Why Motor Skills Matter

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Toe Walking

By Cara Yochai PT, DPT

“This little piggy went to market. This little piggy went home…”

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Many children walk on their toes for a variety of reasons. Pediatricians may recommend a wait and see approach as toe walking is often considered typical when first learning the nuances of walking.  If your child is consistently walking on toes over the age of two years, it is recommended to return to your pediatrician and seek physical therapy services for your child.

Why is my child toe walking?

  • Children may walk on their toes due to a sensory need (Refer to our posts on Sensory Processing: The Tactile System and The Proprioceptive System for more information)

    • Hyposensitive to tactile input:

      • Your child may have difficulty sensing the input from the ground.  By walking on toes, your child is altering the walking pattern to increase the intensity of the input to the ball of the foot.  

    • Hypersensitive to tactile input:

      • Your child may feel the ground too much.  Lifting the heel off the ground may help to decrease some of the tactile input.

    • Difficulties with proprioception: the knowledge of where your body is in space

      • Your child may have a hard time knowing where their body is in space, frequently called “poor body awareness.”

      • Sometimes, walking on toes helps your child to compensate for difficulties with proprioception by increasing the input they feel when they take a step.

  • Other reasons your child may walk on toes:

    • Decreased range of motion in the ankle

    • Decreased flexibility of ankle and lower leg muscles

    • Decreased muscle strength

    • Visual perceptual problems which may need to be ruled out

Is it harmful for my child to toe walk?

  • Toe walking alters the typical walking pattern:

    • The center of mass is shifted upwards and forwards, causing your child to utilize different balance reactions while walking

  • Certain muscles are overused:

    • The muscles at the back of the legs, such as gastrocnemius and soleus, are constantly overworking.

  • Certain muscles are underused:

    • The muscles at the front of the legs, such as quadriceps muscles at the knees and tibialis anterior muscles at the ankles are constantly underworking, and may have decreased strength

    • Abdominal and gluteus muscle weakness can also contribute to toe walking

  • Certain muscles can become tight:

    • The muscles at the back of the legs, such as gastrocnemius and hamstring muscles, may become tight from frequently being in a shortened position.

Activities that help to decrease toe walking:

  • Penguin walking (refer to our post on animal walking)

  • Sit with feet on a support surface

    • If your child has to point their toes to reach the floor, help them by placing something underneath their feet.  This gives your child a chance to experience the sensation of their entire flat foot touching the surface.

    • Use a box or a wedge if you need more height underneath your child’s heels.

  • Calf stretching and ankle pumps:

    • Sit with back against the wall and move toes up and down to promote moving through an increased range of motion at the ankle and increasing flexibility of the calf muscles.

If you are concerned about your child toe walking, please refer to a pediatrician. Some children are recommended for braces to improve the position of the ankle.  However, this does not always address the cause of toe walking for all children and physical therapy may be able to help!

Tara Liddle
Pigeon Toes

By Ina Joshi,PT, DPT

“When life throws you a rainy day, play in the puddles.”

-Winnie the Pooh

Pigeon toed or in-toeing gait is when a child walks with their feet pointed inward. This pattern commonly comes from inward twisting, or torsion, of bones in the feet (metatarsus adductus), the shins (tibial torsion), or the hips (femoral anteversion). Internal torsion through the leg bones stems from positioning in the womb. The fetus’ limbs are rotated inward to fit into the small space. As the child grows and bears weight through the legs, derotation of the bones naturally occurs. Sometimes this derotation takes longer and we see kids walking with their toes pointing in.

In-toeing gait is associated with tightness of hip internal rotator muscles and weakness of the hip external rotator muscles. Commonly, parents complain of children tripping over their feet and falling more frequently than peers. Exacerbation of in-toeing gait occurs with persistent  W-sitting. The W-sit position is related to femoral anteversion, tightness in hip internal rotators and weakness in hip external rotators.

The majority of children with in-toeing gait develop a typical gait pattern by the time they are in their teens and up to 99% of torsional abnormalities self correct by puberty. Surgery is only considered with severe torsional abnormalities. Surgery is not recommended until 5-6 years old for tibial derotation and 10-12 years old for femoral derotation. Most often, children are treated with observation. Researchers state potential changes may occur to the knee cap or foot bones due to compensatory alignment, however, there is no evidence showing long term consequences of in-toeing gait.

Addressing balance and muscular changes seen in children with in-toeing can be beneficial to optimize a child's participation at home and in school. Here are some ideas for play:

  • Promote sitting in long sit, circle sit, or criss-cross. Limit W-sitting.

  • Animal Walks that promote external rotation motion and strength: Penguin walk, Frog jump, Bear walk, Lizard

  • Balance beam, standing on one foot, kid’s yoga

You can refer to our blogs on W-sitting, animal walks, and kids yoga for more play details. Reach out to your pediatrician if you are concerned about your child's in-toeing walk.

Tara Liddle
Happy Halloween!

By Cara Yochai, PT, DPT

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“Magic is really very simple. All you’ve got to do is want something and then let yourself have it.” – Aggie Cromwell, Halloweentown

Autumn has officially arrived. The weather is cooler, the days are shorter, the leaves are changing color and beginning to fall.  

Autumn is such an exciting time to participate in outdoor activities as a family: apple picking, pumpkin decorating, and of course trick-or-treating.

  • Apple picking:

    • Hold your child up and see how far they can reach for an apple to pull off the tree.  This will challenge their motor planning, strength, and balance

  • Pumpkin Decorating:

    • Finger paint to increase tactile input and exposure to different textures and temperatures

    • Use a paint brush to work on more precise fine motor skills, controlling the force of movement, and coordinating the strokes to create one coherent picture

Halloween is a fun time to get creative.

  • Create a costume from things that you have around the house

    • Cardboard box→ racecar

    • Wrapping paper →present

    • Bubble wrap → bubble, balloon

  • Include adaptive equipment in costume

    • Wheelchairs→ racecar, airplane

    • Walkers→ Hang items from the walker that can help complete the costume!

Classic Halloween games are always a hit!

  • Bobbing for apples: no hands please

  • Cover empty cans or jars and put scary creepy crawlers inside

    • Peeled grapes make great slimy eyeballs

    • Wet spaghetti as intestines

    • Wet cotton balls as brains

Let your imagination go wild!

It is important to note that not all children enjoy the hustle and bustle of Halloween.  Please be mindful of how your child may react to the noise, commotion, and to “monsters.”

Have a fun and safe Halloween.

Send us your pictures so we can share them on our blog!

Tara Liddle
The Proprioceptive System

By Yi Chen, PT, DPT

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“A child’s play is not simply a reproduction of what he has experienced, but a creative reworking of the impressions he has acquired.”

~Vygotsky

The proprioceptive system is a system that is in charge of unconscious awareness of body position. There are receptors in muscles, tendons, and ligaments, which tell us about the position of our body parts, their relation to each other and their relation to other people and objects. These receptors send messages to the brain to help coordinate movement.

The proprioceptive system allows us to know how much force is necessary for the muscle to exert and allows us to grade our movement for various tasks such as holding a cup and writing with a pen.

The proprioceptive system works closely with the vestibular system, (check our previous article on vestibular system.) A healthy proprioceptive system helps children to develop motor planning skills and move in a smooth, coordinated, and efficient way.

Some examples of things you may notice if a child has difficulties with proprioception:

  • Bumps and crashes into objects and people (children who appear as clumsy)

  • Appears weak and is resistant to participating in heavy work activities

  • Messy handwriting (i.e. writing/coloring with heavy pressure or barely visible writing /coloring on paper)

  • Demonstrates poor body awareness and motor planning skills (i.e. playing with a ball, riding a bicycle etc.)

Activities that can help promote a healthy proprioceptive system:

  • Pulling or pushing a shopping cart

  • Playing tug of war

  • Jumping rope or on a trampoline

  • Wheelbarrow relay

  • Monkey bar

  • Climbing activities such as climbing walls, ladders and ropes

  • Sandwich games with pillows

  • Moving/lifting heavy laundry baskets

  • Playing with theraband /rubber band and stress balls

  • Animal walks (check our previous article)

  • Kids yoga (check our previous article)

Tara Liddle
Quadruped Crawling

By Tara Liddle

  “You’re off to Great Places! Today is your day! Your mountain is waiting, so…get on your way!”    -Dr. Seuss

“You’re off to Great Places! Today is your day! Your mountain is waiting, so…get on your way!”

-Dr. Seuss



Young infants playing on their belly will eventually begin to weight-shift, belly pivot, and push up, and reach for objects (see our blog on Tummy Time). They may also spend time moving forward and backward on their tummy (commando crawling) and in and out of side-propping positions as well. The strength needed to crawl on hands and knees comes from all the earlier tummy time play.

Eventually, the infant will push back onto their knees. The quadruped position is the hands and knees position. Once in this position, the infant will begin to rock forward and back. This rocking provides both vestibular and proprioceptive input. Before actually moving forward to crawl your baby may move backward. Sooner or later, crawling will be the primary mode of locomotion.

Crawling requires core strength, motor planning, coordination, and balance. Quadruped crawling helps to improve the proximal strength of the hips and shoulders and also the wrists, hands, and fingers. Crawling builds confidence and learning by allowing for exploration. It is an important milestone for the typically developing child and helps to prepare the body for more advanced activities.

Activities for Crawling

  1. Encourage balance and strengthening by having your baby reach for toys when they are up on their hands and knees. First, have the toy within reach and then slowly begin moving the object slightly out of reach.

  2. Have your baby crawl over you or large pillows scattered on the floor. This is great for strengthening, coordination, and balance.

  3. Explore crawling through large boxes or tunnels. This an excellent activity for proprioceptive sense and coordination. The infant will figure out how to get in and out while also learning about size-does my body fit in this box or tunnel.

Tara Liddle
Interview with Pediatric Occupational Therapist

By Cara Yochai, PT, DPT

Occupational Therapists put the fun in function.

- Anonymous

 
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Bernadette McMahon ORT/L

q1. What is one thing you wish that everyone knew about Occupational Therapy?

A: "What it is (laughs). Occupational therapy works to improve overall function to increase independence in everyday activities, also known as activities of daily living including self-care, play, and school tasks. Occupational therapists use therapeutic play to help children meet developmental milestones and improve various skills such as gross and fine motor, visual motor, and sensory.

q2. What are the three most common conditions that you work with?

A: "Fine motor skill delay, Sensory processing disorder, Handwriting delay."

q3. When would you suggest a parent to seek occupational therapy services for his or her child?

A: If you feel your child is having trouble completing various tasks such as

Fine motor tasks: Grasping, picking up toys, holding a pencil, using both hands together, lacing

Gross motor tasks: Coordination, difficulties crossing midline, catching/throwing playground ball

Visual motor tasks: Hand eye coordination, tracing, handwriting, cutting,

Sensory: Decreased attention, poor body awareness, hyperactivity (unable to sit still or concentrate on an activity) or hypoactivity (fear or difficulty moving). Having adverse reactions to touch, noise, smells, tastes, and visual stimuli.

Self-care:  Buttoning, zippering, shoe tying, holding feeding utensil

Q4. How can PT and OT work together?

A:  In pediatrics, it is great when Occupational and Physical therapists collaborate. Each bring an important knowledge base to work together to provide the best treatment plan for each child. Together they work on positioning, gross and fine motor movements, the coordination of upper and lower extremities and create modifications to improve overall participation in various activities.

Q5. What is one of the most rewarding parts of being an Occupational Therapist?

A: One of the most rewarding parts of being a pediatric occupational therapist is seeing the happiness a child feels when they are successfully able to complete a task independently. (ex: tying their shoe or writing their name)

Q6. Any advice you can give to parents at home, who has a child that may be in need of occupational therapy services?

A: My advice would be do not hesitate to seek help. Speak to your child’s doctor for any questions or concerns you may have in order to make sure your child is getting the help they need.






Tara Liddle
Congenital Muscular Torticollis

By Ina Joshi

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Do not go where the path may lead, go instead where there is no path and leave a trail.  ~ Ralph Waldo Emerson

Torticollis is a tightening of muscles on one side of the neck, specifically the sternocleidomastoid (SCM) muscle. It causes a baby to tilt their head toward the tight muscles and rotate their face in the opposite direction.

Congenital muscular torticollis can be present at birth or develop early in infancy. The cause is unknown, however may be due to a muscular, boney, neurological or visual abnormality. Onset of visual or ocular torticollis may occur later than non-ocular torticollis. Torticollis is common among multiple birth pregnancies, where one of the babies is held in one position, causing tightness through one side of the neck. The incidence of torticollis is reported to be between 2% to 4% and some references report incidence up to 16%. Depending on the cause of the torticollis an X-ray or ultrasound may be performed.

A preference to hold the head in a tilt to one side or to look in one direction is often noticed by the caregivers or pediatrician in the first couple of months of life. Torticollis is often associated with brachycephaly or plagiocephaly, a flattening of the infant’s skull due to prolonged pressure on one area. Torticollis may also be associated with difficulty feeding and nursing, especially to one side.  You may see the infant hiking up their shoulder to the affected side and bending their trunk in the opposite direction.

This asymmetric posture can lead to asymmetric gross and fine motor skills. The child may only roll to the right if their head is shifting their body weight in that direction. They may only use their left hand for reaching and grasping if they are always looking at this part of their environment. If these patterns persist, asymmetric development of gross and fine motor skills can occur. It is important to note “handedness” does not typically develop until 5 or 6 years of age. This asymmetry can lead to impaired balance reactions and delayed independent sitting.

Play at home:

  • Encourage visual tracking to both sides with head in midline, using your face or a toy.

  • Encourage the infant to turn their head both ways by following a toy side to side

  • Position the baby with their head in midline in car seats and carriages. If you are going on a long drive, take your baby out of the car seat during rest stops.

  • Carry your baby in your arms as much as possible, switching sides frequently. Do not favor one side more than another.

  • Encourage use of both arms during play in all positions.

  • Strengthen the neck, arm, and back muscles through tummy time. This is the best position for the baby to work these postural muscles against gravity. See our blog on tummy time!

Earlier intervention and physical therapy treatment help prevent motor delays as well as postural and facial asymmetries. Contact your pediatrician to learn more about physical therapy intervention for congenital muscular torticollis.







Tara Liddle
Sensory Processing - The Tactile System

By Yi Chen, PT, DPT

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The tactile system receives information about touch from receptor cells throughout our body, through the skin.  The tactile system provides information about the quality of objects (hard, soft, dull, rough, smooth, etc) and about the quality of touch we are receiving (light touch, pressure, vibration, temperature, pain, etc.)  This information helps develop body awareness and motor planning.

Children experience various types of tactile input during play every day.  The tactile system helps us decide how to respond and react to the tactile information in the environment.  A healthy tactile system can alert us when there is danger or potential harm and enable us to identify the quality of the object we are touching.

When the tactile system is fully functioning, children are able to attend and respond to all the tactile information they encounter in the environment. They won’t be distracted by tactile input they are experiencing and they are able to filter out unimportant tactile information.  Some children experience difficulty with processing the tactile information during their daily life. They may be hypersensitive, causing them to avoid certain tactile experiences or be hesitant to touch objects necessary for task completion. On the other hand, they may be hyposensitive, not feeling as much of the intensity of the input.  A child who is hyposensitive may seek out increased tactile input in order to help the body receive the amount of tactile input it needs to be able to process the information.

Some activities for promoting healthy development of tactile system include:

  • Use play-doh, Gak, Floam

  • Explore sensory bins with hands (rice, beans, sand, pasta, etc.)

  • Play with vibration toys-vibrating stuffed animal, vibrating balls, vibrating pillow

  • Arts and crafts- finger painting, yogurt, whipped cream

  • Pet a dog, cat or other animals

  • Mix cookie dough, cake batter with hands

  • Scrub with washcloth/scrubby during shower

  • Explore various textures when barefoot (wooden floor, carpet floor, grass, sand, etc.)

Tara Liddle
Back to School

By Cara Yochai, PT, DPT

“You’re off to great places.  Today is your day! Your mountain is waiting, so get on your way!”- Dr. Seuss

It is that time of year again.  Summer is ending and a new school year is starting.  With a new school year comes new opportunity for growth and learning.  School might be difficult for your child, perhaps there is anxiety associated with starting in a new school, meeting a new teacher, or making new friends.  Try to find ways to make your child feel like they have something they are able to control in this time of new things. This might mean giving your child more choice in what they wear to school, with your approval of course.  

If there are concerns about being able to pay attention in class or sit still for long periods, discuss them with your child’s teacher at the start of the year.  You and your child’s teacher may be able to brainstorm activities that improve your child’s performance in the classroom, without signaling them out in a negative way.

  • Wiping the board

    • Gives your child a chance to get up and move

    • Sense of helping to make a difference

  • Sitting on the rug

    • Find a comfortable position for your child; all children do not have to sit the same way and changing positions should be acceptable if sitting for long periods

    • If your child is unable to sit for long periods without back support, perhaps laying on belly is acceptable as an alternative to sitting up

    • As we have shared previously, avoid “W-sitting”

      • Sit with legs crossed

      • Sit with legs out straight in front

      • Sit with one leg bent and one leg straight in  

Tara Liddle
“Play is our brain's favorite way of learning.” Diane Ackerman

By Ina Joshi, PT, DPT

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Muscle tone is the resistance a muscle has to passive stretch at rest. It is what helps us sit upright and maintain posture at rest. There are many cases where low muscle tone is associated with a diagnosis or disorder and may be referred to as hypotonia or as “floppy infant syndrome.”  Often, low muscle tone presents itself without any other diagnoses and there is no known cause.

 

 

Sometimes, an infant with low muscle tone will roll, sit, and creep (crawling on hands and knees) later than other babies, or they may skip creeping altogether.  These infants may also use compensatory movement patterns due to the low muscle tone, such as moving their joints to end range and “locking them out.” These patterns can lead to atypical postural alignment and prevent muscles from fully activating as they should. Proper alignment provides optimal muscle strength and joint health as a child grows.

 

An older child with low muscle tone may have a hard time sitting upright without support. Sometimes these children are working so hard to sit-up, they have trouble paying attention to what is going around them, including paying attention in school.  School aged children with low muscle tone may show poor posture with a large arch in the back and/or hyperextended knees.

 

A great way to help a child with low muscle tone is to keep them active and moving to improve their core and joint stability

 

  • Infant floor play- look for ideas in an upcoming post

  • Play at the playground - climbing, sliding, and swinging activate core and postural muscles

  • Animal walks - activate stability muscles in imaginative way

  • Children’s yoga  - great for body awareness and postural stability

  • Climbing, running, jumping, roller blading, swimming, dancing

Tara Liddle
Yoga for Kids

By Yi Chen, DPT

“Yoga is the fountain of youth.  You’re only as young as your spine is flexible.” - Bob Harper

 

Yoga is popular for adults who are looking for relaxation, improving flexibility, improving breathing and meditation.  Many people do not know that yoga can help children address stress-reduction, internal awareness, self-regulation and social and emotional intelligence as well. Research revealed that children show improvement in executive functioning when mindful movement was completed.

Physiological Benefits of Yoga

-Balances autonomic nervous system

-Balances endocrine system

-Improves sleep patterns

-Decrease pulse rate

-Strengthens the immune system

These are some examples of yoga poses you can practice with your children at home to improve their strength and balance.

Waterfall

 

-Inhale, reaching your hands to the ceiling, stretching your body long

-Exhale, folding your body forward, reaching your body forward, reaching your hands toward the floor

 

BENEFITS

-Relieves headaches and insomnia

-Calms the brain and reduces stress

-Improves digestion

-Stretches back and hamstrings

 

Warrior II

Keep your feet apart, turn your left foot in and your right foot forward, raise your arms, turn your head to the right and bend your right knee (this may be done in both directions)

BENEFITS

-Elongates hip flexors and groins

-Increases stamina

-Relieves backaches

 

Downward Dog

 

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Begin on your hands and knees and take a big breath in. Exhale and push your hands and your feet into the floor. Lift your bottom up to the sky. Look at your feet and try to keep your legs straight. Your heels reach toward the floor.

BENEFITS

-Calms the brain, relieves stress

-Energizes the body

-Strengthens the arms and legs

-Elongates the shoulders, hamstrings, arches of the feet and hand

 

Plank

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Begin in down dog. Look forward and slowly begin to straighten your body to make it into one straight line. Curl your toes under, lift with your belly and straighten your legs

 

BENEFITS

-Strengthens the shoulder girdle, arms and wrists

-Builds arches of hands to aid in grasp patterns

-Tones abdominals

 

Seal or Superman

 

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Lay on your stomach with your forehead on the ground. Stretch your arms and legs away from each other. Inhale and lift your upper body and lower body off the floor first. Exhale and relax into the floor.

 

BENEFITS

-Strengthens the back extensor muscles, gluteus muscles, arms and legs

- Stretches the shoulders, chest, belly and thighs

-Improves posture

- Aids digestion

 

Boat pose

 

 

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Sit down with knees close to your chest, feet on the floor and back tall and straight. Hold behind your knees and lift your feet to bring shins parallel to the ground. Release your hands and stretch arms straightforward.  Lean back slightly as you stretch your legs until they are straight.

 

BENEFITS

-Strengthens abdominals and quads

 

Child’s pose

 

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Kneel on the floor with your legs together. Rest your forehead on the floor. Your arms can remain by your sides or you may stretch your arms in front of you along the mat.

 

BENEFITS

-Stretches the back, hips, thighs and ankles

-Relieves back pain

-Reduces stress and fatigue

 

 

 

Balance pose

Tree Pose

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-Stand in mountain pose, palms to chest; tuck one foot inside the opposite leg. Stretch your arms out like branches, bring your hands together above your head

 

 

Airplane Pose

-Stand with feet parallel and under hips, breathe, focus and stretch on leg back. Tip forward until you are parallel with the floor. Spread your arms out like wings

Connor McCarthy
Animal Walks

“An actor is never so great as when he reminds you of an animal-falling like a cat, lying like a dog, moving like a fox.” -Francois Truffaut

By Cara Yochai, DPT

 

Animals move in a variety of amazing ways. Humans walk on two feet, otherwise known as bipedal locomotion. However, there is much to gain from going back to some of the earlier movements, like crawling. (More to come on that in a future post!)

This is a great DIY-project that your kids will enjoy participating in while also getting the opportunity to work on many gross motor skills. If you have extra cardboard around the house, try taping it into the shape of a cube. Tape the around the edges so that the cube stays strong and sturdy. Print pictures of different animals. Your child can color the picture before you tape it on the cube.

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Bear Walk:

  • Walk with arms and feet touching the floor and knees remaining off of the floor

  • Promotes weight bearing through the arms-strengthens the shoulder muscles

  • Provides vestibular input by the head being inverted

  • Allows your child to work on coordination

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Penguin Walk:

  • Walk on heels with toes up off of the floor

  • Helps to activate the dorsiflexor muscles, the muscles on the top of the foot

  • A great activity to try if your child prefers to walk on his or her toes

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Frog Jump:

  • Sit low near the floor, hips turned out wide, feet flat on the ground (Just like the picture of the frog)

  • Encourage your child to push through both of their legs and try to jump up and forward

  • Promotes a deep squat position with explosion through the legs to help strengthen the lower body

Crab Walk:

  • With face up, push through arms and legs to lift the booty off of the floor

  • Total body strengthening: arms, legs, core, and booty!

  • Challenges the brain to coordinate movement of opposite arm and opposite leg together (reciprocal coordination)

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Donkey Jump:

  • With both hands on the floor, kick up both legs together as high as you can

  • Requires stabilization of the core muscles in order to lift both legs off of the ground

  • Challenges balance by decreasing base of support from 4 points (arms and legs) to 2 points on surface (only arms)

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Snake Crawl:

  • On belly, slither like a snake across the floor

  • Strengthens the oblique muscles, as the trunk side bends  

 

 

Have fun!

Connor McCarthy
The Vestibular System

“And at the end of the day, your feet should be dirty, your hair messy, and your eyes sparking “ -Shanti

By Yi Chen, DPT

Have you ever wondered why children always like going on the swing, slide or seesaw in the playground? Have you thought about how children spend hours jumping on the trampoline? The answer to these questions has to do with one of our sensory systems: the vestibular system.  The vestibular system helps regulate balance and movement.

 

 

The vestibular system provides information to the brain about movement and changing positions.  It works through receptors within the ears. As the head moves in space, there is fluid that moves inside the ear. When this fluid moves, there are tiny hair cells that move in response. These hair cells detect changes in gravity and different types of movement in the environment. A child with a healthy vestibular system feels safe to move at different speeds and is comfortable with body movements in various directions. These changes in movement naturally occur during activities such as jumping, swinging and climbing.

 

 

When a child’s vestibular system is not functioning well, that child may either be hypersensitive or hyposensitive to movements. A child who is hypersensitive to movement usually overreacts to movement and is fearful with any changes in position; on the other hand, a child who is hyposensitive to movement usually craves movement and has a difficult time sitting still.

 

 

 

Daily activities that might be difficult for your child with vestibular dysfunction:

 

 

 

  1. Difficulty with stair climbing

  2. Difficulty with riding bikes

  3. Bumping into things

  4. Unable to walk or sit in an upright position

  5. Difficulty with body coordination

  6. Appear to always be climbing, jumping, rocking, rolling, spinning, etc

  7. Poor safety awareness and often falls

  8. Difficulty with tasks that requires eyes to move to different directions (e.g. reading, copying information from the blackboard)

 

 

Daily activities that may help to organize your child’s vestibular system:

 

 

  1. Slides

  2. Swing

  3. Hanging upside down from playground equipment

  4. Rocking on the chair with rhythm

  5. Playing with Sit and Spin toy

  6. Doing summersaults or cartwheels

  7. Merry-go-round

  8. Jumping on a trampoline/hopscotch / jump rope

 

Connor McCarthy
The W-sit

By Ina Joshi, DPT

"Creative people are curious, flexible, persistent and independent with a tremendous spirit of adventure and a love of play.” – Henri Matisse

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You may see your child sit with their legs and feet out to the side. This is the "W-sit". Their knees are bent and their bottom is on the floor.

W-sitting gives children a lot of stability. In this position, their legs allow for greater surface area on the floor than other positions. Children normally move in and out of this position when playing, especially when they are moving around a lot. This is not problematic and is completely typical!

Sometimes, children start to sit in this position frequently and for extended amounts of time when they are coloring, playing a puzzle, or reading. Children with low tone or inadequate postural stability tend to use this sitting posture more frequently. Their bodies are just being efficient, finding the most stable position when their postural muscles are too tired to hold them up straight in other sitting positions.

Even though they are being efficient, sitting this way can cause problems, leading to tight muscles and abnormal pressure on the hips and knees. W-sitting compounds any tight muscles your child may have, especially in the hamstrings, hip abductors, internal rotators, and heel cords.   

W-sit is such a stable position, it is too stable! It puts the pelvis in a blocked position, which makes it hard to turn the trunk when playing. This limits how children use their hands to reach across their body, an important task to learn spatial awareness. W-sit is so stable, it makes it hard for children to transition into other positions, limiting dynamic play.

Written below are some suggestions to help steer your child away from the W-sit position

  • Say to your child, "Can I see you feet?" or "Where are your feet? I don't see them."

  • Say, "Sit like me" and demonstrate these positions: long sit, criss-cross, tailor sit

  • Play in prone (on the stomach) or in side propping/side sitting  

  • Use a small bench or a child's chair with hips and knees in 90 degree angles

 

If your child has difficulty sitting in positions other than W-sit, consult with your child's pediatrician.

 

Connor McCarthy
Newborn Tummy Time
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By Tara Liddle

TUMMY TIME

Is important for both gross and fine motor development.


Helps to stretch the front muscles and strengthen the head/neck, shoulder, back, abdominal, and hip muscles. All of which are needed to maintain good alignment, movement and balance.

Prepares and strengthens the hands for manipulation skills later on.

Helps to prevent plagiocephaly (flat head syndrome) and Torticollis (tightness and/or weakness of the neck).

Can begin as soon as you bring your newborn baby home. There is no need to wait for the umbilical cord to fall off.

Essential Points of Tummy Time:

Never leave your newborn infant unattended on their belly. Your baby may not be strong enough to lift their head up enough to clear the surface to breathe.

“Back to Sleep”-Do not put your baby to sleep on their stomach.

Your newborn will not tolerate belly time for long periods of time.  Some babies may only tolerate belly time for 10 seconds to 1 minute.

Read your baby’s signals. They will let you know when they are tired of playing on their tummy.

Helpful Hints:

Begin to incorporate belly time into your general routines: diaper changes, massaging, burping on your lap. Short sessions throughout the day work well based on tolerance and temperament.

Many newborns prefer belly time on their parents’ stomachs or chest rather than the floor.  Try lying down on your back and place your baby on your chest or stomach. Sing, talk, and encourage your baby to look at you.

Place a rolled towel under the arms. This can help to shift the weight back to assist with head righting.  Make sure your baby’s weight is distributed evenly over the roll.

A baby proof mirror may also help encourage your baby to look up at themselves.

Placing your baby on blankets with different textures will enhance their sensory experience while they play on their tummy.

 

Connor McCarthy
“Touch has a Memory” -John Keats

By Cara Yochai, DPT

 
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Touch it. Feel it. Explore it. Learn it. Remember it.

The sense of touch is so powerful. It is important to appreciate that not all people feel tactile input the same way. For some, a light touch might actually feel painful and cause a sense of fear and panic. While for others, it might be difficult to sense that very same light touch. The second person in this example might need to feel a firm touch, to process being touched at all.  It is necessary to keep these differences in mind when playing with children and be mindful that what feels one way for one child may feel completely different for another. When the body is touched or touches something, the nervous system is actually very hard at work relaying information to and from the brain to process what is being felt.

There are many opportunities to challenge the brain and introduce new tactile experiences.

Explore some of these tactile activities on a summer day at the beach:

  • Feel the sand with your hands and your feet.

    • Does it feel different on various parts of the body?

  • Touch the very top of the sand and underneath a big pile of sand.

    • Does the temperature change?

    • Is it wet or dry?

  • Pick up one tiny grain and then a huge handful.

    • Do they feel the same?

  • Head on over to the ocean and collect some water in a bucket to bring back to the sand.

    • Does the texture of the sand change?

  • Hide a toy in the sand.

    • Can you dig with your hands and find it?

Enjoy the tactile experiences at the beach this summer. Take a moment to think about all of the amazing things to feel. Appreciate your child’s ability to learn about different textures and sensory information through the power of touch.

It is sure to be a day to remember.

 

Connor McCarthy
“Play is really the work of childhood.” -Fred Rogers
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We are a team of pediatric physical therapists who are passionate about all things movement.  Through this forum, we aim to enlighten you with our knowledge on “Why Motor Skills Matter!” We are thrilled to share with you this first blog post, written by Cara Yochai, DPT.

 

 

Have you ever watched a child play? If not, I highly recommend it. It is a humbling reminder of all that the human body is truly capable of. It helps adults remember movement patterns that were easy when they played in childhood.  Yet, the same movements may now frighten in adulthood. What if adults joined their children in these playful movements? The child above is able to hold a deep squat, while engaging in a fine motor task as he draws and colors with chalk.  During play, physical activity becomes enjoyable again.

There are so many opportunities to play, especially outside in this beautiful summer weather. Here are a few simple ideas to try outside with your kiddies:

  • Draw with chalk:

    • Try drawing in a squat or while on the tummy.

  • Hopscotch with rocks:

    • Jump with both feet, then try with one! Switch off each time.  

    • Try and aim for a specific number.

  • Jump over the crack in the sidewalk

    • Jump forward, backward, and sideways!

  • Create shadow creatures during sunset

    • Simulate standing tall and still like a tree. Pretend to be a certain letter of the alphabet.

    • Try and guess what your child is pretending to be.

These are just a few ideas, but the possibilities are endless.  Adults often have to designate specific time to workout. A child, however, has the chance to workout throughout the day. Don’t underestimate the hard work that your child is participating in.

Encourage your child to play. Play well and play often!  

Please share if you and your child try any of these outdoor activities!

 

Connor McCarthy