Winter Therapeutic Activities

It’s that time of the year where the temperatures drop and the indoor activities begin, but this also tends to pose the question – What can we do to keep the kids entertained ALL of those hours?  Below are some great activities that can be completed indoors. These activities can incorporate so many skills that are beneficial to a child’s development including activities that work on language, play, fine motor skills such as coloring, cutting, drawing, and manipulation of small objects, gross motor skills to address overall strengthening, endurance, coordination and balance, and activities that help with sensory processing and self regulation, and executive functioning skills.  Therapeutic Activities: Scavenger hunts around the house Stickers Potato sack races Dance parties Sensory bins  Animal walk races  Kosmic kids yoga videos Charades  Playdoh – homemade or store-bought Build a Fort Hidden picture books or printables Science experiments  Mazes – on paper, build your own to walk through Origami  Jewelry making Baking Bubble mountain Painting Create sensory bottles Balance boards Paper plate skating across the carpet Scooter boards Obstacle courses: climbing over obstacles, balance beams, jumping over obstacles, army crawling  Coloring and cutting activities: snowmen, mittens, snowflakes, penguins, polar bears, arctic animals, sleds Build-it crafts: popsicle sticks, q-tips, cards, graham crackers, build-it kits 

Reflexes?!?! What is the big deal?

If you have been around No Limits Pediatric Therapies long, you have probably heard one of the occupational therapists mention “primitive reflexes.”  You may be wondering what is a primitive reflex?  And what is the big deal? According to Webster Dictionary, a reflex can be defined as “an automatic and often inborn response to a stimulus that typical involves a nerve impulse passing inward from a receptor to the spinal cord and then passing outward from the spinal cord to an effector (such as a muscle or gland) without reaching the level of consciousness and often without passing to the brain.”  For this blog post, we will be focusing on primitive motor reflexes and how they can impact your child’s function. According to the Medical Dictionary, a primitive reflex is defined as “any of various simple, stereotypic, automatic neuromuscular responses characteristics of the mature fetus and newborn but typical inhibited (or integrated) during the first year of life: primitive reflexes are directed by the brainstem centers and include Moro, rooting, and tonic neck reflexes.” It is thought that these reflexes help infants learn to organize motor behavior.  Integration can be defined as “the inhibition by higher centers of neurological control which modify the reflex in such a way that the pattern of response is no longer stereotypical.  The reflex does not disappear; it may reactivate under stress or during activities requiring great strength.”  If these so called “primitive reflexes” continually remain to be displayed beyond the expected of typical developmental time period, their presence by indicate an underlying developmental of neurological issue.  When a child’s primitive reflexes do not integrate, they may interfere with a child’s development of more advanced motor skills, which could lead to difficulty participating in one home, educational or community environments to their highest potential.   Now, let’s take a look at the three primary tonic reflexes: Asymmetrical Tonic Neck Reflex (ATNR): Onset: 0-2 months     Integration: 4-6months Stimulus: Rotation of the head Response: Arm and leg on the “jaw” side extends. Arm and leg on the “skull” side flex. Importance for Baby: Assists with early eye-hand regard, provides vestibular stimulation, changes the distribution of muscle tone. Significance on Early Development if Persists: May impair ability to roll, use hands smoothly together at midline, poor visual regard for object(s) being held, poor balance. May impair creeping or crawling. Baby loses balance and/or falls when rotates his head from midline; very frustrating and causes excessive fatigue. Symmetrical Tonic Neck Reflex (STNR): Onset: 4-6 months       Integration: 8-12 months Stimulus: Flexion and extension of the head (neck) Response: With neck flexion the upper extremities will flex and the lower extremities will extend. With neck extension the upper extremities will extend and the lower extremities will flex. Importance for Baby: The STNR assists in the development of bilateral patterns of body movement. Allows the child to move up against gravity and assume quadruped (on all fours like a dog). Integrates as the child begins to crawl and can lift the buttocks from the heels without flexing the neck. Integrated when rocking back and forth on hands and knees. Significance on Early Development if Persists: Interferes with advanced reciprocal creeping. Impairs dissociation between the two lower extremities and transitioning between quadruped to sitting to kneeling to standing and vice versa. If strongly influenced by the STNR a baby will not be able to creep; will bunny hop versus true creeping/crawling on the floor. Tonic Labyrinthine-Prone & Supine (TLR): Onset: Birth               Integration: 6 months Stimulus: Change of orientation of the head in space; position of head in relation to gravity while prone (on belly) and supine (on back). Response: In prone flexor tone will predominate with arms flexed by the child’s chest. In supine extensor tone will predominate. Importance for Baby: Allows the baby’s posture to adapt to that of the head. Significance on Early Development if Persists: Will interfere with movement that requires smooth grading of flexor and extensor muscles. In supine child will have a compromised ability to raise their head up against gravity; this will affect anti-gravity control for movements such as bringing feet and hands together and rolling. In prone (on belly) child will have compromised ability to raise head, extend spine, and bear weight on elbows.  This, in turn, will limit time spent on his/her tummy for crawling and developing the movement in their pelvis and shoulders that sets the stage for moving in and out of various body positions (sitting to stand). Without such ability, the baby will be without options for exploring. This will affect social and cognitive gains.  (Above graphics from “Primitive Motor Reflexes & Their Impact on a Child’s Function”) Now that we have reviewed tonic reflexes, how can  the presence of these primitive reflexes effect your older child? Influences of Retained Asymmetrical Tonic Neck Reflex (ATNR):  Poor isolation of individual body movements Pore sitting posture Attention & Focus Impaired pre-writing and writing Impaired scissor use Fasteners/Typing/Musical Instruments Impairments in reading Keyboard Use Impairment in gait (walking) Running Influences of Retained Symmetrical Tonic Neck Reflex (STNR): Decreased strength and balance Sitting Floor Sitting Walking Writing Ball handling skills Influences of Retained Tonic Labyrinthine Reflex (TLR): Walking Sitting Writing  Balance Now, we have discussed primitive reflexes and how they may present in your older child; as well as the difficulties they may lead to.  Let’s look at some activities to help integrate these reflexes. Prone for fine motor activities & games- The elbows provide a point of stability for freeing the hands for manipulating. Hold a large dowel with both hands, use this to push a ball back and forth Use arms to push a ball back and forth Color, paint, draw, read, or complete puzzle in prone Use whistles or play games that require blowing through a straw Pivot in both directions Prone on therapy ball, platform swing, or over bolster Prone on scooter board-push off with arms from wall to glide backward Prone on scooter board-being pulled by a rope while grasping onto it with both hands  Superman/SuperWoman – prone extension with arms