Many children have hemiplegia due to cerebral palsy, a stroke, or any other injury to the brain. Hemiplegia is when one side of the body has abnormal muscle tone and tightness due to a brain injury or stroke on the opposite side of the brain. In comparison, hemiparesis is when the person has muscle weakness and "floppy" tone (AKA flaccidity) due to the same reason. This means if the person has a stroke on the left side of the brain, then the right side of the body will be effected. The person loses not only muscle strength, mobility of the joints, and coordination but also sensation. When a person doesn't have full sensation in a limb, then they tend to not use it. For adults with this problem if they have normal cognitive skills, they can force themselves to use the arm and leg on the involved side of the body. Also, an older child might be able to do this. But for infants, toddlers, and young children this is not typically the case especially if they had the brain injury in utero and never had typical movement of the involved side of the body. Physical and occupational therapists have strategies they can teach the child and parent to aid in the child using the arm and leg, but sometimes this just doesn't work, because the child wants to use the other side because it is easier to use and it has full sensation.
Some children who have hemiplegia may benefit from constraint Induced Movement Therapy (CIMT) which is the technical word used for "forced use". The following link has links to various articles and research that has been conducted on the effectiveness of this approach with children.
Children's Hemiplegia and Stroke Association
I had a co-worker about 6 years ago who was conducting her thesis on CIMT. She set up a summer CIMT camp at the clinic we worked at in which several school-age children with hemiplegia participated. They had their non-involved arm casted so that they weren't tempted to use it. This "forced" them to use their involved arm which was hypothesized to build strength, coordination, and sensation. Certain criteria had to be met just to participate, because if the child had too much spasticity or other problems then CIMT wasn't going to be able to help. CIMT is not for children who can't use the arm at all (complete paralysis); there has to be at least some movement.
The end results of the project were good. Although every child made progress, I am not sure that any of them achieved completely "normal" use of the involved arm, but I do know they all continued to receive weekly OT and PT to build upon the progress that was made over the summer.
I have not ever used CIMT with the toddlers that I work with at early intervention (ECI), because I think they would just be frustrated and confused. Maybe a child in preschool or early elementary age would better understand the purpose of CIMT and not get so frustrated. However, I do "hold" the involved arm down for an activity as well as place toys to that side of them so they are more likely to use the involved hand instead of ignore it. Other techniques I use with young children with hemiplegia or hemiparesis include: NDT handling, bimanual activities, electrical stimulation, dynamic and static splinting/orthotics, kinesiotaping, adaptive equipment, infant massage, and sensory integration therapy. My favorite dynamic splint for infants is the Joe Cool (TM) splint, but they tend to not be as effective with the toddlers because they have figured out how to unstrap the velcro! The most important thing in helping infants and toddlers with hemiplegia/hemiparesis is teaching simple therapy techniques to the caregivers and parents because they are the ones who are primarily with the child all day long. For some of my kids who attend daycare in large classrooms and have parents who work long hours, the techniques asked of the caregiver might be simple such as making sure the child wears his hand splint during table-top and "centers" activities. I also suggest that at snack and lunch time that food and drinks be placed to the center and each side of the child to increase the chance that he may use his more involved hand; if the food and drinks are placed only on the non-involved side, then the child is not likely to use the hand that needs to get stronger. These are simple and do-able suggestions! If I give complicated strategies, the caregivers are not likely to have the time to perform them.
Showing posts with label physical therapy. Show all posts
Showing posts with label physical therapy. Show all posts
Wednesday, October 13, 2010
Sunday, October 10, 2010
Turning Everyday Items Into Therapy Tools
This week has been one of those weeks that just flew right by: doctor visits, allergy shots, soccer practice and game, birthday party for my daughter (7th), work, and all of the normal things that happen in a week! So, I was just realizing that I haven't blogged since last week. I couldn't even think of anything interesting to blog about not that nothing interesting happened, but because it was such a busy week that everything that happened work-wise seems so long ago. It was about that time that I started the last load of laundry and realized what I should write about: laundry baskets and other everyday items. "Laundry baskets" are not ordinally the most interesting topic, but I'm going to discuss how they can be used as a therapy tool to help children with meeting their developmental milestones.
Laundry baskets:
1. When inverted they are an excellent item for children to push around the room. If the child can stand but not yet walk, this is especially a great activity because of their wide base of support the child gets lots of stability. For those children who can already walk and need upper body strengthening, pushing the basket across carpet can give some extra resistance.
2. Have the child sit in the laundry basket and take him/her for a ride. For children with a language delay, you can encourage them to say/sign "more" or "stop" as you push them across the floor. For children who need to work on social engagement, have another child push the basket and then they can switch rider-pusher in order to work on turn-taking and talking to a peer.
3. Have the child sit in the laundry basket as the basket is on an adult's lap. The adult can tilt, bounce, or rock the basket for vestibular input to work on balance/equilibrium skills.
Blankets:
1. Magic Carpet Ride: Have the child lay on a blanket as you grab one end of it and run across the floor. This is a perfect opportunity for the child to say he wants to go slower, faster, more, or "all done" with words or sign language. It can also be a turn-taking activity if there is another child; the child pulling is getting lots of proprioceptive input whereas the child who is lying down gets vestibular input.
2.Hot dog: Have the child roll up in the blanket as if he is the weiner and pretend that the blanket is a bun. Then, give the child deep pressure as you pretend to put different condiments on the "hot dog". Give joint compressions to the feet as you "shake on salt and pepper".
3. For infants and toddlers (or light-weight preschoolers), a blanket can be used as a swing. Two adults can each grab an end as the child lays in the center. They can bounce the blanket up and down or rock it side-to-side. The child can have his body perpendicular to the adults and then switch to being parallel to the adults in order to give input to different receptors of the vestibular system.
Large Bowls:
1. When inverted, they make wonderful drums! If you have plastic or wooden spoons, those make great drumsticks. But if you only have a bowl, the child can bang it with his hands as if it is a bongo drum.
2.Put a ping pong ball in a large bowl, then move the bowl in a circular direction (clock-wise). Stop, then move the bowl in the opposite direction (counter clock-wise). This is a great activity for eye tracking in a circular direction. For children with low vision or poor attention span, use contrasting colors such as a black bowl with a white ball. For eye-hand coordination, the child can try to stop it with his hands and grab it.
3. Have the child jump over the bowl pretending it is a "candlestick" while you repeat: Jack be nimble, Jack be quick, Jack jumped over the candlestick!
Socks:
1. Wad a pair of socks up to the size of a bean bag and use them for bean bag toss at a target such as a bowl, box, or any other item around the home. If you bounce them off of an exercise ball or mini-trampoline, they will go flying across the room...usually guaranteed to make the child laugh!
2. Empty a clean load of laundry out onto the bed or other clean surface and have the child sort the socks by color and/or design. This is great for oculomotor skills and the visual perceptual skills of figure ground, visual memory, visual discrimination, and form constancy, especially if there are other items in the pile besides just socks.
3. Put potatoes or other items similar in weight within larger socks and use them as weights for the lap or over the shoulder; good for proprioception and/or muscle strengthening.
There are SO many more everyday items that can be used therapeutically. What are your favorite activities to do with household items? I would love to hear your ideas!
Laundry baskets:
1. When inverted they are an excellent item for children to push around the room. If the child can stand but not yet walk, this is especially a great activity because of their wide base of support the child gets lots of stability. For those children who can already walk and need upper body strengthening, pushing the basket across carpet can give some extra resistance.
2. Have the child sit in the laundry basket and take him/her for a ride. For children with a language delay, you can encourage them to say/sign "more" or "stop" as you push them across the floor. For children who need to work on social engagement, have another child push the basket and then they can switch rider-pusher in order to work on turn-taking and talking to a peer.
3. Have the child sit in the laundry basket as the basket is on an adult's lap. The adult can tilt, bounce, or rock the basket for vestibular input to work on balance/equilibrium skills.
Blankets:
1. Magic Carpet Ride: Have the child lay on a blanket as you grab one end of it and run across the floor. This is a perfect opportunity for the child to say he wants to go slower, faster, more, or "all done" with words or sign language. It can also be a turn-taking activity if there is another child; the child pulling is getting lots of proprioceptive input whereas the child who is lying down gets vestibular input.
2.Hot dog: Have the child roll up in the blanket as if he is the weiner and pretend that the blanket is a bun. Then, give the child deep pressure as you pretend to put different condiments on the "hot dog". Give joint compressions to the feet as you "shake on salt and pepper".
3. For infants and toddlers (or light-weight preschoolers), a blanket can be used as a swing. Two adults can each grab an end as the child lays in the center. They can bounce the blanket up and down or rock it side-to-side. The child can have his body perpendicular to the adults and then switch to being parallel to the adults in order to give input to different receptors of the vestibular system.
Large Bowls:
1. When inverted, they make wonderful drums! If you have plastic or wooden spoons, those make great drumsticks. But if you only have a bowl, the child can bang it with his hands as if it is a bongo drum.
2.Put a ping pong ball in a large bowl, then move the bowl in a circular direction (clock-wise). Stop, then move the bowl in the opposite direction (counter clock-wise). This is a great activity for eye tracking in a circular direction. For children with low vision or poor attention span, use contrasting colors such as a black bowl with a white ball. For eye-hand coordination, the child can try to stop it with his hands and grab it.
3. Have the child jump over the bowl pretending it is a "candlestick" while you repeat: Jack be nimble, Jack be quick, Jack jumped over the candlestick!
Socks:
1. Wad a pair of socks up to the size of a bean bag and use them for bean bag toss at a target such as a bowl, box, or any other item around the home. If you bounce them off of an exercise ball or mini-trampoline, they will go flying across the room...usually guaranteed to make the child laugh!
2. Empty a clean load of laundry out onto the bed or other clean surface and have the child sort the socks by color and/or design. This is great for oculomotor skills and the visual perceptual skills of figure ground, visual memory, visual discrimination, and form constancy, especially if there are other items in the pile besides just socks.
3. Put potatoes or other items similar in weight within larger socks and use them as weights for the lap or over the shoulder; good for proprioception and/or muscle strengthening.
There are SO many more everyday items that can be used therapeutically. What are your favorite activities to do with household items? I would love to hear your ideas!
Saturday, July 24, 2010
How to Improve a Toddler's Balance & Vestibular Processing Skills During Play | eHow.com
Typically developing toddlers like to defy gravity whether it be spinning around in Daddy's arms, swinging in the backyard, or jumping on the bed. But when a toddler has consecutive ear infections, sensory processing disorder, low muscle tone, or any other thing that impairs balance, movement may not be so fun for them.
Below is a link that gives ideas to add movement into a toddler's play routine:
How to Improve a Toddler's Balance & Vestibular Processing Skills During Play | eHow.com
The vestibular system, located in the inner ear, is in charge of balancing the body every time the head moves. Muscle tone, bones (orthopedic alignment), nerves, and the eyes also have a big role in balancing too. If something is wrong with any of those body parts, then the person can have poor balance. So, if your toddler is absolutely terrified of movement in some directions no matter what you do, then he may need an occupational or physical therapy evaluation to determine the cause.
Below is a link that gives ideas to add movement into a toddler's play routine:
How to Improve a Toddler's Balance & Vestibular Processing Skills During Play | eHow.com
The vestibular system, located in the inner ear, is in charge of balancing the body every time the head moves. Muscle tone, bones (orthopedic alignment), nerves, and the eyes also have a big role in balancing too. If something is wrong with any of those body parts, then the person can have poor balance. So, if your toddler is absolutely terrified of movement in some directions no matter what you do, then he may need an occupational or physical therapy evaluation to determine the cause.
Wednesday, May 26, 2010
Responding to Toddlers Who Bite
About 9 months ago, my 23-month old son began biting his sister when he became frustrated. Then, once he became more verbal the unwelcomed behavior faded away. Also, when I was able to figure out why he was mad, I would label what he was thinking, and that reduced the biting. So, if his older sister was playing with a toy he wanted, and I saw "that look" on his face, then I said "my turn" as I helped him point to himself and then had her share with him. So, in my son's situation the biting was due to him lacking the language skills to express what he wanted to say. Many of the kids I work with for therapy bite for the same reason, but others bite for other reasons. Here is a link to Zero to Three's website providing information on toddler biting and how to redirect it:
Zero To Three: Chew on This: Responding to Toddlers Who Bite
Out of the blue the behavior popped back into our lives again. Just yesterday, my son tried to bite my arm. This time it wasn't due to lacking language skills, it was because he was mad at me. He was playing at his train table, and I said "Let's go bye-bye". He didn't want to go, so I picked him up whereas usually he walks over to the door, and then that was when he attempted to bite me. But I caught him in time, and turned his face away from my arm. I then labeled his feelings and said "You are sad that we are leaving. Bye-bye trains and cars." He waved goodbye to his toys and then was happy again. My son is usually a happy-go-lucky toddler, but those "terrible two's" take over from time to time. But the nice thing he is usually redirectable or distracted easily. Us Moms and Dads have to be one step ahead of our little toddlers to help diminish those unwanted behaviors!
The Zero to Three link I provided above is not geared at children with developmentally delays or special needs, but I think the information still applies. Yet I also think there are other reasons for biting and undesirable behaviors with special needs kids including side effects to medication, seizures, and pain (from gastrointestinal discomfort, headaches, or other medical problems). Additionally, many of these children have multiple developmental delays which means a simple task such as completing a formboard puzzle or playing at the park takes more effort than it does for a typically developing child. By the end of the day, these young children are exhausted and it doesn't take much for a tantrum or "meltdown" to occur.
If your child receives occupational, physical, or speech therapy, be sure to discuss the undesirable behaviors and see if they have any suggestions.
Zero To Three: Chew on This: Responding to Toddlers Who Bite
Out of the blue the behavior popped back into our lives again. Just yesterday, my son tried to bite my arm. This time it wasn't due to lacking language skills, it was because he was mad at me. He was playing at his train table, and I said "Let's go bye-bye". He didn't want to go, so I picked him up whereas usually he walks over to the door, and then that was when he attempted to bite me. But I caught him in time, and turned his face away from my arm. I then labeled his feelings and said "You are sad that we are leaving. Bye-bye trains and cars." He waved goodbye to his toys and then was happy again. My son is usually a happy-go-lucky toddler, but those "terrible two's" take over from time to time. But the nice thing he is usually redirectable or distracted easily. Us Moms and Dads have to be one step ahead of our little toddlers to help diminish those unwanted behaviors!
The Zero to Three link I provided above is not geared at children with developmentally delays or special needs, but I think the information still applies. Yet I also think there are other reasons for biting and undesirable behaviors with special needs kids including side effects to medication, seizures, and pain (from gastrointestinal discomfort, headaches, or other medical problems). Additionally, many of these children have multiple developmental delays which means a simple task such as completing a formboard puzzle or playing at the park takes more effort than it does for a typically developing child. By the end of the day, these young children are exhausted and it doesn't take much for a tantrum or "meltdown" to occur.
If your child receives occupational, physical, or speech therapy, be sure to discuss the undesirable behaviors and see if they have any suggestions.
Wednesday, May 19, 2010
Improving a Toddler's Balance & Vestibular Processing Skills During Play
My 23-month old son is like most toddlers, he's busy and likes to climb. If I leave the room and return a few minutes later, I am likely to find him standing on a chair or behind the couch. Yet, even though he loves to be in motion, he sometimes still falls. The good thing is, he doesn't fall as often as he did when he had just learned to walk. But, somehow he gets "bobos" on his forehead at least once a month.
Many parents ask me "How do you help a toddler's balance skills?". Well, first of all, know that most toddlers still fall from time to time, but if a child is falling excessively then discuss this with the pediatrician. If that doctor feels that the toddler is falling excessively, then maybe a physical therapy (PT) evaluation will be suggested. PT can look at to see if there are any possible problems orthopedically, neurologically, developmentally, or with the child's level of strength. If these problems have been ruled out, then the child's sensory processing skills should be evaluated, in particular the vestibular system. This can be done by either a PT or occupational therapist (OT), depending upon the therapist's training. The vestibular system has receptors in the inner ear that detect which direction the head (and body) is moving. The possibilities for directions of movement include: up-down, front-to-back, side-to-side, upside down, and in circles. If a child has difficulties processing vestibular input, it may be because he over-reacts, under-reacts, or overly craves the input. Examples of overly reacting would be the child not wanting to be tossed in the air or being scared of swinging. An example of under-reacting, would be a child who seems lethargic and needs extra time running or jum[ing to detect that he is moving. In comparison, a child who overly craves vestibular input can be described as the "Energizer Bunny", and doesn't seem to tire of the motion. Although toddlers should like to move around some, eventually they should move onto to a sit down activity such as rolling cars, feeding a doll, or stacking blocks. A toddler who overly craves vestibular input, may not be able to focus while staying seated more than 20 seconds. Vestibular problems may also be because the child has poor: postural control, the ability to discriminate the input, or an ability to motor plan his actions. An additional problem could be visual processing and/or a poor ability to see far or near; if this is the case, the chid should be evaluated by an eye doctor. For more on understanding sensory processing problems in toddlers or older children visit: www.spdnetwork.org and www.sensorysmarts.com and for more on understanding sensory processing problems in babies visit: www.sense-ablebaby.com
Also, I wanted to share this article that I wrote almost 9 months ago on an informational site. I purposefully simplified the description of vestibular input so that the average person could understand it. It gives ideas on how to help with balance and vestibular processing for toddlers:
How to Improve a Toddler's Balance & Vestibular Processing Skills During Play | eHow.com
I purposefully kept the list of activities simple and short, and suggestions are things that can be done anywhere not just in a therapy clinic. Feel free to comment on any fun ideas you have found that help to develop balance and stimulate the vestibular system. The more ideas, the better!
Many parents ask me "How do you help a toddler's balance skills?". Well, first of all, know that most toddlers still fall from time to time, but if a child is falling excessively then discuss this with the pediatrician. If that doctor feels that the toddler is falling excessively, then maybe a physical therapy (PT) evaluation will be suggested. PT can look at to see if there are any possible problems orthopedically, neurologically, developmentally, or with the child's level of strength. If these problems have been ruled out, then the child's sensory processing skills should be evaluated, in particular the vestibular system. This can be done by either a PT or occupational therapist (OT), depending upon the therapist's training. The vestibular system has receptors in the inner ear that detect which direction the head (and body) is moving. The possibilities for directions of movement include: up-down, front-to-back, side-to-side, upside down, and in circles. If a child has difficulties processing vestibular input, it may be because he over-reacts, under-reacts, or overly craves the input. Examples of overly reacting would be the child not wanting to be tossed in the air or being scared of swinging. An example of under-reacting, would be a child who seems lethargic and needs extra time running or jum[ing to detect that he is moving. In comparison, a child who overly craves vestibular input can be described as the "Energizer Bunny", and doesn't seem to tire of the motion. Although toddlers should like to move around some, eventually they should move onto to a sit down activity such as rolling cars, feeding a doll, or stacking blocks. A toddler who overly craves vestibular input, may not be able to focus while staying seated more than 20 seconds. Vestibular problems may also be because the child has poor: postural control, the ability to discriminate the input, or an ability to motor plan his actions. An additional problem could be visual processing and/or a poor ability to see far or near; if this is the case, the chid should be evaluated by an eye doctor. For more on understanding sensory processing problems in toddlers or older children visit: www.spdnetwork.org and www.sensorysmarts.com and for more on understanding sensory processing problems in babies visit: www.sense-ablebaby.com
Also, I wanted to share this article that I wrote almost 9 months ago on an informational site. I purposefully simplified the description of vestibular input so that the average person could understand it. It gives ideas on how to help with balance and vestibular processing for toddlers:
How to Improve a Toddler's Balance & Vestibular Processing Skills During Play | eHow.com
I purposefully kept the list of activities simple and short, and suggestions are things that can be done anywhere not just in a therapy clinic. Feel free to comment on any fun ideas you have found that help to develop balance and stimulate the vestibular system. The more ideas, the better!
Monday, May 10, 2010
When It's More Than Just A Cleft Lip and Palate
One of my childhood friends had a baby a few years ago that was born with a complete cleft lip and palate (unilateral). Luckily, after several surgeries and speech therapy, the young boy caught up with his development. But some families are not as lucky. Sometimes there are more things going on with the child. Often, these things are obvious such as heart or kidney defects, genetic syndromes, or neurological impairments. Other times, the problems are mild so it takes longer to get noticed; even the ones that are genetically linked. I'm not sure if the pediatrician doesn't refer the children for genetic testing or if the family doesn't find it necessary to meet with a geneticist.
Since cleft lips and palates may occur due to a neural tube defect that takes place during the first trimester of pregnancy, other parts of the body- especially in the mid-line may have not been formed properly either. Somethings I often see in children with cleft lips and palates include dysgenesis of the corpus callosum, global hypotonia, poor crossing of midline, swallowing problems (esophageal), and strabismus (eyes turning in). These children luckily get referred for occupational therapy (OT) and/or physical therapy (PT) in addition to speech therapy. The ones who do not get referred right away are often the ones with mild hypotonia and incoordination on both sides of their body; maybe they are just a little behind with their fine-motor and gross-motor skills as a toddler or preschooler. If this is not addressed, these children approach school with a disadvantage and all of the sudden a mild delay that is not addressed becomes a significant delay. This is when it is helpful to have a speech therapist (SLP) who knows alot about motor skills so that they can properly refer to PT and OT. If you are a parent or SLP who is wondering when it is appropriate to refer to PT/OT, then consider the following:
- Can your child keep up with his/her peers at birthday parties, playgrounds, or other group situations? Does the child fatigue easily?
- Can he/she jump by age 2 1/2? Ride a tricycle by 3 y/o? Do jumping jacks by kindergarten?
-Can the child play in a variety of postures: on the belly in the floor, in side-sit, ring-sit or criss-cross, long-sit, or kneeling?
- Does the child have a hand dominance by preschool age? even when there is a dominance the child should be able to use both arms and legs as well as cross the middle of the body. Does the child ignore one of his hands or efficiently use 2 hands such as to throw a ball and manipulate interlocking blocks? Does the child rotate his body in the chair to avoid crossing the midline of the body?
-Can the child feed himself with utensils age-appropriately? hold a cup?
-Is the child's pre-writing or handwriting skills delayed or sloppy?
If the answers warrant concern, then it is suggested that your child receive a PT and/or OT evaluation. After the evaluations, the therapists can discuss if therapy intervention or home exercise program are needed.
Since cleft lips and palates may occur due to a neural tube defect that takes place during the first trimester of pregnancy, other parts of the body- especially in the mid-line may have not been formed properly either. Somethings I often see in children with cleft lips and palates include dysgenesis of the corpus callosum, global hypotonia, poor crossing of midline, swallowing problems (esophageal), and strabismus (eyes turning in). These children luckily get referred for occupational therapy (OT) and/or physical therapy (PT) in addition to speech therapy. The ones who do not get referred right away are often the ones with mild hypotonia and incoordination on both sides of their body; maybe they are just a little behind with their fine-motor and gross-motor skills as a toddler or preschooler. If this is not addressed, these children approach school with a disadvantage and all of the sudden a mild delay that is not addressed becomes a significant delay. This is when it is helpful to have a speech therapist (SLP) who knows alot about motor skills so that they can properly refer to PT and OT. If you are a parent or SLP who is wondering when it is appropriate to refer to PT/OT, then consider the following:
- Can your child keep up with his/her peers at birthday parties, playgrounds, or other group situations? Does the child fatigue easily?
- Can he/she jump by age 2 1/2? Ride a tricycle by 3 y/o? Do jumping jacks by kindergarten?
-Can the child play in a variety of postures: on the belly in the floor, in side-sit, ring-sit or criss-cross, long-sit, or kneeling?
- Does the child have a hand dominance by preschool age? even when there is a dominance the child should be able to use both arms and legs as well as cross the middle of the body. Does the child ignore one of his hands or efficiently use 2 hands such as to throw a ball and manipulate interlocking blocks? Does the child rotate his body in the chair to avoid crossing the midline of the body?
-Can the child feed himself with utensils age-appropriately? hold a cup?
-Is the child's pre-writing or handwriting skills delayed or sloppy?
If the answers warrant concern, then it is suggested that your child receive a PT and/or OT evaluation. After the evaluations, the therapists can discuss if therapy intervention or home exercise program are needed.
Saturday, May 1, 2010
Ideas For Developing Coordination On Both Sides Of The Body
I often work with little kids who have cerebral palsy (hemiplegia, diplegia), peripheral nerve injuries, a stroke, or for whatever reason are stronger on one side of their body than the other. Below are some ideas for encouraging them to use both hands and/or feet:
1. Ribbon Dancers: long wands with ribbons on them. You can have the child carry one in each hand while you do the same, and then move the wands around imitating each other.
2. Zoom Ball: a ball that slides along two parallel strings with handle bars at each end. This activity takes two people, but is SO fun, because as one person closes their arms to catch the ball, the other has to open their arms to send the ball to the other side.
3. Rolling pin to roll out play-dough or cookie dough, then use cookie cutters
4. Mr. Potato Head: one hand is used to hold Mr. Potato while the other is used to insert the pieces
5. Imitating animals: bear crawl, dog, donkey kicks, slither like a snake
6. Scooter board: child lies on his tummy and propels self with both arms
7. Step in paint and walk across butcher paper to do feet art; could also do this with water out on the sidewalk, but of course this artwork will dry up from the sun
8. Obstacle course: climb up, crawl over or through things, jump forward or backward
9. Pushing objects such as large boxes or containers, laundry baskets, strollers
10. Bicycle
11. Yoga: kids yoga books and DVDs are usually easy to follow along
12. Songs with motions of the arms and legs: If You Are Happy & You Know It, Wheels on the Bus, Twinkle Little Star, Little Bunny FuFu
13. Roll cars with one in each hand. The cars that are to be shaken first are fun
There are so many more things that can be done to encourage using both arms and legs. Use your imagnination and you will be able to come up with so many more! Also, ask your child's physical and occupational therapist to give you some exercises and games to work on in between therapy sessions.
1. Ribbon Dancers: long wands with ribbons on them. You can have the child carry one in each hand while you do the same, and then move the wands around imitating each other.
2. Zoom Ball: a ball that slides along two parallel strings with handle bars at each end. This activity takes two people, but is SO fun, because as one person closes their arms to catch the ball, the other has to open their arms to send the ball to the other side.
3. Rolling pin to roll out play-dough or cookie dough, then use cookie cutters
4. Mr. Potato Head: one hand is used to hold Mr. Potato while the other is used to insert the pieces
5. Imitating animals: bear crawl, dog, donkey kicks, slither like a snake
6. Scooter board: child lies on his tummy and propels self with both arms
7. Step in paint and walk across butcher paper to do feet art; could also do this with water out on the sidewalk, but of course this artwork will dry up from the sun
8. Obstacle course: climb up, crawl over or through things, jump forward or backward
9. Pushing objects such as large boxes or containers, laundry baskets, strollers
10. Bicycle
11. Yoga: kids yoga books and DVDs are usually easy to follow along
12. Songs with motions of the arms and legs: If You Are Happy & You Know It, Wheels on the Bus, Twinkle Little Star, Little Bunny FuFu
13. Roll cars with one in each hand. The cars that are to be shaken first are fun
There are so many more things that can be done to encourage using both arms and legs. Use your imagnination and you will be able to come up with so many more! Also, ask your child's physical and occupational therapist to give you some exercises and games to work on in between therapy sessions.
Friday, February 26, 2010
Simple Strategies to Help with Plagiocephaly
Plagiocephaly is a fancy word for mis-shapen head. It can happen for many different reasons in a small infant, especially since their heads are malleable and change shape easily.
My now 20 month old son had a slighly flat spot on the back of his head because he was positioned upright and reclined which put pressure on his head. We had to position him like that due to his severe reflux. I think the flat spot would have been worse had I not put him in "tummy time" so much of his waking hours. Of course, I couldn't lay him in this position until at least 45-60 minutes after a feeding or he would vomit. Once he got around 5-6 months of age, he would roll over and sleep on his tummy. By 7 months he was crawling. These things in addition to all of the reflux medications he was on contributed to a better head shape by 8-9 months of age. His head shape was never severe enough for a helmet. But I explained his situation to indicate how easy it is for a child's head to get mis-shapen and back to being okay.
Often, a baby with torticollis or neurological damage is prone to plagiocephaly. Also, babies with medical problems who aren't able to move age-appropriately, such as preemies, those with heart defects, and babies who have had multiple surgeries. Another reason can be being a multiple (twins, triplets, or more) or a large baby born to a petite mom; this is because there isn't as much wiggle room and they may get stuck with the neck and head in an awkward position.
If your child has been diagnosed with plagiocephaly then hopefully he/she is getting occupational and/or physical therapy services. Therapy can help with neck/trunk strength, stretches, and massage as well as helping with any necessary adaptive equipment to help reposition the baby.
Some simple strategies to help when the head is mis-shapen on the left or right side:
-switch the way the baby is carried, sometimes over the left shoulder and sometimes over the right
-switch the way the baby is held when being fed, sometimes on your right side, other times to your left side
-when using a changing table for diapering, alternate which end the baby's head is at, this helps the baby to look in different directions
-move positioning equipment within the room: bouncy seat, bouncers, swings, etc. so that the view is not always the same for the baby
-when approaching the baby as he/she is in a device or on the floor on a blanket, come from different directions to help the baby look to each side as well as overhead and to the front
-don't sit the child in a Bumbo (R) seat or standing bouncer before he/she has the trunk control to be in it. This is also the case with Jumparoos (R) and Johnny Jump Ups (R). If the baby doesn't have enough trunk or head control, then he will lean to the side which only perpetuates the asymmetry of the head
-offer the baby toys to each side of him wherever he is: swing, floor overhead gym, carseat, on tummy on blanket on floor, etc.
-get down on the floor and play with the baby, sometimes be on his right side, other times on the left or to the front
-infant massage indirectly initially such as to the belly or legs, and then if tolerated to the chest, neck, and arms
-follow through with all exercises/stretches given by the PT and/or OT. Be careful about getting aggressive stretches off of the internet, because depending upon the etiology of the plagiocephaly these stretches could be hurting the baby
Final thought: if your child's doctor prescribes a helmet to help with head shape, then by all means get a helmet and use it the suggested wearing schedule (usually 23 hrs a day). I have seen some amazing changes in head shapes of babies with helmets.
To see pictures of plagiocephaly and helmets, visit www.cranialtech.com
My now 20 month old son had a slighly flat spot on the back of his head because he was positioned upright and reclined which put pressure on his head. We had to position him like that due to his severe reflux. I think the flat spot would have been worse had I not put him in "tummy time" so much of his waking hours. Of course, I couldn't lay him in this position until at least 45-60 minutes after a feeding or he would vomit. Once he got around 5-6 months of age, he would roll over and sleep on his tummy. By 7 months he was crawling. These things in addition to all of the reflux medications he was on contributed to a better head shape by 8-9 months of age. His head shape was never severe enough for a helmet. But I explained his situation to indicate how easy it is for a child's head to get mis-shapen and back to being okay.
Often, a baby with torticollis or neurological damage is prone to plagiocephaly. Also, babies with medical problems who aren't able to move age-appropriately, such as preemies, those with heart defects, and babies who have had multiple surgeries. Another reason can be being a multiple (twins, triplets, or more) or a large baby born to a petite mom; this is because there isn't as much wiggle room and they may get stuck with the neck and head in an awkward position.
If your child has been diagnosed with plagiocephaly then hopefully he/she is getting occupational and/or physical therapy services. Therapy can help with neck/trunk strength, stretches, and massage as well as helping with any necessary adaptive equipment to help reposition the baby.
Some simple strategies to help when the head is mis-shapen on the left or right side:
-switch the way the baby is carried, sometimes over the left shoulder and sometimes over the right
-switch the way the baby is held when being fed, sometimes on your right side, other times to your left side
-when using a changing table for diapering, alternate which end the baby's head is at, this helps the baby to look in different directions
-move positioning equipment within the room: bouncy seat, bouncers, swings, etc. so that the view is not always the same for the baby
-when approaching the baby as he/she is in a device or on the floor on a blanket, come from different directions to help the baby look to each side as well as overhead and to the front
-don't sit the child in a Bumbo (R) seat or standing bouncer before he/she has the trunk control to be in it. This is also the case with Jumparoos (R) and Johnny Jump Ups (R). If the baby doesn't have enough trunk or head control, then he will lean to the side which only perpetuates the asymmetry of the head
-offer the baby toys to each side of him wherever he is: swing, floor overhead gym, carseat, on tummy on blanket on floor, etc.
-get down on the floor and play with the baby, sometimes be on his right side, other times on the left or to the front
-infant massage indirectly initially such as to the belly or legs, and then if tolerated to the chest, neck, and arms
-follow through with all exercises/stretches given by the PT and/or OT. Be careful about getting aggressive stretches off of the internet, because depending upon the etiology of the plagiocephaly these stretches could be hurting the baby
Final thought: if your child's doctor prescribes a helmet to help with head shape, then by all means get a helmet and use it the suggested wearing schedule (usually 23 hrs a day). I have seen some amazing changes in head shapes of babies with helmets.
To see pictures of plagiocephaly and helmets, visit www.cranialtech.com
Friday, October 23, 2009
Abnormal Muscle Tone: Functional versus "Pretty"
When children have abnormal muscle tone such as tight muscles (spasticity) or tremor-like motions (ataxia), then the motions that they make may not exactly look pretty. This is because there is damage somewhere within the neuromuscular system whether it be in the brain such as with cerebral palsy or at the cellular level of the muscles such as with muscular dystrophy.
Back when I had just graduated from therapy school, I went to numerous classes on learning how to improve a patient's muscle strength, tone, and movement patterns. It was my mission to help everyone look typical. That was soon found to not be so realistic. And although a difference can be made with mildly involved persons in a fairly short time, it may take a while for very involved patients such as those who have suffered a TBI- tramautic brain injury. This is because of numerous reasons (medical, neurological, orthopedic, cognitive, behavioral, etc.). So, until their movements look stronger what are we to do? Well, I believe the therapist's duty is to work on functional skills.
For example, I would love for a child with cerebral palsy to hold the spoon perfectly and not spill any food, but that may not be realistic in the short term...for some kids, it may never be realistic. The immediate goal should not be to not let the child feed himself unless he has used the "proper" movement patterns, but instead to make sure the child is functional, even if that means that the movements do not look "pretty". It may mean using a wide handled, curved, or swivel spoon. Although the ultimate goal as a therapist is for the most efficient movement patterns by each muscle group during a functional task, this can take time to develop, and requires daily strengthening. Maybe it can be practiced during snack or at the end of a meal, but it would only frustrate a child to be helping them move "properly" during every single bite. Yet, as a therapist why is it so hard for me to just sit back and watch a sloppy eater? I have had to chill out and realize that I am being a much better therapist by encouraging independence even if the movements aren't the prettiest.
Also, responsibility goes to the parents for carrying out daily activities and exercises to help the child improve. I wouldn't just go to the gym once a week and expect to gain a better figure, so how could we expect that a child with neurological damage is going to improve with tone and strength by only going to therapy once or twice a week? The therapist MUST train the parents to do easy activities and exercises to incorportate into daily routines. Examples include having the child push the siblings stroller to build arm and leg strength, buy toys that encourage manipualtion, carrying grocery bags, "rough house" with parents, taking the child to the park to work on climbing, sliding, and swinging, and the list goes on.
Finally, we as therapists need to know when it is time to discharge a patient from services and guide them to community facilities such as karate or gymnastic lessons. There are some children who have endured years of therapy at a high frequency and although overall they have made gains, there comes a time when those gains aren't so drastic. It could be due to hormones, growth, attitude, needing a change, or that there is just an extreme amount of neurological damage. No matter the reason, I completely believe that it is okay to discharge a child from therapy even if all of his movement patterns are not "pretty". Now, if the child is willing to do all of the work it takes to get stronger and change movement patterns, then I might keep them in therapy longer. But I would still emphasize function. If the child wants to be an artist, then we would work on movements that are made at an easel. If the child wants to be a secretary, then we would work on typing skills whether it be with two hands on a typical keyboard or with a device on an adapted keyboard. I would also work on movement patterns needed to play, cook, clean, dance, or participate in sports.
Back when I had just graduated from therapy school, I went to numerous classes on learning how to improve a patient's muscle strength, tone, and movement patterns. It was my mission to help everyone look typical. That was soon found to not be so realistic. And although a difference can be made with mildly involved persons in a fairly short time, it may take a while for very involved patients such as those who have suffered a TBI- tramautic brain injury. This is because of numerous reasons (medical, neurological, orthopedic, cognitive, behavioral, etc.). So, until their movements look stronger what are we to do? Well, I believe the therapist's duty is to work on functional skills.
For example, I would love for a child with cerebral palsy to hold the spoon perfectly and not spill any food, but that may not be realistic in the short term...for some kids, it may never be realistic. The immediate goal should not be to not let the child feed himself unless he has used the "proper" movement patterns, but instead to make sure the child is functional, even if that means that the movements do not look "pretty". It may mean using a wide handled, curved, or swivel spoon. Although the ultimate goal as a therapist is for the most efficient movement patterns by each muscle group during a functional task, this can take time to develop, and requires daily strengthening. Maybe it can be practiced during snack or at the end of a meal, but it would only frustrate a child to be helping them move "properly" during every single bite. Yet, as a therapist why is it so hard for me to just sit back and watch a sloppy eater? I have had to chill out and realize that I am being a much better therapist by encouraging independence even if the movements aren't the prettiest.
Also, responsibility goes to the parents for carrying out daily activities and exercises to help the child improve. I wouldn't just go to the gym once a week and expect to gain a better figure, so how could we expect that a child with neurological damage is going to improve with tone and strength by only going to therapy once or twice a week? The therapist MUST train the parents to do easy activities and exercises to incorportate into daily routines. Examples include having the child push the siblings stroller to build arm and leg strength, buy toys that encourage manipualtion, carrying grocery bags, "rough house" with parents, taking the child to the park to work on climbing, sliding, and swinging, and the list goes on.
Finally, we as therapists need to know when it is time to discharge a patient from services and guide them to community facilities such as karate or gymnastic lessons. There are some children who have endured years of therapy at a high frequency and although overall they have made gains, there comes a time when those gains aren't so drastic. It could be due to hormones, growth, attitude, needing a change, or that there is just an extreme amount of neurological damage. No matter the reason, I completely believe that it is okay to discharge a child from therapy even if all of his movement patterns are not "pretty". Now, if the child is willing to do all of the work it takes to get stronger and change movement patterns, then I might keep them in therapy longer. But I would still emphasize function. If the child wants to be an artist, then we would work on movements that are made at an easel. If the child wants to be a secretary, then we would work on typing skills whether it be with two hands on a typical keyboard or with a device on an adapted keyboard. I would also work on movement patterns needed to play, cook, clean, dance, or participate in sports.
Sunday, September 6, 2009
W-Sitting
Every picture my parents took of me sitting on the floor below the age of 4 years shows me "w-sitting". What is w-sitting? It is when the child sits on the floor with his knees bent and his ankles are right next to his bottom...as if he had been kneeling and then just relaxed the feet out to each side. It is termed w-sitting, because looking at the child from a "bird's eye" view, the legs look like the letter "W". It is not good on the knees, hips, or feet. In fact I have awful knees probably because I was a big time w-sitter! They squeak when I bend over or walk up the stairs. If I go to aerobics class or walk a far distance, my knees ache for the next 3 days to the point that I can't sleep without pain medicine. So, I am not a fan of letting a child remain in a w-sitting posture for long lengths of time. I am now in my 30s but was told back in my 20s to quit jogging and aerobics classes or my need for a knee replacement would be sped up. So, I stick to biking, pilates, and yoga....wow, do I miss the adrenaline rush of a nice jog!
W-sitting is a posture that babies and toddlers use briefly as they move in and out of various postures. Little ones move so quickly, you will often see them transition from crawling, to sitting, to kneeling, to standing, back down to the floor, etc. So, w-sitting is not bad in and of itself. It is only not a good position if the child remains in that posture for long lengths of time, such as while playing with puzzles or watching television for 10 minutes. It puts unnecessary pressure on the knee joints and contributes to pronated feet (caving in at the ankles and collapsing at the arch). It can alter a child's balance and even make their gait look funny, especially while they run. My daughter tended to want to w-sit as a baby and toddler, and I had to redirect her quite often. I took her to a co-worker (at the time) who was a physical therapist and she gave us stretches and used kinesiotape to help with leg alignment.
Why do children w-sit? Most of the children use this posture because it is easy...it is less work for the trunk muscles because it widens their base of support. Some kids just prefer it just because. But many kids prefer it because they have low muscle tone (AKA hypotonia) or muscle weakness. It is common to see children with developmental disabilities such as cerebral palsy and down syndrome w-sit. I think that my daughter and I have mildly low muscle tone so that is why we have both been w-sitters. It is not uncommon for me to walk into a daycare (I do early intervention OT in natural environments) and see typically developing children using this posture. It does make me cringe, and oh how I want to correct the child. But I can't if the child is not my client. I can however educate the daycare staff about how w-sitting is not a posture that benefits children's gross motor development.
The following are some suggestions that I have found beneficial in reducing w-sitting in a baby, toddler, or older kid.
W-sitting is a posture that babies and toddlers use briefly as they move in and out of various postures. Little ones move so quickly, you will often see them transition from crawling, to sitting, to kneeling, to standing, back down to the floor, etc. So, w-sitting is not bad in and of itself. It is only not a good position if the child remains in that posture for long lengths of time, such as while playing with puzzles or watching television for 10 minutes. It puts unnecessary pressure on the knee joints and contributes to pronated feet (caving in at the ankles and collapsing at the arch). It can alter a child's balance and even make their gait look funny, especially while they run. My daughter tended to want to w-sit as a baby and toddler, and I had to redirect her quite often. I took her to a co-worker (at the time) who was a physical therapist and she gave us stretches and used kinesiotape to help with leg alignment.
Why do children w-sit? Most of the children use this posture because it is easy...it is less work for the trunk muscles because it widens their base of support. Some kids just prefer it just because. But many kids prefer it because they have low muscle tone (AKA hypotonia) or muscle weakness. It is common to see children with developmental disabilities such as cerebral palsy and down syndrome w-sit. I think that my daughter and I have mildly low muscle tone so that is why we have both been w-sitters. It is not uncommon for me to walk into a daycare (I do early intervention OT in natural environments) and see typically developing children using this posture. It does make me cringe, and oh how I want to correct the child. But I can't if the child is not my client. I can however educate the daycare staff about how w-sitting is not a posture that benefits children's gross motor development.
The following are some suggestions that I have found beneficial in reducing w-sitting in a baby, toddler, or older kid.
- For a baby, just correct their posture by placing them in kneeling, criss-cross (AKA Indian style for those of us raised in the 1970s & 80s), or a side-sitting posture
- For toddlers and children, encourage them to sit at a kiddy table and chair while performing fine motor activities such as coloring and puzzles. It is almost impossible to w-sit in a chair
- While the child (not baby) is playing on the floor, have a stool, bench, or tray (like a "breakfast in bed" tray) available. Have the child slide his legs under the device. Because these devices have "legs" or sides, then it increases the chances that the child will sit with his legs out straight to the front of him.
- If the child is in the "terrible twos" stage or is the type who likes control, then give him choices. When you see him w-sit, say "Would you like to fix your legs by sitting criss-cross or legs to the front?"
- Make up a silly song as a reminder. I made up a song titled "Legs in Front" to the tune of Frere Jacque. Then, as I only hummed the tune, my daughter was reminded of correcting her legs out of w-sitting
- Place toys to the side of the child so he will need to reach out of his base of support. This typically encourages a child to side in a side-sit posture (both knees are pointed towards one side or criss-cross style.
- Try not to nag the child by constantly saying "fix your legs" or picking them up and placing them in another posture. I find it best to set up the environment for success by using some of the above-mentioned ideas. Don't redirect the child if he will only be in the w-sit position briefly...if you do, he will tune you out everytime you redirect him...not good!
- There are probably many other ways to help with w-sitting but these are some common ones that I use
- If it is severe enough of a problem, then the child probably needs a physical therapy evaluation. The PT may suggest certain stretches, therapy techniques, furniture, or shoes to help the child
- If the child has sensory processing delays in addition to the low muscle tone, then the child may benefit from an occupational therapy evaluation. At http://www.sense-ablebaby.com/ there is loads of information on sensory processing problems seen in babies and some ideas to help.
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