Monday, March 30, 2009

Water and Risk of Being Overweight

Brain Gym proponents as well as some pediatric therapists have been promoting the concept that drinking water can help learning. One of the 4 components of the PACE program from Brain Gym is to drink water to provide energy for the brain. The current issue of Pediatrics reports on another benefit of water for school age children - preventing obesity. This study was done in Germany with 2950 students. The experimental group received four lessons to promote water consumption. Water fountains were installed and water consumption was measured. The results showed that the children in the water group decreased their risk of being overweight by 31% compared to the control group. There was no difference in body mass index. The intervention group drank 1.1 more glasses of water per day than the control group.

Reference: Muckelbauer, Rebecca, Libuda, Lars, Clausen, Kerstin, Toschke, Andre Michael, Reinehr, Thomas, Kersting, Mathilde Promotion and Provision of Drinking Water in Schools for Overweight Prevention: Randomized, Controlled Cluster Trial Pediatrics 2009 123: e661-e667

Sunday, March 29, 2009

What's Missing Tactile Game Video

Here is a fun activity that encourages upper extremity muscle strengthening, proprioceptive input and tactile input.

What more sensory motor activities? Check out 50 Sensory Motor Activities for Kids!.

Friday, March 27, 2009

Physical Fitness and GMFM Scores

Developmental Medicine and Child Neurology published research on the relationship of physical fitness and Gross Motor Function Measure scores in children with cerebral palsy (45 with hemiplegia and 23 with spastic diplegia). The study results indicated no relationship between aerobic capacity and body mass index and sections D (standing) and E (walking, running and jumping) on the GMFM. There was a moderate to high correlation between short term muscle power, agility, functional muscle strength and sections D and E on the GMFM. The authors conclude that this correlation can help to guide treatment planning to improve motor capacity in children with cerebral palsy.

Again, we see that muscle power and strength correlate with function in children with cerebral palsy. Always keep this in mind when working with children with cerebral palsy - increasing muscle strength can translate into improved function. Give parents simple activities to carry out during the day that will help to maximize muscle strengthening i.e. stair climbing, heavy work chores, etc. Try making muscle strengthening fun for children. Foster games and activities that children will want to participate in instead of just basic therapeutic exercises.

I was surprised to see that body mass index and aerobic capacity did not effect motor abilities.

Visit for an electronic activity book on muscle strengthening through play. For simple activities to carry out during the day check out Therapeutic Activities for Home and School at

Reference: OLAF VERSCHUREN, MARJOLIJN KETELAAR, JAN WILLEM GORTER, PAUL J M HELDERS, TIM TAKKEN Relation between physical fitness and gross motor capacity in children and adolescents with cerebral palsy Developmental Medicine & Child Neurology
2009 1469-8749 PN: 0012-1622 DOI: 10.1111/j.1469-8749.2009.03301.x US:

Thursday, March 26, 2009

Team Blog for Pediatric Therapists

After the poll results from the last few weeks, we have set up a team blog for pediatric occupational and physical therapists. I think this is a great idea to share ideas, links, discussions and more. Be sure to visit. All you have to do is email us with your email address to approve you to write on the blog. It is super simple. Once you register, Google blogger is easy to use. So get posting and let's all blog together!!!!

ARRA of 2009 - Stimulus Money for IDEA

The American Recovery and Reinvestment Act of 2009 will provide millions of dollars to help fund IDEA Part B and Part C. Therapists need to be informed regarding the distribution and purpose of this money. The goals of the IDEA Recovery Funds for Services to Children and Youths (early intervention through high school students) with Disabilities are four fold:
1. Spend funds quickly to save and create jobs
2. Improve student achievement through school improvement and reform.
3. Ensure transparency, reporting and accountability
4. Invest one-time ARRA funds thoughtfully to minimize the "funding cliff"
(must be able to sustain projects after the funding expires)

Here is an excerpt from the fact sheet on the American Recovery and Reinvestment Act of 2009:

The IDEA recovery funds constitute a large one-time increment in IDEA, Part B funding that offers states and local education agencies a unique opportunity to improve teaching and learning and results for children with disabilities. Generally funds should be used for short-term investments that have the potential for long-term benefits.

Some possible uses for the funds that therapists should be aware of:
1. Obtain state-of the art assistive technology devices and provide training in their use to enhance access to the general curriculum for students with disabilities.

2. Provide intensive district-wide professional development for special education and regular education teachers that focuses on scaling-up, through replication, proven and innovative evidence based school wide strategies

Keep in mind what the definition of assistive technology (Public Law 100-407) is: "Assistive technology is defined as an item of piece of equipment or product system either acquired commercially, off the shelf, modified, or customized and used to increased, maintain or improve functional capability for an invidividual with disabilities".

Therefore, therapists should be thinking about and advocating for students with disabilities who may need adaptive equipment or assistive technology. Maybe now is the time to suggest to your administrator to purchase that Hoyer lift, gait trainer or some other large piece of equipment that has always been on your wish list. Perhaps there are many students on your caseload that would benefit from assistive technology software such as word prediction, text to speech or voice recognition. Maybe a smart board would help your students to me more involved in the lessons. These are simply just suggestions to get your ideas flowing. Now is the time to think and request.

Regarding professional development again get your ideas flowing. Maybe now is the time to get teachers on board for a specific handwriting program for the entire district to follow. All children would benefit. Perhaps suggest professional development on universal design resulting in less modifications being necessary for all students.

Take a proactive approach and provide your school administrator with a letter of justification for the equipment now. This may allow for your requests to be first on the list. Get moving though, some of the money is scheduled to be available within the upcoming months. And as our government states "spend funds quickly..."

Take our vote at the right side of the blog - What would you spend the IDEA stimulus money on???

American Recovery and Reinvestment Act of 2009: IDEA Recovery Funds for Services to Children and Youths with Disabilities. Retrieved from the web on 3/25/09 at

Definition of Assistive Technology. Retrieved from the web on 3/26/09 at

Tuesday, March 24, 2009

Another Assistive Technology website to share

Heard about this on Twitter NICHY -
TECHMATRIX - . This is a great website to compare different products and do research on assistive technology. It is super easy and super informative! I always like that.

Developmental Coordination Disorder and Functional Skills

Researchers in Taiwan determined that children with developmental coordination disorder (DCD) and suspected DCD perform significantly lower on the Vineland Adaptive Behavior Scales and School Function Assessment when compared to typically developing peers. This indicated that the children with DCD and suspected DCD exhibit inadequate functional skills at home and school.

Limitations of the study is that the sample was on Taiwanese children and all of the standardized testing was done with the Chinese version.

The study does give us information as to the degree of how developmental coordination disorder effects children in their functional activities.

Functional performance of children with developmental coordination disorder at home and at school Developmental Medicine & Child Neurology 2009 1469-8749 0012-1622
DOI: 10.1111/j.1469-8749.2009.03271.x US:

Monday, March 23, 2009

New Idea for Sensory Ball

Here is a new way to use a sensory toy. This is a spiky ball that can go on a child's head so there is a hole in it. Stuff the inside with a cloth napkin or dish towel. Mark one counting stick (or coffee stirrer) with a piece of masking tape on it. The child puts all the sticks in the spiky ball. After all the sticks are in, the adult or another child, pulls out one stick at a time. How many sticks do you have to pull out before you reached the marked one? If more than one player, the winner is the first one to find the marked stick. This activity encourages fine motor skills, bilateral coordination and tactile input. Want more activities like this? Go to

Saturday, March 21, 2009

Motor Skills and Function in Children with CP

Developmental Medicine and Child Neurology published research that compared children with cerebral palsy's scores on the GMFM-66 and the Vineland over 3 years. The study results indicated that there is a significant relationship between what a child can do (GMFM)and what a child does do (Vineland). The relationship was more positive for GMFCS Level I children. Therefore, improvements in individual motor skills resulted in improved motor performance during personal and social skills. The authors recommend also focusing on environmental adaptations and mobility equipment.

This study is beneficial to justify why, at times, therapists recommend individual therapy sessions in an isolated setting outside of the classroom. If motor skills can be practiced and refined during therapy, then everyday functional skills should improve as a result as well especially in GMFCS Level I children with cerebral palsy.

Longitudinal study of motor performance and its relation to motor capacity in children with cerebral palsy Developmental Medicine & Child Neurology 51:4(303-310) 2009. DOI: 10.1111/j.1469-8749.2008.03263.x

Thursday, March 19, 2009

Imagination Playground

And I thought therapists carried a lot of stuff! Check this out. Where can I get one of these?

Motor Skills and ASD

Here are two interesting research studies on autism and motor skills both from Developmental Medicine and Child Neurology. One study reports that out of 101 children with ASD (wide range of ASD and IQ), 79% exhibits movement impairments as reported on the Movement Assessment Battery for Children. Children with childhood autism and IQ of less than 70 exhibits more movement impairments than children with IQ's over 70 and broader autism.(1)

The second study appears to further explain the increased movement impairments in children with childhood autism. Using electroencephalography, researchers compared movement related potentials (MRP's) between children with high functioning autism, children with Asperger's and a healthy control group. The results showed abnormal MRP's in the children with autism but not Asperger's. The researchers concluded that this study supports a "neurobiological separateness" of autism and Asperger's. (2)

I would guess most therapists who work with children on the autism spectrum would have experienced these results in day to day practice with regards to motor skill abilities in children with autism and Asperger's. The interesting part of the research for me is the movement related potentials. These abnormal responses can indicate an interruption at the basal ganglia, thalamus, and supplementary motor area. Remember what the basal ganglia and the thalamus do? The basal ganglia helps to determine the intensity of motor activity. The thalamus prioritizes sensory information and maintains alertness. So the next question is can we infer anything from this study regarding sensory differences in children with autism? Something to think about.

1. DIDO GREEN, TONY CHARMAN, ANDREW PICKLES, SUSIE CHANDLER, TOM LOUCAS, EMILY SIMONOFF, GILLIAN BAIRD (2009) Impairment in movement skills of children with autistic spectrum disorders Developmental Medicine & Child Neurology 51:4 (311-316)
DOI: 10.1111/j.1469-8749.2008.03242.x
2. PETER G ENTICOTT, JOHN L BRADSHAW, ROBERT IANSEK, BRUCE J TONGE, NICOLE J RINEHART (2009) Electrophysiological signs of supplementary-motor-area deficits in high-functioning autism but not Asperger syndrome: an examination of internally cued movement-related potentials Developmental Medicine & Child Neurology Published online on March 11, 2009. DOI: 10.1111/j.1469-8749.2009.03270.x

Wednesday, March 18, 2009

Motor Skills During Adolescence in children with CP

Developmental Medicine and Child Neurology published research stating that adolescent children with cerebral palsy GMFCS Level III, IV and V demonstrated a functional decline in skills which were clinically significant. This longitudinal study followed 657 children with CP using the Gross Motor Function Measure-66. Children with cerebral palsy levels I and II did not experience a functional decline. Children at GMFCS Levels III, IV and V showed a peak in functional skills at ages 7 years 11 months for Level III and 6 years 11 months for Levels IV and V.

As pediatric therapists, can we make a difference in preventing or delaying this functional decline in GMFCS Level III, IV and V through direct therapy and consultation with parents? I would like to hope that we can, but insurance companies don't pay for hope they want evidence. The good news is that this is important research to share with parents of children with cerebral palsy. We can inform that at GMFCS Level I and II we do not expect to see a significant decline in skills during adolescence. For children who are Levels III, IV and V, we can inform parents to possible expect a decline and work on prevention. Please comment or share your experiences.

Reference: STEVEN E HANNA, PETER L ROSENBAUM, DOREEN J BARTLETT, ROBERT J PALISANO, STEPHEN D WALTER, LISA AVERY, DIANNE J RUSSELL Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years Developmental Medicine & Child Neurology 2009 1469-8749 0012-1622
DOI: 10.1111/j.1469-8749.2008.03196.x

Check out Teaching Motor Skills to Children with Cerebral Palsy digital edition. This is a great book for any pediatric therapist or parent of a child with cerebral palsy.

Tuesday, March 17, 2009

ASD and Sensory Sensitivities

This is certainly not news to those who work with young ASD children on sensory processing skills. The Journal of Autism and Developmental Disorders published research stating that young autistic children experience specific sensory sensitivities with regards to tactile input, taste, smell and auditory filtering when compared to other children with different developmental disabilities. The researchers recommend that these differences are considered as specific symptoms in young children with autism.

It still leaves the question - is sensory processing disorder a diagnosis or a symptom of other disabilities?? In my non expert opinion, this research study is a score for the theory that sensory sensitivities are a symptom and not a disorder by itself. Any comments?

Reference: Lisa D. Wiggins1, Diana L. Robins, Roger Bakeman1 and Lauren B. Adamson (2009) Brief Report: Sensory Abnormalities as Distinguishing Symptoms of Autism Spectrum Disorders in Young Children Journal of Autism and Developmental Disorders Published online March 13, 2009 doi 10.1007/s10803-009-0711-x

Monday, March 16, 2009

Flat Feet and Hip Internal Rotation

The latest issue of The Foot journal reports that flat feet in children ages 3-6 years old has a highly statistically significant relationship with increased hip internal rotation. Of the 569 children studied, 16% had flat feet. One hundred percent of those children had increased hip internal rotation compared to zero of the children without flat feet.

Pediatric physical therapists work with many children for in-toeing when walking. Frequently the focus of treatment is muscle strengthening and stretching to correct for muscle imbalances. This study reminds us to always check the feet as well. Both the feet and the hips need to be addressed when working with children who have increased hip internal rotation.

Reference: George Zafiropoulosa, Kodali Siva R.K. Prasada, Thomai Koubourab and George Danis (2008) Flat foot and femoral anteversion in children—A prospective study The Foot Volume 19, Issue 1, March 2009, Pages 50-54 doi:10.1016/j.foot.2008.09.003

Saturday, March 14, 2009

Purposeful Hyperactivity, ADHD and Sensory Diet activities

Recent research in Abnormal Child Psychology reports on a study of 12 boys with ADHD were compared to 11 typically developing boys. All of the boys ages 8-12 years old wore actigraphs on their wrists and ankles during working memory tasks. The research indicated that all children moved more during working memory tasks but the boys with ADHD moved significantly more that the typically developing children. The researchers concluded that excessive movement in boys with ADHD may have a functional purpose during working memory tasks.

This is some great research to support sensory diet activities in the classroom. You can explain to teachers that movement may help the children to accomplish working memory tasks. Here is where theraband around desk chairs, swinging foot rests, balls, and other movement ideas can be helpful additions to the classroom. Reinforce the idea with teachers that by forcing any child to sit perfectly still during certain tasks may actually inhibit working memory.

On 4/9/09 Time Magazine printed an article about the previously mentioned study entitled Kids With ADHD May Learn Better By Fidgeting. Worth a read if interested in this topic.

Reference: Rapport, M, Bolden, J, Kofler, M et al (2008) Hyperactivity in Boys with Attenteion-Deficit/Hyperactivity Disorder (ADHD): A Ubiquitous Core Symptom or Manefestation of Working Memory Deficits? J Abnorm Child Psychol DOI 10.1007/s10802-008-9287-8

Thursday, March 12, 2009

Clothes Pin Counting

Here a child has index cards with numbers on them. Using clothes pins, the child is hanging the cards in the correct numerical order. Then the child presses the clothes pins to drop the cards. Hanging the line next to the wall helps to control the clothes line and makes it easier for the child. Need more activities like this? Check out Get Up and Learn!, Clothes Pin Collection or Colorful Clips at our website,

Wednesday, March 11, 2009

Listen to Podcast

You can listen to the podcast of the live show from March 11, 2009 on the right hand side of the blog from the TalkShoe badge. It is a 30 minute broadcast of a large mix of items such as the purpose of the podcasts, perceptions of school based therapists, educating teachers and parents and bringing physical activity into the school day. The next live show will be April 2, 2009. Comment on topic ideas that you would like to discuss.

Live TalkShoe Pediatric Therapy "Radio" Show Tonight at 9pm EST

Don't forget to tune in tonight at TalkShoe, for our first ever LIVE talk show about pediatric therapy. It is scheduled at 9pm Eastern standard time. Join us for a live discussion on pediatric occupational and physical therapy. Please be patient with me for this is first broadcast. I am hoping it goes smoothly but I can not make any promises. I just think it will be fun and informative for us to collaborate and discuss pediatric therapy topics together. You can either call into the show via VOIP or a phone. You can join in by text as well. Stop by and just listen if you would prefer not to participate.

Again, tune into Your Therapy Source's Talkshoe tonight at 9pm.

Tuesday, March 10, 2009

Adaptive Seating

Here is some research to possibly include in a letter of medical justification for children with disabilities. Archives of Physical Medicine and Rehabilitation reports that adaptive seating on the floor and the toilet for children with GMFCS III and IV with cerebral palsy resulted in a positive impact on the child's and family's life. Removal of the adaptive seating had a negative impact on family life.

Reference: The Impact of Adaptive Seating Devices on the Lives of Young Children With Cerebral Palsy and Their Families Stephen E. Ryan, Kent A. Campbell, Patricia J. Rigby, Barbara Fishbein-Germon, Darlene Hubley, Betty Chan Archives of Physical Medicine and Rehabilitation - January 2009 (Vol. 90, Issue 1, Pages 27-33, DOI: 10.1016/j.apmr.2008.07.011)

Monday, March 9, 2009

Occupational Therapy Blog Carnival

Wanted to let you know about the Occupational Blog Carnival that was recently posted. This is the first edition where blog articles could be submitted on the topic of occupational therapy. We submitted our article on 10 Things They Don't Teach You in School - Learning on the Job as a School Based Therapist. This first issue was hosted by E-nable OT blog.

We will be hosting the May edition of the OT Blog Carnival. Articles will have to be submitted by May 1st and the blog will be published May 4th. More details to follow.

Your Therapy Source's Sqworl Page

Heard about Sqworl from Paul Hamilton's blog. I just created a Sqworl page for Your Therapy Source. This is a visual look at all the places Your Therapy Source can be found on the Internet.

Sqworl could also be used for some of the students that you work with. If there is websites that the students always go to, you can create a Sqworl page for free. Once the student is on the Sqworl page, they can use the visual icons to pick where to go versus having to read links or use a search engine. The visual pictures are direct links to specific web pages.

Check out Your Therapy Source's Sqworl page to get ideas.

Friday, March 6, 2009

Word Cloud for Pediatric Therapy

Playing around on computer and created this Word Cloud on Wordle. Check it out.

Obesity and Motor Skills

Here is another interesting topic to me. Just read some research from 2008 Neuroscience Letters indicating that obese and overweight children had decreased fine motor control when compared to normal weight peers. Fine motor skills were decreased more when postural challenges were present (standing on balance beam while doing peg activity.

In addition, Adapted Physical Activity Quarterly reports on recent research that concluded obese children scored significantly less than overweight or normal peers on the MABC in ball skills, balance and manual dexterity.

Pondering today if therapists consider this when evaluating overweight and obese children. If using standardized testing to determine eligibility, should it be taken into account that it may be "normal" for overweight children to score below age level? If motor skill deficits are noted along with decreased muscle strength, functional deficits, sensory issues and more how much motor skill gains can we expect if the obesity is not addressed simultaneously?

Reference: Eva D'Hondt, Benedicte Deforche, Ilse De Bourdeaudhuij, Matthieu Lenoir Relationship Between Motor Skill and Body Mass Index in 5- to 10-Year-Old Children
APAQ, 26(1), January 2009

Reference: Eva D’Hondt, Benedicte Deforchea, Ilse De Bourdeaudhuija and Matthieu Lenoira (2008) Childhood obesity affects fine motor skill performance under different postural constraints Neuroscience Letters
Volume 440, Issue 1, 25 July 2008, Pages 72-75

Thursday, March 5, 2009

Great FREE Assistive Technology Resources

Heard about this on Twitter - The Wisconsin Assistive Technology Initiative (WATI) is now offering free access to many of their superb resources. There is a free 337 page book entitled Assessing Student's Needs for Assistive Technology. There are numerous resource guides, forms, assessments and more all for free.

Wednesday, March 4, 2009

Functional Physical Training and CP

Recent research in Pediatric Physical Therapy reports on thirteen children with cerebral palsy who participated in functional physical training 2x/wk for 9 weeks resulting in significant improvements in ambulation, aerobic endurance, and walking distance.

This might seem obvious but I think therapists need to be reminded frequently what works time and time again - aerobic training results in improved functioning. Sometimes therapists can go off on too many tangents when working with kids. Sticking to the basics, muscle strengthening, practice and aerobic training gets results.

Now how to apply this study to school based therapy. Most children do not receive PT or OT 2x/week. Although, many receive PE or APE that many times. Try consulting with the PE teachers and help to create stations that work on aerobic conditioning. Also, try offering parents suggestions to do at home with aerobic stations that are simple to set up. Get the child motivated to participate. Create a chart - when 18 sessions are reached award that child with a prize. Any other ideas? Please comment.

Reference: Gorter, Hetty PT; Holty, Lian PT; Rameckers, Eugène E.A. PT, MRes; Elvers, Hans J.W.H. RI, MSc; Oostendorp, Rob A.B. Prof Dr (2008) Changes in Endurance and Walking Ability Through Functional Physical Training in Children with Cerebral Palsy [Research Report] Pediatric Physical Therapy:Volume 21(1)Spring 2009pp 31-37

Tuesday, March 3, 2009

Yet Another Use of Velcro

Here is a three year old girl working on hip external rotation, weight shifting, eye foot coordination and crossing midline. There is Velcro strap on her feet with Velcro coins on the cards on the floor. She is matching the cards on the floor in front of her to cards to the left and right of her. Try for active range of motion, crossing midline, coordination or as a precursor activity to donning/doffing shoes and socks. Need more activity ideas for pediatric therapy? Check out

Monday, March 2, 2009

Preschoolers and Physical Activity Time Tip

Pediatrics reports that children in preschools with high quality scores, less fixed playground equipment, more portable playground equipment, less media time and larger playgrounds experienced more moderate/ vigorous physical activity per hour and fewer sedentary minutes compared to other preschool children.

That seems like a simple way to increase physical activity time in any preschoolers we may be working with to develop gross motor skills. Perhaps suggest to the preschool director more portable playground equipment i.e. balls, jump ropes, etc rather than always relying on fixed playground equipment for gross motor time. This would help all children in the class. With our extensive problems with childhood obesity in this country, this simple addition to play time may encourage more moderate/vigorous activity in children which is a huge plus.

Does anyone else have any simple suggestions to increase physical activity time in preschoolers? We have several electronic books and articles at our website to promote physical activity. We would love to hear from you and what you do in your therapy practice to encourage physical activity. Please comment.

Reference: Dowda, Marsha, Brown, William H., McIver, Kerry L., Pfeiffer, Karin A., O'Neill, Jennifer R., Addy, Cheryl L., Pate, Russell R.
Policies and Characteristics of the Preschool Environment and Physical Activity of Young Children Pediatrics 2009 123: e261-e266

Sensory Friendly Films

The Autism Society of America and AMC Entertainment are now offering movie showings in certain cities specifically for children with sensory differences. Basically, at specific times, movies will be shown with the sounds turned down, lights up and children are allowed to move around and even dance! This is an AWESOME idea.

Flat Feet and Motor Skills

Pediatrics reports on research indicating that flat feet in children ages 11-15 did not have a significant effect on 17 motor skills or athletic ability. The researchers do not recommend treating flexible flat feet for athletic performance.
That is a swift blow for all orthotists. This study was done on 11-15 year old children. I would love to see similar research in younger children.

Reference: Tudor, Anton, Ruzic, Lana, Sestan, Branko, Sirola, Luka, Prpic, Tomislav
Flat-Footedness Is Not a Disadvantage for Athletic Performance in Children Aged 11 to 15 Years Pediatrics 2009 123: e386-e392

Sunday, March 1, 2009

Live TalkShoe Pediatric Therapy "Radio" Show

I am really excited about announcing this. We are going to host our first ever LIVE call in talk show on pediatric therapy. I think it will be fun to try out. All you have to do to participate is to log on to TalkShoe on March 11, 2009 at 9pm. It is free! For our first episode, I will be discussing pediatric school based therapy in general i.e. bringing therapy into the classrooms, therapy ideas, etc. It would be great if we can get a large group of pediatric therapists to listen, text or talk to participate. The call in show will only support 250 participants so you will want to sign up on time on 3/11/09. Be patient with me for the first one. I am by no means a talk show host nor an expert on every pediatric therapy topic. I just think it will be fun so join me. Let me know if you have any questions or topics that you would like me to discuss. Please make suggestions. You can find out more information by clicking on the TalkShoe gadget on the right hand side of the blog.
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