Improving Balance Through Simple Play

I used to work in a therapy clinic and before that a hospital. One of the positives to those facilities, was LOTS of equipment including swings, rocker boards, balance beams, balls of various sizes, rock walls, air mattresses, trampolines, and more! It is so much easier to help children work on their balance with all of this equipment. The downside is that the child doesn't have this equipment at home, and at the most the child is getting 1-3 hours of weekly therapy in the clinic. So, what about all of those waking hours spent in play at home with no equipment? How can the family help the child improve on his balance skills? Well, going to the park, restaurant playgrounds, and mall play areas are great ideas, but those locations are limited also...you can't live there after all. You also can't live at the facilities that have gymnastics, dance, and karate lessons.

I like to teach parents simple ways to help a child improve his balance skills that doesn't require any equipment at all; just their bodies and items they already have around the home. Some simple ideas for babies and young toddlers include:

-Lap play: have the child sit on your lap while facing you, and as you sing and talk to him, bounce him gently up/down and side-to-side to help elicit equilibrium reactions in which the arms come out to the side and the head comes back to the middle. I sing songs such as "The Noble Duke of York", "Rock, Rock, Rock Your Boat", "Getty Up Horsie", and make up songs that don't even exist. Initially, place your hands on the child's trunk (belly/back), then as he improves, lower your hands toward his hips. Be sure to watch the facial reactions in order to know if you can make it harder or should slow down.

-Animal walks: toddlers love to play pretend such as getting on all fours on the floor and pretending to be a cow or puppy. They also like to slither on their bellies as if they were a snake. My two favorite animal imitations are donkey kicks (get on all fours and kick the legs behing you) and bear crawl (similar to a dog, but straighten the legs so that the bottom is pointed in the air, if you are into Yoga it is the "Downward. Dog" pose). Try these or make up some animal imitations.

-Dance: Hold the older baby or toddler in your arms while you sway side-to-side, spin both ways, or jump up and down. Even lean over to see if the child can handle his head being upside down.

-Jumping on the bed: hold the child if he can't jump yet and help him jump. Then after awhile, place him on the floor and see if he can stand longer on his own. Often, the proprioceptive input from jumping helps with "body in space" awareness". If the child can independently stand and jump, then make the game harder such as squatting to jump like a frog or bunny, or add singing or music, especially a song about jumping. For an older toddler, have them jump down from a stool or over the stool as if they are Jack Be Nimble jumping of the candlestick!

I have many more ideas...the sky is the limit! I just listed a few to let you know that you don't need lots of expensive equipment to work on balance skills in between therapy visits. Well, time to go join my husband and daughter playing "Five Little Monkeys Jumping On the Bed".

Fun Activities To Play With Toddlers

Today at work I had a blast! I knew I had won the heart over of a new toddler client when he gave me a zerbert...you know, a slobbery kiss with tooting noises. The goal of the OT session today was to help with his poor balance and upper body strength. But he didn't know that, he just thought that some lady came to play with him. You know that a toddler had fun with your activities during the therapy session when they don't want you to leave. Even though this family had lots of toys and a big house, and parents willing to buy any toy that would help this child improve with his developmental delays in motor and speech skills, I opted for fun activities for a toddler that are free. I did this by searching the game room and his bedroom for any toy, game, or activity that could be used to help his balance. Then, we played things that require absolutely no equipment, just our bodies. Some fun activities for toddlers that we played were:

• Animal walks with animal noises: donkey kicks as we said "eh-oh", bear crawl as we growled (the downward dog yoga pose), slithering on the belly like a snake as we hissed, and jumping like a frog as we said "ribbit"
• Obstacle course: we had a step stool to jump off of, a tunnel to crawl through, a large tall table to slither under, and a large pillow to crash onto after a 5 foot bout of "wheelbarrow walking". Although he had fun and was giggling, we had to help with sequencing. Don't add too many items to the obstacle course of a toddler.
• Lap play: as he sat on my lap and I bounced him, I encouraged him to act like a cowboy riding a bull. As he had his arms in the air and I bounced him, I also "threw" off his balance to the sides to encourage him to use his arms to protect himself. Without protective extension, the toddler will have lots of bo-bos!
• He wanted to play chase, but I discouraged this for him, although it may be good with other kids. This little toddler has a habit of running off when things become too difficult either at home, community, or at his preschool. So, I didn't want to feed into this. But I did however encourage other reciprocal activities such as turn-taking, rolling or kicking ball back and forth
• "rough housing": him and his Dad rough house, so I showed the family how to do this where this toddler boy could be building up trunk strength (core stability) and improving in his upper body strength
• I encouraged him to sing songs and perform novel motions. Examples, "If You Are Happy & You Know It, Clap Your Feet"- this really takes trunk balance to sit on the floor as your feet clap together. Another song was "Jump Around the Rosies" instead of "Ring Around the Rosies".
• Be creative when playing toddler games...the sillier the better. At home with my own toddler, I turn on the TV to a toddler music station, and he loves to move and dance to the music as he plays in the living room
• I encouraged the mom to take the little boy to the park and swimming pool, 2 really good activities to build strength and coordination
• I suggested that after he has got out the "wiggles" to encourage him to sit in a chair without a back and play with puzzles, stringing beads, Mr.Potato Head or other 2-handed activities. This lil' toddler has difficulty crossing the middle of his body or using 2 hands at once due to mild low muscle tone in his trunk and extremity muscles
• I suggested the parents use their exercise ball to have the lil' tot balance and bounce on in different positions: sitting, lying on back, lying on belly, sidely, or stand
• Water art out on the sidewalk as he squats: get sponges or paint brushes and play away! the water dries quickly (or at least where I live because it is hot here!) and they can start all over again!
• The final tip, was to have him help with yard work such as using the water hose or watering can to water the flowers. This is fun and buids upper body strength. You might even get lucky enough to see a butterfly or lady bug!

The possibility of toddler games is endless and so often the activities can be played for free. This is such a fun age because they are usually redirectable and easily distracted, even if they can be stubborn from time to time.

Humpty Dumpty Had a Great Fall

Why are some kids so clumsy? They fall often or bump into things...accidents waiting to happen! Well of course, each child is different. Some possible reasons are listed below and may require intervention from a physcian, therapist, or other healthcare practitioner:

• Ear infections or vertigo. The balance receptors are in the inner ear, and any disturbance with the ear can hinder balancing abilities
• Orthopedic impairments: whether it be pigeon-toed, bow-legged, tippy toe walkers, flat or pronated feet, or other differences, it could be the bones out of alignment for whatever reason including muscle tone, joint laxity, or muscle weakness. Also, kids who tend to "w-sit" often have hips that turn in and pronated feet (collapse at the arch and turn in)
• Sensory processing: vestibular (sense of motion and balance), tactile (sense of touch), vision, and proprioceptive (body-in-space awareness) senses contribute to balance, and if there is a problem in one of these senses, the child may fall often or bump into things
• Needing glasses for visual acuity
• Cross-eyed (AKA strabismus)
• Shoes: lack of wearing them or poor fitting shoes can hinder balance skills
• Environment: maybe the room set-up is too "busy" and hard for the child to maneuver without falling.
• Strength and tone: some kids are "floppy" and/or have low endurance
• Hyper-activity or autistic spectrum disorder (ASD): these kids may be extra busy, therefore use momentum as they zoom around the room, so fall often. This is even the case for a child with advanced gross motor skills who can climb the staircase as a baby, but when not on an apparatus (swingset, stairs, slide, etc), he falls

Obstacle Courses

One of my favorite things to play with my daughter and the older toddlers that I work with as an O.T. is "obstacle course". My daughter likes to set up a few movement activities in a sequence in the living room, and then maneuver through the obstacles while I time her with my stop-watch. I like this activity because it is good for strength, coordination, balance, praxis, sensory processing, and cognition. The activities we often include within the obstacle course at home are: crab-walking, fabric tunnel, exercise ball with handle (AKA hippity hop), hula-hoop, dining room chairs, and large pillows. Sometimes I challenge her more by having her crawl backwards through the tunnel, jump into the hula hoop with both feet as it is laying on the floor and then hop out of it on one foot, slither under the chair, and bounce on the ball while circling a piece of furniture. She gets the biggest kick out of this!



When I am in a client's home I just search through the play room, toy box, and other areas to find objects that are in the environment that could be included within an obstacle course. Below are some common things within homes that could be used:

• Place mats: place 2-3 in a row and have the child jump from one to the next
• Blankets and chairs: create a tunnel to crawl through by draping a blanket over 2 chairs
• Large pillows or couch cushions: pile a bunch of pillows together and have the child climb over them, slither under them, log roll or forward roll over them
• Coffee or end tables: slither under them like a snake or walk around them forward or backwards
• Exercise ball: roll, bounce (on bottom, standing, back, or belly), carry over head, "crash" into it
• Heavy quilts: take a "magic carpet" ride by being pulled on it or pulling sibling on it as they sit or lay down
• Laundry basket: the child can push it while it is inverted, or sit in it and be pushed or spun
• Balled up socks: toss balled up socks into a box or large plastic bowl
• Stairs: walk up or down them, "booty bounce" as the child bumps down as he sits on his bottom
• Common toys kids have: trampoline, rocking horse, tricycle or other ride-on toy, tunnel, tent
• Activities to incorporate: marching, jumping, hopping, running, walking or jumping backwards, rolling, bear crawl, crab walk, army crawl, galloping, spinning, donkey kicks