Exciting announcement! NESCA is accepting clients for home- and/or community-based Real-life Skills and Executive Function Coaching with Leah Bridge, MSOT, OTR. Leah is available for in-person occupational therapy (OT) and coaching services in the Newton, MA and Central MA areas. NESCA’s team of coaches offer Real-life Skills, Executive Function, Functional OT and Parent/Caregiver Coaching remotely for those outside of the Newton area. To learn more or book coaching services, complete our Intake Form.

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balance

154

Learning to Ride a Bike: A Rite of Passage

By | NESCA Notes 2021

By: Jessica Hanna MS, OTR/L
Occupational Therapist, NESCA

If there is one positive takeaway from the COVID-19 pandemic, it’s the ever-growing love for being outdoors. It’s spring, the flowers are blooming, the sun is out, and the air is light. Everything in our body is telling us to go outside and play.

For many kids with and without disabilities, bike riding is meaningful, liberating, and a rite of passage. Close your eyes and try to remember the first time you rode a two-wheel bike. Can you remember the color of your bike? The smell in the air? The complete joy it brought you? That was the day we all felt a bit more confident and like we grew a bit taller.

So how do we help our children achieve this meaningful occupation? The days of running behind our children while holding onto their bike seat, telling them to pedal, not to stop, and hoping for the best and that they will forgive us when we let go (when we clearly promised we would not let go!) should be far behind us. But are they?

A lot goes into learning how to ride a bike, so do not let your child give up so soon when it takes more than a couple of days, weeks, or months to get it right. Consider the following skills that are addressed in learning to ride a bike:

  • Attention and concentration
  • Bilateral coordination
  • Balance
  • Body awareness
  • Core strength
  • Hand-eye coordination
  • Motor planning
  • Postural stability
  • Sensory processing
  • Upper and lower extremity strength
  • Visual scanning

Children as young as five years of age will begin to acquire and develop the skills needed to ride a two-wheel bike, and still others may not feel ready until they are pre-teens or even into adulthood.

Before getting started, here are a couple things to consider regarding the equipment involved in learning how to ride a bike:

  • Bike – The height of the bike is a crucial element to success when learning how to ride. When seated on the bike, your child’s feet should be firmly planted on the ground. The bike seat may appear too low and the bike too small; however, this technique enables movement security, engages proper core and postural stability, and increases confidence.
  • Braking System – Be sure to learn the difference between hand brakes vs. coaster brakes (using feet to backpedal). Both braking systems have pros and cons. Hand brakes are a personal favorite. They are more flexible to position, offer better control, but require adequate hand strength and coordination to manipulate. Coaster brakes (using your feet to pedal backward to brake) use an intuitive motor planning motion for children. When you pedal forward, you go; when pedaling backward, you stop. They are helpful for children who lack the hand strength skills to wrap and squeeze their hands around a hand brake; however, they provide awkward foot positioning and the constant tendency to backpedal.
  • Helmet – Safety, Safety, Safety! When handling a bike for any occasion (i.e., walking a bike, doing balance drills on a bike, or riding a bike), it should become an automatic habit to wear a helmet. Your child should be in charge of putting on and taking off their helmet independently. There is nothing more important than wearing a helmet that fits correctly with fasteners that can be easily manipulated. When choosing a helmet, be cognizant of the type of fastener/clasp it comes with and if your child has the fine motor skills to adjust it (this skill could take time to learn).If you are unsure if your child’s helmet is a good fit, any cycling store will be more than pleased to assist in finding your child the most appropriate size. 
  • Pedals – When learning to ride for the first time, the removal of pedals should be highly considered. It provides the opportunity to address balance, core, and postural stability for both younger and older children while also increasing movement security.
  • Training Bike – Which is best…balance bikes vs. training wheels? Balance bikes are light in weight and can be introduced to children at a much younger age than a pedal bike. They promote core strength and increase motor planning, sequencing, and balance training skills, making the transition from a balance bike to a two-wheel pedal bike more fluid and easier to manage. Training wheels promote ease in learning motor planning techniques to push on pedals while providing assisted balance. It’s important to note that removing the balance component can be disadvantageous when transitioning from training wheels to a two-wheel pedal bike.

Overall, the literature supports the observation that, for children with and without disabilities, learning to ride a bike is a popular activity that increases confidence, provides opportunities for shared recreation with families and peers, and promotes social inclusion (Dunford, Bannigan, Rathmell (2016).

Several of the many clinical diagnoses of children who can ride a bike follow here; however, this list is certainly not inclusive of the many other diagnoses that do not preclude children from bike riding:

  • ADHD
  • Anxiety
  • Autism Spectrum Disorder
  • Cerebral Palsy
  • Developmental Coordination Disorder
  • General learning disability
  • Hearing impairment
  • No diagnosis

The art of bike riding can be broken down into various steps, from learning how to use the kickstand to the act of pedaling. Each step deserves attention, because through repetition and practice, confidence is achieved.

If using these tips feels difficult or is not helping your child with the level of focus and skill they need to successfully achieve their goal to use a bike, we recommend reaching out to your occupational therapist or getting an occupational therapy evaluation. If in-person direct services continue to be a concern, biking riding skills can be offered via telehealth from the comfort of  your home. Jessica offers successful biking riding drills and adaptive home exercise plans through telehealth that address the skills required to learn to ride a bike. Contact NESCA’s Director of Clinical Services Julie Robinson, OT, to learn more at: jrobinson@nesca-newton.com.

 

References
Dunford, Bannigan, Rathmell (2016) Learning to ride a bike: Developing a therapeutic intervention. Children Young People & Families Occupational Therapy Journal 20(1) 10-18

 

About the Author

Jessica Hanna has over 10 years of pediatric OT experience in conducting assessments and providing treatment of children and adolescents with a broad range of challenges and disabilities, including autism spectrum disorders, sensory processing disorders, visual impairments, cerebral palsy, executive function deficits and developmental disorders of motor function. Prior to joining NESCA, Jessica trained and worked in a variety of settings, including inpatient and outpatient hospital settings, private practice, schools and homes. She has served on interdisciplinary treatment teams and worked closely with schools, medical staff and other service providers in coordinating care. In addition, Jessica provided occupational therapy services at Perkins School for the Blind and Spaulding Rehabilitation Hospital pediatric inpatient unit, where she conducted comprehensive evaluations and interventions for children with a broad range of presentations.

 

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

6

Helping Your Anxious Child through COVID-19

By | NESCA Notes 2020

 

Almost a year into Covid-19, many of us can use this blog as a reminder when our children exhibit signs of anxiety from learning of new developments with the pandemic; friends, family or others testing positive for Covid-19; or returning to school. The guidance shared in this blog still holds true, nearly one year since many of us went into lockdown and schools shuttered. 

 

By Yvonne M. Asher, Ph.D. 
Pediatric Neuropsychologist

A recent New York Times article by Jessica Grose discusses ways to support your child, specifically helping them to feel less anxious, during the COVID-19 situation. Their “top 4” suggestions are great ones – validate their feelings, manage your own anxiety, aim for some kind of predictable routine and try mindfulness or progressive muscle relaxation activities.

The larger consideration in this case is this: anxiety, particularly in the current situation, is normal. We can label it with clinical words, give you our best clinical tools and recommend that you seek help (and please do!). At the same time, if we take a large step back, being anxious right now is exactly how we are meant to feel. We are social beings, designed to live in the community and support one another through face-to-face social interactions. When something threatens our safety, or the safety of our families, it is normal to respond with fear, worry and hypervigilance. Everyday interactions that would typically result in no response, like hearing someone nearby cough or sneeze, all of a sudden have become indicators of a threat. Even having others in close proximity to us is now a threat, meaning that the social communities in which we are supposed to thrive have now become potentially dangerous places. In this new environment, our bodies, well-attuned and primed to handle threats, are doing what they should do – they are putting us on “hyper-alert mode,” keeping us exceedingly sensitive to these threats so that we can avoid them and preserve our safety.

Children are in this mode, too, albeit with far fewer resources to help mitigate their fear and worry. As adults, we have far more lived experience with threats, anxiety, fear and worry, and we can use this experience to manage our responses to this novel situation. For children, this may be the first time they are struggling with persistent worry and fear. Or, they may have struggled to cope with other fears and worries for a long time, and this new stressor has overwhelmed their system. In either case, it is important to normalize fear and anxiety, in addition to the myriad of other emotions that children may be experiencing.

The key is balance. We have to balance validating and normalizing feelings with reinforcing unhealthy habits. What does that look like? One dimension to consider is time – validating and normalizing feelings is a short acknowledgement that the child is heard, understood and believed. On the other hand, repeatedly discussing the same questions or topics, engaging in persistent conversations about the threats and explaining “adult” information to children (especially dire predictions, long-term impacts, etc.) is not healthy. These behaviors may appear to decrease anxiety in the short-term, but over time, can be detrimental.

Another important consideration is space – focusing on what is happening in the present is important to help children process and understand the radical changes that are impacting their day-to-day lives. However, if you find that your conversations linger on the past or the future, try to shift back to the present. Your mind may be filled with regrets from the past (e.g., “I knew we should have stocked up on their favorite snack last time we were at the store”) or fears for the future (e.g., “My parents are elderly and at high risk”), and these thoughts are entirely normal. At the same time, when talking with children, it is important to try as much as possible to focus on the here and now. Of course, it is important to give children the space to express their fears for the future, and we can and should acknowledge and validate these fears. We can also, simultaneously, bring children’s focus back to the present and back to tangible, concrete things that they can do (e.g., “I know you are really worried about grandma, and it’s sad that we can’t see her right now. Everyone is working hard to keep her safe, and we are going to call and talk to her later today”).

For some children, advanced intellectual abilities may allow them to understand (at least, in some sense) a great deal of the information that is portrayed on the television and news media. However, it is important to remember that, while their cognitive abilities are years ahead of their peers, their emotional development is not. It may be necessary to closely monitor their online activity, as they may be seeking out information (which is a normal response to fears, especially fear of the unknown) without having the critical thinking abilities to understand the source or potential biases in the way the information is presented. On the other hand, some children may struggle to understand the situation, either because of their young age, learning disability or other developmental delays. If this describes your child, consider putting together a story, with pictures and words, to help them understand some basic information (e.g., why we can’t go to school right now, why we can’t go play with friends). This is often referred to as a “social story,” and clinicians at NESCA can help you create one specifically for your child.

Last, and most certainly not least, seek help and support for yourself, your child or anyone in your family who is struggling. While experiencing anxiety during these times is normal, when these thoughts and feelings are taking over your child’s daily life (or your own), it may be time to look for assistance. Many clinicians, including here at NESCA, are available via phone or videoconferencing, and we can assist with a range of concerns. Whether you want a brief consultation to help you respond to persistent questions from your child or whether your child has a pre-existing anxiety disorder that is exacerbated by these challenging times, we are here to help.

 

About Pediatric Neuropsychologist Dr. Yvonne Asher:

Dr. Yvonne M. Asher enjoys working with a wide range of children and teens, including those with autism spectrum disorder, developmental delays, learning disabilities, attention difficulties and executive functioning challenges. She often works with children whose complex profiles are not easily captured by a single label or diagnosis. She particularly enjoys working with young children and helping parents through their “first touch” with mental health care or developmental concerns.

Dr. Asher’s approach to assessment is gentle and supportive, and recognizes the importance of building rapport and trust. When working with young children, Dr. Asher incorporates play and “games” that allow children to complete standardized assessments in a fun and engaging environment.

Dr. Asher has extensive experience working in public, charter and religious schools, both as a classroom teacher and psychologist. She holds a master’s degree in education and continues to love working with educators. As a psychologist working in public schools, she gained invaluable experience with the IEP process from start to finish. She incorporates both her educational and psychological training when formulating recommendations to school teams.

Dr. Asher attended Swarthmore College and the Jewish Theological Seminary. She completed her doctoral degree at Suffolk University, where her dissertation looked at the impact of starting middle school on children’s social and emotional wellbeing. After graduating, she completed an intensive fellowship at the MGH Lurie Center for Autism, where she worked with a wide range of children, adolescents and young adults with autism and related disorders.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

To book an appointment with Dr. Yvonne Asher, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

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