By: Dr. Ali

Do you feel like your child never stops moving? Like they are here, there and everywhere, running in between destinations and fidgeting in their chair while eating a meal? Even if you have asked them to take a pause they seem to not listen, or be physically unable to follow the instructions you are giving to slow down, even if they are traditionally a very good listener? Being in constant motion can be related to certain diagnoses, like ADHD. ADHD often presents with additional signs and symptoms, like forgetfulness, difficulty staying on task, trouble listening while another is talking, excessive talking, unsafe and impulsive behavior, and/or trouble with turn taking. Regardless of whether your child has a diagnosis of ADHD or not, there may be another factor contributing to their need for constant motion.

That “thing” is something we PT’s call postural control. Postural control defined as the act of maintaining, achieving, or restoring a state of balance during any posture or activity (1). When someone has a very “fine tuned” postural system, their body, vestibular system (little balance center in the ears), and eyes are telling their brain where they are in space and what position their body has to hold. Then their brain sends signals to the muscles to hold that specific position. In order for all of this to work, the eyes, the vestibular system, and the body have to send accurate signals, the brain has to correctly process this information, and the body must be able to coordinate muscles on all sides to hold the position steady. Phew, even thinking about this long process can make someone tired! 

When there is misinformation, trouble processing the information, or trouble coordinating the body in response to the brain’s signals, it will show in the body. When this happens, the child’s body may sway back and forth while they are trying to sit still in a chair, they may need to continuously move their feet instead of standing still, or they may just keep changing position when the one they are currently in becomes too hard to hold. When children are in constant motion, it often shows us PT’s that they are stuck constantly “restoring” their state of balance, as opposed to “maintaining” as the definition says above. Their body feels like it is always at risk of falling, so they move to catch themselves and prevent this. It may not look like that is what is happening when they are step, step, stepping, but if they are stuck constantly restoring their balance with decreased postural control, this is what their body is telling them is happening. 

When we see kids who show us this constant need for motion, we help them improve their postural control so that they can achieve and maintain steady postures. This is important for so many reasons other than just giving them greater stability. Sometimes when postural control improves, a child has an easier time paying attention to tasks and school lessons, because part of their brain isn’t being used to keep them on balance. All of that brain energy that was being used to signal movement that would prevent them from falling can be allotted to other things, because their balance system is operating on autopilot!

If you see your child having difficulty staying still and want to get another opinion, come in to KidPT for a free discovery visit, and a PT can answer any questions you may have about this topic!

References: 

1. https://pubmed.ncbi.nlm.nih.gov/10945424/#:~:text=Postural%20control%20is%20defined%20as,change%2Din%2Dsupport%20response.

Parents often ask us the difference between school physical therapy and private physical therapy.

I mean, why should a parent pay for a service they can get for free at school??!!

I totally get that, so I thought I would explain more in a blog post.  Because If they were the same, you would be right!  There would be no reason to invest in therapeutic care for your child that is being provided for free at school.

Let’s get into how they’re the same and how they’re different beyond their location of services.  

Isn’t Physical Therapy, Physical Therapy?

Physical therapists are all licensed to provide physical therapy and to work with all ages and all settings.  However, not only do goals change depending on the setting and the individual, but the role does too.

The role of physical therapy in the school is to support a child’s access to education.  It is to support their ability to participate in the least restrictive environment and support the motor skills needed at school.  The services are determined by the student’s IEP, Individualized Education Plan, and is a related service based on education law.  

Private physical therapy can look outside of the child’s education to look at the bigger picture of a child’s life today and in the future.  Private physical therapy can focus on goals from all parts of a child’s life, from keeping up with the family at the park to protecting a child’s joints so that they will be strong, healthy and pain-free for the future.  

Many children will benefit from physical therapy services in both settings to help them achieve success at school while also being able to guide the child towards their own personal potential.  

If you have questions as to the best ways to support your child, reach out to us today and one of our physical therapists can hop on the phone with you and chat about your options.  We are here to support you and your child and to help guide you to know your options so that you can best advocate for and support your child on their journey!

If you’ve ever watched a pediatric physical therapy session, you will often see us putting a toy or desired object just out of a child’s grasp so they are inspired to roll, crawl, walk, scoot, or reach for it. Setting up the environment this way helps us to encourage kids to utilize emerging motor skills and strengthen those skills while building confidence. When we set our environment up, we are always thinking about where the “goalpost” is and whether or not the goal we are setting is attainable for the child at that time. If it seems too hard, we have to adjust the height, distance, or surface where the toy is located so that the child we are working with is working hard but can still be successful!

Setting attainable goals is so important when kids are learning new skills because we want them to build confidence as they are building skill and we want them to enjoy practicing and learning. One way we see kids get really frustrated or discouraged when learning a new skill is when the goalpost is frequently changing as they are working to reach it. An example of the “changing goalpost” that often causes our kiddos to get upset is when they are a new walker, taking unsteady steps to reach mom, dad, or a toy, and who or what they are trying to get to keeps moving backward. We TOTALLY understand the desire to do this, it gets them to walk more, which is good right? While the easy answer would be “Yes, they are walking more”, it is more complex than this. While they are chasing the desired person or object, they are thinking “Gee, I only had to walk that short distance to mom when I started, and I definitely thought I could do this, but now she is getting farther and farther away, and I am getting tired. I don’t know if I can do this anymore.” Even though they definitely CAN do the skill for short distances, their confidence is then starting to decrease, and they may not want to try again because it takes SO MUCH effort to be successful. 

Don’t worry, this is a very easy fix! Say they are a new walker, have them start with a short distance first. Let them reach the object or person they are walking to and then let them play with the toy, hug mom or dad, and revel in the joy of their success with that mobility. Let them feel that joy for a few minutes while playing with the toy or hugging a parent. Then, once they have played for a short time, move the toy and redirect their attention to have them practice the skill again. Maybe even try to place the goalpost a little further next time, building on their ability as their confidence grows. Now they are learning that they can be successful with that motor skill, they are building confidence in it, while also learning that it is a new way of mobility they can use to reach things they want (a win, win, win)! Learning new motor skills takes a lot of patience, but overall the success your child will experience when moving and reaching each goal is worth the wait!

If you know what Physical Therapists do, you know one of the big things we focus on are MUSCLES! I’m sure you have heard all about your glutes and your abdominal muscles, but there is one group of muscles you may not have heard that much about, because it gets a little neglected sometimes. These muscles are the ones that help you BREATHE! Yes, there is a whole group of muscles that help you breathe, and just like every other muscle in the body, they can be EXERCISED to improve strength, endurance, and control. Normally, you don’t have to think when you breathe, which is really awesome because if we did have to think, we would probably not have the brain power to do anything else. But when we do think about breathing, we can teach the muscles to work in new and more efficient ways. Once you do train these muscles to work better, they start working like that for automatic breathing too! We miss doing these types of exercises at the clinic because of COVID, but that doesn’t mean they can’t be done in a safe, COVID free home environment!

Now, you might be asking yourself, why does this matter? Well, if you notice your child becoming out of breath while trying to walk and talk at the same time, they might have difficulty keeping their breathing efficient while they are moving around. If your child frequently becomes quiet or holds their breath when trying difficult things, they may have trouble coordinating breathing with complex motor and cognitive tasks. If this sounds like your child, here are some exercises that may be helpful for training their muscles for breathing for greater efficiency:

1. Sipping through the imaginary straw (Breathing IN through pursed lips): That motion your lips make right before blowing a bubble or drinking through a straw, when you push them very tight together, that is what pursing your lips looks like! Breathing in through pursed lips (the imaginary straw) increases the resistance you have to breathe against, which means that your diaphragm, the large muscle at the bottom of your lungs whose main job is breathing, can work toward getting STRONGER!
2. Blowing BIG imaginary bubbles (Breathing OUT SLOWLY): This one has a similar idea, but instead of strength, it’s all about CONTROL! When your child breathes out SLOWLY, they have to control the speed at which their diaphragm is relaxing back to its normal resting shape. If you add counting to this as well, the task involves even more control and coordination because they then have to match the speed of their exhale to an external rhythm, which adds motor COORDINATION into the mix as well! If this is too hard, start with a small mouth, which will help decrease speed naturally due to increased resistance.
3. Singing: Singing is AMAZING for COORDINATION and CONTROL of breathing. Someone who is singing has to match the timing of inhales and exhales to maximize how many words they can sing before taking each breath, which involves using breath control to prevent the air from leaving too quickly. All of these features are wonderful, not to mention that singing is so fun it has the power to bring a smile to anyone’s face!
4. Diaphragmatic Breathing: Diaphragmatic breathing is always a favorite because it works on breathing control, as in some of the exercises listed above, but it also increases relaxation. For this one, have your child lie down on the ground with their hand over their tummy and make sure you can feel see belly move up and down with each breath. Tell them to fill their belly with air while they count for 5 seconds, hold that breath for 3 seconds, then exhale for another 5 seconds. Adding counting to your diaphragmatic breathing again adds an extra coordination component because it requires them to control the rate their breathing muscles contract and relax to an external rhythm. If the specific times listed seem too long, they can always be adjusted to fit your child’s current ability so that the exercise is appropriate for you. 

If you found this information interesting and believe these concepts may apply to your child, but would like a second opinion, come on over to KidPT for a consultation with one of our Physical Therapists! And remember, inhale, exhale, and you will go places!

Disclaimer: All information in this post is for educational purposes only. If looking for medical advice, seek a doctor or related healthcare provider.