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.

“Race Running is Awesome!”

Last week 10 children between the ages of 5 and 16 came along to the Feel Good Centre in Waltham Forest and ran around the athletics track – and what’s so remarkable about that you may say?

Well, nothing and that is what is remarkable! All the children came in their wheelchairs or walkers and joined in with the Waltham Forest Wolves Athletics Club, running alongside their siblings and new friends.

It was wonderful to see them all having fun, out of breath and rubbing their aching leg muscles after their run…

What better way to tell you how the taster session went, than to hear from the children and families who attended:

“We had a wonderful time and Victoria was so pleased with herself, we want to come every week” – Victoria’s mum.

Victoria
This is Victoria 8 years old, who has a seisure disorder and presents with hyperkinesia.

 

 “I loved it was fun, I want to go back and do it again” Champ – aged 16, loves football, wrestling and can throw some moves on the dance floor, also has Cerebral Palsy affecting his arms and legs.
You have to watch this Video of Champ running to complete his full lap of the track!
“It’s taken nearly 17 years but we finally see our son run without falling over and may we add 400 meters! Was one of the proudest, most memorable times of our lives” Sarah and Mark Yearsley, Proud Parents.
“My son Matt is a sport obsessed 9 year old who also has cerebral palsy.

IMG_1327.jpg
This largely affects his legs and as such he uses a wheelchair, walking frame and sticks.
I spotted the Race Running taster session on a facebook post and did not hesitate to make the 60 mile journey to Walthamstow.
The running frames offer the chance to run freely. It sounds daft but it is not something Matt has ever had the chance to do. He loved the track, being with other children and competing against himself.

I know these frames are very expensive but they offer much more than a way of running. The confidence and camaraderie the children will gain will be immeasurable. If we can get a running club up and going we will definitely use and support it.
My son has big dreams and plans for himself so who know’s where these bikes will take him!” Matt’s Mum.
Mia said: “I definitely want to go back again. I enjoyed it and it was nice to see other children who use wheelchairs like me.”
thumbnail_IMG_1335
Mia is 10 and currently busy doing her SATS in school.
Her parents said “we enjoyed the session too –  a friendly and welcoming atmosphere. Everyone was so supportive, patient and understanding. We really hope you get sufficient funding to run this as it will be so beneficial for the children to be able to take part in sport.
As parents, we are often told by physiotherapists and occupational therapists to get our children to do relevant activities to help with coordination, muscle strength etc but it is almost impossible as the facilities are almost non existent, or impractical.
We most certainly would support and attend race running with Mia at Waltham Forest Athletics Club”
Aish is 7 years old and her favourite thing to do is to drive in her electric wheelchair, She said: “I can now run fast and take part in school sports”.

Her Mum: “For me I would say I never thought that my daughter would be able to run. It helps her breathing, improves her core muscle strength and boosts her confidence. I have been looking to get her joining a sport which she will be able to do with little help. Race runner gives her that independence.
             She enjoys it a lot and planning to use it for taking part in a triathlon. But will need lots of practise.

 

Amar
This is Amar who is 9 years old and has Dystonic Athetoid Cerebral Palsy.

All the children who came along were eager to come again. The only difference between the children in the wheelchairs and walkers and their able-bodied siblings and friends is that they need a RaceRunner – a sort of modified bike – to be able to run around the track.

So, the plan is to fundraise to buy some RaceRunners f or the club. Of the many obstacles and challenges these children and families face, this is surely one we can help to knock down relatively easily.

Watch this space to find out when we have the RaceRunners, and kids and their Families can come every week to have Fun, get Fit and make Friends.

If you are a family with a disabled child that might like to have a go at RaceRunning, or if you are a physio and would like to get involved, then please comment below or email me.

If you want to help us to raise money to buy the bikes (do a sponsored event for us? make us your work’s charity of the month? fundraise at your kids’ school?), again, email me.

 

This is what Hayley, one of the Coach’s from Access Sport, said after the event:

“Access Sport is a UK based sports charity which believes every child and young person should be able to access, experience and enjoy the power of sport to enhance their life prospects. We are delighted to be working in partnership Ellie to support the development of RaceRunning and meet the needs of those athletes who cannot run without assistance.

At the taster day, it was fantastic to see so many young people eager to try out RaceRunning. In such a short space of time, they all made great progress and some really were flying round the track! It would be fantastic to see those young people have regular access to Race Runners and reap the physical and mental benefits from participating in physical activity”.

I am really excited to be able to offer all the children I am supporting as a Physio the opportunity to participate in an accessible sport they can achieve in. Already it has helped the kids and I set meaningful, fun goals for them to work towards in their regular Physio sessions: “getting faster, going farther, needing less help… when they next hit the track!”

 

We already have £500 in our pot from Access Sport and CP sport may be able to lend us their RaceRunners so we can get started soon. Charlotte, who is a wonderful Physiotherapy Assistant who works with me, (and did so much to help turn my ideas and wishes to set up a Race Running club, into a reality) has got a few meetings lined up to discuss more donations.

So, finally HUGE thanks to the families and kids, and local Physio – Vivian from Waltham Forest- for coming along; Thanks to the lovely Charlotte for all her hard work and perseverance and for donating her time on Sunday morning; to Quest88 for providing the RaceRunners and tech support for our taster session; to the Feel Good Centre for hosting us; and to Access Sport and the Waltham Forest Wolves for letting us gate-crash their regular Sunday training session, and starting off the fund-raising with their donation.WFW_2017.jpg

If you’re interested in joining the Wolves check out this Poster for more details.

 

Whats On? Race Running Trial Day

I am setting up a RACE RUNNING Club

First step:

We are inviting all children aged between 5-21 with a disability (all abilities welcome from electric wheelchair users to walkers), to

Waltham Forest Wolves Athletics Club Waltham Forest Feel Good Centre  170 Chingford Road Walthamstow London E17 5AA

For a RaceRunning Taster Session on Sunday 7th May – 10-11:30 am

Please, come along and trial the bikes as well as joining in with the Athletics club who meet there each week at the same time.

For questions call me on 07812 158 519 or email elliejbarton@hotmail.com

I hope to see everyone who lives in the East London and surrounding areas there next week.

Next Step after that is to raise some money (potential donors have been invited to the Taster Session) so we can purchase some bikes and children can come and train each week.

Then, who Knows we could be training future Paralympians!

Read more about the dream of getting RaceRunning on the Paralympic programme in 2024: http://www.racerunning.org