Obstacle Courses

Obstacle Courses

As a pediatric physiotherapist, obstacle courses are one of my favorite tools to use when working with my kiddos. As a Mom, they are my secret weapon for boredom. As the weather turns colder and wetter, many families spend more time indoors and often that means more screen time. I’m hoping this post can open give you another option for fun indoor time that most kiddos will love!

Benefits of Obstacle Courses

There are so many amazing benefits of doing obstacle courses. My usual objective as a physiotherapist is to work on gross motor skills including balance, strength and coordination. Depending on the activities you choose, it can also be great for working on motor planning or incorporating sensory input for those that need it. It is also a wonderful way to work on sequencing and memory skills, which are often non-physio goals for a lot of my kiddos. It really is a fantastic way to incorporate so many of the things that all our children need to work on in one fun, engaging activity.

Ideas For Success

The biggest key, in my experience, is to make the courses child appropriate, with respect both to tasks and the number of sequences.

Paediatric occupational therapists and physiotherapists often talk about the “just right challenge”. What we mean by that, is something that may be challenging for your child to complete, but is doable and not so hard that they get discouraged and give up.

If your child is seeing an OT or PT, you can often use therapy activities to give you an idea of a “just right challenge”. If not, think of what your child can do fairly easily and then try to push it slightly more.

As for the number of sequences, again, it depends on your child and their abilities. Younger children, or those with sequencing difficulties, may need to do 2 step obstacle courses, such as first and then/last. As that gets easier increase to 3-4 sequences. Older children may be able to do 10 or more sequences.

The next step to success is reviewing the course to make sure the child/children know what to do.

This could mean sitting and talking through all of the steps of the course; writing out the steps on a piece of paper or white board; or, for younger children, physically demonstrating the steps or using pictures to make a “map” of the course.

Lastly, pick activities that use different body parts and mix up gross motor and fine motor skills.

Perhaps your child might jump from one floor cushion to another, then blow through a straw to move pom poms over a line, and then pick up the pom poms with a clothes pin, and crab walk back to the starting line.

Extra Fun

To make obstacle courses extra fun, consider making up a story to go along with the course.

A favorite one at our house is the floor is the ocean and there are sharks waiting to eat you, so you have to get around and do the mission without the sharks getting you!

Encourage the whole family to get in on the action – nothing is more fun for a child then Mom or Dad doing the course with them!

Another idea to increase the fun factor is to use the furniture, especially if that is something not typically allowed.

And, lastly, make sure you revise and change the obstacles all the time.

It’s amazing how creative you can get with things you already have around you house!

Sitting

Sitting

Let’s talk about sitting!

Sitting is often one of the big milestones that many parents look forward to – that and walking of course, but we will save that for another day!

Children often are excited to sit as well, as it opens up a new world for them to watch and interact with.

What does it take to sit?

Just like with rolling, in order to sit there are some fundamental skills a child needs to be able to do to sit independently.

Sitting requires control of flexion (bending) and extension (straightening) movement patterns, which start to develop during rolling.  Sitting also requires automatic postural reactions, which are made up of righting reactions (keeping head on body), protective reactions (putting our hands out if we are falling) and equilibrium reactions (balance).  These reactions also start to be developed during rolling and continue to progress with sitting.

So you can see why it’s important for children to achieve milestones in the right order, as they help develop skills that they need to complete the next one!

How sitting develops

Sitting is one of the only milestones that a child typically learns before they are able to get in and out of that position.  Parents typically put a child into sitting position and the child starts in what is called Tripod sitting – this is when a childs legs are out, often in a “V” position or a ring position, with their hands planted on the ground between their legs.  Once the child gains better control, they will start to come into a more upright position with the back in a c-shape and the child will start taking their hands off the ground to play briefly.

The child will then work on shifting directions and their body weight in the c-sit to gain more balance and control.  C-sitting should then continue to improve to nice upright sitting, with the child able to reach in front of themselves for toys, rotate to look the sides and reach up for higher toys.

When should my child be sitting?

Children can typically begin to tripod sit (within a parents legs) around 4 months of age.  C-sitting for brief periods (with lots of tipping over!) should start to develop just after 5 months.

I recommend parents stay close by, but allow their child to tip in order to help children develop those important reactions mentioned above.

You may also try propping pillows just beside and behind them (or use a breastfeeding pillow) so that you can be in front of your child to play and engage.

By 6 months, children should be starting to sit independently (working towards that tall sitting) with only the occasional loss of balance.  This typically coincides with introducing solids, as a child should be able to maintain good sitting posture in a high chair to ensure safe eating.

If your child is not showing the building blocks of sitting by 6 months, call your local pediatric physiotherapist for a consult.  As always, if you are in Kitchener-Waterloo or Perth County, give me a shout!

Rolling

Rolling

A typical question for most physiotherapists who see children (and honestly one I think most moms ask themselves at one point or another) is ‘should my child be doing X by now?’  So, I thought I would take a few blog posts and write a little about each of the big gross motor milestones.

Let’s start with rolling, the same thing most kiddos will start with.  I know for my husband, that was when ours stopped being “a loaf of bread” and became a tiny human to him – suddenly they can move!

What does it take to roll?

Rolling can seem simple to us as adults but in reality is quite complex.  There are a LOT of components to rolling.  A child needs neck control, shoulder mobility and control, the beginning of core stability and, finally, hip and knee control.  Without all of these components, the child may not be able to initiate the movement, or they won’t be able to control the momentum.

To start learning all of those fundamental building blocks (especially the neck control and shoulder mobility/control), it takes practice, and that means TUMMY TIME!  Tummy time is so vital – more on this another day!

The start of rolling

The first part of rolling that parents typically see is when their child is on their back and they are able to roll to their side.  This usually starts to emerge around 2-3 months.  This either happens because they are looking at something to the side and up from them or because they put their feet in the air and they tipped over.

Then it progresses to a purposeful head movement and the body follows the head. When this starts, the body is quite stiff and tends to roll like a log, and the roll can be a bit uncontrolled sometimes, startling a baby.  But, as those fundamental skills improve with practice, we see rolling with rotation and bending through the trunk.

To roll from tummy to back, babies need to bring one knee up toward their chest and lift their pelvis slightly to start the roll.

When should my child roll?

Some children start rolling as early as 4 months, but a typically developing child should roll both directions by 6 months.

If your child is not showing the building blocks to rolling by 4 months or isn’t rolling by 6 months call your local pediatric physiotherapist!  As always, if you are in Kitchener-Waterloo or Perth County, give me a shout!

Private AND Public Therapy Services?

Private AND Public Therapy Services?

This is a big topic amongst a lot of my families and within the therapy community in general.  It’s a conversation I would say I have at least twice a month with a family, another physiotherapist or another therapist from a different discipline:

Can I use private therapy services even if I’m getting treatment through the public system?  Why would I see a private therapist if I’m being seen in the public setting?  Should I see one vs the other?

My answer is: do BOTH!

I encourage all of my families to call their local children’s treatment centre (in our area, you can get in touch with either KidsAbility or Thames Valley Children’s Treatment Centre) and put in a referral for services.  Parents can self-refer or a medical doctor/specialist can refer on behalf of a family.  This is a vital resource that can help get access to a variety of services, including therapy and, in the long term, planning transition to school.

The most important thing is to get the referral in early!  Some treatment centres only provide services until school age, at which time care is transferred into the school system.  As well, given the number of children requiring services, wait times for assessment and treatment can be lengthy.  The sooner you put in your referral, the better!

So, what is the role of the private therapist?

Treatment in the public system looks different for different families.  For some families it’s more consultation based – once every month, or six weeks to provide suggestions for exercises at home, providing equipment to increase a child’s function or ease of caregiving.  For other families, it may be blocks of treatment 2-3 times a year to work on specific goals.

This is where a private therapist comes in!  I have a number of families I have seen while they are waiting for public services and, in some instances, we are able to achieve their goals before they get their assessment.  For other families, a private therapist can provide more frequent, hands on treatment to supplement public services they may be receiving.

However, there are some guidelines we need to follow – the College of Physiotherapists of Ontario has a standard of care that lays out the expectations for a physiotherapist who is treating a client who is receiving care from another health care provider (including a physiotherapist).  The key is communication between the client/family and the other treating therapist.  We need to make sure the treatments are compatible, discuss how the therapists are dividing treatment and that there is nothing that interferes with the delivery of safe, quality care.

At the end of the day, I feel like the more help a child can get to accomplish their maximum potential, the better!  If a family can afford private physiotherapy (through benefits, bursaries or private pay) I think it can be a wonderful addition to public services.

The Truth About Toe Walking

The Truth About Toe Walking

Let’s talk about toe walking!  I recently went to a course solely focused on toe walking and was super excited to go.

Why?

Because I had been finding that these kiddos were hard to treat, I often wasn’t getting the gains I had been hoping to, and, when I did, they didn’t always last.

Let me tell you, this course changed EVERYTHING!

I will honestly admit I had been doing it wrong all along!  I had been taught in school (like most physios) that toe walking was the result of tight calf muscles.  So, we did things like stretches, night splints and surgery.  What we now know is that tight calves is the consequence, rather than the cause.

Idiopathic Toe Walking

It isn’t uncommon for children who toe walk to be diagnosed with idiopathic toe walking.  Idiopathic means that there was no known cause, but what has happened over the years is that is has morphed to people thinking there isn’t a cause.

NOT TRUE!

There is always a cause.

Toe walking is super inefficient, and the only reason your body will do it is to meet a greater need.

Toe walkers of today are different then the toe walkers of previous generations.  We are using more equipment with our kids than we used to and more supportive toys when learning to walk.  We have more kids with sensory needs and/or autism.  All of these things make for fundamentally different toe walkers.

Which means that the assessment and treatment of these kids needs to go beyond looking at the calves!

Wait and See

I have come across some families that tell me they were informed that toe walking is normal and not to worry, as they will grow out of it.  Toe walking is NOT a normal part of development – if your child has just learned to walk in the last week or two and you see them up on their toes and then they go back down to the soles of their feet, and this happens less and less, then you likely don’t need to be concerned.  But studies show almost all 18 month olds step with their heel first.

Did you know our balance strategies during walking are developed by 3 years old and the bones in our foot are solidified by 4 years old?

AND it is possible for walking on the toes to actually deform the foot bones!

It’s a challenge to make changes to both of these things after that point.

Lastly, our adult walking pattern is solidified by 7 years old, so how a kiddo walks at 7, is how they will walk as an adult.

That’s why earlier is better to try to address these issues BEFORE our foot, balance and walk are all solidified!

Toe Walking as a Marker

Earlier in this post I talked about how toe walking is inefficient and that the only reason someone will do it is to meet a greater need.  A new study has shown that there’s a correlation between speech difficulties, learning disabilities and toe walking.  This likely explains the underlying reason the child is toe walking in the first place.  Because children typically start walking before they have much speech, toe walking can be a marker for other concerns that haven’t yet emerged, but should be monitored.

Long Term Consequences 

You may be thinking, what is the big deal?  Is it THAT important that my kiddo is up on their toes – they are walking, right?!

Wrong!

There are long term consequences!

Some long term consequences of toe walking include increased frequency of injuries, knee instability, difficulty finding shoes and early arthritis and joint pain.

But what about those kids that can, when asked, put their heels down?  A recent study found their calf strength and overall endurance was significantly less then their peers, which means they have a harder time keeping up!

There is an interesting video/interview here talking about the long term repercussions of toe walking.

So, the long and short of it is that toe walking is a complex issue, much more than most physiotherapist and doctors ever thought.  Treating it is possible without drastic measure such as night splints, botox or surgery.  However, as with most things, the earlier the issue is addressed, the better the likelihood of results.  So, if you have concerns regarding your child’s toe walking, book an appointment with a physiotherapist who has training in toe walking and will take a wider approach than  simply looking at their calves!  If you are in my area feel free to reach out to me at erin@newhorizonsrehab.com or (519) 291-5402.