F-Words Paper – The ‘F-words’ in childhood disability: I swear this is how we should think


Therapy – it should be all about the F Words?!

This is a great article encouraging therapists and parents to think about the future of children with disabilities – in a positive way – right from the start. Addressing function, family, fitness, fun and friends to constantly remind us of what is important in the development of all children.

It made me reflect about my role as a Physio and how successful I am in my aims – which are; to reduce the impact each child’s impairment has on their ability to join in with their friends and family, have fun, be successful at something and be fit and able to face their future. And, to support families and carers so they have the skills and knowledge to bring the best out of the children they are caring for.

Are all my programmes and session plans focused around what the child wants to do? Am I always successful in my goal to make sure my therapy input enriches the lives of children and their families?

I have seen many therapy programmes (some of mine included) with aims like “to maintain length of hamstring muscle”; “to improve posture and balance in sitting” and I am now more than every asking, so what?

Parent’s feedback to me frequently that they feel guilty for not doing therapy with their child more often – not spending more time, out of their quality family time, to do their therapy programme – this can’t be the message we are meaning to send out.

It makes me question where we are going wrong, we should be making the lives of families less stressful, enabling their child and therefore making parents worry less about the future.

Let’s think about the F- words from the article, I think as therapists we can strive to deliver an approach that has these words at the heart of it and as families we can check that we make decisions and advocate for our children with the now and their future in mind.

Function – Children’s lives should be rich with experience. They need opportunities to practice skills, be suitably challenged, make mistakes and learn from them. We need to ensure their environment is suitably adapted, that they have adequate support so that they can be more independent, more involved. We need to promote activity and with that comes function.

Family – Empowering families so they can make informed decisions. I was once asked to help a Mum sort through all the advice and therapy programmes she had been given for her 5 year old child (with Cerebral Palsy) as she couldn’t see how she could follow it all. Well, she had 5 different Physio programmes; 3 feeding programmes, speech advice about using signs, key words and switches, 4 Occupational Therapy programmes; play therapists ideas; school homework and then various different pieces of equipment she had been given over the years with advice about how long to use it for. She didn’t know if the most recently dated therapy programme replaced the others or if she should be doing it all – and to be honest it wasn’t clear to me either (for a few the newer programmes seemed to add things into a home programme but didn’t necessarily replace an older programme). There was nothing in all the information she told me, or that I saw written, that pulled it all together – nothing that linked the therapy aims to her goals for her child!

Fitness – Children need to be able to access recreational opportunities to become and stay physically active, some kids may love doing a strengthening programme with an adult – for a while – but most will want to get stronger so they can… wheel faster in there chair; kick their legs more in the swimming pool; run faster in their walker/ running bike; knock more skittles down…

Fun – What is fun for one child may not be for other so first things first; find out what your child wants to do. Most activities can be adapted to allow all children to pursue their interests. They may not do it the way others do it, or the way we may want them to do it, but if they are participating and having fun then they are achieving!

Friends – Social development is an essential aspect of personhood. In this article Rosenbaum and Gorte ask us to consider, “what can be done to encourage, empower and enhance children’s opportunities to develop and nurture meaningful peer connections”.

Future – “the future is what child ‘development’ is all about” – isn’t it just! We need to choose a therapy approach that is centred on the strengths of each individual child and their family. Think positively about the future and what each child can do; about how we can support them to have Fun, make Friends, and be Fit and Functioning to the best of their ability.

Continue reading “F-Words Paper – The ‘F-words’ in childhood disability: I swear this is how we should think”



At the ABM workshop I met Jean-Pierre, who is a bit of a celebrity in the world of Children’s Therapy. He encouraged me to book onto his MAES (Movement Analysis and Education Strategies) training course. His approach also works on upgrading the way the brain works, but unlike Anat Baniel (ABM) Jean-Pierre is a specialist in working with babies and children with Cerebral Palsy – with over 25 years’ experience.

So, I booked onto the training course! Why wouldn’t I: He has spent 25 years working on and developing his framework – I am only 1 year in really, to specialising an working solely on treating children with Cerebral Palsy and similar neurodevelopmental conditions. I feel privileged to be able to learn from him and hopefully bring some of the amazing results he achieves with the children he works with, to the families and children I am treating.

Jean-Pierre is another gifted therapist who looks like he has magic hands when he is working with children, in his hands children move in ways they have never before been able! But he assured me at the workshop that on the course he will share the secrets of his handling.


I have just returned from 2 weeks in Somerset, where I attended Part 1 of the MAES Course with Jean Pierre and 9 other therapists. I can tell you I was not disappointed – we are learning the secrets behind the magic handling and so much more.  This course is making me look at Cerebral Palsy and therapy input in a very different way to how I have considered it in the past.

I still have 2 more weeks at the end of September to go so won’t say much more on here until I have completed the course, worked a bit with it and then I will share my reflections.

But I wanted to post this as I have had several families already, asking about ABM following my last post. If you are eager to explore this type of therapy approach then I would recommend looking at MAES, for several reasons – I know more about it than I do ABM and it is a specialist approach/ framework developed through Jean-Pierre’s extensive experience and background working with babies with developmental delay and children with coordination difficulties, movement disorders and whose difficulties are complex and neurological in nature, such as Cerebral Palsy.

Learning to Stand Lying Down – Reflections Following 2 day Anat Baniel Workshop

“Learning to stand lying down” is a catch-phrase that Anat Baniel used on several occasions during the workshop I attended in London a few weekends ago. Anat Baniel is a gifted practitioner who studied high performing adults and children with special needs over many years and gradually formulated her approach and 9 essentials to upgrade the way the brain can organise information. The essentials involve giving the brain the quality information it needs to keep learning.

Anat’s applies her approach and ‘9 essentials to adults and children, as they all have one thing in common: they all have a brain, and their brains require ‘upgrading’ to improve the quality of their movement. She spoke about how a common approach, using movement can enable the brain to ‘upgrade’ and improve a violinist’s playing a ballerina’s alignment and coordination or a child’s ability to communicate in social situations, to roll, to reach or to walk. Anat has developed the Anat Baniel Method (ABM) that she now teaches, working on the assumption that if we provide the brain with varied, high-quality information it is then more able to spontaneously discover new and more successful solutions to overcome or solve a variety of difficulties.

A few of the families I work with take their children for ABM lessons, and one family asked me to go along to the workshop to find out more about it. I read Anat’s book Kids Beyond Limits [http://www.anatbanielmethod.com/members/shop/kids-beyond-limits/], which sparked my interest– she seems to have consistently good outcomes when working with children with additional needs and she has the long game in mind – yes a child may be able to walk now if we teach them or allow them to move like this, but we know that the way they are moving will likely mean that they will not be able to walk this way as an adult. ABM is not goal focussed, the aim is to build quality foundations with which the child can move in a greater variety of ways which will enable them to do a great variety of things and keep learning more.

The theory or approach didn’t sound dissimilar to what I am striving to do and I felt it perhaps started to explain why certain techniques (tools in my Physio treatment tool box) work better than others. Sometimes I will use a certain technique with a child and it will work well, and when I repeat the same movement with a different child or even with the same child it won’t have the same effect – and sometimes I’m not sure why this is. Reading about Anat’s “Nine Essentials for Positive Brain Change” and then discussing them over the course of the workshop has helped me to start to understand why a technique might be more, or less effective, in given situations.

Anat’s nine essentials are as follows:

  1. Movement with attention: We know that the best way to communicate with the brain is through our senses (look back at some of my earlier posts if you don’t know this). During the workshop we talked about our sense of movement and balance (vestibular), our sense of body awareness (proprioception), and our sense of touch (tactile). All these can help either to calm and organise the brain, or to arouse and alert it (Sensory Integration). When Anat talks about ‘movement with attention’, I think she refers to helping a child to register, to take note of components of sequences of movement.

An example of how I’ve applied this to my own practice: when working with a child with cerebral palsy that has dystonic spasms, rather than trying to reduce the spasm by bringing the child into an opposite pattern, I have been experimenting with going with the spasm and making the child more aware of it, and so helping the brain to really register this movement again – when it has likely become an habitual pattern of movement.

From only a weekend workshop I can’t start to use this approach so I am trying to link this theory to what I know. So, I look at which movements to use and to play with when working with a child to help them start to build more quality and I go to my knowledge of typical child development. I look at babies when they’re moving on the floor, rolling, coming up against gravity, and look at all the complexity of the movements they do before they have assigned any intention to the movements. These are the movements and sequences I have experimented with. I have had success – revising child development and seeing that the patterns of movement needed for standing and stepping, for example, can be practiced on the floor (where it is easier for the child to focus and be more relaxed to be able to move with attention), then when the child stands the quality of their postural adjustments is better. The is presumably because they have been able to experience the sequence with greater attention to how the whole body is involved and how distinct parts move in rhythm with other parts.

  1. Slow: This essential is a reminder that the brain can only learn something new if the information it must process is provided slowly enough. If someone tries to teach you something new but expects you to take it in fast or react fast, you will tend to revert to what you always did before, to get to where they want quickly. If on the other hand someone teaches you something slowly, and you move with attention, you can take time to think about the different components and then may be able to learn new skills. This is something I often need to remind myself of when learning new things and teaching them!
  1. Variation:  The brain responds to things that are new and different; this is something I was aware of from my sensory integration training – from the workshop I got some more ideas about how to introduce variation to get the brains attention. It can be very simple: if you’re going to lie down on your tummy, lying down first through the right side, and then the next time you do it, through the left side lying means to think more about how you are moving. Or if you have your hands behind your head, switching the interlace so that one hand is on top then the other– offers subtle change to bring your attention back to the movement, so that the brain is registering the changes and can learn something new.
  1. Subtlety: This essential is about the importance of parents and therapists using subtle, light handling, and recognising (and encouraging children to recognise) subtle differences in movement. The body has so many joints, and so many different ways it can move; sometimes a movement will look the same, but if you’re able to recognise the subtleties, you’ll see that the child has made a change and you’ll know you’re on the right track. This has emphasised to me the importance of my ability to hone in on subtle differences, and has helped me to highlight them to both parents and children so that they can become more aware of them too. It has also made me think about facilitation and handling I do with children and when light touch is not enough or when I use equipment – I wonder how much long-term change I am making within these activities? I am starting to think what am I aiming for and is there another way to do it that doesn’t require such force to get the child into a position of for the child to achieve that task.
  1. Enthusiasm: Often, and for me especially, enthusiasm looks like someone saying, “Yay, well done, good job!” – but Anat calls this ‘cheerleading’ and says that it’s not helpful. Anat talks about a ‘quiet’ enthusiasm to help the child recognise and be proud of their own movement, and not need external input to validate it. We have the ability within our own brain to check whether a movement has been successful, and Anat says we detract from this if we give too much external validation. She has found that when parents sit quietly during sessions, smiling and noticing subtle changes with internal enthusiasm, rather than cheering from the side lines, this allows the child to feel the improvements themselves, to ‘own’ them and to feel their own enthusiasm for them, rather than looking for external validation from their parents or therapist. Thinking back over my past sessions, it seems to me that this could often be the key to why children perform better in certain circumstances than in others; this is something for me to consider further.
  1. Flexible goals: Rather than trying to ‘fix’ problems, Anat talks about helping the brain to get back on track so that it can start learning again. If a brain has ‘stalled’, for example if a child is repeating the same movements again and again, those movements may have become a habit. Rigid goals, such as for the child to be able to roll within three months, do not leave room for the child, parents or therapist to be enthusiastic about more subtle (and possibly more important) changes – for example, the way a child is moving with more attention. According to Anat, if you have got the brain back on track and it is more aware of different movements, we know where the goals are going to go because we know from child development that children work towards certain milestones.

If I am working for quality, is this a goal? Then my aim could be for a child to be able to reach further or stand for longer. Or could better quality of movements be my aim, and then the child being able to use this for improved performance in reaching, standing could be an inevitable bonus, but not the goal or aim I work towards. If I set a timed goal that a child will achieve an improvement in a specific task within 3 months my focus may come off the quality and be too much on the performance. This is something that I need to have a think about in relation to how I practise and the goals that I set. Short term a child may take longer to be able to perform a task but if we feel that when they do get there the quality of how they can move will be better, and if this means they will be able to perform that task better, and maybe for longer or in a greater variety of positions or environments then this is what we want to work for, no?

  1. The learning switch: I think we all recognise when a child is really ‘in the zone’ and paying attention. This comes back to something I really learned and started to practise following my Bobath course – there is a difference between distracting a child and having them actively participate. If a child is being distracted, they are probably not paying attention to what you are doing with them, which means the learning switch is not on – so the movements or sequences you are supporting them to experience are being done to­ them – then there is less potential for positive brain change.

However, if a child is actively participating in a reach, or a roll, or just in being aware of the position their body is in, the learning switch is on.  I’ve found that when I say things like, “Can you feel your spine?” or, “Can you feel your shoulder blade moving?”, I can often see the child taking notice of whatever I’m drawing their attention to. This is something I’m trying to look out for more often, and something I am helping parents and carers to look out for.

  1. Imagination and dreams: We did some movement lessons during the workshop where we were lying on the floor performing simple movements lying on our backs, our sides and our fronts. The sequences were parts from that we see young babies practice when they are playing with movement. First, we did a lot of work on one side of the body and then we all felt a bit uneven – one leg felt longer, one arm was more relaxed. We then imagined the same movements (which we knew well by this point – lots of repetition and fine tuning the quality) on the opposite side, and after imagining the sequence of movements two or three times, we then performed it once or twice – and felt the same results as we had on the first side after only minutes rather than the twenty minutes+ we did on the other side. This brought home the power of the imagination to communicate with the brain to help learning, and how much the quality of a movement sequence is dependent on the planning stage in the brain, rather than the muscles actually doing.


I’ve started to use this more with the children that I work with, after working through a sequence, or components of a sequence in a position where child is relaxed, they are then able to imagine other sequences (involving those components) as being easy and effortless, thinking about the movement starting in the trunk or spine and then the shoulder girdle offering stability for the arm to move… When children have been able to do this before they perform a movement, I have noticed less spasms and improved flow of the movements – it is easier and the quality is better.

  1. Awareness: I have become more aware of what I am doing and why I am doing it, how things are helping, why some things don’t work. I have become more attuned to when a child is better ‘awaring’ – as Anat puts it, when they are thinking about a new movement I may be doing with a part of the body. Being more aware, more present, can also help parents, families and carers to know what to look for to see that we are building on the quality of movements. Then we know the brain is making positive changes.

I now have many more questions to ask myself and discuss with colleagues, to think about how we approach treating children with cerebral palsy or other similar neurological conditions. How we can build better quality foundations of movement for them to use as what they want to do demands better variety.

Learning to stand lying down – refers to bringing children back down, sometimes to the basics, moving on the floor to improve the quality of how they move and help them think about their movements and be more selective with how they complete a sequence. To move in new ways a child needs to slow down and build the quality, to learn to stand through activities lying down.

I found the workshop thought provoking. I want to learn more feel I should be able to get to a similar place as a Physiotherapist and don’t need to throw out everything we know and do now as therapists– as Anat suggests we do, and re-train as an AMB practitioner.

That is not to say that what we, as therapists are doing now is always getting it right. If we knew how to consistently ‘get it right’ we would all do the same thing – yet there are many approaches to treating children with the same conditions. It is something to look into whether ABM practitioners get better results on long-term with children with complex neurological based movement disorders, than we do currently using our therapy approaches. Our approached predominately work on reducing the impact of the compensation strategies that children are using, because the lack the selectivity and quality of movement.

ABM practitioners look like they are using some of the same treatment tools that I have and use, but why they are doing it is different. I think they are working more slowly, working with children more intensively, to improve the quality of movement, communicating directly with the brain to give the brain more movement experiences and help it to better organise them rather than on ‘treating what we see’. So, instead of working on muscles to lengthen them, or on muscle tone to increase or decrease it, they work on getting a stalled brain back on track and moving again – in any direction. If a child is doing something else, moving in a different way, they are learning and if children move in many different ways then we will not need to treat or work to manage the implications of the repetitive strategies they use when they can’t. Food for thought indeed!

ABM Workshop was 17th and 18th June – blog post with my reflections written 20th July.

Race Running Update

We are still working hard to set up our Race Running Club in East London

Since the taster event I have found that many of my Physiotherapy sessions have become training sessions instead.

Kids wanting to get fitter so they can perform better next time they get on their Runners!!

This is wonderful, the children are really motivated and enjoying being treated like atheletes in training.

We really need to get these kids back on the Race Runners as soon as possible. I am meeting with our local Rotary Club next week, who will hopefully feel the cause is worhty and have suggested they may be able to buy the club a couple of runners!

We have also put together some fundraising materials and a page for donations. Please share these around to help raise money for the Race Runners. The coaches are there and waiting, I am free and eager to start supporting the kids on Sunday mornings so all we need is the money to buy the bikes.

A RaceRunning Club for East London

Our Fundraising page: https://www.accesssport.org.uk/fundraisers/a-racerunning-club-for-east-london

Please share this link or brochure and consider donating to help us get this club up and running as soon as we can.

Playing with your baby physio style

So your baby is starting to have some awake time, and looking up you with their wide eyes expecting you to entertain and play with them… What should you do??

Sometimes just place them on the floor nearby and watch them kick their legs, punch the air with their fists, discover sucking their hands and then even cooler sucking their own toes!

Yep leaving them on the floor in safe place, to learn about where there body ends and the world begins, is therapy approved parenting!

Read on for other fun activities you can do to help them in their quest to ‘colour in their body map in their brain’ – which is building the foundations for so many exciting things to come (including being able to self-regulate -which is just a fancy therapy way of saying calm themselves down!!!):

In the first few months it’s all about sleep, milk and getting those poops out! But even with all that going on babies have to find the time to start to make connections in the brain to register and organise things they are sensing – most importantly at the beginning sensations like pressure, pain, temperature, position, movement, vibration (somatosensory system – just to throw in a big word so you remember I’m a Physio), alongside hearing and vision.

So you can help them by being aware of what activities and environments provide what type of sensory input as the only way to learn to process different types of sensory input is to experience it.

Everyone, baby, child and adult will have a different threshold (tolerance) to different types of sensory input.  So helping them to experience a certain movement, or sound or touch in a safe way will enrich their sensory body map. You might be increasing their threshold so they can cope better in a certain environment (a busy noisy train); an activity (having a bath or nappy change). Or conversely you may be helping them reach a higher threshold – if they aren’t noticing, responding (registering) a certain sensory input yet, by repeating it or playing it louder, bringing it closer you send stronger input until the threshold is reached and the information is sent up the pathways and registered in the brain. Experience is the only way to establish and then reinforce the pathways.

So many sensory pathways are being made in the first few years of life, we don’t keep them all! So if your little one starts to explore independently they will keep strengthening the pathways and experiencing more and more, building on those foundations. However if they are not able to explore in a broad a varied way due to a motor relay or neurological impairment then they will reliant on you make it possible to keep exploring and reinforcing the foundation’s, even when they are also working on acquiring and mastering higher level skills.

These are some activities/ play ideas that all babies can enjoy and will benefit from experiencing:

Activities and positions to encourage:

Just being on the floor – babies do very important learning just being left in a safe place to move their arms and legs, to look at their hands and reach for their feet.

Maybe under a baby gym they will reach up or out for something.


Use a rolled up towel to tilt his pelvis and flex (bent) his hips and knees when he is on his back

This will encourage and help him to reach for his toes and build his tummy muscle strength.

Using nests  gives baby boundaries so they feel safer and have something this push against, this gives them more sensory feedback so they are learning more about their body.

You can play with baby bringing their feet together and clapping them, bringing hands to feet and rocking side to side.

Opposite hand to foot to help them clap like this or pull of a sock – all helps with them connecting the two sides of their brain and learning about their bodies.

Tummy Time: Really rolling time – babies are only ready for tummy time once they can roll onto their tummy!! Once they can do this, they can lift their head so will enjoy being on their tummy to play.

If your child has additional needs then you may wish to use tummy time as therapy and you can help your little one be happier for longer on his tummy by using a rolled up towel under his chest and by applying a little pressure to his bottom to help him shift his weight back.

Movement – with baby in your arms bounce them up and down, swing them forward and back, side to side. Spin them around. Stop and see their reaction. Give them chance to tell you what they think and make vocalisations to say go (ready steady…). They will start to anticipate and shout for go. Movement is the best way we have to communicate directly with the brain – when kids are moving they are learning.

Tactile play– offer pine cones, wrapping paper, space blankets, crisp packets to rustle, sponges to squeeze etc.

Vision and hearing- try a torch in the dark and see if your baby will track the light with their eyes. Encourage them to follow visual toys that are quiet so they are using vision and not relying on their hearing. Then you can bring on the noisy toys and start and stop, building anticipation and see if they can reach for the toy to turn it on. The beginnings of cause and effect.

If you are worried that your child has significant difficulties processing sensory information then you can ask your GP to refer you to children’s Occupational Therapist.

If you are worried your child has a developmental delay again contact your GP, or call local Physio team.

Some other posts in the pipeline:

– The low down on baby slings

– Some Physio tried and tested toys and equipment I would recommend.

To finish, an apology for the lack of posts this month – it has been a busy one. I will do better in July!