Thursday, December 29, 2011

Idiopathic Toe Walking and Left Handedness

Acta Pediatrica recently published research that children with a diagnosis of idiopathic toe walking have a higher incidence of left handedness. It was a small sample size of 19 Australian boys and 11 girls with a diagnosis of idiopathic toe walking and 30 in the control group. The average age was 6 years old and the children had otherwise normal neurological examinations. The results of the study were the following: 27 of the control group preferred their right hand and 3 preferred their left hand compared to 18 of the children in the toe walking group preferred their right hand and 10 preferred their left hand.

Do you find in your practice that children with idiopathic toe walking are left handed?

Reference: Wall Street Journal. Left-Handedness May Come From Toes. Retrieved from the web on 12/28/11 at

Monday, December 26, 2011

Playing with Children

During this time of year, children usually have many new toys and gadgets to play with. Parents can play a supportive role in encouraging play skills and get in some fun bonding time. Here are several tips when playing with children:
1. Turn off all cell phones, televisions and computers while you are playing with your child. Set a good example by ignoring your electronic devices while you play.
2. Follow the child's lead. Let the child decide what to play with. If the child is playing pretend play along and follow their directions.
3. Play at the child's level. If the child is playing on the floor, get down on the floor to play with him or her.
4. Do not have a plan. This is the hardest to follow. With all the routine and rushing in today's lives, it is very hard as a parent not to have a plan. Just sit and play even if it is just for a few mintues. The child will appreciate your undivided attention.
You can print out this flyer to hang up in your playroom to remind parents how to "behave" during playtime.

Thursday, December 22, 2011

Use of Time - Adolescents with Cerebral Palsy

Child: Care, Health and Development published a research study that took a close look at how ambulatory adolescents with cerebral palsy use their time. They compared 41 Australian adolescents with cerebral palsy to 82 typically developing peers. They had each adolescent complete a validated interview of recall of information over four days. The results indicated the following:
adolescents with CP spent 91 minutes/day participating in physical activity vs. 147 min/day (typical developing peers)

adolescents with CP spent 28 min/day in active transport versus 52 min/day

adolescents with CP spent 25 min/day in team sports versus 39 min/day

adolescents wtih CP spent 116 min/day in quiet time versus 80 min/day

adolescents with CP spent 6 min/day in social interaction versus 22 min/day

no significant differences were noted in sleep, screen time, domestic activities or school-related time.
This is an area where occupational and physical therapists can offer suggestions to adolescents with cerebral palsy. Perhaps provide them with a list of ideas that encourage physical activity time. Start a social club where the adolescents can get together to socialize. If they can not get together physically, why not try some of the social networking sites. There are several that are safe for children to join. Therapists can work to offer leisure activities. There was a large different in quiet time comparably. Perhaps the adolescents just need some ideas of what to do with their free time based on their motor abilities.

Any other suggestions? Do you have any creative leisure activity ideas? Any tips on appropriate social networking sites for adolescents?

Reference: C. Maher1,J. Kernot, T. Olds. Time use patterns in ambulatory adolescents with cerebral palsy Child: Care, Health and Development. Early view online. DOI: 10.1111/j.1365-2214.2011.01352.x

Wednesday, December 21, 2011

Jingle Bell Pencil

Here is a super simple idea that promotes fine motor skill practice and handwriting fun. Have the child string some jingle bells on to a pipe cleaner. Wrap the pipe cleaner and bells around the pencil. Start your musical writing!

Tuesday, December 20, 2011

Practice Screwing and Unscrewing Caps

Here is a simple activity box to create using recycled baby food pouches and the caps. I love this idea because some of the caps have a nice large diameter which can be a little easier to unscrew than a regular water bottle top for example. The smaller caps have ridges for gripping.

Friday, December 16, 2011

GMFCS Parent Questionnaire

Did you know that you can download a parent questionnaire to fill out for the Gross Motor Function Classification System (GMFCS)? CanChild offers the questionnaire in three age groups - 2-4 years, 4-6 years, 6-12 years and 12-18 years. It is also available in 6 languages - English, Arabic, Farsi, French, Portuguese and Thai. You can download them all at the CanChild website.

LEGO Grant

LEGO grants are available on a quarterly basis for programs that encourage creativity, technology and communication projects. The next grant application is due by January 15th. Here is some information from the website:
Local and national communities, organizations and groups who cater to children ages birth - 14, with special consideration for the following:

* groups that support disadvantaged children
* groups that are supported by LEGO employee volunteers
* special projects or programs designed to elevate a child's opportunities for
exploring creativity
* organizations serving Connecticut and Western Massachusetts

Here is a great opportunity to see if you would qualify for some grant money to help children. The average grant approved is $3000. Why not start an after school club to build fine motor skills and creativity? You can get more information at the LEGO grant website.

Thursday, December 15, 2011

Play Outdoors Tear Off Sign

Here is a cute sign with some suggestions for children to play outdoors. Sometimes they just need some basic ideas to get started. Hang this by your back door or in the therapy room so kids can tear off an activity idea. Go to to download the sign and print it.

Wednesday, December 14, 2011

Letter School App

Letter School is an app that was just released. I just tested it out because it looked so interesting. I have to admit I am pretty impressed for $2.99 (there is even a free version so you can test it out yourself before buying). Here is what it has to offer:
  • different fonts to practice - D'Nealian, HWT and Zaner Bloser
  • practice capital letters, lowercase letters and numbers
  • reinforces phonics and meaning of letter
  • entertaining visual feedback
  • two levels

You simply pick the style of handwriting and type of letters or numbers in the settings. When you pick a letter it will show you the letter, verbalize the letter sound and show you a picture of an object that the letter begins with.

Then you proceed to practicing forming the letter. In the first stage you only have to tap the dots not actually form the letter. Once you tap the correct dots the animation will move to complete the letter.

For stage two, you trace the letter from dot to dot. Again, the animation will help you to complete the letter. Check out these train tracks. I know I lot of kids will love these!

In the final stage you form the letter with no dots or letter to guide you.

I have tested out a few letter tracing apps and I give this one the award for the best so far. You can get more information on the website for Letter School or visit the app store.

It is also available on android devices here - Letter School for Android devices.

Tuesday, December 13, 2011

Move and Play Results for Children with Cerebral Palsy

The Move and PLAY study was conducted from 2006-2009 in order to understand determinants of motor abilities, self-care, and play of young children with cerebral palsy. Over a one year period 430 children were followed.

There are three research summaries currently available on the Can Child website - Conceptual Model of the Move and PLAY Study, Health Conditions of Children with Cerebral Palsy (CP), Gross Motor Function Measure (GMFM), New Shortened Versions.

In addition, four measures that were developed during the Move and PLAY study - Early Clinical Assessment of Balance, Gross Motor Function Measure (GMFM-66-B&C), Health Conditions Questionnaire Spinal Alignment and Range of Motion Measure.

You can view all of the research summaries, measures and presentations at the Can Child website.

Well worth a look!

Monday, December 12, 2011

Use of Thumb Splint in Children with Hemiplegia

Clinical Rehabilitation published research on the functional abilities of 7 children (ages 2-7) with unilateral cerebral palsy who used a neoprene thumb opponens splint (McKie splint). The children were followed for 4 months - about one month baseline, 2 months intervention and one month follow up. Goal attainment scaling and visual analog scales were used to assess function. The results indicated that four children increased their scores following use of the splint. Only two children benefited from the splint when it was worn. All the children tolerated the splint well.

Reference: Ten Berge SR, Boonstra AM, Dijkstra PU, Hadders-Algra M, Haga N, Maathuis CG. A systematic evaluation of the effect of thumb opponens splints on hand function in children with unilateral spastic cerebral palsy. Clin Rehabil. 2011 Dec 1. [Epub ahead of print]

Friday, December 9, 2011

Wii Jogging for Individuals with Cerebral Palsy

I am highly interested in the Wii and its use in rehabilitation. In a high priced market of therapy products the Wii comes in at a dirt cheap price. There are many university students who are working on "hacking" in the Wii remotes to be able to adapt them for different activities and motion analysis. I also read recently that Microsoft is opening up the Kinect to some developers to see how it can be used in terms of motion analysis. For now though there are some great simple way to use the Wii at home for children and I have discussed some of them in previous blog posts. Just type Wii into the search box on the right of this blog to read previous posts.

I came across this video on You Tube and wanted to share how motivating the Wii could be at home. Here is a young man who is holding onto a standing frame (built by his Dad it says in the comments). Using the Wii Jogging from Wii Fit he is able to track his progress on the screen which keeps him motivated to keep working. Check it out.

Thursday, December 8, 2011

Growing Pains and Somatosensory Dysfunction

A recent study in the Journal of Pain Research researched how children with growing pains responded to various sensory inputs. Thirty three children, ages 5-12, with a history of growing pains underwent sensory response testing to touch, dynamic brush, cold, vibration, and deep pressure applied to limb and abdominal sites. The results indicated that children with growing pains exhibited "minor but statistically significantly increased responses to cutaneous cold, vibration, and to deep pressure stimuli in cases compared to controls, evident in a wider distribution than the symptomatic lower limbs". The researchers concluded that growing pains is a regional pain disorder with deficits in somatosensory processing.

Question of the day - do you find that children who have deficits in somatosensory processing complain more often of growing pains or pain in general? Just curious...

If sensory integration techniques are successful in children with sensory processing disorder would they be helpful for children with growing pains? I know this is a HUGE conclusion to make from this small study but just makes me question where we as therapists can help.

Reference: Pathirana S, Champion D, Jaaniste T, Yee A, Chapman C. Somatosensory test responses in children with growing pains. Journal of Pain Research December 2011 Volume 2011:4 Pages 393 - 400

Wednesday, December 7, 2011

Brain Correcting Bumps To Body

An interesting study was published in Nature about how the human body corrects itself when knocked by an external blow. The scientists discovered that the pathway of the primary motor cortex provides this information for limb correction. One of the researchers states that "the corrective movement pathway works by limiting and correcting the domino effect of involuntary bodily movement caused by an external blow". They are suggesting that in certain individuals who have had strokes the sensory message to the brain may need to be addressed first rather than the motor response.

Makes me wonder what about children with dyspraxia or sensory processing disorder? Is there changes in the primary motor cortex that influence the corrective movement pathway in these populations as well as patients who have had strokes? How does the corrective movement pathway work in individuals with motor planning deficits? Any insight?

Reference: Queens University. Scientists discover how brain corrects bumps to body. Retrieved from the web on 12/7/2011 from

Monday, December 5, 2011

A Farewell to Handwriting?

Check out this CBS news story entitled A Farewell to Handwriting? Great video to show to start a discussion at school districts debating between handwriting, cursive and keyboarding.

Sunday, December 4, 2011

FREE PVC Assistive Tech Book

Came across a great free resource on how to make adapted equipment using PVC. This is a 57 page book with detailed instructions on how to make many projects such as adapted writing aids, eye gaze frame, sand/water table and so many more. Great find from Adapting Creatively Blog (original blog post).

Here is a link to the document entitled Practical Versatile Cheap Assistive Technology Supports published by ATEN in Floridda.

Saturday, December 3, 2011

Support Walker Survey

Pediatric Physical Therapy published the results of a survey completed by 513 pediatric physical therapists who use support walkers. Support walkers were used most often to improve mobility, gait, participation at school and socialization with peers. In general, the devices were used for one month as a trial period before purchasing. This was followed by 9 sessions of training provided in the school. The researchers concluded "Pediatric physical therapists use SWs to increase postural control, mobility, and children's participation in school".

You can read more on this study over at Rifton where there is a nice summary of the study with more details regarding therapist's reasoning behind choosing support walkers.

Reference: Low, Sheryl A. PT, DPT, DSc, MPH, PCS; McCoy, Sarah Westcott PT, PhD; Beling, Janna PT, PhD; Adams, Janet PT, MS Pediatric Physical Therapists' Use of Support Walkers for Children With Disabilities: A Nationwide Survey. Pediatric Physical Therapy: Winter 2011 - Volume 23 - Issue 4 - p 381–389
doi: 10.1097/PEP.0b013e318235257c

Friday, December 2, 2011


Wanted to mention about the new social networking site Pinterest. It is basically a virtual board where people categorize different ideas and activities. My description is the following - it is a people driven search engine instead of a computer driven search engine. So if a person finds an activity on the internet that they think would benefit fine motor skill development, they "pin it" to the board on Fine Motor Skills. Other people can than follow that board or create their own.

I have to say I really enjoy the visual format of Pinterest. I also do find that it is one more thing to distract me though. Check it out for yourself so you have a better understanding of it. Here are the boards that I have created - Pinterest YTherapySource
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