Keeping Children in Motion

Keeping Children in Motion

by Barbara Mizrahi

The Routine

Tom Murphy walks into Children’s House in Holyoke carrying a stack of blue plastic step stools and a beach ball and pulling a worn canvas carry-on suitcase on wheels.  A tiny kid who is probably three years old looks at him and grins, then hides his face except for one peeking eye  when he sees the gaggle of college students in Tom’s wake.

A few minutes later, three kids between three and four years of age are standing on step stools, eyes focused on the beach ball in Tom’s hands.  He puts the ball down between his feet, so that he can hold up both hands in front of him and demonstrate how he wants kids to hit the beach ball with both hands made into fists.

Tom’s manner is calm and low key.  This is play, but it’s also work for the kids and it looks like they are feeling both cheerful and challenged.  Tom bounces the beach ball in the direction of a serious looking four year old girl and she nails it with both fists at the same time.  “Perfect,” says Tom and bounces the ball to her again.  He bounces it to each of the three kids in turn.  When the little guy at the end barely makes contact with the ball, Tom says, “Almost!  Try it again!” in the same matter-of-fact but positive tone of voice used to say “perfect” a moment ago. After several activities involving hitting the beach ball, jumping, catching and throwing, the kids sit on their stools while Tom gets out a jump rope.  He hands one end to the girl sitting on his left  and together they turn the jump rope to the rhythm of Tom singing, “Round and round and round…and round and round and round.”  The rope makes a satisfying “thwack” sound each time it hits the floor.  Tom and his preschool partner hold the rope steady and low for the others to jump over, then high for them to crawl under, which they do with astonishing speed and happy grins.

This scene was my first taste of Tom Murphy’s simple and powerful mix of motor activities with preschoolers.  After fifteen minutes of play, the smallest of the three kids, who initially couldn’t jump off the stool with both feet or even step up onto the stool without tripping, was able to do these things and more.  He could catch a beach ball by giving it a gentle hug and throw it through a hula hoop, hit the ball while jumping, hit it with a tube held like a baseball bat, hit it up and hit it down.  He did not stop smiling once.

It was early in the second semester of an independent study which is collaboratively hosted by Smith College and Springfield College, both in southwestern Massachusetts.  This class, already evolving after only one semester, is called Bogin Playscape Project, and it is at its heart, all about preschoolers and play.  The activities described above are part of a play routine that Tom has been bringing to preschoolers in Holyoke for twelve years.  He knows the importance of play and is at a point in his life where he wants to share what he knows with others, which is how the other students and I got to be there.

A Brief History of Tom

Tom began working with kids at the age of seventeen.  That’s when Nan Bogin – the mentor for whom this project is named, hired him to work in a preschool.  He knows that he was lucky to have found out so early that he loved working with young kids and that he had an aptitude for it.  Now, forty years later, Tom is an occupational therapist working at Cooley Dickenson Hospital  in the pediatric outpatient department, but he has also been working in Holyoke preschools for more than twelve years, and this work is the focus of the independent study and of this article.  I asked Tom to tell me about the inspiration for this work.

“Community Partnership had a grant available that allowed therapists like me to come into the the preschools with the idea of identifying kids that might have been missed by their pediatricians, kids with motor delays that were going to impact on their performance in school but hadn’t been identified in any way.”  Tom explained that children with developmental delays can receive early intervention services in this area up until the age of 2.9 years old. After that, they have to go through the schools to get services.     “The idea wasn’t to work only with kids with delays, but to work with everybody, but in practice what I was able to do was to work with the kids who had greater need more.  In terms of justice in the world, it was great to be able to say,  ‘Well, this kid needs more, so he’ll get more.’  And as anybody in the field knows, it doesn’t always work that way.  Sometimes it depends more on the kids having savvy parents.”  Unfortunately, not everybody has the knowledge and the assertiveness to negotiate the system, so some kids that have great needs for services don’t get them.  “In my way of providing fairness,” Tom says, “the kids with the greatest need could come every week and the other ones would come a little less often.  Everybody gets a boost, but the kids that need more of a boost get more of a boost.”

I asked Tom to talk about the activities he does with the kids.  “I needed to get kids moving, and to do that I needed some simple games and fun things that we could do that would help me to screen kids and that could teach me which kids I needed to look more closely at. They started as screening activities, but they also turned out to be great learning activities. What surprised me was that kids never seem to get tired by these simple games. Some kids could do the same activities week after week, sometimes for several years, and still have fun.”

The truth of this statement is immediately apparent to anyone watching the routine.  Part of the charm for me, is that the activities seem so simple, yet keep the attention of the kids so beautifully.  Tom found out early that the step stool was a great way to keep kids organized and paying attention.  “ Each kid has a stool, it’s theirs – they know where to go.  The stool is an organizing place for child.”  But, he says, “it’s also this perfect little climbing task so I can see:  ‘Did he just step up onto the stool confidently, jump off confidently with both feet – and if they can do this five or ten times without getting tired – that’s a kid who has pretty much got motor skills intact for their age.’  The ones who can’t climb onto the stool without using their hands – or maybe they can do it two or three times but then they’re tired – those are the ones I’m going to want to see more of.”

Props

Tom’s choice of materials came in part from his work at Cooley Dickenson.  “I’m always looking for something simple and inexpensive for parents to use at home with their kids. He says, “If I can tell them, ‘go out and get a step stool and do these jumping games,’ that’s something they can do.  If they can get the kids to move 20 minutes a day 5 or 6 days a week, that’s going to get more results than an hour a week with me.   I’m always looking  for props.  I can say, ‘Use your little step stool that’s under your sink.’  I don’t want to say, ‘Go buy this $300 swing.’ “

Tom’s other favorite prop is the beach ball.  He jokes that he is the king of beach balls, because he has purchased hundreds of them over the years.  “I’ve probably thrown a beach ball ten thousand times,” he says, and I believe it. “It costs 99 cents and its a great prop if you’re trying to get kids to move and you want them to be successful.”  It doesn’t take a lot of strength or even very good hand-eye coordination to hit a beach ball.   “ I want things that work for everybody and are fun for everybody and things that are safe for everybody – if a  beach ball bumps your nose…all you do is laugh.”

Tom can quickly run through five or six games involving the beach ball – each one just a little different from the others so that the activity builds in a little more challenge, or uses slightly different skills to perform.  They punch it with both fists, punch with hands squeezed tightly, punch it while simultaneously jumping off a stool,  hit it with a cardboard tube held like a baseball bat, throw it throw a hula hoop, catch it, hug it and bounce it.  This stuff is fun, but it has a serious purpose.  The kids are learning where they end and the rest of the world begins, to use both sides of their body at once, to track the ball as it moves through space – as they move through space, and to do these things automatically in response to the movement of the ball. They are learning to “cross the midline,” which is what happens when they swing a baseball bat:  Their two hands and arms move together from one side to the body to the other without switching gears.  It’s the kind of thing that seems ordinary until you try to imagine what it would be like to function without these abilities (imagine trying to pass the mashed potatoes at a family dinner if your hands and arms won’t cross from one side of your body to the other).  People acquire these abilities through experience – specifically through movement.  They do not occur by themselves and children do sometimes get to school without having fully developed these skills.

The Big Question

Why do they need to have all these skills for school?

Tom says, “That’s sort of the big question – why does this stuff make such a difference.  The reason is that the gross motor skills – the postural stability when your body is strong and you know where you are in the world,  those are the skills that you need just to sit up in a chair and pay attention.  When kids have poor body awareness and weak muscles, they have to work harder just to sit up; they may get distracted more easily; you’ll see them rest heir head on their desks and they’ll start to slump.  If you look at kids trying to hold a pencil, part of what holding a pencil involves is holding your whole body up.  We call it proximal stability – you have to have that stability in your trunk to support distal stability.”  In other words, your hands can be coordinated and strong when they are supported by active and strong arms and shoulders; arms and shoulders rely on strong trunk muscles.

“That’s a really important piece and you see that so clearly when I work with kids on the floor:  kids prop themselves up with one hand.  Try doing a puzzle or legos with one hand. You’re not going to want to do it.  Kids begin to avoid things that they don’t feel successful at doing. Then they don’t learn and explore and keep trying and get better skills. Gross motor skills are crucial for supporting fine motor development and fine motor development is what it takes to write something or draw a picture or do a puzzle – which people want kids to do to get ready for school.  You need to know where your hands are.  We talked about some of the kids – you put a writing tool in their hand – it’s like they don’t really know where their hands are – they have such poor awareness of their entire bodies and especially their hands – they’re not going to have a good pencil grasp if they don’t know where their fingers are.”

“You’ve probably seen that when I ask the kids to put their hands together to punch the beach ball, sometimes they just kind of look as if they don’t understand what I’m asking.  If you can’t put your fingers together, that’s when I become a little worried about you.  They get this look like,  ‘I don’t know that my hands can go together.  I don’t know that my fingers can go together.  I don’t know where they are.’  I really want them to be able to know where their bodies are, know where their hands are – and then I want to see if you can do that and jump at the same time.  Do you know where your arms and legs are at the same time?  You’re not thinking about it you just want to hit the ball.”

At  this point I share with Tom my mental image of people rolling their eyes and saying, “They don’t where their hands are?  Of course they know where their hands are!”

“They can’t control very well what their hands are doing,” Tom says.  “I’m very thrilled to have that video with Arlene Spooner talking about the importance of play in prone position with hands pushing down on the ground.”  Tom demonstrates the hands pushing down, to indicate the strength required; this is the kind of activity which provides information and stimulation needed for a baby’s neurological and motor development.  “‘I know where my  body is.  I know where my hands are!’” he says.  “When kids don’t get that as infants they have a much harder time when they get older.”

Child Development and Movement – a Panel Discussion

Tom is referring to a panel discussion he organized featuring himself and three other people who work with young children.  Arlene Spooner is a physical therapist who has worked extensively with infants; Dr. Scott Cochrane is a former physical therapist  who became a pediatrician; Nancy Milch is a pediatric occupational therapist, who works in a school setting.

All of these people have noticed an increase in developmental problems among children which can be attributed to several changes in the lives of infants and toddlers.   Scott Cochrane has seen a rise in the number of babies whose skulls are flattened in the back and usually a bit to one side.  This can cause further problems, such as tight muscles on one side of the neck.  This problem, once associated with preterm babies, is caused by the weight of the head pressing against the mattress at a time when the skull is still malleable.  The increase of this problem in full term infants has been linked to the “Back to Sleep” public education campaign, which advocated having babies sleep on their backs because of research indicating that a prone sleeping position is associated with increased risk for sudden infant death syndrome, or SIDS.

Arlene Spooner has more to say about the subject of prone positioning and also about the importance of moving through space with the head in different positions; something that occurs naturally when a baby is carried around on a parent’s back.  (Arlene’s demonstration of this concept is my favorite part of the panel discussion video.)  The experience of movement through space is important in developing a child’s vestibular sense, which is involved in our ability to keep our balance and adjust our movements in response to slight changes in position.   Babies need time spent on their tummies to develop their proprioceptive sense – the sense that tells us where our bodies are and what they are doing – the sense that lets you know that the mosquito bite that’s bothering you is on the top of your foot, which is resting on the rung of the chair in which you are sitting.   Reaching down to give it a scratch doesn’t even require thinking.  Lying on their tummies encourages babies to raise up their heads against gravity and build the muscles in their upper bodies which allow them to begin to move around.  It also helps to build spatial awareness and depth perception, because the view from ones tummy shows lots of overlapping things that move in relation to each other as your head moves.  (Try contrasting the view seen from the same spot in prone and supine positons.  After some time looking around while lying on your belly,  lie on your back and look around.  There’s a lot of open space if you are looking up and not a lot of overlapping stuff.)

Nancy Milch has noticed large increases in the number of referrals for fine motor development, especially in regard to handwriting, and for vision problems, such as poor convergence and divergence, which is the way eyes focus together.  Without this ability for eyes to move in concert, people may struggle with double vision or may gradually transfer visual processing to the information being received from only one eye, which influences depth perception.  Nancy thinks that these problems might be related to screen time – that is, the number of hours children spend focusing on a screen which is always about the same distance from their eyes (such as a hand held game, computer or television screen).  Playing video games is fun for kids, but if it’s not balanced with more active play, their eyes are not getting enough practice changing focus from near to far and back, a skill they need in order to copy the homework assignment written on the blackboard into their notes.

Tom says that at the preschools, he used to see a few kids in every class who needed help, but, “Now there are sometimes five or six in a class of twelve.”  He has also seen a large number of kids in his practice who have problems with visual tracking.

A Culture Change

Changes in child development trends probably have more than one cause, but there are some likely influences that are easy to identify.  Safety has become a sort of obsession in the United States and industry has stepped up to the demand for products to increase safety.  Some car seats combine safety with convenience so well that children may stay in them for hours at a stretch.  They go from car to high chair, to stroller and back. Subsequently, people are spending less time holding and carrying their babies.

Most people over the age of twenty or thirty have childhood memories of being active – riding bikes, playing tag, swimming, climbing trees and playing on playgrounds that included swings, tall slides, merry-go-rounds and see saws – equipment that is rarely installed in playgrounds now.  All of these activities had inherent risks, but they also  helped to shape our neural networks into strong functional systems that have allowed us to participate fully in a huge variety of physical, social and academic activities.    Active children fall and bump, scrape and bruise, sometimes break bones and even sometimes die as a result of accidents during play.  Fear of injury and fear of law suits have caused public playgrounds to eliminate many of the features that once provided rich opportunities for sensorimotor activity.

There are other cultural changes responsible for, or at least related to a decrease in movement opportunities for children.  One is the simple stress level of an average family in this country in which both parents work.  Exhausted parents are less likely to take kids outdoors and play and are probably relieved when their children can entertain themselves with television or a video game.  When I was  kid, “Go outside and play!” was a routine command from my mother.  But in many of our urban areas, outside is not a place parents feel they can safely send their kids.  Many playgrounds have been allowed to fall into disrepair or have become gathering places for gang members, drug users and other people whom parents tend to consider dangerous.  Getting from home to a playground also poses risks to safety in some areas, especially when playgrounds are not nearby.

Schools too, have changed.  Speeches decrying the state of public education have become popular among politicians and have raised the emotional temperature of many election campaigns. Lawmakers have passed huge bills requiring higher academic standards in elementary school and  high school, and have also stipulated that there must be perpetual improvement.  Even in kindergarten and preschool,  many children are expected to spend more time engaged in sedentary activity designed to teach them reading, writing and math at an earlier age.  Unfortunately, depriving kids of the movement they need to develop properly may be causing more academic problems, more special education referrals and higher school costs which, ironically, are addressed by budget cutting measures which exacerbate the problem – like cutting or reducing physical education programs.

Toys for Promoting Play

Bogin Playscape Project has a mission to promote active play, and is designing, identifying, creating and building toys that would promote active play in preschools.  Tom can’t continue working as he does in preschools forever – in fact the grant has already become a casualty of budget cuts.  And teachers have a host of competing demands placed on their time, even in preschools.  Preschools are, however, among the few remaining institutions which still understand and promote the value of play.  The Bogin Playscape Project started with the idea of creating and identifying some simple, inexpensive toys and ideas for active play in preschools, in the hope that doing so might help to get kids moving without placing additional demands on preschool teachers.  Tom is particularly determined to come up with activities which can be played indoors, since here in the northeast, weather can keep kids indoors for long stretches of time.

The hurdles to producing toys and equipment for use in schools have turned out to be immense.  Concern over safety has created many obstacles to designing for and working with children.  Regulations related to playground equipment and toys for public places and preschools are formidable.  The amount of height a child can climb without padding and a fall zone has decreased from eight inches to four inches in some instances.  Now that Tom’s grant to work in preschools has ended, the liability protection provided by the city has also ended and some preschools that once were delighted to have help, now can’t take the risk of having this type of assistance on a voluntary basis, for fear of litigation.

Creating equipment that is safe, attractive to kids, easy to store and use in a classroom and if possible, simple enough for people to make themselves, has turned out to be a big challenge.  In spite of the challenge, Bogin Playscape Project has created ball-stomps, bucket stilts and activities designed for indoor play and there are several more ideas being explored.

Some Thoughts About Kids and Culture

I have been thinking about the complex nature of child development, interconnected as it is with physical and social experiences and interactions.  Children’s growth and development are dependent on their responses to experience.  A child with good body awareness and a sense of competence and connection to the world is more eager to engage in the activities and occupations of childhood, and to build on each experience.

Our culture is a powerful mediator of experience.  When we see a change in child development trends, especially a change which indicates a problem, such as poor coordination, weak core muscles, difficulty with vision related to lack of coordination between the muscles that enable visual tracking and focus; that is a change to pay attention to.  If the perceptions of our panel are accurate, something significant is happening here.  More research is needed into the relationships between development and the thousands of variables involved in human biology, culture and growth.  In the meantime, it makes sense to pay attention to what we already know.  People need to be actively engaged in life to develop fully.  The kinds of activities important to young people are those which support them to develop and grow from where they are to where they can be next, the way that crawling can lead to walking, and play can lead to social competence.

Kids need to move, interact and play.  These are issues worth addressing now.

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