17 different women, 36 crazy children, 0 babies in utero
Adventures, Advice and Questions from a group of Mormon women who met in Queens, NY and have now scattered all over the place.

Friday, July 14, 2006

The Incompetent PT

That would be me.

When my 3 1/2 year old son, Noe, was diagnosed with autism a year ago, we quickly realized that he needed much more help than we could give him. So we hired a team of professionals: Behavioral therapists, a speech therapist and an occupational therapist to be exact. The neurologist who diagnosed my son also recommended physical therapy to address low muscle tone (a common side effect of autism) in Noe's back, neck, arms and hands. Because his muscle tone issues were relatively minor and because we couldn't really afford to pay bills from yet another therapist, I decided to train myself to be Noe's physical therapist.

My training involved reading a few books and putting Noe in physical therapy just long enough to learn what exercises he needed to build muscle tone. Basically, the physical therapist had him do modified sit-ups, push-ups and back lifts on an exercise ball. Noe tolerated the monotonous exercises because he also got to jump on the cool trampoline at the therapist's office. When we tried the exercises at home, he cried through each session. I could hardly blame him. Really, are two and three year olds meant to do push-ups and sit-ups?

I persevered for a couple of months, setting a timer for 20 minutes each day for us to workout. Noe never learned to like the exercises and I never learned how to make them fun for him. So gradually, our workouts were less and less consistent. It's been a good four months since our last workout.

I do not regret forgoing physical therapy. Noe's gross motor development is only slightly delayed and only noticable to the professional eye. But recently I find myself rubbing his back and touching bone where there should be lean muscle tissue and I feel guilty.

I'd like to recharge Noe's workouts, but I need help from more experienced moms. What kind of exercises do your kids enjoy that also help strengthen their arms, hands and back?

Here is what we are currently doing (and not doing):

* We go to the playground EVERYDAY and I make sure he is doing things that work his back and arms like climbing and swinging (not a problem...he LOVES both of these activities).

* I know that swimming is a great way to build muscle tone, but right now Noe is scared to go in the water. (Any suggestions on overcoming this fear are also welcome).

* I try and get him to lift and carry practical objects (his toys, big balls, groceries from the car). He doesn't particularly enjoy this activity, but will usually cooperate.

Short of putting the kid on steroids, I'm at a loss and your advice is greatly appreciated.


  • Ok, I have NO idea if this is a good idea or not, but both my boys, ages 2 1/2 and 4 1/2 love doing this with their dad.

    We have a "medicine ball"- which is a weighted ball that looks like a playground ball, but weighs about 5 pounds. My husband and the boys play toss with it, and they LOVE it. It's not so heavy as to be strenuous, but it is more substantial than a regualr, air-filled ball. It works for us in our house.
    posted by Anonymous tracy m at 7/14/2006 08:10:00 PM  

  • Hmmmm, I don't know if these will help at all, but these are some things that our kids do for fun and I know it strengthens their muscles:

    Wheelbarrows with dad in the backyard - dad holds their ankles and they walk on their hands. They love it. Sometimes we have them "walk" like this towards a particular object - makes it more like a "course".

    Raking and shoveling - my kids have child size rakes and shovels. I show them a plot of dirt/mud and tell them to "rake" it - they have at it. Same for pulling weeds. At this age, they think this is a fun activity and really works up a sweat for little kids!

    T-ball. Good for hand/eye coordination. At 3 and 4 they're not going to hit the ball everytime but they get used to using those muscles.

    Running races - object at one end of the yard/house, child at the other. Use a pretend stopwatch and tell them to run as fast as they can.

    There is a book called "The Wiggle & Giggle Busy Book" by Trish Kuffner - 365 fun, physical activities for toddlers and preschoolers - I just picked this up and its got tons of great physical activities that are FUN for kids.

    Hope this helps...
    posted by Blogger chloe at 7/14/2006 09:01:00 PM  

  • If he loved the tramp at the office so much, is it possible to get (a little) one for your home? Maybe use it as a reward for some of those exercises you know work, but that he hates? If it worked there, it might work at home...I dunno.

    www.infantaquatics.com for the water thing. It's not in every area, so you'll have to look at the locations on the website to see if they have anything near you, but they are excellent at water safety and water training for little kids. Also, when we go to our lessons, there are kids there with cerebral palsy, and one grown man who has some issues, I'm not sure what, but the point is they're very used to special needs.
    posted by Blogger The Wiz at 7/14/2006 09:08:00 PM  

  • Jen, Marian has a little trampoline for Max and he loves it - ask her where she got it - my kids liked playing on it too.
    posted by Blogger chloe at 7/14/2006 10:14:00 PM  

  • Are you still seeing the ocupational therapist? They may have some suggestions. I have a friend who is an OT, and there is some overlap between PT and OT.
    posted by Blogger Mike at 7/15/2006 05:32:00 AM  

  • Roe really loves a few basic activities that might help:
    Climbing onto the couch (he is still small enought so it does work his back, arms and legs) and then he jumps off. Not the best for your couch, but it kind of has the jumping payoff in the end after climbing so much. sometimes we count how many times he can do it, i take pictures and basically make a big deal out of it.
    We have also taught him to climb in and out of his highchair. Yes. i know this doesnt sound safe, but he gets a work out and I do stand there with him. its a wooden one from IKEA so its not too high off the ground.
    The other thing he loves is the bars at the playground. there is actually one right above the slides so he hangs there and lifts his legs a bit so he swings back and forth and then he gets to slide down.
    Im thinking anything that has that great payoff, so it doesnt seem like he is working out. (Kind of like me and my workouts). Dance in the livingroom to his favorite music for 10 minutes. Throw in a few toe touches and "reach for the sky" kind of stuff. It sounds like you keep him pretty busy.
    Im wondering if the PTs assume that these kids dont get much physical activity. Running around and playing does work your muscles and heart, so he is getting something just by the things you have described.
    I also think the trampoline is a great idea. kids really do love them.

    Good luck. I think Noe is lucky to have such a loving and attentive mother. You are willing to try things and thats worth a lot.
    posted by Blogger ksl at 7/15/2006 07:00:00 AM  

  • somersaulting and downward dog.

    I am proud of you that you stuck to it for 4 months. I decided to teach my four year old to read, and that lasted about 4 days.
    posted by Blogger Kage at 7/15/2006 07:38:00 AM  

  • This is the trampoline that Max has. He loves it, jumps on it all the time. It's small, but you get plenty of bounce out of it!
    posted by Blogger marian at 7/15/2006 07:43:00 AM  

  • I would get a big therapy ball for your home--do you have one? I got one in a Pilates kit, actually, to do Pilates on it. J loves it, so I actually don't do much Pilates on it!

    With the ball, there are about a thousand things you can do that can just be a game, and still be good for him.

    For example, you can sit across from him, with both your legs spread in a straddle position, and then push the ball back and forth to each other. My son could play this game with just a small ball for hours. Forcing him to sit on his bum would reinforce trunk control, which is vital for kids with low tone, and then he would also have to push the big ball to you with his arms, which would help with his upper body strength. Also, simply sitting and bouncing on the big ball is a great ab toner (that's what it's built to do for Pilates), and again, reinforces trunk stability, the vital force of all other movement. You don't have to be structured about it, just call it "ball play time", or something, and have him bounce on it for a little while until he wants to stop. Then play the game where you push it to each other, and then play whatever else that kid wants to do with that ball. Above all, keep it fun.

    Another thing you could do is stretch him over the ball on his back, roll him backwards, and then have him flip himself over on his feet, sort of like doing a back flip with the ball as his spot. That can stretch his back, work his abs, and you can call it flipping over! J loves to do this too, but it does take some supervision.

    The monkey bars on the playground are also great for upper body strength, and if you ask him to try to hang upside down from them (with full supervision from you, of course), and then pull himself back up, that's also a great trunk work out.

    I can not emphasize enough how important trunk stability is for low tone kids, which is probably why your PT had him doing sit ups. But there are lots and lots of ways to focus on trunk stability that can be fun!

    Also, have you ever checked out horse therapy? It's pricy, unfortunately, but kids REALLY respond to it, and you can maybe do one or two sessions with the PT, who could then direct you to other exercises. Good luck!
    posted by Blogger Heather O. at 7/17/2006 10:09:00 AM  

  • One more thing--have you ever considered enrolling him in a gymnastics course for little kids? Lots of fun jumping, rolling, and stretching that would be in a structured environment on a regular basis. J LOVED his gymnastics course, and I really saw a marked improvement in his upper body strength. With gymnastics, your son could have PT without the "therapy" part of it. They probably even use most of the same kind of equipment, and you are not paying the therapy price tag.
    posted by Blogger Heather O. at 7/17/2006 10:11:00 AM  

  • Sorry I got distracted from my post, but I really do appreciate all of the suggestions and I am going to incorporate them into Noe's new & improved therapy sessions!

    Heather, we do have a ball and I appreciate your suggested exercises because they sound like WAY more fun than the ones we were doing. I would LOVE to do horse therapy with Noe. We were back in Oregon on vacation and Noe went on his first horseback ride. I thought he would be afraid, but he LOVED it. I don't think I've ever seen him happier. He has the wrong mama though, cause I know nothing about horses. I'll check into but probably opt for gymnastics class for now (another great suggestion). Thanks everyone!
    posted by Blogger Jen at 7/17/2006 08:17:00 PM  

  • Hardly incompetent. Sounds like you are doing a great job.
    posted by Blogger Melissa at 7/17/2006 08:23:00 PM  

  • My six year old son has a language disorder and had other "issues" when he was younger. So I know how overwhelming it is. There is no way, to work on everything all the time. So you've got regular mother guilt, plus "I should be working on that" guilt on top.
    You have identified the most important areas and have put your energy into them. If you think right now those areas are being covered and its time to get creative and find a solution for the PT issue, then great. Every few months I do the same thing, I look at where we're at, and think what else should we be working on.
    So, an official pat on the back from me for being a great mom (i.e. creative problem solver).
    My ideas:
    1. 20 minutes of organized exercise is too much. But maybe 3 or 5 minutes is doable? Can you pick one official, boring exercise to do?
    2. Routine - right before something, right after something
    3. Bribery - you don't want to bribe for everything, but sometimes go right ahead. I give my kids fish oil for the EFAs and then they get the gummy bear vitamins as their "reward."
    4. Look for alternate PTs. Look for a college student or high school student or mom who is interested and is good with kids.
    5. Make your husband do it. (My husband is willing to do stuff, but he doesn't think of things himself). Suggest Dad wrestles and does other physical play.
    6. Videotape him doing an exercise, and then put that on the TV while you do the exercise.
    7. Favorite music, favorite movie?
    8. You dance (and do exercises) and he decides maybe he'll join in?
    9. Go with his interests. If he loves volcanoes, draw a big volcano on a mat and have him do his stuff there. If he loves Sponge Bob make a bunch of them and he has to reach to get them while on the ball....or whatever.

    I wish I could help you out about actual physical activity but that is actually something that is way down on my list of strengths, so I don't know enough about muscle groups to help.
    Good luck!
    posted by Anonymous JKS at 7/17/2006 08:27:00 PM  

  • Oh, I forgot to ask. Is he getting any therapy from the school district?
    Also, I just read some of your other posts and read that your son is very visual/spacial. As soon as his fine motor skills develop a little more, he will probably be like my son and build some really cool stuff with lego, Tinker toys, k'nex, etc. I would take pictures of all the stuff he would build (airplanes, rockets, ships).
    My son Connor was has some social success in "regular" preschool because he could build such cool stuff. Kids wanted him to build him something or show them how to build something.
    Connor was in kindergarten this last year. The best thing I did was walk into his meeting at the beginning of the year with examples of what he could do and detailed lists of his strengths (not just his weaknesses). All they had was "paperwork" sent from the early childhood intervention and he's more than just paperwork.
    posted by Anonymous JKS at 7/17/2006 08:39:00 PM  

  • Jen-

    The horse therapy is called "hippo therapy", and you don't have to know very much about horses to have your child do it. I have a PT friend who does it, and I am currently in the process of trying to get certified to do speech therapy with it. My friend's therapy course was very casual, and it seemed that she could do just one or two sessions with kids, or whatever, according to their needs (and probably their pocketbook). I also know that she allowed people to observe the therapy, provided that they are a substantial distance away from the animals, etc, etc. Also, the stables that do hippotherapy are always in need of volunteers, in case that's the route you want to start with. It's definitely a switch from the typical speech and language therapy, which for me has never been all that appealing, or, frankly, very effective.
    posted by Blogger Heather O. at 7/18/2006 06:41:00 PM  

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