head and shoulders, knees and toes: a comprehensive look ...€¦ · thelen, e. (2004). the central...

October2019

Doty, Hutchison, & Minard 2019: reprint with permission only

Antonette Doty, PT, PhD, PCS

Walsh University, LLA Therapy

Debra Hutchison, COTA/L

LLA Therapy

Carey Minard, OTD, OTR/L

Walsh University, LLA Therapy

Why Kids Need Recess

A performance driven culture….

…and our ban on play


https://youtu.be/hfCXTarOS9k

The Evidence

• 2015 Vanderbilt study

• Finland Education Reports

• Container Babies



https://www.ted.com/talks/sara_dewitt_3_fears_about_screen_time_for_kids_and_why_they_re_not_true

• Movement cannot be separated from perception and cognition. Cognition cannot be separated from movement rather it is embodied, meaning that it arises from bodily interactions with the world. Our experiences and interactions drive our abilities and conceptual understand of tasks such as opening a milk carton and riding a bike. (Thelen, 2004)

• The Importance of Practice (Adolf et al. 2012)

• 4 hours of baby play


https://www.youtube.com/watch?v=8vNxjwt2AqY

Quiz!



• Toddlers gain approximately 5# per year and 2.5” of length (mostly in lower extremities)

• Walk well and enjoy running, stair climb

• 2 year old can kick a ball, steer a push car

• Up/Down Stairs with support and mark time

• Walk on tiptoes• Stand on one foot • Jump with both feet• Throw/catch using arms

& body• Joyfully dressing

independently• Gallop• Eat with a spoon• Gradually developing

impulse control



• Pronated Grasp (2-3 years of age)• Imitating vertical, horizontal and

circular strokes• Stringing beads• Snipping with scissors• Stacking 10 blocks• Copying 3-4 block designs

3 years

• Alternating Feet/Reciprocal up the stairs

• Controls speed of movement• Happy riding a trike (no

steer-steer)• Momentary hopping, single

hop on dominant foot


• Appears less physically coordinated, stumbles, more fearful of movement

• Bowel and Bladder: dry all day; physical & emotional skills all present

• Delayed gratification• Seek autonomy but still seek intermittent

reassurance from caregiver


• Buttoning/unbuttoning• Lacing string• Cutting lines• Copying intersecting lines• Tracing lines


4 Years

• Typically “Out of bounds” in exuberance

• Wild, self-confident, & bragging• Walk down step alternating feet • Catch with hands only• Roller skates, small bike with

training wheels


4-4.5 Years

• Copying square• Cutting circle, square• Copying pyramid block design• Tripod grasp• Digit opposition (fingertips to

thumb)


5 Years

• More conforming, behaviorally

• Can dodge • Skip, long jump at

least 2 feet• Jump rope &

acrobatics• Overhand throw


5 Years

• Coloring between lines

• Copy a triangle• Copy some letters• Draw a person

with at least 6 body parts


6 Years

• Constantly on the go• Lugging, tugging, climbing to high• Consciously practicing balance &

climbing• Clumsy indoors• Spill things, appears less

coordinated than at 5 years oldDoty, Hutchison, & Minard 2019: reprint with permission only

Gross and Fine Motor Activity in A Functional Context = PLAY

• Children’s activity memory (for carry over & transfer of skills) is better when

• There is a clear outcome of the activity (2 y.o.)• Actions of the activity are logically sequenced• They help plan it before carrying it out (3 y.o.)


Developmental Sequences as a Therapeutic Framework

• Caution!! Why??

• Task & environment critical

• Multiple processes involving both proximal & distal function can develop at the same time

• Motor milestone sequences can be overlapping, or have spurts & regressions


Developmental Sequences as a Therapeutic Framework

• There are variations in typically developing children

• Must consider development of multiple domains

• Age and extent of disability must be considered when

deciding which skills will be functional

• Child & family involvement when deciding goals


Activities Sensory hallways


https://www.youtube.com/watch?v=D-3BDwL8rUA


• Simon Says• Jumping jacks• Obstacle Courses• Cross lateral marching• Weighted ball toss• “Basket”ball• Yoga• Wheelbarrow walks• Crab walks/crab soccer

• Peel stickers• Daubers• Tongs• Lacing cards• Clothes pins• Therapy putty/playdough• Pennies in bank• Buttons



Hyperdoc of Resources

https://docs.google.com/document/d/1mDM9bmCsxq8PcJ-wSI_FX-qiM_08YRIPxPCORoZqYwk/edit?usp=sharing

https://docs.google.com/document/d/1mDM9bmCsxq8PcJ-wSI_FX-qiM_08YRIPxPCORoZqYwk/edit?usp=sharing

References

Minard, Doty & Hutchsion, 2019: reprint with permission only

Adolf, K., Cole, W.B., Komati, M., Garciaguirre, J.S., Badaly, D., Lingeman, J.M. & Sotsky, R.B. (2012). How do you learn to walk? Thousands of steps and dozens of falls per day Psychol Sci, 11, 1387-1394. https://doi.org/ 10.1177/0956797612446346.

Centers for Disease Control and Prevention. (2019, February 8). Important milestones: Your child by five years. Retrieved from https://www.cdc.gov/ncbddd/actearly/milestones/milestones-5yr.html

Folio, M., & Fewell, R. (2000). Peabody Developmental Motor Scales [Measurement instrument]. Austin: PRO-ED

Lipsey, M.W., Farren, D.C., & Hofer, K.G. (2015). A randomized control trial of the effects of a statewide voluntary prekindergarten program on children's skills an behaviors through third grade (research report). Nashville, TN: Vanderbilt University, Peabody Research Institute.

Thelen, E. (2004). The central role of action in typical and atypical development: A dynamic systems perspective. In Stockman, IJ (Ed) Movement and action in learning and development: Clinical implications for pervasive developmental disorders. San Diego, CA. Elselvier Press.

Walker T. (2015) The joyful, illiterate kindergartner of Finland. The Atlantic. Retrieved from www.theatlantic.com/education/archive/2015/10/v-joyful-illiterate-kindergartner -of-finland/403825.

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