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The Rewards of Adaptive Bicycles for Children

Bicycle or tricycle riding is an important component of childhood. For certain children with medical complexities, there are special equipment that enable them to explore the world just like any other child.

When I was working as a physical therapist on the pediatric floor of a rehabilitation hospital, I encountered many children and families impacted by debilitating conditions and circumstances. From cerebral palsy and brain injury, to spinal injury, or cancer, many of the children I met proved that being physically and cognitively limited did not keep them from participating in stimulating play activities.

Adaptive tricycles are designed to provide less able-bodied children a way to exercise their limbs, practice their skills and encourage their participation. 

They often come with various features and accessories such as extra wide frames, trunk reinforcement, head support, leg straps, hand straps, steering assist, etc. They make it possible for children who have low muscle tone, motor control, coordination, or cognitive function to engage in locomotion.

How Can an Adaptive Bicycle Help?

For children with diagnoses that reduce their trunk control, adaptive bikes provide a safe environment where they can work on coordinating their limbs while having their back fully supported or strapped in.  For children who fatigue easily due to their medical conditions, adaptive bikes offer the option of having an adult help steer from behind.  For children who lack the motor control to alternately pedal their legs, foot straps and connected pedals make the reciprocal motion easier by putting muscles and joints through those much needed ranges. Depending on the type of bike, adaptive handles can also accommodate all kinds of grip. So when a child with upper body weakness has a hard time grasping or holding the handlebars to steer a regular bike, an adaptive bike allows them more control of their locomotion.

Durable wheels and a parking brake make adaptive bikes safe for children with a wide range of physical abilities and conditions.  Children with medical complexities who are restricted to a wheelchair can still benefit from rides in an adaptive bike.  Aerobic training and upright posture, as well as limb movements (facilitated or self-initiated), are an essential part of the growth and rehabilitation process for children of all different capabilities. All of this is made easy by special equipment such as the adaptive bike. Being outside and being able to participate in activities with other children promote emotional health and create positive environments for mental and physical growth.

The Rewards of Using Adaptive Bicycles

I have watched many children blossom behind the wheel of an adaptive bicycle. Taking part in that transition is such a rewarding process.  Children who were unable to move certain parts of their bodies after an injury were eventually able to transfer what they learned during cycling to standing and walking tasks. Toddlers who were never able to stand on their own were able to experience, for the first time, limb movements and self-propulsion locomotion. Seeing the smiles on their faces, and hearing the laughter of their parents and siblings… Those moments definitely made my job worthwhile.

How to Teach your Child with Sensory Processing Difficulties How to Ride a Bike

Learning to ride a bike can be a scary and overwhelming adventure for both the parents and the child involved!  There are many components required for bike riding, such as motor planning, body awareness, trunk control, balance, self-confidence, following directions, safety awareness, timing, and sequencing.  However, one of the best things about bike riding is that the child is typically very motivated and excited to do it, as he sees his friends or other children in the neighborhood doing so already.

SPD Child riding a bike

Below are several strategies on how to get started:

  • Practice lots of balance activities:  balance is a huge part of bike riding; therefore, it is important to strengthen these skills by challenging your child’s ability to maintain various positions including standing on one leg, sustaining yoga poses, walking across balance beams, or kneeling on an unstable surface such as the bosu ball.
  • Incorporate a variety of activities with wheels:  while being able to ride a bike independently might be the ultimate goal, it is beneficial to incorporate other similar skill sets into your child’s play experience.  This will help you and your child to take the emphasis off of the fact that he does not know how to ride a bike and help to focus on the excitement of trying new things (e.g. scooter, skate board, tricycle, roller skates, etc.).  Similarly, your child might really excel at one of these activities, in which this activity can then be used as a confidence booster when the child has already mastered it.
  • Practice inside:  have your child practice simply balancing on the bike/sitting on the bike in a safe environment, such as inside (e.g. basement or playroom/living room if appropriate).  Place large pillows/beanbags next to the bike so the child feels secure, and if he falls, he will crash into the pillows.
  • Involve different family members/friends:  bike riding can be a very complex task; therefore, it can be extremely beneficial to involve different family members/friends to help with the process. Different people have different strategies and ways of motivating and sometimes one strategy will really hit home for your child.  Similarly, then the same parent and child won’t get so frustrated with one another.
  • Visual schedule:  help your child to make a visual schedule/calendar to illustrate when the child will start practicing and what skill he will work on each day (e.g. getting onto bike; peddling with both legs; ride to the corner etc); then the child can put an “x” or a sticker on the chart when he completes a day of practice, or practices a skill etc.  Visual schedules can be motivating for the child, and provide structure.
  • Take the pedals off:  taking the pedals off of the bike helps initially with learning the feel of the bike/balance. Take the bike to a small hill and have the child ride down without the pedals, this provides an introduction to moving and balancing on the bike without needing the coordination to pedal.

Learning a novel activity can be intimidating for a child, as it is a totally new experience and requires a significant amount of following directions and motor planning.  Similarly, teaching  novel activities can be nerve wracking for the parents, especially if it is a skill they have not taught before, like bike riding.  As parents, it is important to keep in mind that every child learns differently and requires different levels of support when learning a new skill.  Make sure to constantly praise your child during this challenging activity, even if it seems like the tiniest accomplishment (e.g. buckling bike helmet independently; putting kickstand down independently).  As always, feel free to talk with an occupational therapist or physical therapist if you need more individualized strategies or have other gross motor concerns for your child.

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5 Swings Used in your Child’s Therapy Sessions

Oftentimes, parents probably wonder ‘what makes the swings and equipment at my child’s therapy different than the swings at the  playground’?  The answer is that each of the swings used in the therapy gym are able to be used in a much safer and controlled Little girl sleeping in hammockenvironment, as the therapists are able to place mats and pillows under and around the swings, and the therapist can therefore challenge how the child engages in the activity and moves and manipulates his body (e.g. hanging underneath the barrel swing).  Similarly, the swings used in the therapy gym are able to be hung on a rotating hook to allow the child and the swing to move in a variety of planes and directions, providing the child with a greater amount of vestibular and proprioceptive input.

Below are explanations of 5 of the swings therapists use throughout your child’s therapy sessions to help best understand the benefits of using the therapy equipment

  1. Superman swing: The superman swing is also referred to as our prone extension swing, meaning that the child is lying in a prone position (on his belly with his arms and legs extended). The superman swing is suspended high enough off of the floor so that the child has to weight bear through his upper body (shoulders, arms, hands). We often refer to this position as using his ‘wheelbarrow’ arms. This position helps to improve upper body strength, neck strength, trunk control, and multi-tasking/motor planning, as the child is typically playing some sort of board game or activity while maintaining this prone extension position in the swing. As the child gets stronger, he shoots to remain in the swing for longer and longer durations.
  2. Cuddle swing: The cuddle swing is mostly used for self-regulation and calming, as it mimics a hammock, in that it completely surrounds, engulfs, and molds to the child’s body. While in the swing children often feel extremely secure and at ease as the swing provides them with a squeezing sensation- much like a big bear hug from mom or dad. The cuddle swing can provide the child with slow rhythmic movement, which can be very relaxing for a child, especially when he is feeling anxious or when his body is moving too quickly. The cuddle swing can also provide a child with more intense vestibular input, as the child can be spun in circles, when he is seeking more fast-paced input.
  3. Rainbow swing: The rainbow swing looks exactly how it sounds, as it has 4 different colored layers, which the child can crawl in and out of. The rainbow swing provides a rhythmic motion when the child lies on his back or stomach in one position, while the therapist swings him back and forth. Similarly, the child can start at one end of the swing and crawl through like a resistive suspended tunnel, until he reaches the other end and can crash out onto a pile of pillows. This serves as a heavy work activity and can ideally help to increase his attention and body awareness.
  4. Frog swing: The frog swing looks exactly like a playground swing, in which a child needs to pump his legs or be pushed by a therapist to get his momentum going. Typically, the child is instructed to listen for a ‘magic word’ before jumping off of the swing to crash into a pile of large floor pillows (e.g. ready, set, and ‘go’). This activity helps to work on following directions and motor planning, as the child must figure out how to get his body off of the swing at the correct timing to land on the pillows.
  5. T-swing: The t-swing looks like an upside down letter “T”, and may also be referred to as a barrel swing. The child is required to wrap his arms and legs around the barrel like a koala bear and hold on as tight as he can while the therapist is pushing and swinging him. This swing helps to work on entire body strengthening and endurance, and it also requires motor planning and body awareness in order to assume the correct position initially to get onto the swing.

As therapists, we find that the swings listed above are extremely motivating for our clients to use, and serve many distinct purposes; as such, equipment truly helps us to better reach our client’s goals (e.g. following directions; attention; body awareness; self-regulation).  The swings are also a great reward for clients to work towards throughout a therapy session, as they see all of the other children playing on them, and they want to partake in the fun too.  Feel free to ask your child’s therapist if you can come-in and peak at the therapy gym during your child’s session to help you to best understand the treatment process.

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Strategies to Promote Increased Trunk Control at Home and at School

As discussed in my previous blog, our trunk muscles (“core”) greatly influence how we move through our environment and how we engage in gross motor and fine motor activities throughout the day.  Below are a few simple ways to include trunk strengthening into your child’s daily routine.

Trunk Control Activities For Your Child:

  • Make sure that your child is seated at a table/chair that fits him so that he can maintain an erect posture throughout the tabletop activity (e.g. feet girl slouchingflat on floor, knees and elbows at 90 degree angle)
  • Use a sensory cushion at the table or during circle time if your child demonstrates increased fidgeting, decreased awareness of personal space (e.g. propping/leaning on peers), or propping on elbows.  A sensory cushion helps to give your child a boundary of where his body should be and allows him a little bit of “wiggle room” to move his body without disturbing others, and without having to get up and move around during the task at hand
  • Practice yoga or animal walks as a sensory break or as a transition activity (e.g. “tree pose”- single leg balance; “crab walks”, “Wheelbarrow walks”).  Yoga and animal walks require attention, following directions, motor planning, trunk control, strength and endurance.
  • Use an exercise ball as a chair during tabletop activities.  This helps the child to work on balance and stabilizing his trunk (“core”) muscles.
  • Practice extracurricular and sporting activities during the summertime (e.g. swimming, ballet, gymnastics, and climbing at the park).  These activities require trunk control, along with upper and lower body strength.

Note:  Remember to contact an occupational therapist or your child’s primary care physician if you have immediate concerns about your child’s trunk control.

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