bouncy chairs, exersaucers, click and go car seats) parents have to make a point of allowing their child to spend time on their belly. (see also ‘Strategies For Tummy Time‘)
2. Give them motivation and a challenge:  This is in response to how to get their kids to move.  Now some kids may have other challenges going on but the same ideas still apply.  If you want your child to move don’t put everything right in their reach.  I remember going to a family’s house and they were concerned because all their daughter did was sit in one spot and didn’t attempt to move.  When I looked to where she was sitting, she was on her blanket with every toy she could possibly want right in front of her.  She has no reason to move!  Find out what is motivating for your child, let them engage with it and then move it just a little bit out of their reach.  Let them try to struggle and figure out what they need to do to get to it.  The struggle is part of the learning process.  Its when they get to figure out what their body can and can’t do and how to react to any changes.  This is where motor planning is developed.  Now, I don’t torture the kids, I will usually let them try to figure it out and then assist them into having some success so they can play with whatever motivates them and then move it out of reach again and start all over.  Over Christmas my cousin’s little girl really wanted to move but couldn’t figure out what she needed to do.  We put the little baby doll that she wanted a little bit in front of her and then I gave her some assistance at the legs so she could push herself along the floor.  After a few tries she started to grasp that by moving her body she was able to get to her toy.  That awareness helped her to pick up the skill even faster.  (see also ‘Frustration + Problem Solving = Motor Planning and Movement‘)

To be continued…Tune back in for more of my amazing tips!

photo from: kidsexercises.net

Okay, so I love football, specifically the Denver Broncos so as you can imagine (if you follow football) its been an exciting season with lots of controversy!  As a result of all my football watching recently, I can’t help but notice the extremely large muscles on the guys on the field!  It started me thinking about strength training and how important it is for function at any level, from pro sports to a child trying to learn/relearn how to walk.

At our clinic we do a lot of strengthening with kids.  This includes functional strengthening as well as targeted muscle specific strengthening.  For the targeted strengthening we use the Universal Exercise Unit, because it works well for our needs.  We tend to do high repetitions and low weight/resistance for the strength training we do with the kids.  This can cause a lot of questions from parents who are used to traditional strength training for adults because many trainers and physical therapists recommend fewer repetitions and larger amounts of resistance for maximum strength gains in adults.   The reason for the low weight/resistance and high repetitions lies in the developmental differences between how children and adults make functional strength gains.

(In general strengthening is done to improve function in day to day life which is why I keep mentioning functional strength gains.)

Strength training in adults causes the muscle fibers to get thicker or hypertrophy.  These bigger muscle fibers are the reason adults who are strength training develop bigger muscles (which they can flex and show off to their friends) and thereby make functional strength gains.  For adults to maximize muscle hypertrophy and their ability to “build” muscle, heavier weights at lower repetitions are recommended over the course of 6-8 weeks of consistent strength training.

On the flip side, strength training in children, uses improved motor unit recruitment (or muscle fiber recruitment) to cause functional strength gains. This process does not result in muscle hypertrophy and while we may see improved definition in the muscle when contracted, the overall size of the muscle does not grow.  By using high repetitions in each strengthening exercise the child has more opportunities to practice a movement against a set amount of weight/resistance.  This practice provides the opportunity to produce the motor learning that allows them to more effectively and efficiently recruit their muscles when a task demands increased strength.  The lighter weights, allows a child to actively participate in more repetitions or opportunities for practicing calling on specific muscles for specific movements prior to fatigue.

Kids don’t begin building muscle through fiber hypertrophy until puberty but depending on the goals of strengthening and/or a child’s diagnosis a pediatric physical therapist may continue to use higher repetitions and lighter weights while working with children that have already entered puberty if their goals are not necessarily purely strength based, but rather motor control, selective muscle activation, or endurance based.

Hopefully I made this understandable and not too confusing but feel free to ask for clarification if something wasn’t clear!  I also included some references for those of you that like to look things up!

References:
1)      Faigenbaum A, Kraemer W, Blimkie C, Jeffreys I, Micheli L, Nitka M, Rowland T.  Youth resistance training: updated position statement paper from the national strength and conditioning association. J Strength Cond Res. 2009;23(Supplement 5): S60-S70.
2)      Raynor AJ. Strength power and co-activation in children with developmental coordination disorder. Dev Med Child Neurol. 2001; 43:676-684.
3)      ACSM’s Guidelines for Exercise Testing and Prescription, 7th Ed. Baltimore, MD: Lippincott Williams & Wilkins; 2006.

I love Top 10 lists!  Here is this years list of Top 10 Blog Posts:

10.  Core Muscles:  Building a Solid Foundation

9.  No Kid Left Inside – Benefits of Outdoor Play

8.  Having a Ball With Core Muscle Strength

7.  Gross Motor Development vs. Fine Motor Development

6.  Standing Straight and Tall

5.  A Glossary of Sitting

4.  Let’s Play!

3.  What is Protective Extension?

2.  Why is W-Sitting a Four Letter Word?

And the most read blog post by a landslide:

1.  Torticollis:  What Is It?

Thanks for everyone who reads and I look forward to the next year!

Do your kids ever get tired of the same activities during therapy or even while playing?  Well one of the ways I’ve tried to spice things up is by adding in obstacle courses.  Generally I take the same skills we’ve been working on and put them all together.  For the older kids I let them help me create the order and the items that are in the course.  The great thing is you can put as many or as few items as you want in it and if the kids are helping you they will most likely pick an activity that you regularly work on!  In addition to working on the individual skills it also helps them work on sequencing and transitioning from one task to the next.  Add in a stop watch and you can make it a lot of fun!  Usually the first effort is the slowest because they are figuring out what’s next and how to do each skill so they generally ‘beat’ their time on the next round.  You can really spice it up by using dice to see how many times they have to do the entire course and/or how many times they have to do each item in the task.  We have made indoor and outdoor obstacle courses and sometimes a combination of both!

Here are some ideas that I have used recently:

Outdoors – ride bike a certain distance, run to the play structure, traverse the monkey bars (after climbing up the ladder), climb up the climbing wall/ladder, go down the slide, walk on the ledge separating the grass from the bark (balance beam), and skip back to the bike.

Indoors – hopping on right foot on dots, jump rope, hopscotch one way, jumping jacks, animal walk out and back (bear, cat, snake, frog, etc), hopscotch back, jump rope, hop on left foot on dots

Some indoor variations – add in knee walking (I have them pretend they are a choo choo train), set up cones and have them heel walk while zig zagging one direction and toe walk while zig zagging back, step up onto a step stool and step down or hop up and hop down, do a forward roll, crawl through a tunnel, climb over a stack of cushions, hop like a bunny, step from one step stool to the next or one phone book to the next, walk on a tape line, and many more

Some outdoor variations – bounce a ball in place or moving, kick a ball (for distance or into a goal/target), walk backwards on a curb/ledge, climb down a ladder, crawl in the grass, ride a scooter instead of a bike or ride a tricycle, carry a plastic egg on a spoon, hop in a potato sack (you can buy fun kid ones now or you can use extra large pillow cases), run zig zag through cones

Another idea is a fine motor obstacle course or a combination of both.  You can create fine motor stations and they have to do gross motor activities to get between each one!

These are just a few of the ideas I have used.  I would love to hear some of your ideas!

So we just finished our first Motor Smart Kids group ‘Music and Movement’ and were able to get creative with some of the games we played so I thought I would pass them along.

Ten Little Monkeys

For this song we had the kids jumping on a trampoline with a crash pad located in the middle.  You can also have them jump on the ground too.  We took turns for each verse jumping on two feet, left foot and right foot.  The best part was the crashing into the crash pad when the monkeys fell off the bed!  In order to get more interaction between the kids they took turns jumping and then letting the next person know when they had crawled off the crash pad.  You can also use pillows or couch cushions for this if you don’t have a crash pad.

Red Rover

We took turns having each kid be the person talking.  They would say ‘Red Rover Red Rover have (kids name) (run, skip, hop, forward roll, gallop, jump, walk backwards, cross the balance beam, etc) over”.  Afterwards they would go back to the end of the line and the child who just came over would call out the next kid.  We of course had our crash pit at the end so they all got to crash once they made it over but again, its not necessary!  In the beginning there was lots of prompting for what activity they could do but the kids got creative as we went and got really good at using their ‘loud voices’.

Simon Says

This one is really simple, we just took turns being the leader and gave the kids a chance to pick what was happening next.  Sometimes we changed the name to ‘(kids name) says’ but we always gave them the vote if it was regular simon says or a different version.  Depending on how old the kids are you can play that they have to do it only when simon says but for us we just wanted the kids to practice the skills.

Turkey Dance

We adapted the chicken dance to be the turkey dance for Thanksgiving and we gave the kids cues of ‘beaks’, ‘wings’, ‘tail feathers’ and clap clap clap.  Then for the part where they dance around we had them squat down and walk like turkeys (or ducks).

All in all the kids had a great time, got a work out and really worked on their gross motor skills and social interactions!

What are some of the ideas you have when adapting kids games?