What is Dry Needling? Dry needling is a form of skilled instrument-assisted manual therapy. By inserting a thin filiform needle into a muscle, pain can be decreased. It can also reduce muscle tension, and improve joint mobility.  Dry needling helps “reset“ the muscle by stimulating the nervous system. It also improves blood flow, promotes relaxation, and decreases over activity of the muscle.

Dry needling is not a stand-alone intervention. Therefore, it is part of a broader approach of physical therapy using an individualized blend of exercise, stretching, and other appropriate interventions. It resets the muscle by eliciting a reflexive, local twitch response to help decrease spontaneous electrical activity, improve blood flow, decrease banding, and promote relaxation of the muscle.

When an injury occurs from repetitive use or an acute trauma, damaged tissues produce inflammation. These tissues may go into a protective tension state. This guards against further damage from the use of the injured muscle. This produces trigger points which are tender, taut bands of muscle that can produce either local or referred pain. These trigger points inhibit circulation which prevents oxygen-rich blood from reaching the tissue and waste products from leaving.

Other adverse changes that occur in these tissues include increased acidity, spontaneous electrical activity at the neuromuscular junction, and biochemical changes that can affect pain sensitivity. These changes stimulate the body to produce fibroblasts, a cell that produces fibrosis or scar tissue. Adhesions may build up around the muscles and tissues. This limits their ability to fully lengthen or shorten. It can also cause compression and irritation of nerves, such as with carpal tunnel syndrome. This typically leads to biomechanical disturbances in muscle activation patterns and daily function.

The Difference Between Dry Needling and Acupuncture

Dry needling is not acupuncture, and there are many key differences between the two. Dry needling is based on western neuroanatomy and the modern scientific study of the body. It treats specific musculoskeletal or neurological impairments and pain. Acupuncture is based on the ancient principles of traditional Chinese medicine and uses the “Chi,” or flow of energy, to treat systemic dysfunction such as allergies, digestive problems, poor eyesight, and the common cold, as well as musculoskeletal issues.  Aside from the theoretical basis, the technique, depth of needle insertion, intent, and duration of treatment also varies considerably. Dry needling is not appropriate for everyone and the treating physical therapist will help weigh the benefits and risks of treatment and ensure appropriate patient selection.

The trouble with a child who is missing sleep is that her behavior is confusing. It’s hard to believe that the real culprit behind her temper tantrum is lack of sleep when bedtime is one of your biggest battles, or she loses it simply because you dropped her water bottle. And when she can’t even dress herself, even though she did it yesterday, it feels more like a plot against you than an issue of fatigue. How can a child who is supposedly so tired somehow garner the energy to veer off her path just far enough to bop her brother in the head? Then, jump on her bed laughing hysterically when you try to get her down for the night?”

If your child is misbehaving, it’s very likely that he or she is crying for sleep. Sleep-deprived children can include babies who are sleeping less than 14 – 16 hours in a 24-hour period; toddlers sleeping less than 13 hours, preschoolers less than 12 hours, school-age children less than 10 hours, or adolescents sleeping less than 9.25 hours a night.

“And until your child gets more sleep, no punishment, no discipline strategy will stop the challenging behaviors. Sound sleep is a key to good behavior. The problem is that children rarely tell you that they are tired. Instead, they get wired, which escalates into a frenzy of energy. It’s as though their body is out of control — and it is.”

Signs of Sleep Deprivation

• Loses it over little things
• Easily frustrated or irritated
• Upset by changes
• Easily overwhelmed
• Clumsy
• Has to be woken in the morning
• Frenzied, hitting and yelling
• Can’t focus and pay attention, doesn’t listen
• Impatient and bossy, less flexible

How to Tell if Your Child is Getting Enough Sleep

• Wakes up on their own
• Listens
• Stays focused on tasks
• Is able to wait their turn
• Falls asleep easily at night
• Can deal with changes in routine or surprises well

What You Can Do

• Establish a regular wake time (within 30-60 minutes, 7 days a week)
• Exposure to morning light (before exposure to screens)
• Establish a regular breakfast time
• Emphasize exercise
• Protect nap times (for infants this can be within 45 minutes of waking up! For toddlers it can be 1.5 to 2 hours after waking and for preschoolers it is 5-6 hours after waking.)
• Serve snacks and meals on a regular schedule with the same bedtime each night
• Feed your child 6 times per day (about every 3 hours) providing a balance of protein and carbs with an emphasis on protein boost at bedtime

Recommended sleep for your child in a 24 hour period

Infants (0-11 months)                                                                                                             14-18 hours

Toddlers (1-2 years)                                                                                                                13-14 hours

Preschoolers (3-5 years)                                                                                                         11-13 hours

School Age (6-13 years)                                                                                                          10-11 hours

Teen (14-17 years)                                                                                                                    9.25-10 hours

Adult (26-64 years)                                                                                                                 8.25 hours

All information is provided courtesy of Mary Sheedy Kurcinka, a parenting educator located here in our valley and author of several books including Sleepless in America: Is Your Child Misbehaving…or Missing Sleep? Mary can be reached on Facebook at Mary Sheedy Kurcinka, and at [email protected]. She provides classes locally and is available for in-home consultations to help solve your sleeping difficulties. If you have more questions about sleep, reach out to one of our occupational therapists for help.

We often hear the phrases, “Your child needs speech,” or “My child receives speech therapy,” but it’s not as common to hear, “Your child needs language therapy,” or “My child receives speech and language therapy.” This has led to a lot of confusion for individuals who are not speech-language pathologists. Did you know speech and language are actually two completely different things?

What is Speech and What is Language?

Speech includes: articulation (the formulation of sounds using the tongue, teeth and lips), voice, and fluency. When a child has trouble making his sounds correctly, such as saying “tat” for “cat” or has problems with his voice (hoarseness) or fluency (stuttering) he has a speech disorder. This is separate from a child’s ability to organize thoughts using the correct word or combination of words.

Language is the ability to understand others in order to share thoughts and ideas completely and clearly. It does not have to do with how sounds are made. We separate language into two parts: receptive language and expressive language.

Receptive Language

This is a child’s ability to understand language. It is known as input.  It includes both verbal (words and sentences) and nonverbal (gestures) language. Receptive language includes several things. For example, a child’s ability to understand a directive as a command. It also includes understanding that a question is a question and therefore, requires an answer. It also includes a child’s ability to understand concepts such as “in” or “big” as well as their ability to correctly interpret complex grammatical forms. For example, understanding that in the phrase, “The baby was kissed by the lady,” it was the lady who did the kissing, not the baby.  In typical development, children begin to develop some receptive understanding before they begin to express themselves.

Expressive Language

This is a child’s language output.  It includes a child’s ability to use words and grammar rules that dictate how words are combined to make phrases, sentences, and paragraphs. Expressive language includes a child’s use of signs, gestures, sentences, etc.

An easy way to remember the difference between receptive and expressive language is receptive language is how a child understands language and expressive language is how a child uses language. When a child has difficulty understanding others or sharing their thoughts clearly and completely, he has a language disorder.

Language disorders and speech disorders can occur together or by themselves; therefore, your child may only receive therapy to work on improving receptive and/or expressive language or they may receive therapy to work on improving articulation (speech). They may also receive therapy to work on improving expressive and/or receptive language AND articulation (speech).

 

Prior to walking, your child should be able to pull to stand and lower to the floor independently without falling. He or she should be able to pick toys up off the floor and return to stand while holding onto a support surface and continue playing in supported standing indefinitely. Again, in order to move, your baby has to have the freedom to move. This means daily time spent on the floor outside of car seats, strollers, standers, swings, etc.

Cruising

Cruising activities help to build leg and lower back strength while working on balance.

• While standing and holding onto a piece of furniture, place a toy just out of the reach of your child and encourage them to go get the toy. To start, move the hands and feet one at a time in the direction of the toy. Practice going to both the right and the left. Gradually increase the distance your child has to cruise to reach the toy.
• Practice rolling a toy car along a low surface while walking.
• Work on cruising around corners to the right and the left.
• Practice walking sideways left and right while holding onto both of your child’s hands or while your child is holding onto a slowly moving toy, such as the side of a wagon.
• Progress to cruising at taller surfaces or by using a flat wall.

Standing

Independent standing demonstrates a child’s ability to keep their balance without support and shows adequate strength to maintain upright posture.

• Have your child stand while lightly holding on to their hands. Slowly release the support of one hand and practice maintaining balance. Start having your child reach for toys with the unsupported hand. Gradually decrease to one finger assist only.
• Complete the activities above with your child standing at a support surface.
• Have your child stand with his or her back against a couch or wall and reach for or play with toys.

Have your child stand on a stable floor and slowly release your support. Make sure that their feet are about shoulder width apart and that they are not leaning to one side or falling forward or falling backward you release your support. Be ready to catch them before they fall.      

Walking

Walking is a lifelong motor skill that we use to access our environment, for recreation, and for exercise. It is a required prerequisite for advanced balance and coordination activities, such as running and jumping.

• Start practicing step taking while holding your child around the waist. Assist with weight shifting by leaning slightly to the side so that it is easier to un-weight the opposite foot and move it forward.
• Progress to holding onto both arms, then both hands, then one hand. Practice stepping on bubbles, bug stickers, etc.
• Have your child walk while holding onto a push toy. Weight the toy down to make it heavier so that it doesn’t get pushed too far in front.
• Hold a hula hoop or dowel and have your child walk while holding onto the other end.
• To progress independent steps, place toys on two support surfaces (such as a couch and a coffee table) so that your child has to move between the two to get their toy.
  •  To start, the support surfaces should be close enough together that no steps are needed but far enough away that they can’t touch both sides at the same time.
  • Once your child is able to move easily between the two surfaces, gradually increase the distance between them until steps are required to get from one side to the other.

Once your child starts walking more than 5-10 steps, work on these activities:

• Walk to a toy, pick it up off the floor, and continue walking.
• Carry items of varying sizes from place to place.
• Walk around obstacles.
• Change directions. Start with small turns and work up to 180° turns.
• Walk over varying surfaces – hardwood, tile, carpet, grass, dirt, sand, etc.

If your baby isn’t walking alone by 16 months of age, they might benefit from a physical therapy evaluation. Contact MOSAIC Health & Rehab to schedule a free screen or to set up an evaluation. Check out Gross Motor Milestones: Jumping to learn what your child should develop next. To learn more, check out this great milestone moments list from the CDC.  

Crawling is a major milestone that really allows babies to independently explore their environment. Crawling strengthens the extensor muscles of the trunk and head and increases core stability, which are important for later gross motor skills, such as standing and walking. It promotes shoulder stability, which is important for fine motor tasks such as handwriting and tying shoelaces. It’s a repetitive movement that stimulates brain growth and control of cognitive processes, such as “I see something, I want it, and now I am going to make my body go to it.”

Crawling uses both the right and left sides of the body and promotes communication between the right and left sides of the brain. Throughout the progression of crawling, important vision skills are developing, including the ability of the eyes to work together, to look at an object in the distance (target) and then focus close up (on hands), and is the start of training eye hand coordination.  If your baby isn’t crawling by 9-10 months of age, he or she might benefit from a physical therapy evaluation.

Tummy Time

• The first step to promote crawling is to practice tummy daily every day, multiple times a day.

Hands and Knees

• Help your child lift up onto hands and knees, supporting around the trunk. Gradually decrease the amount of support you provide to help up into the position. See if your child can hold the position with help around the trunk, again gradually decreasing the amount of support you are providing. Once your child can maintain this position with minimal support, practice rocking back and forth on hands and knees.

Reaching on Hands and Knees

• Once your child can rise into and maintain hands and knees without assistance, start to have them lift one hand at a time to reach for a toy. This allows them to practice un-weighting a hand and shifting their weight, which they will need to do in order to move their body forward. Make sure to practice lifting the right and left arms. If your child only wants to reach on one side, gently apply light pressure to the top of that hand in order to force them to reach with the non-preferred side.

Crawling Forward

• Once your child can get into, maintain, and reach with each arm while in hands and knees, it is time to practice moving forward. Place toys 4-5 feet in front of them. Physically assist by pushing on the child’s feet or guiding their arms. Play chase games, and crawl around, under, and through obstacles.

Crawling Over

• Place items such as hula hoops, jump ropes, towel rolls, or pillows on the floor and encourage your child to crawl over them to get a toy. Gradually increase the height of the barrier until they can crawl up and over both of your legs when they are straight out together in front of you.

Always make sure to celebrate the small successes, and make it fun! If your baby isn’t crawling, they might benefit from a physical therapy evaluation. Contact MOSAIC Health & Rehab to schedule a free screen or to set up an evaluation. Check out Gross Motor Milestones: Standing to learn what your child should develop next. To learn more, check out this great milestone moments list from the CDC.  

Play can be defined as “any spontaneous or organized activity that provides enjoyment, entertainment, amusement, or diversion” (Parham and Fazio, 2008, p. 448). Play is one of children’s major jobs—how they occupy their free time and learn. Building play skills is an important activity for your child because play helps to facilitate positive growth and development.

Physical health, social and emotional well-being, and positive mental health are also promoted through play. When a child is building play skills, they experience new ways to solve problems and learn skills needed to become a healthy adult. Research has shown that children who participate in play frequently grow quickly, experience higher achievement in school, and develop healthy habits for adulthood. A study of 11,000 third graders found those who participated in more than 15 minutes of recess per day behaved better in the classroom and were more likely to learn than their peers who had little to no recess opportunities. (Barros, Silver, & Stein, 2009).

Using daily routines and activities during the day to build play skills encourages the happiness and joy that can be experienced through play. And, simply allowing children to be playful can enhance their health and well-being.

How can Families Build Play Skills?

Early Childhood

Play teaches infants, toddlers, and preschoolers about their bodies and about the effects of their actions on the world around them. Play promotes growth and development through movement and exploration. Family members are a child’s first playmates.

• During their first few months, babies enjoy colorful mobiles, rattles, vocal play such as talking and singing, and games involving moving their arms and legs. Encourage your baby to participate while lying on their back, belly, side, or while supported on your lap.
• As babies learn to reach, grasp, and sit on their own, they will enjoy mirror play, balls, and toys that involve squeezing, stacking, and pulling apart. Babies also enjoy interactive games like peek-a-boo, music, and books. Water play with toys that float and plastic letters to stick on tile walls provides bath time fun.
• Since babies enjoy and learn through putting toys in their mouths, make sure they play with toys that are age specific and are made without small parts.
• As children learn to walk and run, they enjoy climbing, chasing, hide-n-seek, and pull toys.
• Toddlers develop hand skills by dropping shape toys into slots and scribbling with crayons. They also  enjoy books and toys that make sounds. They begin to imitate by using, for example, a toy telephone or hammer.
• Imitation and pretend play increases during the preschool years, through use of dress-up, puppets, and toy cars and trains. Preschoolers enjoy construction games such as building toys and puzzles, which further build play skills and develop their coordination. Playground time and riding toys encourage large muscle movement. Playing with materials with different textures, such as finger paints and sand, allow sensory introduction. Games during the preschool years teach turn-taking and getting along with others. These activities also help children develop language skills.

Elementary School

The elementary school years are an important time for learning to play by rules and participating in cooperative activities such as sports teams. Motor skills are being fine tuned, and there is an increased interest in developing hobbies. Play often serves as a way of developing friendships and expressing one’s unique personality. Finding a balance between formal play (e.g., participating on a sports team) and informal play (e.g., participating on the playground) allows for play time to be both active and creative.

Try these ideas to build skills and expression:

• Participate in board games and sports activities with your child; this helps your child to learn to follow rules.
• Have various craft materials available to spark creativity and interest.
• Offer options for extracurricular activities that include both physical and creative exploration (e.g., sports teams or performing arts experiences).
• Provide play options that include both structured and less structured choices (e.g., being on a school team or playing soccer in the yard with neighborhood friends).
• Encourage your school to support recess as a necessary part of every child’s day. This is a good time for physical movement that can promote learning and positive behavior.
• Like recess, active play before homework time can prepare your child for learning.
• Don’t forget to keep play activities fun! If you lose that element, it is no longer play.

Middle School

The early teen years mark a time of exploring social relationships. This is a teens’ form of play. Teens tend to like group activities, such as spending time with friends, listening to music, talking, and going to the mall. This time with friends allows them to improve social, movement, and mental skills; gain an understanding of themselves as individuals; and practice new skills in different environments without continuous parental supervision. These opportunities can promote a sense of wellbeing. Young and older teens also enjoy after-school activities, such as clubs (drama, music, art, athletics) and work (volunteer and paid).

• Encourage your child to join school and community-based clubs and after-school activities.
• Participate in leisure activities with your teen, such as table tennis or biking, to help strengthen family ties and offer opportunities to build communication.
• Ask questions about your child’s preferences in movies or music to indicate your interest and to spark conversation.
• Consider your own habits and routines of leisure and whether they include physical activities and model a balanced lifestyle of work and play. You are a role model for your teen.

High School and Beyond

During the high school years, play promotes cooperation and opportunities for teamwork. Through play, older teens are able to get to know themselves better and pinpoint their interests and their strengths. As school and social pressures increase at the high school level and  beyond, leisure activities can reduce stress and offer a sense of belonging and a chance to develop their goals.

• Encourage your teen to balance homework with leisure time to promote a healthy lifestyle that addresses both mental and physical wellness.
• Encourage limited screen time (TV, computers, and iPod/iPhones) and increased physical activity to help prevent or reduce problems that are associated with obesity and depression.
• Find a good fit between the demands of the leisure activity and the skills and interests of your teen. For example, depending on your child’s personality, physical abilities, and interests, he or she may prefer more physically demanding activities like swimming, whereas other children may prefer debate or drama clubs that challenge verbal and other cognitive skills.
• For all age groups, offer healthy, balanced meals as the fuel needed for physical activity.
• To prevent injury for all age groups, be mindful about the use and proper maintenance of appropriate safety equipment, such as helmets for biking. Know the signs of concussions. Encourage stretching before and after vigorous exercise.
• Low-cost, easily accessible leisure pursuits such as chess or basketball offer lifelong participation through community leagues and recreational centers.

Play shouldn’t stop in childhood. It continues to help build coordination and strength as well as creativity and social skills in all ages. Play also helps to develop emotional well-being and increases a child’s ability to explore, problem solve, and create.

How can Parents Help Early with Building Play Skills?

• Encourage sensory rich play by using balls, sand and water toys, slides, swings, finger paints, and magnets. During sensory play, children use their senses to incorporate smell, touch, sound, vision, and movement.
• Encourage manipulative play, such as using play dough, LEGOs, and board games. Toys such as puzzles, pegboards, beads, and lacing cards help improve the child’s eye–hand coordination and  dexterity
• Promote imaginative or pretend play with things like dolls and stuffed animals, toy furniture, puppets, and telephones. Pretend play encourages creativity and role playing and provides an opportunity to rehearse social skills.
• Choose toys that are appropriate to the child’s age and/or maturity level. They do not have to be expensive or complicated to be beneficial. Common objects, such as pots and pans, empty boxes, spools of thread, shoelaces, and wooden spoons are readily accessible and encourage children to use their imagination.

How can Occupational Therapists Help with Building Play Skills?

• Help modify the environment or adapt toys to provide optimal sensory input without overwhelming the child.
• Recommend toys and play activities that provide the right amount of challenge for the child, so they learn while having fun. The occupational therapy practitioner can also recommend ways to build on the child’s strengths and abilities.
• Offer play opportunities that encourage turn taking and problem solving. Consider family routines and priorities when recommending play strategies. Observe, identify, and develop play strategies that promote a healthy lifestyle and relationships.

If you have a newborn and need ideas about how to start building play skills from the start, check out MOSAIC’s Infant Play Activities.

References

1. Barros, R. M., Silver, E. J., & Stein, R. E. K. (2009). School recess and group classroom behavior. Pediatrics, 123, 431–436. Retrieved March 22, 2011, from http://pediatrics.aappublications.org/cgi/content/abstract/123/2/431
2. Parham, L. D., & Fazio, L. (2008). Play in occupational therapy for children (2nd ed.) St. Louis, MO: Elsevier.