Friday, May 31, 2013

6000 Step Count for Preschoolers

McMaster University published a resource on physical activity for preschoolers.  A recent study indicated that preschool children should take at least 6000 steps every day participating in at least 180 minutes of physical activity per day of any intensity.  By age 5, children should participate in 60 minutes of energetic play (ie biking, running, playing tag, etc.).    

This information is helpful for goal setting for young children at risk for motor delays, decreased endurance and/or obesity.  

Reference:  McMaster University. Step Counts and Physical Activity.  Retrieved from the web on 5/31/13 at http://canchild.ca/en/childrenfamilies/resources/chemp_newsletter_issue_10.pdf.

Wednesday, May 29, 2013

Motor Skills of Toddlers with Autism

A recent study in Autism describes the gross and fine motor skills of a cross-sectional group of 162 children with autism spectrum disorder between the ages of 12 and 36 months. Age equivalents were determined for gross and fine motor skills for all children. The results indicated gross motor and fine motor differences became significantly greater with each 6-month period of chronological age. The importance of addressing these motor delays during the early years is discussed in the article. 

Reference: Meghann Lloyd,Megan MacDonald,and Catherine Lord. Motor skills of toddlers with autism spectrum disorders Autism March 2013 17: 133-146, first published on May 24, 2011 doi:10.1177/1362361311402230

Tuesday, May 28, 2013

Good Handwriting Good Grades

I have posted before on good fine motor skills in preK translating into better grades in Grade 2,  but I came across this video which is helpful to explain to someone why handwriting is still important in this day of technology.  This is the video from Florida International:

Early Identification of Motor Delays

The American Academy of Pediatrics has published new research on early identification and evaluation of motor delays and variations in muscle tone.   A multidisciplinary expert panel developed an algorithm for the surveillance and screening of children for motor delays using formal developmental screenings at 9,18,30 and 48 month well child visits. The additional 48 month check is to identify problems in coordination, fine motor, and graphomotor skills before a child enters kindergarten.

This full text article offers a flow chart for decision making for pediatricians, summary of gross motor and fine motor skills at various ages, examples of questions to ask regarding motor history, suggested examination techniques, suggested testing such as neuroimaging and blood work, chart of red flags, chart for common genetic disorders with clinical testing and clinical presentations and suggestions for referrals.

If you are a pediatric therapist working with younger children, ages birth through early elementary years, this full text article is worth a read.  Personally, I found the wording of questions to ask parents regarding their child's motor history very beneficial to use during an evaluation or goal setting.

Reference:  Garey H. Noritz, Nancy A. Murphy,and NEUROMOTOR SCREENING EXPERT PANELFrom the American Academy of Pediatrics: Clinical Report: Motor Delays: Early Identification and Evaluation. Pediatrics peds.2013-1056; published ahead of print May 27, 2013, doi:10.1542/peds.2013-1056

Friday, May 24, 2013

Truly Learning a New Skill

Did you ever stop to assess whether some of your students have truly learned a new skill when you mark off "goal achieved" on a IEP?  Meaning has the child learned the skill so that it can be performed with no physical or verbal cues?  Does the child choose to use the skill in all environments at home and school?  Does the child ever even use the new skill at all?

It is something to think about.  Sometimes the best time to check if someone has truly learned a new skill is to wait a bit and then check on that skill at a later date. 

One of two things will happen - yes, the child has learned the new skill or no the child has not.  But, important information will be gained.  If yes, provide that child again with positive reinforcement and congratulations on using the new skill.  Is there a higher level skill that the child can work towards building upon this skill?  Ask the child if the skill has helped him or her.  This helps you to formulate future goals for other students.

If no, determine what requires further advancement.  For example, does the child require occasional reminders?  Is the child unable to perform the skill only in art class?  Does one small part of the overall skill need review?  By answering these questions, one can help a child reach his/her full potential. 

Thursday, May 23, 2013

Treadmill Training Effects on Balance

Recent research was completed that compared treadmill training versus overground walking effects on balance skills using a randomized controlled trial with blinded evaluator. The participants were children with cerebral palsy ages 3-12, GMFCS levels I through III. The experimental group received 30 minute treadmill training session two times per week for 7 weeks. The control group participated in overground walking, 30 minute sessions, 2 times per week, also for 7 weeks.

The results indicated the following:
  • both groups exhibited better functional balance after the protocol. 
  • the experimental group had higher Berg balance scale scores and exhibited lesser mediolateral oscillation with eyes open in comparison to the control group.
The researchers concluded that treadmill training had greater effects on balance skills and  mediolateral oscillation than the overground walking.

Reference:  Grecco LA, Tomita SM, Christovão TC, Pasini H, Sampaio LM, Oliveira CS. Effect of treadmill gait training on static and functional balance in children with cerebral palsy: a randomized controlled trial. Rev Bras Fisioter. 2013 Feb;17(1):17-23.

Wednesday, May 22, 2013

Free Visual Spatial and Motor Planning Puzzle

Check out this free printable visual spatial, visual motor and motor planning puzzle from our latest ebook, Crossing Paths.  Scroll down to get the free sample page.

Tuesday, May 21, 2013

Blank Picture Frames Freebie


Get 10 free blank picture frames to print to create some collaborative artwork and promote wrist extension.  Go to YourTherapySource to get the free frames to print.  

Monday, May 20, 2013

Active Videogaming and Children

A recent study in the Journal of Pediatrics indicated the benefits of exergaming for children.  The researchers studied 15 children, ages 9-11 years old, participating in high intensity exergaming, low intensity exergaming and a graded exercise test on a treadmill.  The results indicated the following:
  • high intensity exergaming (Kinect hurdles) was equivalent to moderate intensity exercise
  • low intensity exergaming (Kinect bowling) was equivalent to low intensity exercise
  • high intensity exergaming significantly reduced flow mediated dilation (vascular response) 
  • high intensity gaming increased heart rate and the amount of energy burned.
Reference:  Andrew Mills, BSc, Michael Rosenberg, PhD, Gareth Stratton, PhD, Howard H. Carter, BSc, Angela L. Spence, BSc, Christopher JA Pugh, PhD, Daniel J. Green, PhD, and Louise H. Naylor, PhD. "The Effect of Exergaming on Vascular Function in Children," The Journal of Pediatrics, DOI 10.1016/j.jpeds.2013.03.076

Thursday, May 16, 2013

5 Make and Take Ideas for Summer

Here is a fun idea - have kids create their own activities to do over the summer break.  Start now during part of a therapy session to assemble and teach students some games or activities that they can do over the summer for carry over of therapy skills and to keep them busy.  Once you have created an activity and reviewed how to play it set it aside to give to the child the last day of school.  Hopefully, by the time that day comes the child will have created several activities for over the summer.  Here are some suggestions:

1.  Rock Tic Tac Toe - Go outdoors and collect 10 small rocks (or head to Dollar store to buy a bag of river stones for $1).  Paint 5 'X's and 5 'O's on the rocks.  Using sidewalk chalk draw a tic tac toe board.  Play tic tac toe with the rocks - either place the rocks in a square or toss them from far away.  Place the rocks and the chalk in a plastic bag to send home.  Maybe include other games to play with the rocks - hopscotch, hide and find, etc.

2.  Journals - Cut apart a recycled cereal box.  Using two large pieces of cardboard cut two rectangles to make the front and back covers.  Glue colored paper over the cereal boxes.  Cut out 10 pieces of paper the same size.  Punch holes in the paper and covers.  Tie a string through the holes to assemble the journal.  Include several story starter ideas.  Need it easier than this?  Print out Doodle Diaries, staple and ready to go! 

3.  Activity Idea Book - At each session ask every child for an activity idea to do over the summer.  Perhaps a trip to the library, blowing bubbles, hide and go seek, etc.  Once you have documented everyone's answers write or type them all together on a sheet of paper.  Add this hand out on Physical Activities for the Summer.  Makes copies for each student to add to their summer bag of make and takes. 

4.  Printables from Your Therapy Source - Print out fine motor, gross motor or visual processing ebooks activities or from the free stuff page all sorts of activities.  Put out suitable activities on a table.  The child can go through the activities and select some to put in a folder to bring home for summer.

5.  Play Dough - Make large batches of home made play dough.  Give each child a small container of play dough and activity ideas to do with the play dough.  Need activity ideas - check out Creative Clay Activities or Play Clay Mats to print and send home.  


Wednesday, May 15, 2013

Another "Get Moving" App for Kids

Here is another app to add to the list to encourage physical activity in children - Big Cat Race (and its free!).  Basically you pick an avatar - lion, leopard or cheetah.  You pick a level - easy, medium or hard.  Then you pick a race - either number of steps, timed or free run.  Then get ready to race.  When the iphone says go the child runs holding the phone (the iphone screen goes black while the race is on so be sure to tell the child there is nothing to watch while they run).  Then when the race is over you get to see how long it took, how many steps you took and what your speed was.  It saves your times based on the profiles you create.  You can even play back the race and watch the animals.

This was a fun app that got a 7 and 8 year old running all over outdoors to see if they could beat the big cats.  We found that if you really want to win the race try the 10 step race.  They seemed to win that race consistently.  Occasionally they did get frustrated because they ran as hard as they could on the two minute race but did not even come close to winning when they watched it playback.  

This app certainly got the kids up and moving!   

Tuesday, May 14, 2013

Strength Training and GMFCS IV

Developmental Neurorehabilitation published a case study to evaluate functional strength training (4x/wee x 10 weeks) for a 9 year old child classified as a level IV according to the Gross Motor Function Classification System (GMFCS).  Data was collected using an isokinetic dynomometer, the Gross Motor Function Measure and the Timed Up and Go test at baseline, 5 weeks and 10 week post intervention.  The results indicated the following:
  • improvements were found in hip, knee and ankle muscles strength
  • increase in GMFM-88 score
  • decrease in time for TUG test performance.
Reference:   Dos Santos AN, da Costa CS, Golineleo MT, Rocha NA. Functional strength training in child with cerebral palsy GMFCS IV: Case report. Dev Neurorehabil. 2013 Apr 25. [Epub ahead of print]

Monday, May 13, 2013

Social Skills and Early Powered Mobility

Assistive Technology published research on social skills and early powered mobility.  The participants included 23 children with physical disabilities between the ages of 18 months and 6 years of age.  Data was collected at wheelchair evaluation, wheelchair delivery, and approximately 6 months later.   The following results were seen:
  • significant increases were found in parental perceptions of positive social skills for younger children after receiving a wheelchair
  • slightly older children showed improvements in social skills before the wheelchair was received
  • no changes were found in negative social skills
  • parental ratings also indicated a significantly greater difficulty remaining engaged in tasks after receiving a wheelchair
  • a significant increase was noted in the number of mobility activities during indoor free play but no difference was seen in interaction with toys or objects
  • improvement in the qualitative level of outdoor interactive free play was reported but there was no change in verbal interactions. 
Reference: Guerette P, Furumasu J, Tefft D. The positive effects of early powered mobility on children's psychosocial and play skills. Assist Technol. 2013 Spring;25(1):39-48; quiz 49-50.

Saturday, May 11, 2013

Motion Perception and Autism

The Journal of Neuroscience has published research on enhanced motion perception in children with autism.  Previous studies have reported that children with autism can have enhanced visual perceptual skills with static objects but this is the first study that indicated an enhanced perception of motion which may help to explain why some children with autism can be hypersensitive to motion.

The participants in the study were 20 children with autism and 26 children without autism ranging in age from 8-17 years old.  The children were asked which way bars were heading (right or left) on a video screen.  The bars became increasingly smaller when a child answered correctly.  When the the images were low contrast both groups performed similarly.  When the images were high contrast, the children with autism performed twice as well as their peers.

One of the researchers, Foss-Feig, stated the following:
"This dramatically enhanced ability to perceive motion is a hint that the brains of individuals with autism keep responding more and more as intensity increases. Although this could be considered advantageous, in most circumstances if the neural response doesn't stop at the right level it could lead to sensory overload."
This research is particularly interesting to me.  Makes me think of many what-ifs which I know we should not do with research but I can not help myself.   Sensory integration treatment sessions involve the children receiving sensory input and requiring a motor and behavioral response.  When we talk of sensory input though it usually includes some sort of manual therapist/parent intervention (ie - joint compressions), physical motion (ie proprioceptive input) or receptive input (ie white noise).  Visual input is included at times as well such as natural lighting.  But if the overall trigger of sensory overload from movement is visual input are we occasionally missing a key component?

What ways can we include this current research into practice?  Does a child experience hypersensitivity to motion only in more visual stimulating environments of high contrast?  Are children with gravitational insecurity less fearful in environments with less visual stimulation?

Take using a swing for example, should we give a child ample time to explore movement by just pushing the swing and not actually getting on the swing?  Maybe another child or adult can push the swing at a certain speed with the child watching.  Have the child then get on the swing with it going at the same speed.  Then get off the swing and have the child observe again with a faster speed and then get back on the swing to experience this faster speed.  By repeating this task, will it help the child to process motion perception by calling in different senses (vestibular) to help prevent sensory overload?  What if the swing is a bright color against a visual stimulating environment?  Obviously, there are certain children that this approach is taken due to fear or anxiety to use the swing. But do you think about this with other children where it is not so apparent? 

Obviously the visual system and the vestibular system are significantly intertwined but does the visual system play a larger role in sensory overload?  What would the results of this study be if the children had a third intervention where the images were low contrast and the children were moving at the same time?  How about moving and high contrast images?  Something to ponder further...

Reference:  University of Rochester. Enhanced Motion Detection in Autism May Point to Underlying Cause of the Disorder.  Retrieved from the web on 5/11/2013 at http://www.rochester.edu/news/show.php?id=6332.


Tuesday, May 7, 2013

3 Free Therapist Appreciation Ideas

As the end of the year approaches, I occasional get emails from parents if we offer gift certificates for therapists.  Unfortunately, we do not but it brings me to today's topic - end of year gifts.  Therapists never expect a gift from any student or parent.  But if you are looking for ideas here are a few suggestions that don't cost a dime:

1.  Make a handmade gift.  Something simple would be most appreciated, perhaps it is a painted hand print, a poem or a picture.  A therapist, especially an OT, would be so proud to get a hand made gift from a student.  And, I mean truly hand made from start to finish by the student.  You would truly give that therapist a gift a pride and satisfaction in that student's accomplishments.

2.  Leftover Supplies from your house.  Sounds silly I know but maybe you have some loose stickers, highlighters, colored tape or other fun items that could be used during a therapy session.  Therapists usually pay for all of that stuff out of their own pocket.

3.  Write a thank you note.  I once received a handwritten thank you note from a parent a few months after I was done working with their child.  The mother was very grateful for the physical therapy I provided her son and the progress that he made.  I have NEVER forgotten that note.  It really meant so much to me. 

Any therapists care to add to the list?  What is one of your favorite appreciation gifts that you have received?

Monday, May 6, 2013

Therapists Learning from Teachers

School based occupational and physical therapists can learn so much from teachers.  We may know lots of information on fine motor skills, gross motor skills, visual perceptual skills, sensory processing and coordination but we are lacking in many other educational traits.  Watch, oserve and learn from teachers (pushing in for therapy services offers this opportunity).  Here are what I consider the top 5 things school based therapists can learn from teachers:

1.  Use a plan book.  Teachers are required to have their lessons planned in advance.  Therapists should try this idea.  I plan for the next session for a student(s) the week or night before but I do not always write it down.  You can download a therapy lesson plan form at YourTherapySource.com. 

2.  Group management.  Teachers are amazing at managing large groups.  Therapists frequently only have 1 student at a time.  Watch and observe how teachers manage large classrooms.  If they can manage 25 students at a time we can certainly manage small therapy groups.

3.  Recording grades.  Obviously we do not have to grade assignments but checking annual goals more often than on a quarterly basis is important.  Teachers record grades and correct homework to make sure a student is progressing satisfactorily.  Make sure your therapy students are progressing towards their annual goals in a timely manner by checking those goals at least biweekly.

4.  Progress Reports and Report Cards.  Teachers will frequently send home progress reports if a student is not performing as well as can be expected.  If a student is not making satisfactory progress towards his/her therapy goals do you let the parents know before the quarterly reports come home?

5.  Have a back up plan.  Do you ever notice that good teachers seem to always have a back up plan?  If the class unexpectedly finished an assignment early they always have an extra activity planned and ready to go.  Sometimes it is a traditional fun game or it is the next assignment.  Therapists should have back up activity ideas if a student reaches the goal quickly, loses interest or fatigues.

What is your favorite lesson you learned from a teacher?

Thursday, May 2, 2013

5 Alternatives to Traditional Therex At Home

Near the end of the school year, the weather gets nice and the children get antsy to be done with school.  Asking children and parents to do traditional therapeutic exercises at home can be difficult this time of year.  Here are 5 alternatives to traditional therex at home:

1.  Instead of asking a child to perform a traditional exercise ask the child to think of an activity that strengthens the same specific muscles or muscle groups.

2.  Instead of sending home an activity idea, ask the child to find objects or materials in their own house that they could use to work on a certain skill.

3. Instead of assigning traditional home exercises, sneak in therapeutic exercises through everyday play or chores.  Check out Therapeutic Activities for Home and School for ideas.

4.  Instead of assigning a certain practice activity, ask the child to find a skill at home that he/she needs to improve and report back on a way to practice that skill at school and at home.

5.  Instead of suggesting games to play at home to practice skills, ask the child to create a game to practice a certain skill.

What other ideas do you have to switch up home exercise programs?

Wednesday, May 1, 2013

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