With summer upon us some of us have lighter PT schedules because of camps and vacations but that doesn’t mean we can’t help our kids reach their PT goals. We spoke with Physical Therapist Erin McFarling to get some tips on helping while still having fun this summer.

Can you provide us a few ideas how we can turn a normal activity into a (secret) therapy session?

At the park – Use the slide for dynamic sitting balance and once at the bottom have your child practice sit to stand rather than helping pull them up. Getting on the swings can help with the vestibular system. Use the monkey bars for upper extremity strength and coordination. Play tag to work on endurance and running activities. If there is a bridge that moves between structures practice jumping for higher level balance on a dynamic surface. Use the steps to the structures to practice walking on steps. If there is a sand box or woodchips practice walking on these alternate surfaces. If there is a steering wheel or tic tac toe game or something of the sort set up play these games to work on hand eye coordination and balance.

In the back yard (balls, riding, etc) – Practice kicking soccer ball in sitting and/or standing, batting beach ball back and forth, shooting basketball into goal or target – all of this can work on coordination, balance, motor planning and motor control. Ride bicycle around for reciprocal leg movement, range of motion and endurance. Draw a hopscotch course to practice jumping and balance.

Sprinkler (bubbles) – Go through the sprinkler in various positions such as walking forward, backward, sideways, or crawl over it. Bubbles can be used sitting or standing to pop work on leaning to right, left, forward and backwards for weight shifts and getting out of base of support. Popping bubbles can work for reaching as well.

Could you give us a couple of ideas of activities for each range of ability?

Learning to sit up – Practice first from lying on side and pushing up off of forearm while bringing legs down and in front. Then can progress to lying flat and learning to press up on both forearms and then up onto hands as bring trunk up. It is good to give some support/cuing initially and slowly give less and less support as child starts to succeed at this skill. You may hold a ball up in air and have them sit up to get it or another toy they may like

Learning to stand – Sit behind child with a surface in front of them they can enjoy, maybe a low table to do arts and crafts while you assist at their posterior hip and anterior knees to keep good hip and knee extension – making sure their knees are not locking out. May start initially on their knees to get hips into extension and once good at that move into full standing. It is always best to have good supportive shoes on during this. May also start with a surface they can lean against some such as the couch or a large stability ball. If you have a large drum or instrument to play this can make it fun as well.

Learning to walk – Place fun stickers or designs on the ground to step on to give good visual cuing for foot placement. Sometimes owning a small rolling stool is helpful so one parent can be in front helping child advance legs and second person can be behind patient helping them stand. Riding a bike followed by walking is sometimes successful due to getting legs working in a reciprocal pattern.

Learning to run – Start this activity in a safe environment that the child would feel okay if they fell or stumbled. Starting on concrete and getting a skinned knee may cause them to become scared of the activity. Sometimes it helps to have a person on each side holding childs forearm to help them start up the run so they feel secure. Mats that you can jump/run/walk on and hear noises always makes this activity more fun.

Learning to safely navigate the world (steps, curbs, playgrounds) – If being introduced to a new area always provide a little extra assistance to child to make it a positive experience. This is the best way to navigate new areas and to allow the child to continue to succeed and explore. Show the child how you would go up/down the curb or steps. And when helping child always stand slightly behind on way up and slightly in front on way down. Kids may also be good at bumping up and down stairs on bottom which may be a good technique as well.

Continuing PT for kids that have “graduated” their first goals of being ambulatory – Just continue to work on walking and staying busy. Getting the child off the couch or out of their chair and continuing to stand, walk, sit on balls, stand on uneven surfaces, kick the ball, throw the ball to keep working on overall balance, strength and endurance. If the child has tight muscles make sure to continue to stretch to keep them functioning. Keep using activities they like or fun games to stay involved.

Any ideas you can share to help us get through the hurdles of our kids wanting to do PT – either in home or with a therapist? Do reward systems work?

Making the activity feel like play rather than work is always very important. We like to use sticker systems, make a little chart of activities to work on daily just as you may do for chores and maybe have a larger reward at the end of the week if they get a certain number of stickers/stars. It is always good to have something to look forwards to, so maybe each sunday make a list of activities to work on each day and then an event on saturday if all activities are met like go to a movie, or go get ice cream etc. Some activities can be done with distractions like sitting on a stability ball while watching a cartoon or standing during TV show and sitting rest breaks during commercials. Music is always a great way to get motivated so find their favorite songs and make a “workout” CD to listen to while practicing standing, walking etc. Play dress up! This is a great way to work on ADL skils and fine motor mixed with gross motor. Try to incorporate therapy into play time, say lets play rather than lets do our therapy. Have child practice walking to something they really want for an immediate reward as well. While walking sing a song or make a beat to the steps.

Are there any toys you like that you’ve been using that you’d like to share with our readers?

Stability balls, toys that make noise or vibrate, stacking toys, puzzles, beach ball, soccer ball, balance disc, piano mat that makes noise when walking over it, mini trampoline, removable large stickers to place on floor, or the window ones, can decorate window and work on reaching! Therapy Shoppe has a lot of great ideas and maybe Sammons Preston as well.

BIOGRAPHY
Erin McFarling is a native of Atlanta, Georgia and went to The Paideia School. She left to attend college at the University of Pittsburgh and Graduate school at the University of Miami to become a Doctor of Physical Therapy. Erin has recently returned to Atlanta to be close to her family and works as a Pediatric Physical Therapist of Children’s Healthcare of Atlanta-Scottish Rite in the Comprehensive Inpatient Rehabilitation Unit. Erin works with children from 0-21 with a wide array of injuries and/or diseases both acute and chronic including brain injuries, spinal cord injuries, cerebral palsy, multi complex traumas, developmental disabilities, neurological disorders and orthaepdics/amputations to name a few. Erin is also a Certified Pilates Instructor through Polestar Pilates and teaches clients at About Movement Pilates in Decatur. In her free time Erin enjoys spending time with her family, friends and her two dogs Miller and Molli.