Tall Kneeling

In January this year, I emailed Matthew's physical therapist (PT) at school to ask how he was doing during his PT sessions. One of the things she said was that in the group he had difficulty staying in a tall kneeling (on knees, not sitting on buttocks) and half kneeling ( one knee up the other down on floor and balancing in this position).

When googling for information on tall kneeling, I came across Adaptivemall.com. We didn't need the equipment but it was very interesting to see that adaptive equipment to help with tall kneeling actually existed. Also to quote from the site:

Tall kneeling is achieved when someone is kneeling and the buttocks are not resting back on the feet. Tall kneeling can assist with the development of balance and leg strength. Note: This position can be difficult for people who have limited ankle bend (plantar flexion) or who wear ankle foot orthotics (AFO).

Matthew doesn't wear orthotics but he does have insole wedges in his shoes for ankle support since he has pronated ankles(but I don't think that matters). The gluteal/buttock muscles are needed to maintain the tall kneeling position. I imagine his gluteal muscles didn't inherently have the tone to easily get into a tall kneel and maintain it. He always preferred to sit on the backs of his feet to stabilize himself.

And of course, I wanted him to develop better balance and leg strength because that will make more physical play activities easier for him. So what do we do? We work on it at home!

How to Position?
His PT and NACD evaluator gave me a few suggestions:
- try kneeling at support surface.
- work on him imitating you go from sitting on heels to tall kneeling position, or in front of a mirror.
- (if he were still in diapers) try bridges, like when his diaper was being changed, ask him to raise his bottom up with knees bent and feet flat on the floor. Hold the position for 5-10 seconds....move a train, ball under his hips to keep hips up.
- have him get on hands and knees and cross creep (crawl on hands and knees). Then while facing him, model getting up into a tall kneel and ask him to do it. From there play something or sing something while maintaining that position.
- practice kneewalking around the room to get things off of the sofa or low tables.

Which strategy worked for him? Asking him to cross creep and then get into a tall kneel to kneewalk and then pause in the tall kneel position helped him understand the concept of tall kneeling. So we played around with kneewalking a lot. He liked jumping and running on giant bubble wrap so I used that as our kneewalking activity motivator.



Within days, his kneewalking improved. More importantly, he was developing the balance and strength to maintain the tall kneeling position for longer periods of time. He'd still sometimes take 3-second breaks to sit on the backs of his feet but he could now easily return to the tall kneeling position without falling over.

Just yesterday, Matthew, Elizabeth, and I had lots of fun playing a fast-paced game of rolling the beach ball back and forth to each other in the tall kneeling position.

At age 2, Elizabeth had no trouble with tall kneeling at all. Seeing her easily play in tall kneeling was one of the many reminders of how much more work Matthew had to put in just to achieve what Elizabeth could do so naturally and effortlessly (relatively). It's at moments like that when one simply appreciates each child's development as it is and admires and learns from Matthew's determination and can-do attitude.

Stickers Activity for Fine Motor Skills

I love great ideas, especially if it's a fun, productive, educational activity for the kids. I recently picked up two great resources for promoting fine motor skills from the facebook group "Educational Strategies for Children with Down Syndrome".

hands on: As We Grow - 30 Kids Activities & Materials for Promoting Fine Motor Skills
PreKinders: Resources for preK teachers - Fine Motor Skills

We tried the sticker activity from "hands on". It was a success! We used small stickers and $1 Shape Tracing activity books from Target. Since I haven't been working on handwriting with either of them, I thought this was a good opportunity to use the tracing books.

Elizabeth was determined to put stickers on the dotted lines to complete her square.

Matthew stayed focused putting stickers on the dotted lines for his oval.

They both did a great job!

Word Hopping

A few months ago, Elizabeth seemed to be taking an interest in sight words. She wanted to participate when Matthew and I looked through his sight word flashcards. She was recognizing "Matthew" and "Elizabeth".

So I jumped at the chance to make her a set of sight word cards. Unlike the picture/ word cards that Matthew started with, Elizabeth's word cards do not have pictures. Each is made of 5-1/2-inch x 14-inch white posterboard with huge red letters, patterned after the word cards described in Glen Doman and Janet Doman's book "How to Teach Your Baby to Read." But like the initial word cards I had made for Matthew, I used words that were of high interest to her.

It took me several evenings to make around 60 words and plan which ones to start with. Then I started with our sight words. After a few days, it didn't seem like she was really paying attention to the words. Maybe I took too long making the cards and she lost interest. Maybe she just wasn't ready to learn it. Maybe she was just interested in the idea of it - the "if big brother is doing it, I want to be part of it" thought process.

So I stopped and decided we would try again in a few months. We put the giant word cards away.

Recently, we rediscovered her word cards. But instead of using them as flashcards, we scattered a few on the floor and hopped on them. It became an addictive and fun sequencing game for both of them.

Taking turns, I'd give Matthew a sequence of 3 or 4 words to hop on. Elizabeth received 1 or 2 word sequences. She wasn't really recognizing all the words yet but with some guidance, she was happily hopping on the words like Matthew was. "What big brother can do, I can do too."

Toy Review Tuesday: Paper Weave

In my search for "Montessori method" activities and toys, I found "weaving paper" on page 40 of Teach Me To Do It Myself: Montessori Activities For You And Your Child authored by Maja Pitamic. I bought my copy from amazon.com.

Materials needed:
white posterboard, cut into 8-inch x 8-inch square
colored posterboard, cut into 3/4-inch x 8-inch strips (2cm x 20cm)
ruler (for measuring)
pencil (for marking cut lines)
scissors and cutter

Cut out alternating strips on the 8-inch x 8-inch square posterboard so you are left with a frame containing vertical bars of paper.

The weaving activity may still be too challenging for the younger ones, like Elizabeth. But she still found it fun to play with the colored strips of paper - naming colors and watching Matthew weave his strips of paper "over" and "under" the white frame.

He Really Loves to Dance

He walks on over to the iPod stereo and pushes the "on" button. The radio station is preset to one of the local ones with few commercials and generally (relatively) better music (no explicit versions). Whatever is on, it's usually music with a good dancing beat and Matthew is rockin' it! Matthew LOVES dancing and it seems like he'll dance for as long as I let him.

Almost all literature I've read about individuals with Down syndrome include "love for music". Maybe it's true for all, maybe just the majority - I don't know. But I definitely think it's in his genes because I love dancing too (and so does Elizabeth).



Related post:
Matthew Likes Jazz

Toy Review Tuesday: Don't Break The Ice

The goal of Don't Break The Ice is to keep the polar bear on top of the ice for as long as possible. Players take turns tapping an ice block with the included plastic mallets.

Turn-taking is encouraged when playing by the simple rules of the game. My kids prefer a free-for-all game. The faster they can tap out all the ice blocks, the more fun it is. They have more fun making the bear fall through. As a result, each game lasts less than 30 seconds afterwhich they ask me to set up the pieces again saying, "More please" or "Again!"

Setting up requires more hand strength and fine motor coordination than either of them currently possess. They help me gather the pieces and I am more than happy to set it up.

It's a simple game. We can either play by the rules or not. I like it because the kids have fun with it and it's quality time spent together.

Toy Review Tuesday: Pictures on Lids of Baby Food Jars

I saved some lids of the jarred baby food Matthew used to eat. Then I cut small pictures from magazines and glued them on the inside of each lid. We've successfully used them for several activities.

Activity Ideas
"Look for something... (descriptive)" is one game we have played. We'll have all the picture lids facing up and look for something yellow or round or shiny and so on. As a learning activity, not a testing activity, if I find something first, I'll pick it up, show it to the kids, and say, "This banana is yellow." Elizabeth is usually the first echo in the room saying, "banana yellow." (Yes, she's very verbal and articulate).

Matthew doesn't process complex "wh" (what, who, where) questions yet, except he knows some simple, straight-forward ones through rote learning. If I were to read a short story to him and ask him what, who, and where questions in relation to the story, he would not know how to answer them. But if I showed him some picture lids and asked him, "What do we drive?" then he'll pick up the lid with a car. "What can we eat?" then he'll pick up the lid with green beans or other food instead of one with a telephone.

To help improve auditory processing and short-term working memory, I ask Matthew for 3 or 4 pictures out of 4 to 6 picture lids laid out face up in front of him. And I require him to give me the pictures in the same order that I had requested verbally. Ideally, he should do it without any prompting or repetition of the request. When he can't seem to remember or he gets the order mixed up, I guide him hand over hand. Matthew can usually get a sequence of 3 correctly.

Elizabeth likes to look at the pictures, verbally label the ones she knows, and drop them into the can with the slotted lid.

iPhone Apps
For the tech-savvy like Matthew, iPhone apps that are structured like the activity I described above include:
"ABA Receptive Identification by Class" created by Kindergarten.com
"ABA Receptive Identification - FFC Combined" created by Kindergarten.com
"ABA Receptive Identification by Function" created by Kindergarten.com
"ABA Receptive Identification by Feature" created by Kindergarten.com
"ABA Receptive Identification" created by Kindergarten.com

Distract Her With Kisses

It was time for a morning snack. In her little toddler voice, Elizabeth said "no! no!" to yogurt and happily nodded "yes!" to eggs. Matthew was at school. She had me all to herself.

I got out the pan and started to take a few steps to the refrigerator to get the eggs. Elizabeth started whining and clinging to one of my legs. She wanted me to sit and play with her - immediately!

I scanned the area quickly, looking for a toy. There were none nearby. Aha! The old valentine chocolate sitting on our kitchen counter finally had a purpose.

I showed her how to sort by color, count, and pour. She discovered peeling the foil off all on her own.

Cooking the eggs turned out to be a peaceful, non-screaming few minutes. The Hershey kisses had her undivided attention. Even the cat thought it was entertaining.

If only it were this easy to distract her all the time... Maybe I should keep Hershey kisses as a handy distraction when I need to buy myself a little time. But that would be expensive and too much chocolate for me to eat. Real kisses are better - zero calories and priceless!

Toy Review Tuesday: Beans, Beans, Beans

Dried beans are proving to be quite a versatile toy at our house, especially since Elizabeth doesn't mouth toys anymore. In addition to putting them in a plastic container for a Homemade Tactile Sensory box (from an earlier toy review) to practice scooping and pouring and to provide sensory input, we are re-discovering the many fun and educational ways to play with beans.

Beans can be used for counting. One-to-one correspondence counting and other early number concepts like "more" or "less" or "few" or "many".

Beans can be used to make sock bean bags, which is something I learned recently from Elizabeth's visit with our local Parents as Teachers group. Elizabeth enjoys fine motor activities. Usually, whatever Elizabeth is doing, Matthew wants to try too (and vice versa). This activity hits many areas: fine motor control and coordination, pincer grasp, sharing and cooperation between siblings, and attention span.

The only materials needed are dried beans and socks. We used Daddy's socks. (He won't realize they're missing anyway - not until he reads this).

After filling the socks, make a knot so the beans don't fall out.

Then fold over to form a bean back sock ball.

Bean bag socks are great for:
- tossing overhand or underhand into laundry baskets (for a wider target) or small containers (for a smaller, more challenging target).
- a quick game of catch.
- balancing on various parts of the body like the head, arm, knee, and so on.

Our bean bag making activity then turned into a pretend cooking game. Matthew was handing Elizabeth pots and pans and plates as she filled them with beans and stirred with the spoon.

We also made egg shakers filling plastic eggs from last Easter with beans and sealing with glue.

Other good fillers for the egg shaker are uncooked rice and small uncooked pasta.

Related post:
Toy Review Tuesday: Homemade Tactile Sensory Box

Matthew Likes Jazz

Simple, spontaneous moments can be a lot of fun. Sometimes they turn out to be one of the most special moments I have with my kids.

We usually listen to kid music. Matthew enjoys songs by Greg and Steve, The Laurie Berkner Band, songs from the Kindermusik class he was in a couple years ago, and other similar kid music.

The other day, I had my iTunes playing an audio recording of Matthew's cousin reading a book for him. It was in the iTunes list on my laptop. Before I could click on the stop button, a lively jazzy song came on.

Matthew started dancing. He could not contain his excitement. He loves music. He loves to dance. I turned up the volume and we danced. We twirled. We moved around the kitchen. We made up simple dance moves (a fun way to practice listening to directions, reinforce body awareness and body movement).

Elizabeth danced for a little bit then decided to play with cups instead.


"The Blue Room" by Tommy Dorsey from the album "Anthology of Big Band Swing".

It was a lot of fun and brings a smile to my face whenever I think about it. We're going to do this more often.

Toy Review Tuesday: Memory Game

I remember playing Memory Game as a child. It was one of the many games I enjoyed. It makes me happy to see that Matthew has taken an interest in it too.

I began teaching Matthew how to play a few months ago. Starting out with just 2 pairs, I'd illustrate how to turn over the cards individually to find the matching card. I had to be quick and enthusiastic about it to keep Matthew's attention and get him interested. He wasn't very interested the first few times I brought out the game.

Teaching him the objective of the game only took up to a minute or less each time we would "play". Whenever I let him have a turn, I applied the "errorless learning" method, wherein he always succeeded at finding the matching card. This involved either hand-over-hand help or me pointing to the right card to flip over.

Gradually, as he started to show more interest, I added a 3rd pair. These days we play with either 4 or 5 pairs while Elizabeth likes to look at the other cards. It's cute to see her pretend to play too. She'll say "Match!"

A couple of iPhone apps helped build upon his interest and understanding of the game too. The app "Monkey Preschool Lunchbox" has a mini memory game in amongst the other games. Another one I have on my iPhone is "Preschool Memory Match".

When Elizabeth is older, Matthew and I will teach her to play Memory Game too.

Why and How I Teach Sight Words

The brain hears by seeing - something I learned this year. An excerpt from the article Brain Hears Just By Seeing, "The brain's auditory cortex reacts to and categorizes stimuli even when you only see the sound being produced and can't hear it." This probably explains how Bill, when he was a child, could watch a TV show on mute and still understand it. He could lip read.

So if the brain hears by seeing, then the brain can hear speech sounds when presented with a written word. Of course, this would probably be more possible after having the appropriate and correct input once or a few times before it is able to "hear" the word correctly. For example, if the only language I knew was English, then I wouldn't know that the "j" in Spanish was pronounced silently, like an "h". But given the input or knowledge of the Spanish alphabet and/ or language, my brain would be able to recognize "Juan" and enable me to pronounce it correctly with an "h" beginning sound instead of a "j" sound like in "jump". My brain wouldn't hear anything either when presented with Chinese characters because I don't know the first thing about them.

The interesting research on how the brain hears what it sees encourages me to continue teaching Matthew sight words. With a second set of ear tubes and regular ear checks with an otoscope, Matthew's ears have been fluid-free and his hearing has been good as far as I can tell. But hearing levels can fluctuate. Background noise can be distracting. Since Matthew can read, his preschool teacher can show him the words "stand up" if he is unresponsive to verbal instruction. As soon as he sees the words "stand up", he stands up.

Signing vs. Speaking
Signing would've worked too to get him to stand up. Matthew and I communicated via signing when he was 15 months to about 2-1/2 years old. It served as a useful and helpful bridge to fill in the communication gap when Matthew wasn't saying as many words yet. In our experience, sign language seemed to help ease communication frustration (most of the time, not all the time) and increase receptive language skills.

He still signs a few words these days like "more" but he always pairs it with a verbal "more". Generally, we've dropped sign language. As soon as he started articulating more sounds and saying a few words, I decided it was time to encourage spoken language more than sign language.

Increase Speech, Articulation, Vocabulary
Aside from the research on the brain hearing what it sees, there are other benefits to teaching reading at an early age. Articles like "Teaching reading skills to children with Down syndrome" talks about teaching reading to help with speech, vocabulary, and working memory.

The book "Teaching Reading to Children with Down Syndrome - A Guide For Parents and Teachers" by Patricia Logan Oelwin catapulted me into introducing a few words of high interest to Matthew like Daddy, milk, cat, apple, Matthew, Mommy, and ball, pairing the words with pictures to provide a visual cue. What worked best for us included using words that were of high interest to Matthew and words he heard often in daily conversation and routines. He was 2-1/2 years old.

As he learned to read more words, his speech (verbalization/vocalization) and vocabulary picked up by leaps and bounds. Our suspicions of verbal apraxia were dispelled.

Speech therapy at school and using the SmallTalk Phonemes app on my iPhone has corrected many speech errors and improved his articulation of individual letters in the alphabet and a few blends. He says "Mommy" very clearly now instead of just "b" or "bahbee". He was substituting the 'm' sound with a 'b'.



Today, he can read over 110 words by sight without any pictures. He can read many of the words on the dolch list.

Our Favorite Tools and Resources
- Mentioned earlier, the book "Teaching Reading to Children with Down Syndrome - A Guide For Parents and Teachers" by Patricia Logan Oelwin was helpful to me.

- For articulation, iPhone app SmallTalk Phonemes.

- Homemade flashcards. I started with laminated cards with the word on one side and the corresponding picture on the other. It was easy to do with nouns. When we started to move into words on the dolch list I just wrote words on plain 3x5 index cards. I flash 5 to 7 new words a week and review several old ones. We keep the flashcard activity fast and brief.

- Homemade alphabet, number, and word videos, a couple of which I shared on my blog. (Click on "videos-learning". The link is also found in "View Posts by Category" on the sidebar.)

- Preschool Prep Meet the Letters and Meet the Sight Words DVDs, books, and iPhone apps. Matthew loves Preschool Prep.



Factors That Help Sight Reading
We only have one set of eyes and good, clear vision helps tremendously in allowing us to take in information, process it, and learn.

Matthew was around 7 months old when we took him for his first eye exam with a pediatric opthamologist. A little far-sighted than one would expect, the doctor said, but nothing that would require eyeglasses. His clogged tear duct that had been making his one eye gunky and crusty every morning finally cleared up when he was 10 to 11 months old. So surgery was not required to probe the clogged duct. After another eye exam at 16 months and 28 months and no major concerns, the doctor said he didn't require another eye exam until he was 4 years old unless he developed a problem before then.

It is Matthew's good vision that is partially responsible for allowing him to learn sight words. Other factors are his strong visual style of learning, good visual memory, fluid-free ears and good hearing, improving articulation and speech, and of course, high interest in learning to read.

Comprehension
I think comprehension will develop with exposure, practice, and maturity. He understands the meanings of individual words but learning to understand a story or an idea is harder to grasp - for anyone who is trying to learn a language.

Comprehension may also develop by pairing written high interest phrases or sentences with the corresponding situation. Moving forward to 3 or more-word phrases from 2-word phrases, I currently use plain 3x5 index cards to visually prompt him with highly used sentences. "I want more please", "Let's go home", and "Time to eat" are a few examples. Today, he came to me with something on his mind and slowly but clearly said, "I want help please." Unprompted.

In the bathroom, a list is posted as a visual prompt for his toileting routine. He can read it. I use it to prompt his next step in case he gets sidetracked with singing or self-talk.

One of Many Paths to Literacy
Learning sight words is just a beginning step in learning to read. To quote the Preschool Prep DVD:

"Learning to read is a combination of many skills including letter recognition, decoding skills, phonics, phonemic awareness, and memorizing sight words. Knowing sight words alone does not mean that a child can read but it is an important step on the path to literacy."

Toy Review Tuesday: Alphabet Foam Floor Mat

Foam floor mats come in many colors and varieties. We have the alphabet floor mat. The square pieces are interlocking and the letters pop-out for some puzzle fun.

We don't really use it as a "sit down and put together the puzzle" toy though. We enjoy it as just a floor mat.

Activities We've Liked

Create an infinite path. After I modeled walking/ hopping/ jumping/ naming letters as I randomly stepped on them, I got Matthew's attention. He thought it was pretty funny, giggling the whole time he was walking as fast as he could on the foam letters. Round and round the living room floor around the ottoman.

Create a simple obstacle course. I put a wooden board across one area for Matthew to step on and off it whenever he got to it. We have fun AND work on leg strength at the same time.



Connect all the pieces together to form a giant rectangular mat. Lay a quilt and/or blanket on it. Top with pillows. It makes a comfortable lounging/ play area. Matthew and Elizabeth had fun just rolling around on the makeshift bed.

Create a path of letters. Play an impromptu game of "Stomp on/ Touch/ Point at the letter ___."

A line/ path of foam letters also make a fun road for matchbox cars, a landing strip for an airplane, or even a substitute railroad for trains.

Do you have floor mat play ideas you'd like to share? We'd love to try them!

Cons
Matthew is way past the 'mouthing toys' stage. But there's something about these foam pieces that he likes so sometimes I'll catch him biting or chewing on a piece. Elizabeth is teething. I find her chewing on the pieces too sometimes. We have a "no chewing/ biting foam" rule here. The foam pieces are confiscated and rinsed.

Storage was an issue until I rearranged the toys and dedicated one toy box for all the pieces.

Clean up is tedious. Luckily, Matthew and Elizabeth don't take the pieces apart too often.

Monkeys Wrestling on the Bed

After a few minutes of wrestling and rough-housing on our bed with Daddy, Matthew is suddenly more verbal than usual. I think it's an effect of the high dose of FUN. Elizabeth purposely falls back first on the bed, enjoying its plushness, and giggles hysterically. They have a blast hiding under the covers and getting tickled. Besides, it's just the best time ever on the weekends!

Three monkeys wrestling on the bed.
Thankfully, no one has fallen off or bumped their head.
Mama took these photos as she said,
"Oh, be careful wrestling on the bed!"