October 2023 Special Needs Living Magazine

Play Is My Favorite Exercise

BY BECKY ALLEN

As a pediatric physical therapist, I used to dread this comment from parents. When I was just starting into the pediatric therapy world at least once a month a parent, grandparent, or even the occasional co-worker made this most annoying remark. It always got under my skin and because confrontation makes me uneasy, and words become difficult when I am nervous, I was never able to verbalize a well-structured rebuttal. At least not until I was in my car, alone, on my way home. That’s when I would literally say out loud “I should have said…” and insert a very well-structured and thought-out argument. You’ve been there, right? I can’t be the only one that does that. Anyway, by now you’re probably asking “So, what’s the comment?” Well, it goes something like this “Although we think you’re very nice, my husband and I have decided that we are not going to continue with physical therapy, because all you’re doing is playing with him, and we can do that at home.” Ugh. Right?! Even the occasional coworker would say something like “Man it sure would be fun to get to just play around all day.” Insert eye roll here.

So let me explain. Play is my favorite exercise! (Full disclosure, I saw that saying on a T-shirt and it’s my new favorite saying. And yes, I bought the T-shirt!) I love it because it is so very true! Play is my favorite tool in my pediatric toolbox, and I use it daily! Remember, Mr. Rogers saying “Play is a child’s work”? Well, that man knew what he was talking about! Okay, okay, he meant it from an educational standpoint, but it also applies to all therapies as well. For example, did you know that the “speech portion” of your brain is activated by movement? This means kids are more likely to talk while moving. It’s the reason infants start “babbling” around the time they start to crawl and start saying actual words around the same time they learn to walk. Movement activates the speech centers of our brain.

But I am not a speech therapist, I am a pediatric physical therapist. And I still haven’t answered why my therapy sessions might look like I am just playing with your child or why I don’t get that comment any more. It’s simple really. My session looks like I am just playing with your child because I am! The kids I am working with have difficulty moving their bodies in specific patterns, firing the correct muscle when they should, or even stretching a specific muscle in a way that is functional or purposeful. I’ll give you an example, a child may have a weaker gluteal muscle (butt muscle) which makes it difficult for them to lift their tiny butt in the air to assist with diaper changes and will make it difficult to sit independently. Sitting up straight in a chair without

back support will be difficult for a child with a weak core. Sitting in a chair at all may be difficult for a child who has an STNR reflex that has not been properly organized back support will be difficult for a child with a weak core. Sitting in a chair at all may be difficult for a child who has an STNR reflex that has not been properly organized.

Side note: All children are born with certain reflexes or develop certain reflexes that are supposed to get “organized” into our brain and integrate at a certain age, but for many of the kids I treat they have not gone away and can cause delays and discomfort. But that’s a topic for another article.

The key word is “difficult!” Let’s just say math class was difficult for you when you were younger. Did you like going to do math homework? As a child did you say to yourself “Well I know this is hard, but I am only going to get better by buckling down and doing at least 45 minutes of math homework 3x a week.” No, you didn’t. You were a child. NO CHILD LIKES TO DO ANYTHING THAT IS DIFFICULT FOR THEM UNLESS PROPERLY MOTIVATED! And there you have it. How do I motivate a child to move their bodies in a way that is difficult for them? By making that exercise as fun as I possibly can!! Whether that be a fun obstacle course to work on motor planning, kneeling on a cushion to activate the core/glutes/hamstrings while playing Guess Who, or jumping around and singing with my terrible singing voice to get a kid to jump. I’ll do it! Just ask any of my coworkers or patients. Pediatric therapists try to engage your child in any way we can. And play is the best way to do that! In fact, I think the reason I was drawn towards pediatrics was because I like the creativity aspect. I get to be creative while coming up with an exercise or game that strengthens, stretches, or moves the child in a way that also targets my specific goals! Of course, sometimes, especially if your child is older and can follow directions like “lay on your side and do twenty clam shells,” I might throw in some of the basic exercises in the treatment as well. But we pediatric therapists love children and understand that they are often being forced to add something to their weekly schedule that other kids do not. So, if keeping it fun makes therapy a little less stressful both for the child and for the parents, we will do it. Imagine all your brothers and sisters playing in the backyard and you must load into the minivan with your mom and go to a boring exercise class where your instructor is going to make you do all kinds of very hard things you don’t want to do. The only people I know who would like that are the adults who enjoy CrossFit workouts!

Okay. So why don’t I get that comment anymore you may ask? Well, it’s because now that I have been doing this for nearly 20 years I have 1) practiced my rebuttal in my car enough times that I now have a well-verbalized and thought-out response down pat and 2) I have learned that my mistake was lack of education to the parents. I went to school for 7 years to learn about the body and what muscles activate or stretch in what position. Just because I know that playing UNO with the child sitting with their legs out in front of them and back straight is stretching their hamstrings does not mean that the parents know that. And if I don’t educate them, it does in fact look like I just wasted 5 minutes of therapy sitting on the ground playing a card game. Now that I am a seasoned therapist, I make sure to take the time to educate the parents/caregivers on the purpose of the position or game I am doing so that they understand I am not in fact “just” playing with the child and that I am targeting a specific therapy or functional goal. Things go much smoother now and parents are better able to continue the therapy treatments at home, which leads to better and faster outcomes for the child!