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.

Rough and Tumble, Movement Experiences – A really important type of play for all children, especially children with physical disabilities.

Rough and Tumble:

Click on image and it takes you to a great blog ‘The Inspired Treehouse’

This type of play has important developmental significance in a number of  areas and is rich with sensory experiences. It can help your child learn about where their body is in space; improve their balance; regulate their responses to movement, touch, sounds, sights and smells as well as better understand the significance behind a particular, texture, movement, or sound.

Children with Cerebral Palsy or similar physical impairments may have or have had limited opportunities for this type of play. Think of children from 4/5 months rolling along a mat, maybe tipping forward off the edge, then a bit later crawling and climbing onto a sofa – maybe falling off it. By the age of 1 year/18 months, children typically have climbed onto chairs, tables, window sills, draws, Mum, Dad, in and out of their cots… – you get the idea, they will have been on swings, up climbing frames and down slides. We are born to be adventurous explorers and children explore by moving around and climbing onto things, falling off things and trying again.

It is really, really important that children who can’t physically explore this way independently are supported to explore using movement, are allowed to make mistakes (maybe not falling off a table – no one needs to do that – but I hope you see my point), they need to be thrown in the air, to go on a roller coaster, be hung upside down.

Children with Physical disabilities are reliant on trusted adults to help them experience different ways of moving through space and to enjoy and experience sensory movement experiences in a safe way.

Think about different types of movement experiences your child has experienced…

Have they been:

  • On a swing; on a roundabout or down a slide?
  • Tickled and rolled around on the bed?
  • Thrown into the air and caught?
  • Rolled over and over and over along the floor or down a hill?
  • Tipped forward head first in your arms/over a therapy ball, off the end of their bed?
  • Tipped backwards off the end of their bed, out of your arms/over a therapy ball?
  • In a lift/ car/ train?

If they haven’t then think of ways you could support them to experience some of those things.

Then watch and see how do they respond?

How does your child show that they either like or dislike certain activities or movements?

  • Do they smile,
  • do the laugh,
  • do they shout for “more” or for “no more”
  • do they stiffen their body,
  • do they relax,
  • do they cry or panic.
  • do they close, rub, widen or scrunch their eyes,
  • do they get sick?

All of these are important signs to help you understand what your child is feeling and how high or long or far you should go with the movement.

Remember movements affect the brain differently, some can be very arousing, exciting and alerting and others can be very soothing, calming and organising.

Head position influences how calming or how exciting a movement is, the direction of the movement and what other sensory information the child is processing during the movement can make a movement more or less arousing and scary.

Some guidance/ things to start you off using movement with your child:

To calm and sooth (which may then help your child to rest, notice, process or tolerate other sensory information (touch/ sounds/ visual information & information about where their body is in space). To wake up and excite (which may then help your child to notice, process or tolerate other sensory information (touch/ sounds/ visual information & information about where their body is in space).
Rhythmical movements, side to side, up and down or forward and back are more calming Spinning movements and movements where your head is tipped forward or backwards ‘wake up the sensory system’
Support head in an upright position and squeeze, press hold your child tightly during & after the movement reassures and dampens to calm. Movement with varying speeds and stops and starts is more excitatory, changes in directions and head position will be more arousing.
Sing calm, rhythmical, repetetive songs during movement. Music and singing that is upbeat, louder with varying speeds and volumes will be more arousing.
Rhythmically swinging/ rocking child side to side with them held firmly in your arms Swinging child in your arms with varying speeds, directions, heights and stops and starts.

Going on a roundabout.

Bouncing your child rhythmically up and down with them held firmly in your arms Bouncing your child up and down varying speeds, directions, heights and stops and starts.
Walking with your child securly held in a baby sling against your chest Rolling your child along the mat onto their tummy, then their back and tummy again.
Sitting on a therapy ball boucing gently and rhythmically up and down on ball, supporting your child firmly and securly holding their head upright. Sitting on a therapy ball (with your child if needed) and bouncing up and down varying speeds, directions, heights and stops and starts.
Supporting your child to stand against the therapy ball and gently rocking side to side with the ball (their body fully supported against ball). Lying prone (on their tummy) over a therapy ball rocking forwards and backwards.

Lying backwards, tiping back over the ball or your legs will ‘wake up’ the system.

Sitting on a swing with them held firmly in your arms and swinging gently forward and back. Swinging with your child on a swing (with them sat on your knee, held firmly and securely) varying speeds, directions, heights and stops and starts.

Use movements/ experiences and tips from both coloumns to help your child enjoy exploring different movement experiences and / or to feel clamer and better able to be still and able to attend and use other sensors to learn about the world.

If you feel you need support with this then chat to your child’s Physio or Occupational Therapist if they are known to therapy services. If they arn’t but you have concerns or worries then you can also call your local therapy team and ask for advice, or email/ call me – or post a comment.

I also gave some more ideas about how different sensory inputs can be used practically to help children and babies (with and without disabilities) in the comments on my last post – take a look.

Sensory Integration, our 7 senses, Sensory Processing through typical development and how it is affected by Cerebral Palsy

7 Senses?

We have the five senses we all know about: sight, hearing, smell, taste and touch 7 senses.png(tactile). Then we also have our sense of proprioception (our body awareness – where our body is in space) and vestibular (movement).  We’re going to look at tactile, proprioception and vestibular in more detail. These are very important in child development; as they get integrated (this refers to the way the receptors on our skin, in our eyes and so on receive the information, and how our brains process it, and therefore how we react to it).

 

Our sense of proprioception is really important. When we’re born – we tend to be all flexed up in a ball, and this physiological flexion gives us proprioception: i.e. it tells us where we are and is reassuring, along with touch from Mum or Dad, being cuddled. We can see that we need this as, if we lay a babyProp on the floor with nothing touching them, they startle – as they don’t know where their body ends and the world begins.  We get our proprioception from the receptors in our joints and our muscles. They send signals up to the brain and tell you where your limbs are. So if you clench your fist or wiggle your fingers, you can feel your hand; whereas if you just let your hand lie still, it’s more difficult to feel exactly where the hand is. Proprioception relies on movement of the joints and stretch or activation of the muscles.  As you develop; start to hold your head upright in the midline, roll over, push through your arms on your tummy, sit up and balance using the muscles in your trunk, stand and put pressure through your legs and eventually start to walk, you are building your body map, using the pathways between the proprioceptors and the brain.

 

Alongside all of this we receive tactile information through receptors in the skin. The information is carried along two different tracts or pathways up the spinal cord and into tactilethe brain: light touch along one tract, and deeper pressure along the other.  All of this tactile information that we receive as babies (from being stroked, the feeling of our clothes, the pressure of the floor against our back or tummy or side) adds to the body schema and helps us to know where we are in space. That deep, firm touch is similar to proprioception; it’s quite calming, organising, it helps us to know where we are and feel safe. If you’re getting worked up and you clench your fists and bite down – or have a hug – it can help to calm and relax you. The light, more tickly type of touch can be a bit arousing and exciting; it can make you shiver or giggle. It goes up the same tract as pain and it’s more exciting than calming.

 

Your sense of vestibular or movement is affected by where your head is in relation to your body. Your eyes feed into the vestibular system in your inner ear.  The system has two different types of receptors: firstly, there are sponge-like, linear structures (called otoliths), which tell you whether you’re moving up or down, or forwards or back; vestsecondly there are the semi-circular canals, like little cups of water, which tell you whether you are tipping or spinning. The vestibular system is very important in terms of your balance.  As different types of touch can be either calming or exciting, so too can input to the vestibular system. Linear, forwards-and-backwards movements that stimulate the sponge-like receptors can be calming and organising and help you to focus. If the semi-circular canals are stimulated, this is arousing – it’s telling you that you’re tipping or falling and you need to correct vestibu.jpgyourself. This is why riding on a rollercoaster or spinning round and round can make you feel giddy and excited (or dizzy or nauseous!). If you’re feeling sleepy, tipping your head from side to side or turning upside down can be a good way to wake yourself up.

 

Think of a toddler, toddling around. Generally they do lots of climbing, jumping off things, they’re running in the park, they’re on the swings, the roundabout… They’re constantly exploring their body, their muscles and joints are working so they’re getting lots of proprioception (so that’s calming and organising). Your receptors are being stimulated – you’re touching the grass, the climbing frame, the sofa, the carpet, the floor, your whole body is getting different types of touch, you’re rolling on the ground. SI.jpgAlso you’re stimulating the movement sensors in combination with these things. You might be spinning around, you might be climbing up and down things, you’re doing a good mixture of things that are exciting to the system, along with things that dampen down that excitement. That’s what’s called regulation – it keeps you in a good calm, alert state and means that you can still focus on the world around you. You can still listen if your mum and dad are calling you, you can still think and plan what you’re going to do so that you can stay relatively safe. This is the calm, alert state of arousal that you’re in when you’re not so sleepy or under-aroused that you’re not aware of things around you – so that you might trip over a kerb, you might not attend to a noise like somebody calling your name, you might not see someone waving at you – and equally you’re not over­-aroused, so you’re not too excited or too giddy or too upset that you can’t calm yourself down in order to be able to sit still in the classroom, to do good listening, to learn, to function.  The calm, alert state – somewhere in the middle – allows you to listen to the things you need to listen to, and zone out the things you don’t need to attend to.

This is called sensory integration.  As children develop, move around and explore, their senses naturally become integrated. All the information from all the receptors goes up the pathways or tracts into the brain and is processed, and anything that definitely needs to be flagged to remember for next time – such as a green or red light when you’re crossing the road, or a car coming towards you, or your mum saying “Stop!” or “That’s really hot!” – those kind of flags get an immediate response because you’ve learnt that over time. Equally things that you’ve realised you can zone out – things that happen all the time such as doors closing, noises in the night, noises in the classroom while you’re paying attention to the teacher you habituate (get used) to them and you don’t listen to them. That’s if you have good, typical sensory processing.

So What is Different if a child has Cerebral, Palsy?

If you have a child with cerebral palsy, whose independent physical mobility is restricted – maybe their movement patterns are not typical, they might move their arms and legs more in one direction than another, or use certain muscles more than others toCP

activate movement, maybe certain parts of their body might get more touch than other parts – they might have missed the tummy time stage for example, or the rolling stage (rolling over and over is really good for body awareness, for learning where your body ends and the floor begins). They might have missed the crawling stage, when you’re getting weight bearing through the shoulders, elbows and wrists, through the knees and up into the hips, it’s activating the joints, it’s CPPtelling your body where it is in space, if you miss that stage then you’re going to miss out on that proprioception or body awareness. Your body schema (body map) will not be typical, and your perception (e.g. of where the midline is) will be altered. Remember the proprioceptors are the calming, organising inputs that help you to focus and organise and dampen down any excitatory inputs. Your touch receptors – if your hand is closed most of the time you are not going to have experienced lots of different types of touch on your palm.

Your movement sensors… If your head hasn’t been in the upright position in lots of different ways – when you’re lying on your tummy and lifting your head for the first time, when you’re learning your head control, and then when you’re starting to balance in sitting and then standing, using a mixture of your flexors and extensors (the muscles on the front and back of your body), getting that co-contraction – all of these things feed into your balance and your vestibular system. If you haven’t had that, or maybe experienced this in an asymmetrical pattern, then your vestibular system will have an altered perception of what is upright.

How quickly your body responds to you falling sideways, for example, will depend on how well integrated the receptors of that system are, whether the receptors are receiving the information at all, whether enough input has been put into the system for the receptors to have sent it up to the brain, or whether they are over-sending so you’re constantly responding to the information because maybe your muscle tone is high and it’s sending signals all the time.

So not surprisingly, children with cerebral palsy have some difficulty with their sensory integration, and this can affect therefore their calm alert state – so their ability to regulate their emotional state, to calm down when they’re upset, to regulate how excited they get and how they respond to that excitement, to be able to continue with a task if a distraction has caught their eye or some auditory information has come in, to be able to think to themselves “I don’t need to attend to that, I’m going to carry on with what I’m doing”.

You might see that a child can perform a particular task in one situation – when they’ve been doing something prior to that maybe – but then in another situation they can’t do it, and you think, “I know they can do this, but they’re not performing right now.” It may be that the situation that they’re in, the environment that they’re in or the preparation they’ve had affects their performance and their function. This can have a big impact on their learning in school, if one environment they learn or perform well in, whereas other environments they maybe don’t.

Part of our role as Physiotherapists and parents and carers is to ensure that no matter what your child’s physical ability they get to experience a wide range of play activities, positions and movements to build their library of sensory experiences and organise the sensory input so they can attend and respond to stimuli and adapt in new environments, to be more effective learners and players and ultimately successful adults.

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

Rosenbaum-Gorter-F-words-paper-CCHD-2011

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”