It Takes Two To Tango

As promised here are some of my go-to strategies during therapy sessions.  This carries over to home activities as well as any time a child is learning something new or facing a challenge.  None of these strategies have anything to do with physical therapy, movement, or motor development, but without them I wouldn’t be able to guide my kiddos to reach their goals.  The bottom line is that it takes two to tango and if the kiddo isn’t dancing, you’re not getting anywhere!

1. What does the child like?

Take advantage of the child’s interests.  If they are doing an activity they are not interested in then only a little part of the brain lights up, but if they are emotionally engaged the whole brain lights up.  That’s when real learning takes place.  This can be as simple as pretending that the child is Spiderman story while they are doing a climbing activity or to watch out for the alligators when they walk over the balance beam.  Other times the child can choose the game and the therapist or parent can incorporate the game into the activity.  This requires a lot of flexibility and quick thinking, but it’s a beautiful thing to have an excited motivated child working hard to learn new skills!

2. Create Structure

In general it is helpful to design a structured activity with clear expectations.  The child then knows that they need to do something “x” numbers of times to complete it.  The task should have a clear beginning and end and be very concrete.  We can then utilize behavioral strategies as needed.  This can be a reward at the end- blowing bubbles, etc.  If the child is exhibiting behavior problems and the reward isn’t enough, I will lessen the number left, but I will always require the child to finish the task.  Even if it is completed hand over hand, it is done.  The child has learned that they need to complete the task.

To contrast everything I said above about structure, you must be flexible.  Sometimes the task itself needs to be harder or easier.  You can change pieces of the task or you can add verbal cues, hands on assist, or visual cues.

You should feel free to deviate with child’s creativity as long as it’s not avoidance. Let the child repeat a challenging piece of the activity over and over if they choose to- this is a natural way that motor learning will occur.

3. Be fun

This seems like a silly statement, but sometimes as adults we have a hard time getting out of our own way. Its OK to get messy and its OK to be silly.  Sing songs, put funny hats on your head and be willing to do anything for a laugh (see giggle post).  Be creative, introduce new toys/activities/experiences, and get in touch with your childlike self.

4. “Be the toy.”

This is a great strategy for children who have limited attention or engagement with others.  Similar ideas can be found in the Floortime and Hanen programs.  The idea is that you are where the fun happens.  This can be tickles, a flying ride, bouncing on your knee, bubbles, pretending you’re asleep and then being silly, etc.  Any activity that you can do, stop, and then wait for a request (gesture, words, sound) for more.  This facilitates communication, interaction, and attention.  Even as a physical therapist, where my goals are movement, I still need to start with these basics so that I can create a learning environment and so that I can build rapport with the child.

5. Take advantage of sensory preferences

I always use sensory preferences to my advantage- sometimes this means that I know a child will love to be upside down.  I can then work on getting in and out of upside positions.  If a child craves deep pressure, I can have them crawl through a resistance tunnel, push a laundry basket, or help to carry the groceries.  The child is getting the deep pressure they crave while getting the strengthening and postural control that I am looking for.  Children with have vision as a strength often benefit from using visual strategies to organize themselves.  Sometimes having a child stand on a carpet square makes all the difference between them being able to participate in ball play with a peer and being completely unable to participate.

6. Choices

Giving children two choices (both of which are ok with you!) gives the child a feeling of control.  All children, but especially children with disabilities, look for opportunities to control the situation.  One way to diffuse the situation is to give choices.  This also helps children on the road to independence.

7. The only thing constant is change

Children change and strategies that work will change.  For example, my 2 year old was going to sleep fine after I rubbed her back.  After a few months she wasn’t interested in this, and then would ask to go into the crib once I turned the lights off and we sat in the glider together.  Several weeks later I now have to ask her if she wants to “jump” or “climb” into the crib.  She answers and in she goes.  Children will constantly change with growth and maturity- its up to us to keep up!

3 replies
  1. Barbara
    Barbara says:

    This is excellent, Joni – separating these characteristics of interaction from PT. The line is fine between exercise and ‘dance’, between the how of eliciting movement and calling it therapy, but I think your description here can help parents understand why they like some therapists more than others; why some therapists are more effective than others. Very difficult to measure but undeniable.

    Reply
  2. JM
    JM says:

    Excellent post! Thank you so much. This is the kind of thing you don’t learn in grad school, unless you are lucky to have a good preceptor. You might like my post at The Thinking Person’s Guide to Autism today about the therapists I’ve fired. You’re much more positive though!

    Reply
  3. Dr. Joni Redlich, DPT
    Dr. Joni Redlich, DPT says:

    Thanks Barbara and JM! I think I finally have my answer when parents ask me how they will know they have a good therapist! Its unfortunate that students don’t learn more of the “how” to provide therapy- I strongly believe that all the nitty gritty details are the easy part. You have to learn how to work with children and the rest can be learned.

    Reply

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