Tag Archives: clumsy kids

Why Injuries to Hypermobile Joints Hurt Twice

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My new e-book, The JointSmart Child: Living and Thriving With Hypermobility, Volume I, is just about ready to launch.  One of the book’s major themes is that safety awareness is something that parents need to actively teach hypermobile young children.  Of course, physical and occupational therapists need to educate their parents first.  And they shouldn’t wait until things go off the rails to do so.

Hypermobile kids end up falling, tripping, and dropping things so often that most therapists have the “safety talk” with their parents on a regular basis.  What they don’t speak about as often are the long-term physical, emotional and social impacts of those injuries.

Yes, injuries have more than immediate physical effects on hypermobile kids.  Here is how this plays out:

  • The loss of mobility or function after an injury creates more dependency in a little person who is either striving for freedom or unsure that they want to be independent.  Needing to be carried, dressed or assisted with toileting when they were previously independent can alter a child’s motivation to the point where they may lose their enthusiasm for autonomy.  A child can decide that they would rather use the stroller than walk around the zoo or the mall.  They may avoid activities where they were injured, or fear going to therapy sessions.
  • A parent’s fear of a repeated injury can be perceived by a child as a message that the world is not a safe place, or that they aren’t capable in the world.  Instilling anxiety in a young child accidentally is all too easy.  A fearful look or a gasp may be all it takes.  Children look to adults to tell them about the world, and they don’t always parse our responses.  There is a name for fear of movement, whether it is fear of falling, pain or injury: kineseophobia.  This is rarely discussed, but the real-life impact can be significant.
  • Repeated injuries produce cumulative damage.  Even without a genetic connective tissue disorder such as Ehlers-Danlos syndrome, the ligaments, tendons, skin and joint capsules of hypermobile children don’t bounce back perfectly from repeated damage.  In fact, a cascade of problems can result.  Greaster instability in one area can create spasm and more force on another region.  Increased use of one limb can produce an overuse injury in the originally non-injured limb.  The choice to move less or restrict a child’s activity level can produce unwanted sedentary behavior such as a demand for more screen time or overeating.
  • Being seen as “clumsy” or “careless” rather than hypermobile can affect a child’s self-image long after childhood is over.  Hypermobile kids grow up, but they don’t easily forget the names they were called or how they were described by others.  With or without a diagnosis, children are aware of how other people view them.  The exasperated look on a parent’s face when a child lands on the pavement isn’t ignored even if nothing is said.

In my new book, I provide parents with a roadmap for daily life that supports healthy movement and ADL independence while weaving in safety awareness.  Hypermobility has wide-reaching affects on young children, but it doesn’t have to be one major problem after another.  Practical strategies, combined with more understanding of the condition, regardless of the diagnosis, can make life joyful and full for every child!

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Easy Ways To Build Bilateral Hand Coordination for Writing

Why do we need to use two hands for writing?  After all, you only need one hand to hold a pencil.  Well, did you ever injure your non-dominant shoulder or wrist? Without a hand to steady the paper and move it accurately as you write across a page, an adult will write like a preschooler or worse.  When you write, you are using one hand for writing and the other for balance, posture, paper stabilization and paper placement.  Bilateral hand coordination begins before a child’s first birthday and develops through early childhood.  Without it, handwriting is certain to be a challenge.

So many kids that struggle with crawling and walking as infants and young toddlers will continue to have difficulties using both hands together as preschoolers.  Occupational therapists like myself often observe that that they are not using one hand as a “prime mover” ( grabbing, reaching and writing) and the other hand as a “stabilizer”, i.e. holding a container or paper in a skilled manner.  What does it look like to stabilize a container with skill?  The container is held using just enough force and with the opening angled to allow the other hand to fill it without dumping the contents out. Take a look at my post  Better Posture and More Legible Writing With A “Helper Hand” to explore why that stabilizer hand placed on the table is essential for good handwriting.  Problems with bilateral control are often seen with children with ASD, SPD, and many neurological issues such as low muscle tone, but bilateral control delays can exist without any formal diagnosis.

Most handwriting programs, such as Fundations, do not pay much attention to the underlying physical skills needed for legible handwriting.  Handwriting Without Tears does an excellent job of teaching educational staff to remember the physical aspect of handwriting. Children ideally need good bilateral coordination BEFORE they begin hard-core handwriting instruction, not after.  If a child has identified neurological or developmental challenges that contribute to limited bilateral coordination, working on these skills are essential to prevent compensations and delays in handwriting.

As an OT working with kids over 4, when those basic bilateral control and grasping skills should have been achieved, I have to decide whether to spend precious time in every session on handwriting or on the basic abilities (coordination, strength, visual-perceptual, and sensory processing) that support handwriting.  Usually, I end up doing both, building target skills with intensive and complex treatment plans while I am working on handwriting instruction that gets kids up to speed as quickly as possible.

I am going to guess that if some of my toddlers and preschoolers in treatment had received more daily home and school practice with the following activities, I would have more time to teach great writing strategies.  For every parent that has asked me for some effective methods for early bilateral control skills, here you go:

  1. Do not hold or stabilize toys too much for them while playing.  Let them figure out that they need the other hand to steady a soft but large object or container.  Kids will often ask adults to hold a bag for them during clean up.  Your response?  Place their “helper” hand effectively on the bag and direct them to use the other hand to pick things up.  You did help, but you didn’t enable more dependency.  Safety first, so always support a container that could shatter or injure them if it dropped and broke.  But if the contents of a safe container spills?  That is another lesson in coordination to be learned by the child.  Encourage and reward a good clean-up effort!
  2. Provide good containers that demand bilateral skills. My Ziploc post Develop Pincer Grasp With Ziploc Bags also develops bilateral coordination during snacking (one of my favorite times of the day!).  Another fave?  Store little toys in the cosmetic bags with nice big zipper pulls that the department stores include with free-gift-with purchase events. Ladies, if you love makeup as much as I do, you have a pile of these in a drawer somewhere.  If not, the local drug store probably has a selection.  When a container is soft and collapses, it is a greater challenge to stabilize and open.  Challenge is good.
  3. Encourage your child to turn the pages of a book while holding the book on their lap when sitting on the bottom step of the stairs or a low bench.  With the book resting on their lap with one hand holding it, there will be no chance for the floor to hold the book, or for you to do it.  If it is a really heavy or large book, either give them one finger’s wobbly assistance under the book, or pick a lighter/smaller book.  Some of my clients would rather let me hold the book, so I try to have something in my hands to prevent them from asking for assistance rather than working hard.  I cheer them on, and make sure they have great books to look at every time!