May 8, 2013
Dynamic Core for Kids question #2
This next question is a composite of a couple of queries I have received since our Dynamic Core for Kids course in Ottawa last month. I am thrilled that so many therapists are integrating the material into their practice so well.
“Where is the best place to start with a child who is low tone, has lots of flexibility, maintains a posterior pelvic tilt in all positions (even with a wedge) and compensates with head and neck extension. This child does not like any blow toys, or anything near her mouth. She also grinds her teeth.”
I would start in a supported sitting position with this child. Slightly off upright, maintaining alignment so you are using gravity to facilitate descent of the diaphragm. Once in this position, find an activity the child likes to participate in (hitting a switch, batting a toy) that can be shaped to occur on the exhale. The teeth grinding could be an attempt to use proprioception to try to recruit some stability at the TMJ for a feeling of increased head stability. It could also be an up-regulating or a down-regulating strategy. You will need to sleuth a bit and decide why the child is using this. Once you decide what the strategy is for, you can provide input in a different way. Possible options are: searching for stability – deep pressure through the mandible on an angle towards the TMJ. Up-regulating – provide vestibular and proprioceptive input prior to sitting. Down regulating – try deep pressure prior to and during the activity.
Great observations and questions. If anyone else has anything to add, please comment!
I attended the Baltimore course in February and have loved to incorporate a lot of what I learned into my sessions with various kids. I just recently purchased some yoga wedges from yogadirect.com but when they arrived I was surprised by the size. I expected them to be longer like the typical blowup MOVIN sit wedges that we have at school–did I buy the wrong thing? or do you know of anywhere else I can get a good supportive wedge for older elementary to middle school size kids?
Thanks for your feedback on the course. I’m thrilled you have been able to incorporate what you learned into your clinical practice. The yoga wedges are only meant to support directly under the ITs so they tilt the pelvis – they are not meant to be as long as the Movin’ Sit wedges, which are designed to support under the thighs as well. So you did buy what I use in the clinic. I use the yoga wedges successfully with kids up until the early teens (depending on the size of the kids). At that point, I try to modify chairs so that the hips are slightly higher than the knees, which also serves to tilt the pelvis slightly. I have also used ethyfoam wedges at this point. Someone brought this product to my attention recently,http://www.naturalposturesolutions.com/products/the-wedge™/, and it looks promising but I haven’t had a chance to try it. If you come across any other options, please let me know!