Low Muscle Tone | What Does Hypotonia Mean?

In the pediatric therapy world, a diagnosis of “low tone” or “hypotonia” is often given. But what exactly does this diagnosis mean? Muscle tone is the term for the resting length of muscles in the body ( i.e. before a contraction). With low muscle tone, the resting length of the muscles is greater than average and causes hyperextension at the joints, or what some refer to as “double jointedness.” (However, the term double jointed is misleading, as a person doesn’t actually have two joints, just increased muscle length and therefore increased flexibility at the joint).

Signs of Hypotonia in Children:

How can you tell if you or your child has low muscle tone? As stated above, individuals with low tone muscles often have increased flexibility at many joints. The muscles may feel soft and squishy, and because they have increased resting length it literally takes longer for the muscles to contract. Therefore, the individual may seem slow to get going or even lazy, but there truly may be a physiological reason behind it.

Also, because it requires more energy to get the muscles moving, these individuals may be reluctant to move, or conversely, they may move more because sitting still is exhausting and uncomfortable. Read more

Strategies to Decrease Nail Biting and Other Anxious Habits

Many things can cause stress for children, including academics, social problems at school, or even sports. Some children may be less resilient than others, and these stressful events can lead to anxiety problems. Unfortunately, many children may be unable to express their worries and emotions verbally, or they may not be aware of what it is that causes them stress. Therefore, often times children will express their anxiety through behaviors or anxious habits. Stress and anxiety can lead to poor and inconsistent sleeping patterns, depression, fears, difficulties with social interaction and isolation, among other problems. Follow the tips below to help ease the stress in your child’s life.

Tips To Identify Decrease Stress In Your Child’s Life:

• Children don’t often express anxiety with words, as they tend to not understand these feelings, not be fully conscious of them, or do not know how to express them.

• Habits/symptoms that may be signs of anxiety or stress include: nail biting, chewing on fingers, picking on clothing, inconsistent sleep routine, stomach aches, head aches, fear, worry, distress or isolation.

• Anxiety and stress affects concentration, decision-making, ability to make friends, and mood. Depression is closely linked with anxiety.

• How To Help:

Make sure your child has good sleeping habits and can recharge her batteries for the next day. Sleep improves concentration, boosts the immune system and aids in Read more

Help Your Child Develop the “Crossing the Midline” Skill

What is “crossing the midline”?

By the age of 3 or 4 years old, a child should have mastered the bilateral skill (using both sides of the body together) called “crossing the midline”. This is the ability to move one hand, foot, or eye into the space of the other hand, foot or eye. We cross midline when we scratch an elbow, cross our ankles, and read left to right. Crossing the midline of your body helps build pathways in the brain and is an important prerequisite skill required for the appropriate development of various motor and cognitive skills. Children who have difficultly crossing the body’s midline often have trouble with skills such as reading, writing, completing self care skills and participating in sports & physical activities. These skills require a type of coordination that comes from experience with “cross-lateral motion,” which is movement involving the left arm and right leg, or the right arm and left leg at the same time. 

Establishing a “worker hand” and a “helper hand” is a sign that the brain is maturating and lateralization is occurring, and is strongly correlated with the ability to cross the midline. Both sides of the brain need to talk to each other for the “worker hand” and the “helper hand” to work together and compliment each other. Coordinating both sides of the body can be difficult for the child who avoids crossing midline. Often, these children have not yet established a hand preference, sometimes using their left and sometimes using their right to draw, color, write, eat, and throw.

Affects on children who do not develop the bilateral skill:

Furthermore, when a child has difficulty crossing midline, it can affect his/her ability to read. While the child is moving his/her eyes from left to right across the page, the eyes will stop at midline to blink and refocus; however, when this happens, the child will very frequently lose his/her place on the line and become confused as to where they left off. It also affects handwriting, as diagonal lines cross the midline, and the child may need to stop in the middle of the page to switch hands when writing from left to right. Many self care and daily living skills require crossing midline. For example, perfecting the skill of putting socks or shoes on requires one hand to cross over to the other side of the body.

Children who have difficulty crossing midline may appear ambidextrous because they are often observed using both hands, but they actually have a hidden neuroprocessing issue. Both sides of their brains are not communicating, resulting in decreased coordination, decreased motor control of movements and difficulties achieving higher level skills. Often, these children end up with two unskilled hands.

Activities to help develop the ability to cross the midline:

To help develop efficient crossing of the midline, provide children with a variety of two-handed (bilateral) activities. Try some of the below activities to help build more pathways in the brain and to develop the ability to cross the midline, improve coordination, and improve overall functional performance on a daily basis.

Right brain/left brain teasers-

a. Pop bubbles with only one hand (they will have to reach across their body to pop the bubbles floating on the opposite side).

b. Reach for bean bags, balls, stuffed animals, or other objects across midline, then throwing at a target.

c. Draw large figure eights (the infinity sign or an 8 turned on its side) on paper, on the floor with a finger, in the air with a finger, or drive a matchbox car around a figure eight pattern.

d. Let the child play with sand, scooping sand from one side of the body and putting it into a bucket on the opposite side of the body without switching hands.

e. Let the child pretend to drive a car with a ball in his/her hands to use as a steering wheel and encourage the crossing of his/her arms as he/she turns the ‘steering wheel’ OR to make this similar in style to most of the others—pretend to drive a car with a ball in both hands to use as a steering wheel and cross both arms while turning the “steering wheel”.

f. Play flashlight tag. In a dimmed room, lie on your backs and have the child follow your flashlight beam projected on the wall with his own flashlight.

g. Touch the opposite elbow and knee.

h. Cross one foot over the other while walking sideways.

i. Do “grapevine” walks.

j. Knee slap walk- Walk around raising each knee while touching/slapping it with the opposite hand (or elbow). Change it to a skip while touching the opposite knee as it comes up.

k. Windmill-stand with feet spread apart and arms extended out to the sides. Bend over at waist and tap right hand to left foot. Stand back up and then bend and tap left hand to right foot.

l. Point your left finger out and put your right thumb up. Switch them, and switch, and switch, and switch…

m. Hold your nose, then cross the other hand over and grab your opposite ear. Slap your thighs and switch your hands…switch, slap, switch, slap…

n. Write your name in the air while rotating your foot in a circle clockwise.

o. Wash the car and make sure the arms cross midline while scrubbing.

NSPT offers services in BucktownEvanstonDeerfieldLincolnwoodGlenviewLake BluffDes PlainesHinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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Strategies for Oral and Motor/Sensorimotor Input

Children who put toys in their mouths, chew on their clothing or bite their pencils at school may be seeking oral motor/sensorimotor input to help their bodies reach anGirl chewing pencil optimal arousal level. We want to provide them with strategies to get this input in an appropriate manner. Here is a list of alternative strategies to support your child’s oral motor/sensorimotor needs.

Strategies For Children Seeking Oral Input:

1. Engage in activities such as whistling, blowing bubbles and using blow pens

2. Play games with straws (i.e. hockey by blowing cotton balls or splatter painting by blowing on paint using a straw)

3. Have them eat sweet and sour candies

4. Chew gum

5. Blow up balloons

6. Make a chewy necklace out of cheerios and licorice

7. Drink thick liquids (e.g. applesauce, pudding) through a straw

8. Drink water through a water bottle with a straw

9. Make a bubble volcano: Fill a bucket with soap and water, and have your child use a straw to blow bubbles to make the volcano. This is an activity you can use at home to help with self-regulation.

10. Send chewy, crunchy snacks (e.g. pretzels, granola bar, fruit leather, bagels) for lunch

11. Purchase products designed for chewing:

• Chewlery: http://www.therapro.com/Chewlery-and-Chewies-P321445.aspx

• Chew tubes and similar objects: http://www.therapro.com/Designed-to-Chew-C307786.aspx

• Other fun oral motor tools: http://funandfunction.com/oral-motor-chewies-c-65_107_110.html

• ChewEase pencil toppers: http://www.amazon.com/3-Clear-ChewEase-Pencil-Toppers/dp/B001G2DAK8

What Is Executive Functioning?

Disorganized Child“Executive functioning” is a buzzword right now in the academic and parenting worlds. I often hear teachers use the term loosely at staffing and school meetings. What does it actually mean, though, and why do so few children seem to have executive functioning skills?

Executive Functioning Defined:

The definition of executive functioning is actually implied in the name – it is the CEO of an individual’s daily activities. These skills make up the child’s ability to organize, plan, problem solve, inhibit responses, fluidly transition between tasks, monitor work, and effectively change solutions based upon new information.

Examples Of Executive Functioning Skills:

These skills can be seen throughout a child’s day: does the child have a set plan for a morning routine, or is it chaos on a daily basis? Is the child’s room organized so that anyone walking in knows where items should be? What about his/her backpack or locker? Does the child forget to turn in homework assignments that he/she actually completed? Does the child forget to write down daily assignments or forget to bring home necessary materials? What about the social world – does the child struggle planning activities with friends? Read more

Developmental Skills While Playing With Cars

Pediatric therapy sessions typically involve a lot of play time! Why? Children learn about their world through play and child playing with car imitation of adults, and play is much more motivating than sitting at a table completing worksheets. When a child plays with a car, here are a few of the skill areas that are targeted:

Cognition while playing with cars:

• Experiencing cause and effect relationships, such as when a car drops down a ramp

• Labeling basic parts of a car

Fine Motor or Hand Skills while playing with cars:

• Strengthing hand-eye coordination skills and improving hand dexterity while building a toy car. Consider building a visual model for your child to copy

• Improving hand coordination and hand dexterity while repairing a car using toy tools. Facilitate this by placing your hand on the child’s and physically moving his hands if necessary

• Practice using both hands simultaneously while turning a steering wheel Read more

Strategies to Improve Homework Success

boy doing home workAfter a busy day, the last thing you want to do is fight with your child about finishing his homework. Turning in an assignment or performing successfully on a test should feel like a great accomplishment for you and your child, not a constant battle. Every child prefers different organizational and environmental strategies to help him focus and stay on task; and different strategies may work in different days depending on the child.

Homework Seating Tips:

• Exercise ball: By replacing a typical chair with an exercise ball, the child automatically receives more input to their body. He is now required to keep his feet flat on the floor, his shoulders down and relaxed, and his trunk erect with his muscles constantly firing as he keeps hjs body in an upright position. This extra input gives him increased attention and focus during fine motor and tabletop activities.

**Note: Exercise balls used as a chair are not appropriate for children who have poor postural control and weak core muscles, as this will cause them to focus on keeping their body stabilized on top of the ball, as well as on the task at hand. This may lead to rushed or sloppy work because their attention is on the exercise ball, noton their homework. Talk with an OT or PT if you have questions about the best seating for your child. Read more

Successfully Surviving Spring Break at Home with Your Kids

It’s spring break and you are home with your kids: kids drawing at home

What does that mean? It means that kids are completely ecstatic and simply can’t wait for this vacation from school! For them, it means: no homework, no alarm clocks (aka sleeping in), and no racing to the bus before the sun has truly risen for the day. Some parents are thrilled with these benefits and add the many benefits spring break allows for the parents: no packing lunches, no driving from school to school trying to pick up carpools and race to after school activities, and getting to spend some quality time with your kids. Yet, for many parents, spring break evokes a feeling of sheer panic:

WHAT WILL WE DO ALL WEEK WITH ALL THE KIDS HOME TOGETHER, AT THE SAME TIME, WITH NO SCHEDULE, AND NOTHING TO DO?!!!

As a parent myself with 3 school-age children, I can see both sides of the spring break debate. Yet, I’m here to tell you that you can survive staying home during spring break with your kids. Even as I write that, I’m still stricken with the panic myself. But, as I take some deep breaths, I will walk you through some survival tips for the next 7 days.

Spring Break Survival Tips:

1) Have a plan: The worst words a parent can hear from children over break is, “I’m bored!” Ok…that, and the fighting words between siblings. But, the bored part is within our control, at least for a little while. The fighting words between siblings will most likely be addressed in another blog, not to worry. Anyway, back to “have a plan”. If you have never had a family meeting in your household, here’s a great place to start (and a great topic). Call to order a family meeting to discuss possible activities that can be done during the week off from school. Everyone should have a chance to give input.

2) Engage your kids in the plan: Kids like to feel that they have choices and that their opinions count. And, what better time to allow them to have those choices than spring break when the week is full of possibilities? Write down all the ideas the kids have for activities, places they’d like to visit, friends they’d like to see, etc. Even if one of your kids wants to play Wii and relax, there will be time for that and it’s good for the kids to have some downtime. Perhaps that can be the “family game night” activity one night this week.

3) Make a calendar of possible activities: This will allow you (and the kids) to see what the plan is for each day. Whether it’s playdates or a trip to the museum, the kids can see what is planned. It allows them to see that their ideas are put into action and also teaches them the art of negotiation. For example, “Yes, we are doing the activity that Jake chose tomorrow morning, but we are doing your activity on Tuesday when your friend Emily and her mom are free to join us.” Of course, the calendar can be changed, if need be.

4) Be careful not to over-schedule: You’ve heard of not over-scheduling kids’ activities, playdates, etc during the school year, but the same is true for vacations. Be sure to give breaks throughout the day, so the activity chosen is still enjoyable for the kids (and for you). This is especially true for children who have difficulty with transitions. For example, if you’re going bowling in the morning, maybe some game time or an art activity with just the family is good for an afternoon activity, rather than another outing or high-energy excursion. And, it’s ok to have some “screen time” (as we call tv, computer, and video games in our house) to give tired moms and dads a break too.

5) Schedule a grown-up night out: Yes, I did say “schedule”. As parents, it’s easy for us to forget about adult time and especially time for ourselves. So, before you get caught up in the calendar of all the kids’ activities from morning until night, make sure to add a “grown up night” to that calendar. Phone an in-law, a parent, or a sibling and see if they would be willing to watch the darlings for a couple of hours so you can have some grown-up time with your spouse or significant other. Or, see if a friend would be willing to sit for your kids one night and you can sit for theirs another night. Or, if finances allow, hire a sitter! I promise this will be a great addition to your spring break plans. If your spouse travels or you can’t go out together one night during this week, make it a grown-up night with some friends.

Some ideas for spring break kid-friendly activities that won’t cost a fortune:

• local libraries often have free passes or discounts to local museums and attractions-check that out! Or, just spend some time at the library.

• parks (if the weather permits). Try one that you’ve never seen before- maybe in another town and have the kids make a comparison list: what they like best at each park.

• take a train ride

• visit an animal shelter and bring newspapers. They always need newspaper for training

• volunteer at a local nursing home or get a group of kids together to do a talent show of sorts

• rent a movie about something the kids learned about in school-making popcorn helps them forget they’re learning while they watch

• take pictures when you go on activities and even make a scrapbook at the end of the week

Gifted Children And What It Means To Be Advanced

gifted childI was asked to write a blog on giftedness in children – specifically, how to access it and how to ensure that a child with cognitive strength is able to reach his or her potential. This has proven to be a hard topic to write about. I don’t like the term “giftedness” for several reasons, but before I divulge those, I need to discuss what it means to be “gifted.”

A quick review of basic statistics is necessary in order to understand how we assess children has demonstrating superior ability. Traditionally, when we think of giftedness, we are thinking of a child’s IQ score. The vast majority of IQ scores used standard scores. A standard score is a statistical term in which a score of 100 is solidly average (50th percentile) and a standard deviation (the spread of scores from the mean of 100) of 15. In layman terms, scores between 85-115 are considered to be average.

When you are talking about giftedness, we see scores with at least two standard deviations greater than the mean (meaning an IQ score of 130 or higher). So, gifted children are those children that have IQ scores of 130 or higher. Pretty easy to identify, right? Wrong. One of my major critiques of giftedness is that parents and some academic folk rely way too much on the overall IQ score to determine if a child is gifted.

What Are IQ Measurements For Children?

The current gold-standard IQ measure, the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) came out in 2003. On the WISC-IV, children attain a Full Scale IQ score, which is comprised of several factors: verbal reasoning and comprehension, nonverbal reasoning, immediate attention and memory, and processing speed. Here lies one of the concerns in assessing giftedness. Which score should one use? Read more

10 Tips To Get Your Students To Sit Quietly In Class/Circle Time

Girl Sitting LearningIt can be hard to get children to sit still in circle time or at a desk. Ideally, we can take the time to see why a child may be having trouble. For those that are young, fidgety or distracted, we need to know they are not doing it to bother us, and we need to have strategies to help them be more attentive. Remember, some children can sit still longer than others. Others children need to fidget or move because their nervous systems just are made that way.

Here are some ideas and strategies for assisting restless kids:

#1-Use a visual cue. For example, if the teacher is reading Spot, the children can hold beanbags, and every time the teacher says Spot’s name, the children have to toss the beanbag into the bucket. This keeps him attentive!

#2-Use carpet squares or bean bag chairs. Space the kids out so they are not on top of each other!

#3-Some kids can not sit unsupported (and unless you are super strong in your core, you can’t, either!). Make sure you identify these kids, and lean them against the wall, let them lie down, or give them a chair with feet on the ground.!

#4-Have the kids stand up, sit down, get involved with the story, and listen for some name or place in the story to stay attentive.

#5-Use a checklist so that kids follow and check off as things are said or done.

#6-Use multi-sensory teaching strategies. March around while doing multiplication tables, have the children stand up while speaking, and develop fun routines during the day to that will get the kids moving around. Read more