When therapy professionals throw out the term midline crossing, we are referring to an imaginary line that runs from the head to the toes and separates the left and right sides of the body. Midline crossing plays a significant role in daily life skills because it allows the body to smoothly perform practical life, self-care, and recreational tasks. Some tasks that involve midline crossing include driving a car, taking a shower, cooking, moving food in our mouth from one side to the other, and playing sports.

Midline crossing is important on a physical level and a neurological level. On the neurological level, the left and right sides of the brain are responsible for different tasks. They need to communicate with each other to make these tasks functional. When both sides of the brain do not communicate, coordinated learning and movement do not occur.

On the physical level, our bodies typically cross midline spontaneously when we develop a dominant hand preference. When our body does not cross midline, both hands tend to work equally (left upper extremity works on the left side of the body and the right upper extremity works on the right side of the body). Equal practice sounds good, but when this occurs it can be very difficult to establish hand dominance. Fine motor skills may be delayed or poor, negatively impacting the skills necessary for school (i.e. handwriting, coloring, reading, etc.). Without midline crossing, trunk rotation will not occur. Lack of trunk rotation can present as poor core stability, a stiff body, or moving the whole body as a unit.

activities to encourage midline crossing at home:

• Household tasks such as dusting, cleaning mirrors, wiping down benches, and vacuuming
• Marching or dancing to music using both arms and legs (flossing is a great dance move)
• Sorting games (reach from one side and put into a container on the other side without switching hands)
• Using ribbons or streamers to make figure 8’s in the air
• In infants, hold one arm down and place toy on opposite side of the body to reach for
• Have the infant track toys with eyes while laying on their back
• Give babies plenty of tummy time
• Play hand gesture games (this little piggy), and show your child how reach across their body to touch their toes

If you suspect concerns regarding midline crossing in your child, please feel free to contact MOSAIC. If your child is already seeing a therapist, let them know!

Falls are the leading cause of fatal and non-fatal injuries for older individuals. But you do not have to be advanced in years to be at risk of falling. Winter is an especially dangerous time in Montana with weather conditions producing snow, ice, and other hazards. However, there are steps you can take to prevent falls during the winter and decrease your risk of fall related injuries.

Recommendations to Prevent Falls

• Wear shoes with good traction on the bottom. If conditions are especially icy, use YakTrax or other traction cleats. These attach to the bottom of your shoes. They are a relatively cheap (around $20 on average) and can make a world of difference.
• Take shorter steps and walk more flat footed when walking on icy or snowy conditions.
• If needed, use an assistive device such as a cane to help steady yourself. Special attachments for the cane tip are made specifically for snowy and icy conditions and can be purchased online, PriceRite, or similar stores.
• Be extra cautious in parking lots. When getting out of your car, use the door to steady yourself and make sure your feet are both firmly on the ground before stepping away from your car. Use the main, cleared paths instead of taking shortcuts between cars. These are often more difficult areas to clear and are likely to be more icy.
• Plan ahead and pay attention to the weather. If you don’t need to go outside first thing in the morning after a snowfall, stay inside and wait for the weather and sidewalks to clear. If needed, hire someone to clear your sidewalks and/or driveway.
• Keep your hands free and out of your pockets. Wear gloves and be ready to catch yourself if needed.

Improving your balance and strength are other ways to decrease your risk of falls. Physical therapy can help pinpoint exactly what to work on to prevent falls, especially during the winter. Call MOSAIC at (406) 388-4988 to schedule an evaluation today.

W sitting is the opposite of sitting cross-legged or crisscross applesauce sitting. In a W sit, a child’s bottom is on the floor with feet on either side of the hips and toes pointed out. W sitting is common in children, especially in children who in-toe or have low muscle tone, increased flexibility, or poor core muscles. As therapists, we often caution parents about allowing their children to sit in a W position. But why? Most orthopedists are not concerned about how W sitting affects the joints and alignment of the lower extremities. There is very little (or no) evidence to suggest that W sitting causes orthopedic issues.

So why do we care? Kids will often use the W sit position as a transitional movement, that is, to move into and out of other postures. W sitting has the potential to limit development in other areas when used as a sustained posture for playing or floor work. This is not to say that no child should sit in this position. However, for most typically developing children, sitting in alternative positions will challenge the body and allow other systems to mature.

W sitting position may limit the development of:

• Core and Postural Muscles – The W sit position increases a child’s base of support. This, in turn, requires them to use less muscle activation and energy to maintain balance and an upright position.
• Pelvic and Spinal Stability – The W sit position is extremely stable. Children who sit in this position do not have to learn how to keep their hips and their back from collapsing in positions of instability, such as tall kneeling and standing on 1 foot.
• Vestibular Activation – W sitting can slow vestibular function and delay the development of equilibrium and protective reflexes. This can lead to inability to maintain clear vision during rapid head movements. Stable vision is critical for learning to read and write and for developing fine and gross motor control.
• Visual Exploration – A child’s hips, core, trunk, and head don’t move as much or as often in a W sit. Therefore, they don’t move their eyes as much to fixate on toys and their environment.

Children who continue to prefer W sitting may develop problems in these areas:

• Delayed Hand Dominance – W sitting limits trunk rotation and inhibits midline crossing. Children who W sit will use their right hand to grab objects on their right and their left hand to grab objects on their left.
• Poor Protective & Equilibrium Reactions – Kids who W sit do not lose their balance in this position. They do not have to learn how to right their trunk when leaning forward, backward, or to the side. Consequently, they don’t learn to stop from falling when they move too far outside of their base of support.
• Decreased Body Awareness – Kids who W sit have less awareness of where their body is at in space.
• Poor Balance & Gross Motor Skills – Because W sitting limits trunk rotation, children do not learn how to weight shift from front to back and side to side, which is a skill needed to maintain balance while running, jumping, skipping, and playing on the playground.
• Difficulty with the Transition to Kindergarten – Kids are expected to be able to sit on the floor with their legs crossed or upright at a desk in school. So, kids that W sit often do not have the strength or skills to be able to successfully maintain a floor sit with legs crossed or an upright trunk position at a desk.

Encourage alternative sitting options, including:

• Cross Legged/Crisscross Applesauce
• Short Kneel (Feet pointed straight back and directly under the bottom)
• Prone (Lying on the stomach)
• Long Sit (Sitting on the bottom with legs together and knees straight)
• Side Sit (Sitting with bottom on the ground and knees bent with both legs out to the same side).

A pediatric physical or occupational can help. Call MOSAIC at (406) 388-4988 if you have concerns and would like to schedule a free screen.

Here are some statistics about single leg balance:

• By 36 months, 50% of children can balance on 1 leg for 3 seconds with their hands on their hips.
• By 42 months, 50% can hold single leg balance on 1 leg for 5 seconds with hands on hips.
• 50% can hold single leg balance for 6 seconds on each leg with less than 20 degrees of trunk movement side to side with hands on hips by 54 months.
• By 5 years of age, 50% can hold single leg balance for 10 seconds on each leg with less than 20 degrees of trunk movement side to side with hands on hips.

Why is Single Leg Balance Important?

So your child should be able to balance on 1 foot. But why do we care? Single leg balance is a building block for more advanced skills that your child will develop as they get older. These skills include: kicking a ball, hopping, and skipping. It is also used during functional activities, such as putting on pants/shoes and stepping in/out of the bathtub/shower.

Better balance promotes better body awareness, which improves safety and can also lead to more success when playing sports. There is also evidence that poor single leg balance is linked to higher risk of ACL injuries in females. Ability to hold single leg stance is one indicator that the vestibular system (sensory system that provides a sense of balance and spatial orientation for the purpose of coordinating movement with balance) and proprioceptive system (sensory system that informs us of where our body parts are at in relation to other body parts) are well-integrated, which is necessary for a child to sit still, listen, and focus their eyes, skills required for learning.

Ideas For Working On Single Leg Balance

• Make sure your child is able to stand with their feet together without falling.
• Practice kicking various size balls.
• Practice stepping over a string or a stick. Start low (2-3”) and gradually increase the height. Alternate having your child step over with right foot first and then left foot first.
• Show your child how to balance on one leg with their arms out to the side. You may need to start by holding one of their hands and help them hold one of their legs up in the air. Alternate which foot your child is standing on. Gradually decrease your support as able.
• Practice balancing on 1 leg with hands on hips and then with eyes closed.
• Practice putting pants, shoes, and socks on in a standing position. Have your child hold on to a wall for balance if needed at first.

Ideas to Make it FUN!

• Stand with 1 foot on a ball
• Pop bubbles while they are in the air with your foot
• Balance small stuffed animals, cars, etc. on the top of the foot, and lift them up and drop them in a basket
• Play balloon volleyball with your feet
• Practice in the pool
• Pretend to be animals like a stork or flamingo
• Play hopscotch

Check out Gross Motor Milestones: Kneeling to learn what your child should develop next. If you have concerns regarding your child’s balance or if they fall frequently, contact MOSAIC Health & Rehab for additional suggestions or for a free screen. To learn more, check out this great milestone moments list from the CDC.

For dyslexia, early identification of both strengths and weaknesses is key to success with education. Dyslexia is often seen as a disadvantage. When it is viewed as a different way of thinking, this thinking can lead to success. Understanding dyslexia can help make learning easier.

HOW DYSLEXIA AFFECTS LEARNING

Reading

Difficulty recognizing and manipulating sounds, letters, and words makes learning to read difficult. Once reading is grasped, children who are dyslexic often remain slow readers.

Understanding dyslexia can help with Memory Systems

Problems with memory systems can affect all learning. Memory systems include: Verbal Memory (remembering verbal instructions), Sequential Memory (ordering facts and information), Working Memory (keeping facts in mind in order to manipulate them), and Visual Memory (recognizing symbols, letters and words).

Spelling, Grammar & Punctuation

To excel at spelling, grammar, and punctuation, you have to learn to retrieve a series of information, skills, and rules. Children with dyslexia have difficulty with memory systems, making it difficult for them to learn and apply these skills and rules.

Math

Children with dyslexia struggle with sequential and working memory, making it difficult for them to learn and remember multiplication tables. Memory problems make it difficult for them to do mental arithmetic, although they are often very good at conceptual, higher level math. Therefore, it’s essential to identify dyslexia in order to nurture higher level math skills.

Understanding How Dyslexia affect exams

Memory difficulties make recalling facts difficult, particularly when under pressure during tests. The removal of coursework and speaking and listening from exams is disadvantageous for kids with dyslexia. They excel in the reasoning and exploring skills applied in coursework and have strong verbal reasoning and communication skills. When we remove these elements from exams, we limit the opportunity for kids with dyslexia to demonstrate their knowledge and understanding of a subject.

Unlike non-dyslexics, literacy is not automatic for a child with dyslexia. They constantly have to think about every action and process, then put them all together in quick sequence to complete their work. As a result, it takes kids with dyslexia approximately five times longer than others to complete literacy tasks. This is why allowing extra time to take exams is essential for all children with dyslexia. Research by U.S. universities has found that extra time often dramatically impacts grades.

Understanding dyslexia is critical for learning success. MOSAIC can help you provide assessment and intervention for children whose language difficulties involve problems in learning to read and write. These reading and writing difficulties may occur independently of obvious deficits in spoken language or comprehension of oral language.

Tummy Time and Visual Development

There is a wealth of knowledge on tummy time and its importance for motor development and strengthening. Do you how important tummy time is for the visual system, though? If babies do not get enough tummy time, parents may notice delays in crawling, vision development, and other learning disabilities. So, let’s take a look at how a baby’s vision develops.

Additionally, babies learn to see over a period of time, much like crawling and walking. It is important to have healthy eyes and good vision in order to promote the development of “seeing.” To support this development of seeing, it is important that a variety of activities are provided to build and refine vision.

Development of Visual Skills

Vision: Birth to 4 Months

In the first couple of months (birth to 4 months), a baby’s eyes and visual system develop significantly. A baby’s initial primary focus is within 8-10 inches away from their face. Furthermore, they can appear to stare intently at high contrast items. They still are not able to tell the difference between two different items, though.  A baby’s eyes start working together in the first couple of months and vision improves drastically. Then, at around 3 months of age, they begin to figure out eye-hand coordination as they track and learn to reach for items.

Vision: 5 to 8 Months

Around 5-8 months of age, the coordination of eye movements and eye-body movements are being refined. It isn’t until the fifth month of life that the eyes are working together, and babies begin to observe the world in a 3-dimensional view and see things in-depth. By 6 months, a baby is able to hold their head still while using their eyes to look around the room. The emergence of crawling, typically around 8 months, continues to develop and refine eye-hand-foot-body coordination.

Vision: 9 to 12 Months

By 9-12 months of age, a baby can judge distances fairly well and throw items with precision. Babies at this age should be able to pick up smaller items with a fine pincer grasp. Babies will begin to pull themselves to stand and may also begin to learn how to walk, but parents should also continue to encourage crawling as this helps solidify and strengthen eye-hand coordination skills.

Vision: 1 to 2 Years

By 1-2 years of age, a child’s depth perception skills and eye-hand coordination are well developed. Children at this age are learning by watching and listening to all the things happening in their environment, and they will recognize objects and pictures that are familiar to them.

Importance of Tummy Time

After looking at the visual system and how it develops in an infant, we can conclude that tummy time is critical for the development of the visual system. Without tummy time, the body will have weak core muscles. This will delay head control and result in an inability to hold their head steady, causing a child to see blurred images because they cannot control their eye movements. Strong core muscles allow the head and neck to work together with the eyes to locate and track objects.

If you have questions or concerns about your child’s vision, contact MOSAIC Rehabilitation.

References

• www.colemanvisioncenter.com/lack-of-tummy-time-could-cause-learning-delays
• www.clarendonvision.com/childrens-vision/know-childs-vision
• www.friendshipcircle.org/blog/2013/08/01/how-tummy-time-can-help-develop-your-babys-sensory-system
• www.motherhoodcenter.com/blog/parenting-blog/the-importance-of-tummy-time
• www.aoa.org/patients-and-public/good-vision-throughout-life/childrens-vision/infant-vision-birth-to-24-months-of-age?sso=y
• ilslearningcorner.com