Advanced Pediatric Therapies


Spring Fever: Fun Outdoor Learning

Spring is here!  Check out these fun ideas for outdoor learning and play, now that we can finally get outside.  The article appeared from Rasmussen College.

Engaging Outdoor Learning Activities for Kids

outdoor learning activities for kidsYour three-year-old is literally bouncing off the walls, your kindergartener is running the stairs like he has a personal trainer and you’re just wishing you could steal some of their energy for yourself. One thing is for sure: if they stay cooped up in the living room much longer, it’s going to be declared an official disaster zone.What’s the solution? Round them up and head outside! Not only will it give your furniture a relief but the great outdoors holds countless learning opportunities for your kids.We enlisted various experts to provide some examples of outdoor learning activities to help get you started. Try these skill-builders for preschool-aged kids to help your little ones burn off energy while achieving developmental milestones.

10 Fun outdoor learning activities for kids

1. Texture scavenger hunt

How it works: Place nature objects with different textures in several brown lunch bags. You could put a pinecone in one, a stick in another and a stone in a third. Have your kids close their eyes and feel each object. Then send them outside to find a similar texture. As they find matching objects, introduce texture words like pointy, bumpy and smooth.

How it promotes learning: All of those new words will expand your little ones’ vocabulary. Discriminating between different textures also supports fine-motor skills like coloring and writing, according to pediatric occupational therapist Christie Kiley.

2. Beach volleyball

How it works: Playing volleyball with an inflatable beach ball is another worthwhile activity, says Cara Koscinski, pediatric therapist and author of The Pocket Occupational Therapist. You can also simply throw the ball high in the air for your kids to catch if they are too young to play an organized game. Challenge them to count how many times they can clap before catching it! (Hint: If they have trouble gripping the ball, simply deflate it a bit.)

How it promotes learning: You can probably guess that this game teaches counting and social interaction skills. Koscinski explains that catching a ball using both hands also teaches bilateral integration, a necessary skill for learning tasks such as cutting, buttoning and tying shoes.

3. Pulling weeds

How it works: Yep, this is just what it sounds like! Believe it or not, your little ones can help with the gardening and learn at the same time—it’s a win-win!

How it promotes learning: All that digging and pulling is great for sensory exploration as well as building hand and finger strength, explains Kiley.

4. Pool noodle obstacle course

How it works: Get creative with pool noodles and design an obstacle course. Lay them on the ground, cut them in half, attach them to a fence or hang them from a branch. Challenge your kids to jump over them, limbo under them, crawl around them or walk on them like a balance beam.

How it promotes learning: Getting up and moving helps kids build core muscle strength. Koscinksi explains that this will later be used for completing school tasks seated at the desk.

5. Nature hike

How it works: Nature offers plenty of discoveries for kids. Help them explore by encouraging them to find certain types of leaves, bugs, rocks and flowers.

How it promotes learning: A nature hike encourages observation skills, fine-motor skills, hand-eye coordination and the use of the five senses in exploring, according to Barbara Harvey, author of Journeys Through Parenthood and executive director of Parents, Teachers, and Advocates.

6. Critter quest

How it works: Miriam Manela is the owner of Thrive Occupational Therapy and recommends this activity in her book The Parent-Child Dance. As the “critter,” you slowly inch your way around the yard while narrating your movements. You might say, “I’m climbing up the swing set. What letter does ‘swing’ start with?” Try to work in new words like climb, reverse and descend. Your kids are the “trackers.” It’s their job to follow you with their eyes and think about your questions.

How it promotes learning: Critter Quest improves eye movement and tracking, plus it can be used to strengthen vocabulary, letter recognition and phonetics.

7. Chalk jump

How it works: Koscinski suggests using sidewalk chalk to write numbers and letters in different colors. Then ask kids to jump on the number, letter or color that’s called out.

How it promotes learning: This activity helps develop gross-motor skills, counting skills and letter, number and color recognition.

8. Simon says dance party

How it works: Head outside with some music and host a dance party. Give short instructions for nature-based dance moves, like “wiggle like a worm,” “twist like a leaf” and “flap your arms like a bird.”

How it promotes learning: Kids get to practice following simple instructions while being active. Kiley adds that the dance actions help them develop body awareness, coordination and balance.

9. Hula hoop hop

How it works: Line up several hula hoops and have kids hop into the middle of each hoop with both feet, explains Koscinski. Make it a bit more challenging by encouraging them to hop into one hoop with their right foot and the next hoop with their left.

How it promotes learning: All that hopping builds gross-motor coordination skills, which are necessary for sports and bike riding.

10. Flower artists

How it works: Gather your young artists and some paint (watercolors or liquid tempera) near a flowerbed. Watch them create their newest masterpiece!

How it promotes learning: Kids will hone their observation skills and learn about colors. Kiley recommends offering paintbrushes with a built-in grip to promote a mature grasp.

Let the fun begin

These 10 outdoor learning activities will have you having fun with your rug rats in no time. They won’t even realize you’re teaching them new skills instead of watching them tear up the house.

Your search for educational opportunities for children might be a sign you should be doing this for a living.Learn more about other signs you should be teaching preschool!

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What is “Vestibular Processing” anyway?

Spinning is super fun!

Spinning is super fun!

The following is excepted from North Shore Pediatric Therapy:


The vestibular system detects movement and gravitational pull, and it provides information regarding the position of our head in space and acceleration and deceleration of movement. It is the first sensory system to fully develop in uteroandis located in the inner ear. The vestibular system has strong neurological connections in the brain and is a major organizer of varied sensory input. This system is considered the most influential sensory system and has tremendous impact on one’sability to function daily. Directly or indirectly, the vestibular system influences nearly everything we do. It is the unifying system in our brain that modifies and coordinates information received from other systems, and it functions like a traffic cop, telling each sensation where and when it should go or stop.  


This system affects aspects of physical function like posture, balance, movement, coordination, attention, arousal level, impulsivity and behavior. The vestibular system works with tactile, auditory, and visual information to give us our perception of space and our position and orientation within that space. Children affected by poor vestibular processing may be perceived as inattentive, lazy, overly anxious, or seeking attention. They may have trouble reading or doing simple arithmetic. Functioning at school, going out into the community, performing routine daily tasks, or just getting out of bed in the morning may be difficult for children with vestibular difficulties.


Poor vestibular processing (or vestibular dysfunction) can occur for a variety of reasons; often, however,children develop a vestibular disorder for no known reason. Possible causes for vestibular dysfunction include: premature birth and a fairly long period of incubation after birth, exposure to excessive movement or invasive sounds as a fetus or infant, neglect (little handling and moving) during infancy, repeated ear infections or severe ear infections, maternal drug or alcohol abuse during pregnancy, or general developmental delay and immature development of the nervous system.


Symptoms and functional difficulties of poor vestibular processing include:

  • Over-arousal or under-arousal
  • Excessive movement
  • Avoiding movement at all costs
  • Difficulty maintaining attention
  • Motion sickness (car, boat, airplane), dizziness or nausea caused by watching things move
  • Excessive spinning or excessive watching of things spin
  • Inability to read or write in cursive
  • Decreased auditory processing
  • Inability to sustain listening without moving or rocking
  • Problems with balance (static or moving) and/or vertigo
  • Difficulty walking on uneven ground, and difficulty navigating stairs
  • Head banging
  • History of traumatic brain injury, shaken child syndrome, ear cuffing, etc.


The vestibular system primes the entire nervous system to function effectively by sending messages to the higher centers of the brain. When the influences of vestibular stimuli fail to reach their destinations, they cannot adequately contribute to sensory integration. One result of depressed processing in the vestibular system is hypotonicity (low muscle tone); when this system is not integrating information as it should and muscle tone is decreased, it is difficult to initiate movement or to maintain muscle tension during movement, resulting in significant difficulties in fine/gross and oral motor coordination.

The vestibular system also tells us where we are in relation to the ground, giving us a confidence that if we jump, swing, or somersault, we know we will hit the ground on our way down. Thisknowledge is called “gravitational security,”and with this basic sense of stability, children develop emotional security.

A child with dysfunctional vestibular processing, who does not possess “gravitational security,” tends to be inflexible, fearful and controlling due to the fact that he lacks control over the world around him and how he moves through it. This child often suffers from social problems as well, as he feels vulnerable to unpredictable situations caused by those around him.

Our Approach at APT:

At APT, we treat vestibular dysfunction in a variety of ways.  The most obvious are all the swings, climbing apparatus and tunnels you see around.  But we also address vestibular dysfunction by using auditory interventions, primarily therapeutic listening.   We don’t treat it in isolation either.  Most of the activities we utilize integrate many layers of sensory skills and we work toward what is best for your child.   Please ask us if you have questions!

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Why Can’t My Child Focus?

As your child goes back to school, you may be concerned about his or her ability to pay attention.

As your child goes back to school, you may be concerned about his or her ability to pay attention.

At APT, we see a lot of kids who have a hard time paying attention.  They fidget, they get up, their eyes wander.  There are as many reasons for this as there are kids!  By paying attention yourself, you can help your child focus on the task at hand.

You’ve got to move it, move it…  I apologize in advance for getting that song in your head, but it’s true!  Movement kick starts the brain’s ability to pay attention.  Provided in the proper ways, movement helps a child’s focus.  A great way to start the school year is to walk to school, or if you can’t, park further away and walk.  Try and get some movement going in the morning.  Stay away from the tv.

Talk to your child’s teacher.  Giving them a head’s up on your child is important.  Lots of teachers have great expertise in helping kids to focus with such programs as BrainGym.  Doing wall push ups or dots and squeezes prior to activities which require focus is helpful.  Some teachers set aside long periods for seated work.  Let your child’s teacher know that he or she will need a movement break (which can benefit the whole class!)  If you need suggestions for how to talk to your child’s teacher, ask us!

Read to your child, or do crafts.  When kids see that if they put the time in, they will be rewarded, they are more likely to follow through.  Try your hardest to keep going even when your child wants to give up (squirming, eye-rolling…).  Your commitment to the end result (getting to the ending of the story, a complete craft project) will go a long way to helping your child know the consequences of diligence.

Pay attention to posture and breathing.  When kids are slumped or don’t otherwise have room to expand their breathing muscles, they engage in more shallow breathing.  As such, their bodies are telling them, it’s okay to relax and check out now.  When kids sit up, they are more able to breathe efficiently and thereby pay attention better.  Try it yourself.

Board games.  Those board games that are gathering dust?  Pull them out of your closet and give them a whirl.  A game with a beginning, middle and end is a great way to reward sustained concentration.  You may have more fun than you think you will!  See us for ideas on games your child might like.

Go outside and play.  Tag, hide and seek and catch are great ways to encourage longer periods of focus.  Working in the yard, garden or tool shed with dad are great ways to motivate longer periods of attention.

Rethink technology.  Many of us parents are loathe to allow a child to spend time in front of a screen.  Read this article on the Touch Screen Generation.  It may help you figure it out.  Limiting their time and having them earn screen time are good ideas.

Examine your own reactions.  Try not to let them give up, even when accompanied by whining.  Also, don’t run to help them at the first sign of frustration.  It’s good for your child to be uncomfortable and have to struggle to figure something out.  Now is the time for them to learn those skills.

As always, ask your OT to help you if you have questions or concerns.

Thanks to Pediastaff for some ideas in this post.

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Back to Basics: Why Play Matters

Welcome back to the blog!  We’ve been on vacation-hope you had a great summer!

Time for a reminder of what play is really all about.

Time for a reminder of what play is really all about.

As occupational therapists, we believe that work is the job of childhood.  Okay, not the 9-5, clock in-clock out type drudgery they you may be used to thinking of as work.  Play is the primary occupation of kids and as such, it is where they go to learn, make friends, grow and adapt.

Play helps your child learn about the world around them.  Have you ever gotten your child a present only for them to be more enchanted with the wrapping paper and how it sounds when you crinkle it?  Ever taken them to an awesome playground and all they want to do is play with the rocks?  This type of play demonstrates the innate curiosity kids have for the world around them, and their inner drive to discover how it all works.  By engaging in this type of play, they figure things out like:  how big is it?  how does it feel?  will it interact with me?  what made it?

How cool is that?

Play helps kids learn about themselves and their bodies.  Just by throwing or kicking a ball, kids can learn so much about how their bodies work and how to make themselves or other things move.  They learn how tall or short they are, how strong they are and what they are capable of doing.  Mirrors are a great way for kids to learn about their bodies, but so is movement, which is the focus of most of the play you see at APT.

Play helps kids learn about other kids.  By playing with other kids, your child is able to learn a great deal about socializing, cooperating, compromising, and predicting the behavior of others.  It’s how your kids make friends.  When your child plays with other kids, they learn the value of being part of a team or partnership.  Kids learn even when engaged in parallel play (play alongside another child) and they begin to understand what type of play partner they prefer (quiet, busy, etc.).

Play develops muscles and subsequently coordination, endurance and a host of other physical skills.  By moving their bodies, kids build stronger muscles.  Have you tried doing the monkey bars lately?  That is hard work!  Muscles give joints feedback when they are used and give your child a developing sense of where their body is in space.

Playtime provides relief from boredom, sadness and anxiety.  Research suggests that simply getting your kids outside to play is an effective way to stave off depression and anxiety in today’s high pressure world.  Once the skill to get outside is learned, they are more likely to go there to help themselves when they are feeling a little blue.

As OT’s, it’s our work to help your child most effectively engage in play.  Maybe your child is low tone and has a hard time with physical challenges.  Or maybe they avoid other kids on the playground.  Maybe they get too wild and scare other kids away.  Ask your OT about what we can do to help your child get the most out of playtime.

above image courtesy of New York Times

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Rainy Day Activities

There's still lots to do, even if it's rainy outside.

There’s still lots to do, even if it’s rainy outside.

If you are like many parents I have seen lately (including myself!), you are in need of some ideas of activities for your children that you can do during those all too frequent rainy days.   First, find yourself a bucket, bin or other container.  You can label it whatever you like:  “Rainy day ideas,”  “I’m Bored Bucket,” let your child guide you to what it is called.  Within the jar, place folded up paper suggestions for what to do.  You can take ideas from what you have seen your child do in OT or here are some other thoughts from the folks at Sensory Spectrum, Parenting, Real Simple and the tool kit of your OT’s at APT:

1.Visual Scavenger Hunt:  Look outside your window and take inventory of things you see.  Make a list.  It could be a type of tree, a car, a bird nest, a house number etc.  Then let your child take a turn and cross things off the list.  It’s a great visual scanning and visual motor task.  

2.Paper Airplane Race:  Make a paper airplane and have a contest to see whose plane can go the furthest.  Making a paper airplane incorporates many fine motor skills into a fun game.

3.Be a movie director:  Give the kids an idea of something to do.  Give them a chance to plan it out, then shoot the movie!  It’s fun to ask kids how many different ways they can spin, how high they can jump, how many push ups they can do.  They are sure to ham it up for the camera.

4.Whole House Obstacle Course:  Even if your house is small, there are things you can do to make the movements BIG.  For example, jump on bed, roll around room, crawl under table, run up stairs, lie down without moving (often the toughest challenge of all!)

5.Cotton Ball Challenges:  Blow them for a race, crawl while holding the cotton ball on a spoon, running while trying to keep the cotton ball on your head.  All are distinctly challenging to motor planning.

6.Indoor Camping: Making forts are some of the greatest memories and fun of childhood.  Small and enclosed spaces are often very calming to an overworked nervous system.  Try out one for a peaceful refuge or for a picnic.

7.Snuggles:  Always encouraged.  Frequently, but not always welcome by your child.  Squeezes are a super way to spend an afternoon.

8.Puddle Jumping:  In our climate, puddles are a common occurrence.  But instead of yelling at your kids to stay away from them, gear them up and encourage them to make a big splash!  Great, fun way to get proprioceptive input.

9.Draw on the windows and french doors with dry erase/window markers:  Writing on a vertical surface is a fun way to encourage proper writing technique.

10.Make some sensory bins:  Dried beans, cooked spaghetti, foam peanuts, whatever you’ve got.  Hide toys in it.  It doesn’t have to be large.

11.Go Swimming!  Chances are your local indoor pool is open despite the weather.  Swimming is a perfect deep pressure activity, incorporating resistance naturally to any movement in the water.

12.Play Charades:  It’s social, motor, visual: whatever you want it to be.

13.Get Dancing:  Turn up the music!  You can incorporate some play wrestling by pushing on each others hands while dancing.

14.Slow Motion Tag:  A motor planning challenge that’s harder than it seems.  Chase your child in slow motion, talk in slow motion, react in slow motion.

15.Pretend to be a…  Using the idea of starting small and slow, then coming back down.  Pretend to be a seed, then grow and stretch.  Pretend to be a kernel of popcorn then turn into a popping piece, then slow down again.

16.Stand Together:  Sit back to back on the floor, loop arms together, then try to stand up.  Talk to each other to work it out.  Other two person:  Hip waddle:  stand side to side with one arm around the other.  Put a ball between you.  Try to move around the house without dropping the ball.  Rainbow:  Lie down on your backs and push your feet together to arc into a rainbow, touching floor on one side and swooping over to the other.

17.Mud Pies:  That old childhood favorite!  Kids can use out of season sand buckets and shovels to shovel mud and form into “cakes” and “pies” using decor such as rocks, shells.  Digging is deep pressure at it’s best and so is carrying all those heavy treasures!  Yum!

Or if you just want to be left alone for awhile:  There are lots of great kid exercise DVD’s on Amazon.  Read the reviews and find one based on your kids natural interests:  yoga, kickboxing etc.

Have Fun!

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