August Activity Checklist

Make the most of your summer with fun actvities from Country Kids pediatric occupational therapist Molly Markland:

  • Walk on your tip toes all the way around the house.image005
  • Draw a line with chalk and try to walk on it like a balance beam.
  • Put on a button down shirt, and practice buttoning and unbuttoning the shirt.
  • Try and do 10 push-ups, 10 sit-ups and 10 jumping jacks.
  • Draw a picture of where you live.
  • Play hide and seek with a grown up.
  • Play jump rope.
  • Play catch with a big wet sponge.
  • Practice writing your name; make it more fun by doing it with chalk on the driveway.

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July Activity Checklist


You can have a summer of fun trying these activities from Country Kids pediatric occupational therapist Molly Markland:

  • Run through a sprinkler or a hose.
  • Play catch with a water balloon.
  • Draw a picture of a rainbow with sidewalk chalk.
  • Wash a car or a bike with a bucket of soapy water.
  • Try to gallop or skip around the yard.
  • Blow up the balloon and see if you can keep it in the air for 10 hits.
  • Blow bubbles and then try to pop them with your pointer finger.
  • Pretend to fly around the yard like a butterfly.
  • Cut a straw into small pieces and then string for a necklace.

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Deadline to Register for Sensory Handwriting Summer Camp is July 21

When: August 14, 15, 16, 2017 (Mon., Tues., & Wed.)

Time: 9:00 – 11:00 AMCountry Kids Logo final

Ages: 5 through 9

Minimum Participants: 4 Maximum Participants: 8

Fee: $100.00

Registration: Call (920) 339-0700 by July 21, 2017

Purpose of Group: This is a perfect camp to give your child a jump start for handwriting success with the return of school soon approaching. Children will improve handwriting through fun, engaging activities at this camp.

Goals of the Group:
● Build confidence for handwriting
● Improve pencil grasp
● Improve hand strength
● Improve hand dexterity
● Improve fine and gross motor skills

Leader of Group: This camp will be led by an OT trained in Handwriting Without Tears using a developmental multi-sensory and fun approach to writing.


June Activity Checklist

Have a great start to you image002summer with these fun activities from Country Kids pediatric occupational therapist Molly Markland:

  • Make a hopscotch with chalk on the driveway.
  • Roll like a log in the grass.
  • Make a necklace from dental floss and Cheerios.
  • Build a sand castle.
  • Go down a slide three times in a row.
  • Walk backwards across the yard.
  • Go to the library.
  • Blow bubbles and try and pop them with your finger.
  • Cut out pictures from a magazine.
  • Draw a picture of your favorite animal.

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How does Hippotherapy Influence Walking?

Walking, or gait, is a complex pattern of movement that gets us from one place to another. Our bodies are passengers on our lower limbs which consist of multiple joints and muscles. Did you know that selective control and modulation of 57 muscles in the lower limbs is required for controlled gait?

In addition to controlled muscle action, in order for us to walk in an efficient and coordinated manner, several additional prerequisites are required. We need range of motion in the soft tissue to allow the limb to move forward; we need alignment of the body segments to keep our center of mass over our base of support. We need strength in each muscle as it is required to activate and hold. We need mobility in the joints of the ankle and foot which provide a rocker to move the body forward and also provide shock absorption as we step.

All of these things happen within our musculo-skeletal system as we walk, and yet we are not conscious of them. The movements are automatic and efficient, unless we have a disruption in any of those prerequisite factors. A disruption such as those we often see in people with cerebral palsy, or low muscle tone, or hemiplegia, to name a few.

If there is insufficient range of motion to gain full hip or knee extension, one cannot completely straighten the knee to make heel contact during an initial step. Immobility in the heel cord limits the ankle’s ability to move within full range and propel the lower leg over the foot. Weakness in the musculature might mean one cannot sustain weight on one limb long enough to progress the opposite limb forward.

Additional factors that affect gait include functional sensory systems, balance responses, and motor learning that enable us to activate our muscles in response to and in anticipation of environmental stimuli.

Physical therapists have an enormous amount of expertise in the normal development of gait and are able to analyze the components of movement to determine treatment plans.

How can Hippotherapy help?
Hippotherapy is an adjunct form of therapy that can support the gait-oriented goals of the physical therapist. The movement of the horse impacts the movement of the rider in a manner that is similar to the gait cycle. EMG studies have shown that riding activates the muscles in a sequence similar to muscular activation during walking. However, the impact of hippotherapy goes beyond this.

Hippotherapy proAliyah victory low res for emailvides a multi-system impact on the rider. The position on the horse relaxes tight muscles in the lower extremities, while the constant three-dimensional movement requires an instant and continuous response from the rider causing an increase in strength and control over time. The  horse is moving through space, which alerts the visual and vestibular systems which are closely tied to posture and movement. Additionally, the proprioceptive, tactile, and kinesthetic systems are activated, all of which help improve awareness of body position in space and assist in functional motor responses.

Isn’t it amazing that one horse can do all of that? Perhaps the primary influence of the horse is to create a fun and engaging experience for the rider. Fun and meaningful activities are known to have more longlasting influence on learning, including motor learning.

We see better posture, better standing, and better walking after hippotherapy.

In order to maximize it’s impact, hippotherapy is and should be a part of a comprehensive therapy program including physical and occupational therapy. At Exceptional Equestrians we are beginning to collect objective data on the impact of hippotherapy on gait using our gait analysis system.

Lisa Kafka, OTR, HPCS
Diane McInnis, PT

Handwriting Tips

Should I be concerned about my child’s handwriting?

This is a common question asked by parents of school-aged children.  There are so many factors that go into being able to write, such as posture, attention span, fine motor coordination, and visual-motor skills to name a few. Handwriting is being introduced in school as early as pre-K. Typically, all of these skills have not fully developed yet! Here is how you can start at home:

Writing should be introduced in a fun way!  Start with sidewalk chalk, creating lines and circles in shaving cream with your finger, finger paints, and writing with Q-tips and water on construction paper.

Little hands should use little tools. 

  • Ditch the fat pencils. It’s hard for a child to wrap their fingers around them. Short golf pencils are great for beginners.broken_crayons_by_pumai
  • Ditch the new box of crayons. Break the crayons at least in half, and peel off the paper. This prevents holding with the fist and encourages children to hold the crayon with their fingers.
  • Ditch markers. Pencils and crayons provide more resistance on the paper so that the child can have more control.

When should I become concerned about my child’s handwriting?

  • Seek advice from your child’s teacher and attend parent teacher conferences. In addition to getting verbal advice, look around the room at student’s work on display and see what kind of work all the students are producing.
  • Some red flags that may indicate that your child needs additional help with handwriting during or after kindergarten:
    • Your child switches the hand with which they hold a pencil or crayon.
    • Your child has difficulty writing their name.
    • Your child had difficulty using two hands together for tasks such as cutting or stringing beads.
    • Your child has difficulty holding a pencil in their fingers.
    • Your child consistently writes from right to left, writes letters upside down, or reverses most letters.

What does “additional help” mean?

  1. Talk to your child’s teacher to see what strategies they are using in class and provide extra assistance at home. Sometimes there are volunteers or teacher assistants that can provide additional assistance for your child in school.
  1. Talk to your pediatrician about your concerns.
  1. An Occupational Therapist (OT) is trained to work on developing skills needed for handwriting. These services can be provided at school if your child qualifies for service and if their difficulty is impacting their education. OT can also be provided on an outpatient basis if they have physical difficulties also impacting their daily living skills.

Contact Country Kids at (920) 339-0700 if you would like more information, have questions, or would like to know if your child would benefit from an occupational therapy evaluation.

Glossary of Therapy Terms

Glossary of commonly used Occupational Therapy terms

Adaptive Response: An action that is appropriate and successful in meeting some environmental demand. Adaptive responses demonstrate adequate sensory integration and drive all learning and social interactions.

Auditory: Language processing skills: the abilities of listening and verbally communicating, acquired as one hears and perceives sounds and interacts with the environment.

Auditory Figure-Ground: The ability to discriminate between sounds in the foreground and background, so that one can focus on a particular sound or voice without being distracted by other sounds.

Auditory Perception: The ability to receive, identify, discriminate, understand, and respond to sounds.

Bilateral Coordination: The ability to use both sides of the body together in a smooth, simultaneous, and coordinated manner.

Bilateral Integration: The neurological process of integrating sensations from both body sides; the foundation for bilateral coordination.

Binocularity (Binocular Vision; Eye Teaming): Forming a single visual image from two images that the eyes separately record.

Body Awareness: The mental picture of one’s own body parts, where they are, how they interrelate, and how they move.

Cocontraction: All muscle groups surrounding a joint contracting and “working” together to provide that joint stability resulting in the ability to maintain a position.

Depth Perception: The ability to see objects in three dimensions and to judge relative distances between objects, or between oneself and objects.

Directionality: The awareness of right/left, forward/back, and up/down; and the ability to move oneself in those directions.

Discriminative System: The component of a sensory system that allows one to distinguish differences among stimuli. This system is not innate, but develops with time and practice.

Dyspraxia: Deficient motor planning that is often related to a decrease in sensory processing.

Eye-Hand Coordination: The efficient teamwork of the eyes and hands, necessary for activities such as playing with toys, dressing, and writing.

Equilibrium: A term used to mean balance.

Extension: A straightening action of a joint (neck, back, arms, legs).

Fight-orFlight Response: The instinctive reaction to defend oneself from real or perceived danger by becoming aggressive or by withdrawing.

Figure-Ground Perception: The ability to perceive a figure in the foreground from a rival background.

Fine Motor: Referring to movement of the muscles in the fingers, toes, eyes, and tongue.

Fine Motor Skills: The skilled use of one’s hands. It is the ability to move the hands and fingers in a smooth, precise and controlled manner. Fine motor control is essential for efficient handling of classroom tools and materials. It may also be referred to as dexterity.

Fixation: Aiming one’s eye at an object, or shifting one’s gaze from one object to another.

Flexion: A bending action of a joint, or a pulling in of a body part.

Focusing: Accommodating one’s vision smoothly between near and distant objects.

Form Constancy: Recognition of a shape regardless of its size, position, or texture.

Gravitational Insecurity: Extreme fear and anxiety that one will fall when one’s head position changes.

Gross Motor: Movements of the large muscles of the body.

Gross Motor Skills: Coordinated body movements involving the large muscle groups. A few activities requiring this skill include running, walking, hopping, climbing, throwing, and jumping.

Habituation: The neurological process of tuning out familiar sensations.

Hand Preference: Right- or lefthandedness, which becomes established in a child as lateralization of the cerebral hemispheres develops.

Hypersensitivity: (also Hyper-reactivity or Hyper-responsiveness) Oversensitivity to sensory stimuli, characterized by a tendency to be either fearful and cautious, or negative and defiant.

Hypersensitivity to Movement: A sense of disorientation and/or avoidance of movement that is linear and/or rotary.

Hyposensitivity: (also Hyporeactivity or Hyporesponsiveness) Undersensitivity to sensory stimuli, characterized by a tendency either to crave intense sensations or to withdraw and be difficult to engage.

Inner Drive: Every person’s self-motivation to participate actively in experiences that promote sensory integration.

Integration: The combination of many parts into a unified, harmonious whole.

Kinesthesia: The conscious awareness of joint position and body movement in space, such as knowing where to place one’s feet when climbing stairs, without visual cues.

Lateralization: The process of establishing preference of one side of the brain for directing skilled motor function on the opposite side of the body, while the opposite side is used for stabilization. Lateralization is necessary for establishing hand preference and crossing the body midline.

Linear movement: A motion in which one moves in a line, from front to back, side to side, or up and down.

Low Tone: The lack of supportive muscle tone, usually with increased mobility at the joints; the person with low tone seems “loose and floppy.”

Midline: A median line dividing the two halves of the body. Crossing the midline is the ability to use one side or part of the body (hand, foot, or eye) in the space of the other side or part.

Modulation: The brain’s ability to regulate it’s own activity.

Motor Control: The ability to regulate and monitor the motions of one’s muscle group to work together harmoniously to perform movements.

Motor Coordination: The ability of several muscles or muscle groups to work together harmoniously to perform movements.

Motor Planning: The ability to conceive of, organize, sequence, and carry out an unfamiliar and complex body movement in a coordinated manner; a piece of praxis.

Muscle Tone: The degree of tension normally present when one’s muscles are relaxed, or in a resting state.

Oscillation: Up and down or to and fro linear movement, such as swinging, bouncing, and jumping.

Perception: The meaning the brain attributes to sensory input.

Plasticity: The ability of the brain to change or to be changed as a result of activity, especially as one responds to sensations.

Position in Space: Awareness of the spatial orientation of letters, words, numbers, or drawings on a page; or of an object in the environment.

Postural Adjustments: The ability to shift one’s body in order to change position for a task.

Postural Insecurity: A fear of body movement that is related to poor balance, and deficient “body-in-space” awareness.

Postural Stability: Being able to maintain one’s body in a position to efficiently complete a task or demand, using large muscle groups at the shoulders and hips.

Praxis: The ability to interact successfully with the physical environment; to plan, organize, and carry out a sequence of unfamiliar actions; and to do what one needs and wants to do. Praxis is a broad term denoting voluntary and coordinated action. Motor planning is often a used as a synonom.

Prone: A horizontal position of the body where the face is positioned downward.

Proprioception: The unconscious awareness of sensations coming from one’s joints, muscles, tendons, and ligaments; the “position sense.”

Glossary of commonly used Physical Therapy terms

Abduction: A movement of a limb away from midline or the center of the body.

Adduction: A movement of a limb toward midline or the center of the body.

Ataxia: Muscular incoordination especially manifested when voluntary muscular movements are attempted.

Base of support: The weight-bearing surface of the body. For example, in standing = the feet.

Bilateral: Pertaining to two sides of the body, as in both arms or both legs.

Calcaneal Valgum: Angling of the heel of the foot outward, thereby flattening the arch of the foot.

Calcaneal Varum: Angling of the heel of the foot inward, thereby increasing or heightening the arch of the foot.

Cervical: Pertaining to the neck.

Core: Pertaining to the trunk (primarily abdominals and back).

Dissociation: To separate. For example, one extremity/limb performs a movement without the other extremity doing the same or similar movement at the same time.

Distal: Farthest from the center, from midline or from the trunk.

Dynamic: Pertaining to vital forces or inherent power; refers to the body in motion; opposite of stationary.

Extension: A straightening or backward movement of the spine or limbs.

External rotation: An outward turning of the limb away from the body.

Flexion: A bending or forward movement of the spine or limbs.

Genu Valgum: Angling of the knees inward, as in “knock kneed.”

Genu Varum: Angling of the knees outward, as in “bow legged.”

Gross Motor: Refers to movement of large muscle groups.

Hamstrings: A muscle group on the back of the thigh that can bend/flex the knee and straighten/extend the hip.

Hyperextension: Excessive movement in the direction of extension.

Hypermobility: Movement beyond normal range of motion.

Hypertonic: Muscle tone higher than normal; resistance to passive movement; in extreme form = spasticity.

Hypotonic: Less than normal tone; floppy.

Internal rotation: An inward turning of the limb toward the body.

Instability: Lack of firmness in weight-bearing. Difficulty maintaining weight bearing.

Kinesthesia: Conscious awareness (perception) of body movement (direction and speed), detected by joints.

Kyphosis: An increased convexity in the curvature of the thoracic spine (hunchback).

Long-sitting: Sitting with legs straight out in front.

Lordosis: An anterior/forward curvature of the lumbar and cervical vertebrae (spine). An increase is often referred to as “sway-back.”

Lumbar: Pertaining to the low back.

Midline: The theoretical lines that divide the body into two equal halves vertically or horizontally.

Motor Control: The ability of the central nervous system to regulate or direct the musculoskeletal system in a purposeful act.

Motor Planning: The ability to organize and perform movement in a meaningful manner.

Obliquity: A slanting.

Pes Planus: Flat feet.

Prone: Lying on the belly, face down.

Proprioception: The awareness of posture, movement, changes in equilibrium, and the knowledge of position, weight, and resistance of objects in relation to the body. Sensed by muscles, tendons, and soft tissue.

Proximal: Nearest to the point of attachment or center of the body.

Quadriceps: A large muscle group on the anterior/front surface of the thigh responsible for knee extension.

Range of Motion: A measure of the amount of movement/motion available at any given joint of the body.

Recurvatum: A backward bending, frequently referring to the knees.

Reflex: An involuntary/automatic response to a stimulus.

Ring Sitting: Sitting on the buttocks with legs forming a ring in front (not crossed).

Sacral: The triangular-shaped bone below the lumbar spine formed, typically, by the fusion of five vertebrae.

Side-sitting: Sitting on one hip with legs flexed to the opposite side.

Spasticity: Hypertension of muscles causing stiff and awkward movements.

Static: At rest; in equilibrium; not in motion.

Supine: Lying on the back, face up.

Symmetrical: Referring to symmetry of the body, whose right and left halves are mirror images of each other.

Tactile Defensiveness: A negative response or increased sensitivity to touch.

Tailor-sitting: Buttocks on the floor with legs flexed and crossed (“pretzel sitting”).

Thoracic: Pertaining to or affecting the chest or upper back.

Tone (muscle): The degree of tension normally present in the resting state of a muscle.

Unilateral: Affecting or occurring on only one side of the body.

Vestibular Stimulation: Stimulation of the vestibular apparatus (bones of the inner ear and canals) that provides information regarding acceleration and the position of the body in space.

Weight shift: Translation or movement of body weight from one side to another, forward or back.

Core Strength . . . What is all the Buzz?

We all hear how important it is to have a strong core. But why? What is our core? How does equine therapy help? Following are some answers to these questions:

Being able to perform functional movements and activities is dependent upon our core/postural system. The core is a complex series of muscles which are located primarily in the abdomen and mid/lower back. The diaphragm, which assists respiration, is part of the core.

The primary function of the core is for anatomical alignment and support. The core is most often a stabilizer vs. a prime mover. Core stability controls the position and movement of the central body.

Think about the action of throwing a ball. Your arm is the prime mover and completes the action of throwing the ball but, without stabilization from your core, your body would move forward with the momentum from your arm. The core maintains alignment of the trunk and sustains a stable force against resistance.

In patients with core weakness the body has difficulty sustaining alignment against resistance, which can simply be the force of gravity. This can impact the ability to maintain a sitting position, or move to effectively. Sometimes individuals with a weak core will recruit the diaphragm as a postural support assist. (Think about how many of us hold our breath when we attempt to do something difficult like lifting a heavy load.) The primary function of the diaphragm is to help with respiration and secondarily, speech. If the diaphragm is busy being a postural muscle it is unable to perform its true purpose.


Hippotherapy helps two-year-old Eden Duquesnoy develop muscle tone in her core.

Hippotherapy, or equine assisted therapy, uses the movement of the horse to stimulate activation of the muscles in the core. As the horse moves forward the patient must activate muscles or will fall backward. Hippotherapy is the only form of treatment that can provide continuous stimulation of the core muscles over an extended period of time. Repeated activation over time = strengthening. As core muscles are activated and strengthened, the clinician introduces functional activities that reinforce the use of the core as a stabilizer.

This is one reason that in hippotherapy one hears a significant increase in vocalization and speech sounds. Additionally, with improved core stability the patient can perform more functional tasks with greater success such as sitting, walking, and reaching.

To learn more, ask your therapist, hippotherapy clinician, or one of the excellent therapists at Country Kids.

Lisa Kafka, OTR, HPCS

Country Kids Welcomes Physical Therapist Arica Jacobs

Country Kids Pediatric Therapy Services welcomes physical therapist Arica Jacobs to its staff. Arica provides physical therapy for children from birth to age eighteen.

She holds a Doctorate of Physical Therapy from Marquette University where she also earned her bachelor’s degree.

“I enjoy helping children improve function and quality of life in a fun atmosphere. Seeing them do something for the first time is so rewarding,” said Arica.

She is seeing pediatric clients at Country Kids Pediatric Services located at 1142 Orlando Drive in West De Pere. Appointments are available at (920) 339-0700.

Country Kids Pediatric Therapy Services provides pediatric occupational and physical therapy for children from birth to age eighteen. Founded in 1996, the private practice serves greater Northeast Wisconsin. Treatment is provided by licensed therapists specifically trained in the field of pediatrics. Its clinic location is in West De Pere where it shares a campus in collaboration with Exceptional Equestrians. For more information about Country Kids, visit or call (920) 339-0700.