Outdoor Activities That Will Engage the Whole Family!

Outdoor Activities That Will Engage the Whole Family!

By Nichole Hagerty

The unbearable heat has passed us, and cooler, nice weather is here!  What a perfect time to engage our children with fun, outdoor family activities.  I have put together a list of activities that will help improve gross motor skills while having fun in your front or back yard!  A quick trip to a local park will increase the number of activities your family can enjoy.  So take a look at our ideas, head outdoors with your children, and enjoy the weather!

This is just a sampling of games and activities, but we know there are a lot of other ideas out there.  We’d love to hear from you.  Leave us your ideas or fun activities in the comments section below! 

Follow the Leader 

These games not only challenge coordination and balance, but also listening skills and following directions.  Here is a list of some of my favorite childhood games:

• Simon Says (stand on one foot, touch your toes, jump 5 times - the opportunities are endless)   

• Red light / Green light (quick start and stop reaction times)

• Ring around the rosy (fun and following directions)

• Mother May I (take 10 steps forward, 2 hops, 5 steps to the left - the first person to the “mother” wins!)

• Hide and Seek 

Play Hopscotch
Hopscotch is great for balance, strength, and coordination.  Jumping on one foot will work the core muscles.  Straddle jumping will improve strength and conditioning.  In fact, hopping may improve "overall lower extremity mobility given the different movement planes (forward-back, sideways, and rotational)," says Fabio Comana, MA, MS, an exercise physiologist for the American Council on Exercise.  You don’t just have to make a basic hopscotch; you can make a variety of boxes.  You can jump through with two feet in the box, or out of the box.  You can jump on 1 foot the whole way down. Work to the ability of yourself and your child.

Create your own Obstacle course 

This, too, will improve overall strength and conditioning.  Walk along the edge of your driveway, or a line on the sidewalk.  Jump over cracks, run around a tree or cactus (be careful not to touch it!) kick a ball in a goal, climb under the bush, and jump over a small/large rock - make it up as you go.  You can measure results and improvement by timing yourself, your kids, and your neighbor’s kids.  Most importantly, have fun! 

Go for a bike ride 

With younger children who are unable to pedal a bicycle, I recommend a tricycle.  A bicycle with training wheels helps only with the balance of the bike.  A tricycle’s pedals are attached to the front wheel, which will increase motor memory and learning when you push the tricycle.  As your child grows and is able to push the peddles on their own, it becomes similar to riding a bike.  Your child will now have the motor memory and motor planning to perform this skill, allowing the child to move to a bicycle with training wheels.  Riding a bike is an excellent, lifelong physical activity that most children love to learn how to do. 

Play Catch/Kick a ball

Little boys love playing ball with their fathers, but did you know little girls do, too.  Playing catch or kicking a ball works on foot-eye or hand-eye coordination.  These coordination skills will show in a variety of school tasks, such as handwriting.  You can start this activity at a young age by rolling a ball back and forth with your child.  Eventually, you will progress to bouncing a ball back and forth.  Then work on throwing and catching.  Start with a playground-sized ball and progressively work towards a tennis/baseball-sized ball.  When kicking a ball, start with a stopped ball, progress to kicking a moving ball, and finally, moving while kicking a moving ball. 

Go to the park 

There are a ton of fun activities at a park for you and your family.  These activities will allow your child to play, but at the same time work on strengthening throughout the core and extremities, along with vestibular reflexes.  Work on climbing ladders, going down slides, swinging, and walking across and through unstable surfaces.  All these activities work on many of the tasks we like to see kids able to perform when they come into therapy. 

Other ideas for you and your child

• Walk through the zoo

• Go for a hike

• Go to Encanto Park

• Go on “treasure hunts”

• Go Geocaching

• As the temperature rises, go to a splash pad

All of these activities improve basic gross motor developmental skills.  Just as important, your child and you will be outside and active!  Most importantly, they allow you all to have fun!!!

I realize this is just a small sampling of games and activities.  We know there are a lot of other ideas out there.  We’d love to hear from you.  What activities do you enjoy outdoors with your children?

Beginning and Following Through
With Better Fitness This New Year

By Doug Lehman, Physical Therapist 

It’s no surprise the most popular New Year’s Resolution is to get in better shape.  It’s also no surprise that this resolution ends in failure more times than success.  But how can you succeed with this resolution?  What are the keys to getting started, and more importantly, maintaining that focus throughout the year to stay in shape?

I have compiled a list of a few tips and ideas that will help you, but we would like to hear from you in the comments section below.  Tell us what you will be doing in 2013 to challenge yourself by getting in shape AND what helps you keep with it!

• Pick an activity you enjoy
  When choosing a way to exercise, find an activity you will enjoy.  By liking what you do, you will increase your chances that you will stick with that activity.  For example, my goal is to complete 30 minutes of cardio exercise three days per week.  I do not enjoy running, especially indoors on a treadmill.  If my workout plan was 30 minutes on a treadmill, my likelihood of following through is low.  However, I do enjoy basketball, and am more likely to follow through with my exercise plan by finding a league to join.

• Find a workout partner
  Often times it is easier to exercise in a group or with a partner, so if possible choose something you don’t have to do alone.  Having that accountability partner will help you keep your commitment on days when you can’t find your own motivation.

• Don’t bite off more than you can chew
  To start off, you need to start – somewhere.  Rome was not built in one day, and your goal cannot be to run a marathon tomorrow, especially if you have not exercised in months or even years.  If the last time you lifted weights was ten years ago, chances are you are not going to be able to lift the same amount.  This is how injuries occur, and injuries will ultimately delay or end your resolution.  The best advice is to keep your initial workouts simple and short.  If you are starting to run, start with a half mile alternating running with walking.  If you want to lift weights, start with very low weights and work your way up.  If necessary, consult your physician or Physical Therapist prior to starting an advanced exercise program.

• Show up
  You can hear the excuses begin piling up in your head already – “I’ll start tomorrow.” “One day off isn’t going to hurt.” “I just can’t find the time.” The list can go on and on, but the reality is, doing something is always better than doing nothing.  If you can’t make it to the gym, there are plenty of exercises you can do at home.  If twenty minutes is all you can spare – that’s great!  Even if you had to break it up into two, ten minute workouts, morning and night.  On those days when you think you just can’t, you just can’t, whether you’re at a gym, a class, or at home, put in ten minutes, five minutes – do something!

• Be patient
  Whether your goal is to get in shape, play a new sport, lose weight, or just feel better, remember that it takes time and dedication to reach your goal.  There is no quick answer.  Don’t get discouraged.  If you haven’t met your goal in a few weeks, a month or longer, don’t worry, you’ll get there; just keep working.  The best way to get in shape and stay in shape is make regular exercise part of your lifestyle from now on.  Don’t think that using a fad diet or exercise program for a short period of time will get the job done.

• Change your Diet
  Speaking of diets, going leaner and greener is always a good idea! 

These tips should help you get started this new year!  Let us know which of the above is working for you, and we would love to hear your results in the comments section below!

What is Good Posture?

By Teri Roberts

Posture is the position in which you hold your body upright against gravity while performing all activities during rest and movement. Your optimal posture is when the least amount of strain or stress is placed on ligaments and muscles during stationary and dynamic movements. Every person’s exact posture will be different, but the key components do not change. 

Good posture begins with the core. While in a standing, stationary position you should have three natural curves of the spine - an inward curve of your cervical spine (the back of your neck), an outward curve of the thoracic spine (upper back) and another inward curve of your lumbar spine (low back). Along with the three natural curves, while standing, you should have equal weight load through the left and right side of the body, creating a neutral pelvis. Any deviation of these curves or imbalanced weight bearing may cause poor posture patterns that ultimately will lead to injuries.

Correct posture is important to keep your “skeleton” in proper alignment, allowing proper use of your muscles. Correct posture will also help with abnormal wearing of surfaces that could result in arthritis. Proper posture decreases stress on ligaments and prevents fatigue of muscles, prevents strain and overuse, including backache and muscular pain, and is attributed to the appearance of being five to ten pounds lighter. Correct posture is not only important for activities of daily living (working, driving, cleaning, playing), but it is especially important during exercise. When watching athletes exercise, it is noticeable that correct posture leads to much better performance. The athlete that starts each activity with correct posture tends to have more endurance, more strength and fewer injuries. 

How do you determine your correct posture? 
At AZOPT, we utilize the “plumb line screen” to assess posture. The plumb line is a line hanging from the ceiling to the floor. While standing in place, the plumb line should pass through the center of ear, center of shoulder, center of hip and fall just in front of the ankle, as shown in the right image of Figure 1. The left image of Figure 1 demonstrates the neutral alignment with equal weight bearing on the left and right side.

While you do not need to string a line from the ceiling, you can stand in front of a mirror and look at your front and side view to determine if you demonstrate good standing posture. Alternatively, stand with your back against the wall, bringing your feet shoulder width apart and your heels about two inches away from the wall. Allow your head, shoulder blades and buttocks to touch the wall. You should only feel approximately one hand length of space between your back and the wall. If this is not the case, you most likely have poor posture. You can practice this posture at the wall many times during the day to retrain your standing posture. 

Throughout all exercise, it is important to demonstrate good posture. Keep your core engaged throughout the ranges of motion. An injury can occur when you forget to activate through the core and attempt to perform a heavy lift or try a novice movement. Correct posture should not be forgotten, regardless if the activity is standing, lying, or upside down. Our best advice is to maintain proper posture and use good form throughout your workouts.

Vestibular Issues in Physical Therapy

By: Jenna Buckwalter

Physical Therapy has increasingly become important in the treatment of vestibular issues, specifically Benign Paroxysmal Positional Vertigo. BPPV is caused by calcium crystals, called otoconia, that dislodge from their original position in the utricle, a structure in the ear, and travel to the semicircular canals. Here they disrupt the flow of fluid and cause dizziness or vertigo. Common symptoms of vertigo include dizziness, lightheadedness, unsteadiness, a loss of balance, blurred vision, nausea and/or vomiting. Furthermore, torsional movements of the eye called nystagmus may occur. These symptoms are usually brought on by position changes of the head such as lying down, bending over, nodding the head or shaking the head side to side. 

A physical therapist will determine the symptoms' origination point in your ear and canal systems by having you perform a series of movements. It is important for the physical therapist to perform this thorough examination of the patient, to determine if the reported signs and symptoms are from that of a vestibular origin, and not something more serious. Signs and symptoms that may suggest a more serious pathology include the 5 D’s: dizziness, dysarthria, dysphagia, diplopia or drop attacks. Additionally, different or sudden severe headaches, hearing loss, leg or arm weakness, numbness or tingling, and chest pain can all be signs of a more serious diagnosis. If physical therapy is unsuccessful in resolving a patient’s vertigo, or if the vertigo suddenly worsens with no explanation, further medical referral may be needed. 

Physical therapists may be recruited to treat other conditions with vestibular issues such as Meniere’s disease, MS, vestibular neuritis, labrinthitis, Parkinson’s disease and cervicogenic dizziness. One should always be informed of the patient’s constantly evolving status, and keep in mind the implications that these syndromes present to treatment. Although canal repositioning maneuvers are more than likely not implicated for these conditions, balance training and habituation exercises can be a very powerful tool to improve the quality of life for these patients. As it stands, BPPV is the most common vestibular issue treated by physical therapists. Please visit the following links for more about BPPV. 

http://www.tchain.com/otoneurology/disorders/bppv/bppv.html
http://www.mayoclinic.com/health/vertigo/DS00534/DSECTION=symptoms

Using Gymnastics in Adult Fitness Programs: The Key to Decreasing Vertigo

Many adult fitness programs are now utilizing gymnastic exercises in their classes to enhance our mobility and skills training. These gymnastic moves that we heavily favored as children can give us a very nauseated feeling as an adult. The dizziness, lightheadedness, and nausea can become extreme after performing forward or backward somersaults. Some individuals have these feelings with handstand holds or any other inverted positions.  Despite these challenges, it is important to perform these gymnastic skills. Let’s learn why we get so nauseous and what we can do to decrease that horrible feeling after flipping upside down.

Somersaults and other gymnastic moves are a great way to work on flexibility and strength. It places your body in positions that are not performed on a regular basis and allows for end range activity. Gymnastic skills also improve your body’s proprioception (how your body relates to other parts of your body) and body awareness (how you are able to move your body, or, in other words - coordination). Gymnastic moves encourage full body training that requires a “skill” component that will also allow you to track progress of your workouts.  Not to mention that gymnastics is pure fun!

Many adults become extremely dizzy when flipping upside down. This is completely normal and does not suggest a problem with sensory systems. The feeling of dizziness, more accurately vertigo, occurs when there is a conflict between signals sent to the brain by various balance systems of the body. Your brain receives input from four sensory systems of your body - vision, joints or proprioceptive system, skin pressure, and the vestibular system of the inner ear. 

The vestibular system is the primary sensory system in our body that contributes to balance and spatial orientation. The vestibular system comprises of two components - the semicircular canal system (for rotational movements) and the otoliths (for linear movement).  After a rotational movement (somersaults) or linear acceleration (swinging), the vestibular system sends signals to the brain structure of the eyes and the muscles. When you perform a novel activity such as a somersault, handstand or cartwheel, your body reacts to the movement, causing vertigo. The vertigo becomes even more complex when you take away the vision component while performing a backwards somersault. As kids we spent MUCH more time spinning, swinging, and in inverted positions. By increasing the time spent in inverted positions as adults, your sensory system will become more automatic, reacting faster with less less adverse feelings of vertigo.

You may ask, “How can I decrease the feeling of dizziness/vertigo during gymnastic drills?” The best way to improve is to practice. The increased repertoire of movement creates better sensory and neural connections, allowing for your system to react without the extreme feelings of vertigo. Additionally, remember to exhale when you roll, cartwheel or flip upside down and maintain a good level of hydration. Try not to close your eyes, allowing your visual system to assist with the vestibular system. 

If these tips do not eliminate the feeling of vertigo, you may still flip, spin, or hang upside down–just as long as the vertigo dissipates within a few minutes. If you have the feeling of vertigo and dizziness for hours after the workout you may want to call your physician.

Kinesiotape: How Does It Work?

During the summer Olympics, you noticed many athletes wearing kinesiotape on a wide variety of body parts.  From shoulders, to abs, to calf muscles, this colorful tape has been worn on the track, volleyball court and countless other sporting venues.  As physical therapists, we have used this type of taping on hundreds of patients, and we have seen it help athletes and non-athletes alike. 

What is Kinesiotape?  

Kinesiotape, Rock tape and Physio tape are all similar products.  They are athletic tapes with elasticity similar to human skin and muscle tissues.  They have a fibrous pattern or weave that mimics the skin and are designed to be worn for several days without irritation.  The elasticity and pattern of the tape function to lift the skin away from the soft tissue underneath.  This allows for the following benefits:

• Muscle re-education.  This tape is designed to give a sensory input to the muscle which aids in correct firing of the muscle.

• Improved circulation of blood and lymph.  The stretch quality of this tape lifts and pulls the skin allowing greater amount of space and contraction of the underlying smooth muscle.

• Pain relief.  The constant contact to the skin provides a message to the brain that helps suppress the feeling of pain.

• Support of proper joint position.  By facilitating greater muscle contraction, the tape is able to provide increased muscular support to joints that need more stability.  These include shoulders, knees, feet and the spine.

Injuries that respond well to Kinesiotape: 

 In our clinical experience, Kinesiotape works well with the following conditions:

• Plantar Fasciitis

• Patellar or Achilles Tendonitis

• Shoulder Impingement

• Poor Posture/Scap dysfunction

• Low Back Pain

• Performance Enhancement

Kinesiotape isn’t just for athletes. 

 While usually associated with sports injuries and performance, Kinesiotape works well on patients of all fitness levels.  It can give sensory feedback to someone working a desk job that has horrible posture.  It can give immediate pain relief to an inactive person experiencing foot pain or someone with low tolerance to medications.  It has even been used successfully to help the abdominal muscles support a pregnant belly. 

If you would like to find out more about this type of taping, or to see if this treatment might help you or a loved one, please contact your closest AZOPT clinic.  One of our highly trained therapists would be happy to tell you more! http://www.azopt.net/

Tummy Time

By: Teri Roberts, DPT, Kids Place  

Tummy time is the most important position for a child between the ages of birth and 6 months. With the Back to Sleep Campaign it has been strongly recommended that infants should not sleep on their stomach and should always be positioned on their back to sleep. With these updated sleeping positions, tummy time during waking hours has been recommended for infants. In modern America, our infants are used to spending ALL day either on their back or in an upright seated position; while in the swing, bouncy seat, car seat, highchair, etc . The equipment is very marketable, and not all bad, however it limits the amount of time a child spends learning how to move on the floor, especially in the prone (on tummy) position. A child in prone learns how to use their muscles, especially their neck, back and bottom muscles. This blog piece would be hundreds of pages long if every important reason for tummy time was described. Trust experienced therapists when stated that daily tummy time is extremely important for overall gross motor development. Fifteen minutes daily of tummy time is the bare minimum, but the more awake tummy time your child can perform, the more they will enjoy it and the stronger they will become. Unless otherwise stated by your physician, tummy time can start the first day your child is brought home from the hospital. Just remember to monitor your child at all times while they are on their tummy, until they are able to roll onto their stomach independently.

A Solution to Plagiocephaly

Question: What can be done when a child is born with an abnormally shaped head?

Answer:  A child can wear a cranial helmet to correct an abnormally shaped head.

Cranial Helmet

The cranial helmet is an orthotic device that is given to children to correct their misshapen head. The birthing process can cause a baby’s head to be misshapen, but it usually will correct itself gradually. If the abnormal shape continues beyond six week of age, an evaluation by a physician is recommended. The misshapen head is termed plagiocephaly and it can occur before or after birth. The causes of plagiocephaly are restrictions of the womb (multiples or a small pelvis), prematurity (cranial bones are softer), torticollis, decreased amounts of tummy time and overuse of infant seats, carriers, strollers and swings.   



Developmental Feeding Milestones

By: Colleen Riordan, SLP

If you are a new parent or grandparent, you may be wondering when your “little one” will start self feeding. Here is a quick guide on what to expect.

12 months

·      Finger-feed mashed table foods

·      Begin drinking from a straw

2 years old

·      Eat a variety of textures and use a spoon fairly efficiently

·      Drink from a cup without loss of liquid from mouth

3 years old

·      Eat foods from all basic food groups, and be able to try new foods at least once

Poor Posture and Shoulder Pain

By Mark DiSalvo, MPT, OCS, MTC, CGFI

Recently, I have had a rash of patients with shoulder pain and injuries coming into the office. One of the most consistent findings I see, is that people are very rounded in their posture and have very tight pec (chest) muscles. A simple and effective way to approach this type of shoulder pain is a corner stretch. Place your hands AND ELBOWS (this is important) on each wall on either side of a corner. Lean your whole body into the corner so you feel the stretch in the front of you shoulders and possibly in the middle of your mid back. Hold this stretch for 30 seconds and repeat throughout the day.

Developmental Speech And Language



Colleen Riordan

By Colleen Riordan, SLP

If you are a new parent or grandparent, you may be wondering when your “little one” will start babbling and using words. Here is a quick guide on what to expect.

By 12 months of age, your child should:

· Babble using a variety of consonant and vowel sounds

· Imitate movements, environmental sounds and speech sounds

· Use gestures with sounds or word approximations to communicate

· Have at least 1 or 2 words that are used consistently

By 2 years of age, your child should:

· Follow simple commands

· Point to named pictures in books

· Say more new words every month

· Begin putting 2-words together

By 3 years of age, your child should:

· Follow 2-step directions

· Use phrases of at least 3 words

· Have speech that is understood by most familiar listeners

By 4-5 years of age, your child should:

· Pay attention to a story and answer simple questions about it

· Use sentences that provide details

· Name some letters and numbers

· Produce most sounds correctly with the exception of l, r and th

· Communicate easily and be understood by children and adults

I Pulled My Muscle While Exercising. Should I See A Dr.?

By Mark DiSalvo, MPT, OCS, MTC, CGFI

Many people feel little “tweaks and pulls” as they workout. The question I often hear is “When should I see the Doctor or therapist?”If you have been good about icing and stretching after a minor muscle pull and nothing feels better in about 2 weeks, it is probably time to see the doctor. If the pain gets progressively worse in the first few days – this is another indication that it may be time to see the Doctor or PT. As physical therapists, we offer free 15 min screens for musculoskeletal issues and can help you determine if your injury is more serious and needs the attention of a physician. One more thing to look out for - at the time of the injury if you see bruising and swelling, it may be a sign that you have a more serious injury such as a muscle tear. This type of muscle injury needs more rest and specific treatment.

Child Motor Development

By Teri Roberts, DPT

Skill	Normal age range	Concerned time period	Quality of movement
Rolling	4-6 months	7 months not rolling any direction	Rolling should be both directions.
Sitting without assist	6-8 months	After 8 months	Child should also be able to transition in and out of sit by 8 months and play with a toy without falling
Crawling (on belly or hands and knees)	6-9 months	After 10 months	Crawling should be seen with both arms and both legs moving either on tummy or hands and knees
Standing (at a stable surface)	7-11 months	Child should place weight through feet with support for balance by 6 months	Child should be pulling to stand by 11 months and feel stable enough to hold on without loss of balance
Walking	11-13 months	After 17 months	As long as your child is taking steps with hand held assist and can push a push toy it is okay that they are not walking independently

As new parents many concerns arise with regards to motor movement. As a pediatric physical therapist I receive many questions from parents regarding their child’s ability to roll, crawl, stand and walk. The first year of life is such a dynamic time of movement and growth and new parents tend to be concerned with making sure their child is on target for gross motor development. “Normal” development is a very large continuum, with skills occurring at different times for each individual child. The continuum allows for a wide variety of ages to meeting skills, which makes determining normal and delayed development difficult to detect for a non-medical professional. The variations in development can be related to the child’s personality, motivation towards movement, experiences with different positions, the amount of tummy time a child is receiving, head size, muscle tone, etc. The time at which a child is developing a new skill is not as important as the quality of movement. However, it is much easier to see skill development than assess quality of movement, which is the reason we have specific ages that children are supposed to meet their gross motor “milestones”. The following are the averages of meeting gross motor development and the age at which a parent should be concerned.

Again, the above are averages for meeting milestones. The quality of movement is much more important than meeting the skills at a certain age.  If you, or your pediatrician, are concerned about your child’s development  - please call Kids Place for a free developmental screening to determine if your child  has a gross motor developmental delay.