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Using the Nintendo Wii in Occupational Therapy

Thursday, October 7th, 2010

Here we are in the beginning of Fall and some kids are in full sports mode playing soccer or baseball. While the weather is still nice we encourage our kids to get outside and play. But, soon Fall turns into Winter and the kids are inside looking for some ways to play and entertain themselves and they may ask “Mom\Dad, can we go on the Wii?”

Initially we may say “no” because we don’t want to encourage “screen time”, however with a little ingenuity and creativity the Nintendo Wii can be turned into a powerful therapeutic tool. The Wii and Wii Fit games come packaged with numerous activities for strengthening and aerobic activity such as yoga and running. They were designed to be played as you would naturally play any sport. This may become trite over time, so let’s change it up to be more innovative, dynamic and even therapeutic.

To work on shoulder or neck strengthening, try the Wii Fit board.  For the soccer game (in the balance game section) for instance, you can get on your hands and knees, place and push your weight over your hands and try to play the game that way. This encourages neck extension and shoulder strengthening. Still too easy?  Then put your feet\knees on a low chair or low stool and your hands on the board to maintain your full body weight on your hands for a harder challenge.

Looking to gain endurance, try the running game. Instead of running on the floor try standing on a mini trampoline and jump\bounce, or do jumping jacks for the duration of the game. Try sitting on a therapy ball and bounce for extra sensory input. Bouncing on a large ball works with many children who can’t run. You can even put the Wii in front of your treadmill and exercise while playing the game. You can really simulate those hills!

Can’t stand for long periods of time? Then place the Wii board on a chair and sit on the Wii board. Shift your weight from side to side to make the characters move.

If you are playing the Sports games such as baseball, boxing, bowling, you can increase the challenge by putting on wrist weights. Try to improve balance to play the games while standing on a Bosu ball or other unstable challenging surface. This way you are activating your core muscles as well as your shoulder and hand muscles.

There have been studies that indicate that exercising while using virtual reality systems, such as the Wii, tend to be more engaging, interactive, absorbing and FUN! Therefore, people are willing to spend more time and work harder at home exercise programs that include interactive games compared to those exercises that do not include such activities. Your child’s therapist can always recommend specific games and adaptations to meet your child’s individual needs.

So now when the kids ask “Can I play on the Wii?” you can safely respond yes knowing that with a little creativity and ingenuity they are getting a good therapeutic work out.

Gershon Kravetz MS\OTR\L

This entry was posted on Thursday, October 7th, 2010 and is filed under Boost Gross Motor Coordination & Rhythmicity.

Water Games For Upper Body Strength And Coordination

Monday, June 29th, 2009

START THE SUMMER WITH A SPLASH:

Water play is both fun and beneficial for your child. Water is naturally resistive, which makes it so great for strengthening. Additionally, water provides uniform pressure to the whole body, which facilitates body awareness and sense of body position in space.

These activities and toys are best for younger children or those children who are tentative about entering a big pool since they can be done outside the pool or in a small, child-sized pool. They also strengthen the upper body and challenge fine motor control.

Water Toys:

Sponges: Fill up a container by squeezing water from a sponge. Start with smaller sponges and progress to larger ones. Holding the sponge at shoulder level or higher increases shoulder strength.

  • Spray Bottles: Use the spray bottle for target practice by aiming for a particular spot on a wall or plastic easel drawn from chalk or shaving cream. Using a bigger, fuller spray bottle and holding it at or above shoulder level increases the challenge. Use the thumb, index, and middle fingers to squeeze the trigger and the ring and pinky fingers to hold the bottle steady.
  • Use a squeeze bottle (like a restaurant-style ketchup squeeze bottle, www.zesco.com) to fill water balloons. Toss the balloon at the target.
  • Squirt Toys: To increase hand strength, fill the toys up, and squirt the water while aiming for a target.
  • Wind-up Toys: These toys are generally available as bath toys, but are just as much fun in the pool. Use the thumb, index, and middle fingers while keeping the ring and pinky fingers tucked into the palm to prepare the hand for using scissors and controlling pencils and crayons.
  • To build shoulder strength, pour water from pitchers to cups, starting with a smaller, lighter pitcher.

These games are best for children who feel comfortable in the water. For those children who love the water, playing water sports is a fun way to incorporate eye-hand coordination, upper body coordination, and overall strengthening and endurance into summer play. Simply walking through water can enhance the sense of body position in space and balance!

Pool Sports & Games:

Water Volleyball:

  • For younger children, try the Giraffe Volleyball Pool Game (www.toysrus.com)
  • For older children, try Swimways Poolside Volleyball Game (www.toysrus.com)
  • Water Basketball:
  • For younger children, try Kool Dunk Basketball Pool Game or Water Basketball with Ring Toss Game (www.toysrus.com)
  • For older children, try Pro Water Basketball Pool Game (www.toysrus.com)
  • Water Bull’s Eye: Floating Target Pool Game (www.toysrus.com)
  • Water Tag
  • Belly Board: Lie on a kickboard belly down and use your arms to propel through the water to build upper body strength.
  • Pool Races: Run across the pool as fast as you can. Or, try straddling a pool noodle and race across the pool by using your arms to paddle.

Play safe: Remember to always apply sun block regularly, especially after playing in the water.

For additional water play ideas, tips on easing your child into the water, and an explanation of the sensory benefits of swimming, read our blog “Water Fun for Everyone!” (posted on July 15, 2008).

Blog written by: Aviva Goldwasser, MS, OTR & Chaye Lamm-Warburg, MA, OTR, Director POTS
This entry was posted on Monday, June 29th, 2009 and is filed under Boost Gross Motor Coordination & Rhythmicity, Seasonal Tips.

Outdoor Games

Friday, June 19th, 2009

COORDINATION GAMES FOR EVERY AGE

These days the warm weather keeps us outside longer. Whether you’re at a playground or playing in your own backyard, there are lots of fun games that you can play that can help improve gross motor coordination, balance, bilateral integration, eye-hand coordination, and core strength.

Hopscotch: Use the hopscotch in the playground or draw your own with chalk. It is a challenge to hop and balance on one foot and it requires smooth coordination. For beginners, draw a hopscotch board with smaller squares so that it is easier to hop into all the boxes and skip the square with the chalk in it. Start with a small piece of chalk and then use a full piece of chalk to make the activity more challenging. Smooth, continuous hopping and jumping throughout the game is the highest level of performance.

Frisbee: Tossing a Frisbee is good practice for eye-hand coordination. When catching a Frisbee, begin with a larger Frisbee that is easier to catch and move toward playing with smaller ones.

Hula hoop: It looks easier than it is and is a great way to improve the stability and strength of the core muscles in the trunk. For an added challenge, try catching a ball or racing down the block while hula hooping. Alternatively, play “leap frog” by arranging a series of hula hoops on the ground and hopping like a frog from one hoop to the next.

Jumping Rope: Jumping rope is a wonderful form of exercise. It requires the upper body and lower body to work together in addition to challenging balance and rhythmicity. Other games with a jump rope include: (1) When playing in a group, arrange the jump rope in a straight line and label one side “dry” and the other side “wet”. Have one person call out “dry” and “wet” in random order and all players need to jump from one side to the next without touching the rope. (2) Have one person hold the jump rope low to the ground and shake the rope quickly from side to side so that it looks like a rattlesnake. All players need to hop over the rope without it touching their feet. (3) Play Limbo with the jump rope and see how low you can go before losing your balance.

Bean Bag Toss: Choose “targets” around the backyard and toss bean bags at them to improve eye-hand coordination. Keep it challenging by starting further away from the target. Start with larger targets that are easier to hit and progressively move toward smaller targets.

Balloon Bop: This game is good for a younger child or children who are afraid of having a ball flying at them because the balloon travels much slower than a ball. Play alone or with a friend and see how long you can keep the balloon in the air before it touches the ground. Try using round and long balloons (www.orientaltrading.com).

Chalk Bull’s Eye: Draw a bull’s eye on the back or side of the house with chalk. Use a ball or bean bag to aim for the center. Score 10 points for hitting the center, 5 points for the middle circle, and 3 points for the outer circle. See who can earn the most points. Alternatively, make the bull’s eye using shaving cream or funny foam and use a water gun, spray bottle, or super soaker to “melt” the foam. Using a heavier, fuller water gun or spray bottle will help increase upper body strength. Standing farther away from the target increases the challenge of hitting the bull’s eye.

Blog written by:

Aviva Goldwasser, MS, OTR

Chaye Lamm-Warburg, MA, OTR, Director POTS
This entry was posted on Friday, June 19th, 2009 and is filed under Boost Gross Motor Coordination & Rhythmicity, Seasonal Tips.

Spring into Action: PART 2: Riding a Bike

Monday, May 11th, 2009

Last week’s blog highlighted the benefits of enjoying swings to provide vestibular input and improve skills. This week we will discuss another great outdoor activity that can promote balance, gross motor coordination, and rhymthicity.

Bike riding is a fun way for your child to get around and is a great social ice-breaker, but can be a challenging skill to learn. It requires the integration of vision with upper and lower body movements. The eyes must guide a safe path as the upper body steers and the lower body pedals rhythmically- – all while balancing.

For a beginner, start with a tricycle or a bike with training wheels for added stability. This will allow your child the opportunity to get the hang of the pedaling without also having to simultaneously balance. “Getting the feeling” of the movement is a first step in learning most motor skills. Once he is proficient at steering and pedaling, it is time to progress to a two-wheeler, and add the balance challenge.

To ensure maximum efficiency and to reduce the likelihood of injury, make sure that you purchase a bike that is well-suited to your child. Your local bike vendor will be able to guide you when choosing a bike as well as help fit the bike to your child’s individual size and preferences.

Guide to Kid’s Bike Sizes
Age Child’s Height Bike Wheel Size
Age 2 – 5 26 – 34 inches 12 inches
Age 4 – 8 34 – 42 inches 16 inches
Age 6 – 9 42 – 48 inches 18 inches
Age 8 – 12 48 – 56 inches 20 inches
Youth 56 – 62 inches 24 inches

Please note: Children’s bikes are measured in wheel size (diameter) in contrast to adult bikes whose measurements refer to frame size.

A few general guidelines to keep in mind:

  1. When standing over the frame with both feet flat on the ground, there should be 1-2 inches of clearance between your child and the tube of the frame.
  2. Seat height should be set so that your child’s legs can extend almost completely straight, with slight bending at the knee when the foot is on the pedal in the bottom position. If your child can put his feet flat on the ground other than on tippy-toes while seated, the seat is too low.
  3. The seat itself should be as level as possible to avoid sliding forward or slipping backward. You can also move the seat forward and backward in relation to the seat post.
  4. The height of the handlebar should be at a level that feels comfortable to avoid straining the muscles of the back, shoulders, and wrists. Generally, the higher the handlebar, the more upright your child will sit.

Make realistic goals and allow your child to set the pace. At first, start with very short sessions so that your child does not become overly frustrated. Slowly increase the amount of time spent practicing. Take your cue from your child.

Begin on smooth, even terrain free of obstacles as your child learns to pedal. Allow him to get the feel for the rhythm of pedaling, increased speed, and cruising. Attempt an incline before a decline since it can be more unnerving to ride the brakes as the bike gains speed downhill. Depending on your child’s preference, bikes are widely available with either foot or hand brakes.

A good place to start is in a driveway, where the narrowness can help your child naturally steer straight ahead. Progress to an empty parking lot, where you can use cones to create a straight pathway before creating a more challenging obstacle course.

To become a proficient bike rider and learn to balance, have your child pick a point way ahead to focus on. This will ensure that his eyes look straight ahead rather than down, which will decrease the likelihood of falling and help your child steer safely away from obstacles.

Often a child’s biggest fear of bike riding is falling. To make your child feel more confident and less afraid, you can model falling off the bike in a safe way, and getting back up. Be sure to practice somewhere soft, like on the grass.

Safety comes first. Always remember to wear a helmet when riding a bike. As your child learns this new skill, you may be interested in purchasing arm and/or knee pads for added protection.

Information about bike sizing is from www.bicycling.about.com

Blog written by:

Aviva Goldwasser, MS, OTR

Chaye Lamm-Warburg, MA, OTR, Director POTS
This entry was posted on Monday, May 11th, 2009 and is filed under Boost Gross Motor Coordination & Rhythmicity, Seasonal Tips.

Spring into Action: Enjoy the Ride!

Friday, May 1st, 2009

Spring is here! And so is the warm weather. With this blog we begin a series in which we will share activities, games, and crafts for springtime. Stay tuned for fun sensory play ideas that can also improve eye-hand coordination and gross and fine motor skills.

Outdoor activities provide wonderful and rich sensory experiences. Together with your child explore the sights, sounds, and smells that are so unique at this time of year. Look at all the sprouting and budding plants and flowers. Listen to the birds and the sounds of people walking and playing outside. Smell the cut grass and fresh flowers.

The playground is full of opportunities to enhance sensory input. If your child finds the park overwhelming, start in your own backyard or plan to come to the park when it is not as crowded.

Swinging is a great way to get vestibular input. Experiment with different types of swings and using familiar swings in more than one way. Using a variety of swings will provide the opportunity for movement in different planes, which will enhance the sensory input. Sitting on a strap swing is good for linear, front-to-back movement. Alternatively, have your child try swinging on his belly, which will allow him to invert his head. If your child likes to spin (rotary movement), turn round and round on a strap swing so that the ropes are twisted and then release. Try hanging a Little Tikes disc swing (www.toysrus.com) from a tree or on your swing set for wide, circular motion (orbital movement). The type of the input will vary depending on several factors, including the position of the head while swinging (upright vs. upside down) and direction of the motion (linear, rotary, orbital). A more intense experience is achieved by swinging fast, high, and upside down. Note which positions and motions your child craves and which he avoids. Approach each new position and motion gently and provide only what your child can comfortably tolerate and enjoy.

Playing catch while your child is swinging on his belly is a challenge for eye-hand coordination. Or try kicking the ball back and forth while your child is sitting on the swing for eye-foot coordination. Start with a bigger ball that is easier for catching and kicking and progress to a smaller ball as your child’s skill level improves.

If your baby tends to slide around too much in the swing or your child slips off the swing, try placing dycem (www.dycem.com) or a Rubbermaid non-slip mat (www.yahoo.com) on the seat of the swing for added safety.

For a child who is tentative about getting on the swing, start at your child’s comfort level and slowly amp up the challenge as he becomes more comfortable and confident. If needed, place him on your lap. When he is ready to be on his own, start off with a swing that offers more support. Many parks have swings for older children that have backs, which may make your child feel more comfortable. Slow, gentle, front-to-back swinging is a good way to start since the movement can be very calming. Allow your child to set the pace. Maintaining an even speed will make the ride smooth, predictable, and calming. The jolting movements from sudden starting and stopping can be alerting or over-arousing, so set the pace carefully.

Swinging- and playing in the park- is a great way of feeding your child’s sensory needs in an age-appropriate setting. While coming to occupational therapy is important, it is also important for parents to help children find ways to satisfy their sensory needs in a natural setting. It is a social environment for both parents and children alike and provides a good opportunity for peer interaction as well.

Blog written by: Aviva Goldwasser, MS, OTR

Chaye Lamm-Warburg, MA, OTR, Director POTS
This entry was posted on Friday, May 1st, 2009 and is filed under Boost Gross Motor Coordination & Rhythmicity, Seasonal Tips.

Digital Metronome

Monday, April 20th, 2009

For those of you who inquired about the digital metronome we use in sessions, you can purchase the Korg MA-30 Ultra Compact Digital Metronome at many online sites such as amazon.com.

This entry was posted on Monday, April 20th, 2009 and is filed under Boost Gross Motor Coordination & Rhythmicity.

Stick to the beat!

Monday, March 23rd, 2009
Use of a digital metronome to facilitate rhythmicity, coordination and organization has become a part of many treatment sessions at Pediatric Occupational Therapy Services (POTS). Many parents have purchased them and are using them to implement home programs under the guidance of their occupational therapist. So what exactly is this pocket sized “toy” that makes different sounds, and what are the benefits to using it?

What is a metronome?

  • The metronome is used to keep a steady beat. It can typically be programmed to a speed ranging from 40 bpm (beats-per-minute) to 208 bpm.
  • It is often used by musicians to help improve their rhythm, timing, and speed.
  • There are several different versions of the metronome, from the classic mechanical one to the more sophisticated pocket or computer generated variety, each with varying features. Check out the POTS recommended Korg MA-30 Ultra Compact Digital Metronome at www.amazon.com, or look for it at your local music store. The Korg has a visual display and the sounds can be made louder or softer, depending on the needs of your child.
  • At Pediatric Occupational Therapy Services we have been using the computer-based Interactive Metronome (Advanced Brain Technologies; www.advancedbrain.com) as a comprehensive office-based treatment modality since 2002. The digital metronome has enabled us to harness the power of rhythmicity and incorporate it into daily sessions and home programs as well.

What goals can the metronome help my child achieve?

What are some activities that he/she can do with the metronome at home?

  • There are numerous activities that can be performed with a metronome. With each activity, pick a specific speed. Anywhere between 40 and 60 bpm is a typical starting point, but check with your therapist first to determine what speed is the most appropriate for your child.

Try doing the following activities “to the beat”:

  • Clapping with both hands
  • Stomping with both feet
  • Jumping with both feet together
  • Jumping on one foot
  • Clapping and stomping hands and feet simultaneously
  • Hitting a target (make one out of a piece of construction paper) on the wall with your hands
  • Hitting a target on the floor (a colored dot) with your feet
  • Throwing a ball back and forth to another child with or without bouncing it
  • Throwing a ball against the wall with or without bouncing it

To increase the challenge, try activities that require crossing the midline of the body to facilitate bilateral coordination:

  • “Cross Crawl”: Alternate touching your right hand to your left knee and your left hand to your right knee
  • Alternate touching a target to the left with your right hand (yellow dot) and a target to the right with your left hand (red dot)
  • Hand games such as “Miss Mary Mac” and “Patty Cake”

When performing activities, look to see if your child tends to be hyper anticipatory (follows the beat too early) or hypo anticipatory (follows the beat too late). Help your child stay on the beat by having them count out loud and/or close his/her eyes. Do the activities together with them to help get them going.

Encourage your child to be creative and think of new and fun ways to use the metronome themselves.

By:  Rachel Romanoff, MS, OTR/L  &  Chaye Lamm Warburg, MA, OTR
This entry was posted on Monday, March 23rd, 2009 and is filed under Boost Gross Motor Coordination & Rhythmicity, Sensory Integration.