Physifun's new website

Physifun is proud to announce the launch of our new website. We hope you enjoy it!

http://www.physifun.co.za

PhysiFun Health Professionals Courses:

Physifun runs CPD courses (12 points + 1 ethics point ) for  physio's and OTs.

The Physifun Gross Motor exercise programmes, (called ABC and PhysiBall) aim to improve gross motor development, by using a combination of Pilates, Yoga, coordination and balance exercises using the gym ball. Improving gross motor and postural/core control is one of the foundations for higher intellectual, psychological and social functions, especially when implemented in a fun and enticing way- Physifun aims to address not only the physical needs of children, but also the psychological & social needs of a child who might otherwise not want to participate in a physical activity. Health professionals will walk away with ideas and concepts regarding tapping in to a child's perceptions of self efficacy, mindfulness and ways to kickstart the cycle of learning by exploration, play and doing.

Physifun has recently introduced the Physifit exercise programme which is for all children aged 8 to 13 years and is aimed at injury prevention, muscle conditioning, agility training and general core muscle strengthening in a sporting setting.

Some of the content covered during the weekend course is:

·   Developmental Coordination Disorder- a summary of the latest research which supports specific screening tools, interventions and approaches to management

·   Neuromyths and the relevance to education- facts and fiction about the science behind brain research in education.

·   Exercise in the therapeutic and educational setting- the link between physical activity, obesity & its effects on a child's learning ability as well as what motivates children to participate in physical activity. A brief overview is also given on acute and overuse injury prevention during formal exercise programmes and what the coaches should be doing as part of their training sessions and warm ups.

·   Ethical and professional responsibilities when implementing group based exercise programmes in schools and in your practices 

·   Postural control:  How and why it affects your child’s health, learning, behaviour & future A lecture designed for physios and OTs to give to parents and teachers regarding postural control, with take - home, easy-to-implement practical ideas and tips to help children become more aware of their posture and to help their postural control become more consolidated, freer and automatic. 

Physifun Gross Motor Programmes: Physiball and ABC theory and practical Health Professionals can run Physifun group exercise classes in their practices as they might run a pilates class or they can educate local schools (using Physifun power presentations) and parents so that everyone is on board and doing their bit on a daily basis to help these children achieve their maximum potential in the classroom, on the playground and in the sporting and physical environment. Physifun does not replace 1 to 1 therapy , but rather, it is an additional support and educational tool, or a follow-on for those families who cannot afford ongoing therapy or more than 1 session per week. (Please note Physifun is not designed to replace 1 to 1 therapy).

Contact: Natalie@physifun.co.za or 082 3072337

Website: www.physifun.org

What happened to deportment badges...? Postural can affect your child's health, learning, behaviour and future.

Postural control:  How and why it affects your child’s health, learning, behaviour & future – written by Tracy Prowse

The words, “sit up straight” bring back all sorts of memories from my childhood. Deportment badges and  practising walking with a book on my head were all part of a normal school day for me. Today, however, we think of these memories with a smile on our faces and cannot imagine it happening in today’s schools. Sitting up straight at a dinner table doesn’t often feature, since many of us do not eat at the dinner table anymore. Instilling a sense or awareness of good posture in a child seems to have been abandoned, perhaps to the detriment of our children’s health. Nowadays, children are spending more time in a sedentary position than ever before, which should give us more reason to focus on posture, not less. This article aims to explain why being aware of your posture whilst sitting and standing is so important to your  health, behaviour and learning ability and ways to encourage your child to sit and learn in an optimal way.

Postural control describes the way muscles work together to maintain and regain posture and balance, thus liberating our arms and legs to do other things.  Gravity, our sensory systems in our joints and ears (proprioceptive and vestibular), our brain’s ability to perceive the information given to it from these sensory systems and our innate motor development (such as balance, coordination and core stability) are factors that influence the control of our posture. Postural control begins in the womb and becomes refined with each new learnt task.  It takes 7 years of constant refinement to achieve automatic postural control and in order to be “writing ready” postural control has to be adequately consolidated and automatic. However, for some of us, this ability to control our posture is not automatic and perhaps was not ever consolidated as a child and there can be a number of reasons for this.

One reason is that some of us are born with what seems to be loose, floppy muscles and joints. The medical term for this is hypermobility, which means “more movement”. It is characterised by weakness or laxity (looseness) of the connective tissue in our body. Connective tissue’s function is primarily to support, anchor and connect various parts of the body and is found in muscle, ligaments, surrounding organs and even in bone. Therefore, if one is born with a predisposition towards connective tissue laxity, they don’t have a natural supporting and anchoring system to help them sit or stand or move efficiently. As a result, their muscles need to work a lot harder to support and move their joints and maintain a posture than someone else who was born with strong and taut connective tissue system. Children who have hypermobility often find it hard to maintain their sitting posture for very long and will constantly wriggle and move in and out of positions or wind their joints up to the maximum position so that they almost lock the joint. The reason is that the muscles do not need to work in this position because the joint is locked into a sturdy position.  Typical postures would be to stand with their knees locked back, hips thrust forward and a larger curve in their lower back then normal. They also tend to sit in a “W-sitting” position or if they are at a desk, they will try and curl their feet under them or around the chair in order to gain as much stability as possible.

Another reason for not having automatic postural control is purely a lack of practice. Some children are not encouraged to sit at the dinner table and eat their supper or perhaps they were not interested in drawing or table top activities as a toddler and so it was never pursued further. The problem with this is that they never get to practice something which is absolutely fundamental to learning: the ability to sit at a desk for a prolonged period. These children will have weaker sitting muscles, standing muscles and writing muscles than a child who has grown up being encouraged to sit and do an activity (like scribbling, playing with play Doh, eating, lego, or whatever) for short periods-progressively getting to be longer periods-since the time they could sit.

Following on from this scenario, is another scenario where the child doesn’t seem to have the concentration or ability to focus on one thing for any period of time. Their attention is constantly moving from one thing to the next and they are constantly distracted by outside noises, textures, sights or whatever catches their attention. These children do not gain that automatic and consolidated postural control because their attention to the task of sitting has never been present.

Many children (and adults) who have any of these underlying issues with postural control can end up with poor fine motor (movement) and sometimes poor gross motor control. This means that they have difficulty with their handwriting and other fine motor activities, as well as on the sports field during ball games, balance activities or coordination activities like skipping, hopscotch, riding a bicycle. Unfortunately, these are the children who desperately need to practise their motor skills, yet, due to a feeling of inadequacy or difficulty in sport or handwriting, choose not to do these activities. As a result, the weak get weaker, (and the sporty get sportier) and these are the children who often end up with poor posture, bad backs and a poor self-esteem or self-efficacy, later on.

In order to have efficient postural control, the spine needs to be in alignment with the natural curvatures of the spine preserved, with a stable but dynamic base of support in the core musculature. This will free up the arms and legs with minimum effort. Having good postural control strengthens the core stabilisers (postural muscles) and inhibits the moving muscles (non-postural muscles). These moving muscles are often the culprits of those aches and pains one gets when one has a sore back or neck. The moving muscles often try and compensate for the lack of core stability or core support and they try and do the work of the core muscles. However, the moving muscles are made up differently with fast twitch muscle fibres and therefore they cannot sustain the types of demands that maintaining postures requires. This is why they often get tight and sore. They are unable to do the work of the postural muscles for a long length of time.

Having good postural control, whilst sitting, facilitates proper positioning of the writing arm. It enables a shift of gaze with minimal shifts in background posture (“fidgety” kids) and facilitates use of vision and reduces visual strain and increases alertness and oxygenation and prevents back pain (13% of children aged 10-16 have significant incidence of recurrent LBP) (Jones et al, 2001).  So, how do we encourage good postural control in our children?

It is believed that physical activity helps trigger our postural muscles (core stabilisers) unconsciously. Thus, encouraging a child to do physical activity is a way of improving posture, since the core stabilisers are the muscles needed to maintain a good posture. Physical activity is proportional to IQ, achievement, maths & verbal testing (Sibley & Etnier, 2003) and research shows that aerobic exercise is beneficial on brain function which is important for education (Hillman et al, 2008).

Another easy way to facilitate good posture in children is to make sure that their feet are supported whilst sitting. The Erector Spinae muscles (in spine) are triggered by the sensors in the feet, so without foot contact, the spinal muscles have to depend on conscious control. It is essential that the child’s school desk is the correct size and that a child is sitting with a foot stool at the dining table. You will be amazed at our much longer your child will be willing to sit still at the dinner table. Sit with knees apart, feet on floor, elbow at desk level, rest forearms lightly on front table and use light support for alignment, in order to gain natural curves of spine. Imagine that you are pulling the top of your head to the ceiling. Size matters when selecting educational chairs and tables. Age and height considerations are often not reflected in furniture selection, and consequently the furniture is too big or too small. Furniture that does not fit the users will lead to restlessness and discomfort, resulting in a decreased attention span and the consequence is that one size of furniture will not fit all the pupils who use a classroom; they need furniture of different sizes or that can be adjusted to suit their varying dimensions. Desk and chair height needs to be measured for each child and schools need to make use of wedge cushions and writing slopes for the children who are not coping with the standard desk structure (the slope enables the child to keep their hand under the line of writing and the wedge assists the child to maintain a natural curvature of the spine, thereby stimulating unconscious core muscle activation).

Ways to encourage good posture in pre-schoolers are to avoid W-sitting. Encourage good spinal and joint alignment during play by using cushions, wedges, and playing in different positions, such as high kneeling, lying on their tummy, on all fours or standing. Make sure these pre-schoolers have an opportunity to practise the skill of sitting and building up their writing muscles by setting goals for them to see how long they can do it for. Ensure that they eat whilst sitting with good alignment, feet supported and a stable base, but also teach and instill an awareness of themselves, by being present in your mind with your child during these activities.  In the same way that we need to build up the strength of the muscles, so do we need to build up the “strength” of our focus, attention and concentration. The only way to do this is to engage with your child with mindful awareness of the task you are both engaging in.

Poor posture not only leads to a bad back at a later age but even in the young it can have some negative effects with poor concentration, fidgeting and discomfort. Ensure your child reads in a supported position with good alignment or even allow the fidgety child to read with their books in standing on a recipe or music stand. He or she will be able to move around and fidget whilst reading. This will actually improve his or her concentration, rather than hinder it. Incorporating movement into the task of reading might make it more interesting and enjoyable for them.

Give your child a stable base of support with cushions under their arms, knees and head (either lying on a bed or well supported behind the back on the sofa); arms comfortably supported; both hands on sides of book; Fingers long and relaxed; plane of book and the plane of face parallel; Nose opposite the middle of the block of print being read to facilitate easy flow of eye movement across midline.


If we can increase our children’s awareness about their posture and give them responsibility for their exercise and postural habits, then we, as parents are giving them the best start possible to a healthy future.

Parents and teachers need to provide good role models to the children; not only with their own posture, but also, by the amount of exercise and activity that they do. Encourage your child to walk to school, by appearing excited at the prospect yourself. Schools need to educate teachers and children about good posture. Positively praise and reward children for sitting at their desks for a prolonged period (20 minutes maximum for a grade 1 child; 15 minutes max for a Grade R child) and build up to that goal. You cannot expect a child who has never sat down and completed the task of colouring in a picture in Grade R to then sitting at a desk I Grade 1 for 20 minutes. Persist and insist that they move about and have breaks throughout the day (send the fidgety child on errands- they will return more focussed and less disruptive), think about incorporating a 5 minute stretch programme into your school day, such as the Straighten Up UK programme (http://www.chiropractic-uk.co.uk/straightenup). Movement plays an important part in seating. Research has found that “a school in which movement is supported and encouraged has a positive effect on the learning ability and attentiveness of the children” (Dr Dieter Breitheckerxi). Commit to good posture at home and in the classroom and make correct sitting a key component of all tasks at the desk and try and encourage mindfulness or awareness in both you and your child regarding their ability to sit. Be aware that a child may benefit from consulting a physiotherapist or OT, if they have writing or movement difficulties or you have observed symptoms of postural inadequacies. And consider implementing a strengthening exercise programme at the school for the children who are clumsy, floppy, poor posture or uncoordinated, such as Physifun’s programmes (www.physifun.co.uk/physifunpackage), so that they can strengthen their core muscles  and their moving muscles and improve their balance and coordination in a structured daily setting.

Tracy Prowse

Physifun Founder

BSc (Physio) Hons UCT, MPhil (Sports Physio)  UCT/SSISA

PhysiFun 

www.physifun.org

References

1.     Barnett, L et al (2010). Longitudinal evidence for the importance of motor skill proficiency to physical activity. Journal of Science and medicine in Sport. Vol 12, Supplement 2, January 2010, Page e70

2.     Cliff, D et al (2010). Efficacy of a skill development programme in promoting motor skill proficiency and physical activity in overweight children. Journal of Science and medicine in Sport. Vol 12, Supplement 2, January 2010, Page e70

3.     Hunt, L (2009). Core Stability on the curriculum. Frontline. October 2009, Page 15

4.     Weikart, P et al (1995). Foundations in elementary education movement.  Ypsilanti, MI: High Scope Press

5.     Hillman, C.H, Erikson, K.I, and Framer, A.F (2008) Be smart, exercise your heart: Exercise effects on brain & cognition. Nature Reviews. Neuroscience, 9, 58-65.

6.     Kirby, A. & Sugden, D.A. (2007). "Children with developmental coordination disorder". Journal of the Royal Society of Medicine, 100, 1-5.

7.     Orton, S.T (1937). Reading, writing & speech problems in children, New York. Norton.

8.     Sibley, BA & Etnier, J.L (2003). The relationship between physical activity & cognition in children: A meta-analysis. Pediatric Exercise Science. 15, 243-256.

9.     Winter, B, Breitenstein, C, Mooren, F.C, Voelker, K, Fobker, M, Lechtermann, A, Krueger, K, Framme, A, Korsukewitz, C, Floel, A & Kncht, S (2007). High impact running improves learning. Neurobiology of Learning & Memory, 87, 597-609.

10.   Sugden, D.A. & Chambers, M.E. (Forthcoming). "Stability and change in childrenw ith Developmental Coordination Disorder". Child: Care, Health and Development.

11.  Sugden, D.A. & Dunford, C. (2007). "Intervention and the role of theory, empircism and experience in childrenw ith motor impairment". Disability and Rehabilitation, 29, 3-11.

12.  Sugden, D.A. & Kirby, A. (2006). "A moving child is a learning child". Child Care, 1, 13-14.

13.  Green, D., Baird, G. Sugden, D.A. (2006). "A pilot study of psychopathology in Developmental Coordination Disorder". Child: Care, Health and development, 32, 741-750.

14.  Smits-Englesman, B.C.M., Sugden, D.A. & Duysens, J (2005). "Developmental trends in speed accuracy trade off in 6-10 year old children performing rapid and discrete aiming movements". Human Movement science, 3, 1-11.

15.  Sugden, D.A. and Chambers, M.E. (2003). "Intervention in children with DCD:the role of parents and teachers". British Journal of Educational Psychology, 73, 545-561.

16.  Utley,A,Steenbergen,B. & Sugden, D.A. (2003). "The influence of object size on discrete bimanuakl co-ordination in children with hemiplegic cerebral palsy". Disability and rehabilitation, 26, 603-613.

17.  Chambers, M.E. and Sugden,D.A. (2002). "The identification and assessment of young children with movement difficulties". International Journal of Early Years Educaton, 10, 157-175.

What makes a person good at ball sports?

I have recently come across some interesting research around a subject called "Quiet Eye Training". The term was originally coined by Professor Joan Vickers, from Calgary University and has been defined as the final visual fixation of long steady duration (500-3000 milli seconds) found typically in experts in aiming type tasks (golf putt, shooting, basketball free throws) and has been described as a perception action variable. 

Positive findings have emerged from a number of different tasks, from golfing and basketball skills, from surgeons performing laparoscopy, from police fire arms tasks, recently from military marksmen (plus many more) and (why I am interested in this) from children with motor coordination disorder. These studies have varied in design in terms of the duration of training, the delay until retention (how long does it take to retain the skill, as a novice, for example) and the type of situations that a trained-up individual can perform in (initial studies, from Exeter University in both putting and basketball have revealed that the individuals (both novice and expert) who had Quiet eye training (QET) were able to retain their performances better under pressure compared to those who received more regular technical training. Therefore, this is important for athletes who "choke"). The vast majority of these studies have supported QE training as a means to expedite motor learning.

This concept of QET has been around since the 90's and many sports coaches, psychologists and trainers use the concept daily. It has also been incorporated into mindfulness, visualisation, sports specific vision therapy and anxiety relieving techniques in terms of getting the individual to be in the present moment and take time to focus on specifics of their technique (for example looking at the back of the ball for a prolonged moment before you take your back swing of the putt in golf). 

So, it seems natural that researchers are now looking at whether QET can improve the motor outcomes of children who have movement control difficulties. Can we teach children who are not naturally good at ball skills (for example) to focus on aspects of the ball or the target by using a QE technique? Researchers at the University of Exeter are doing just this. They have watched "good ball catchers" and analysed why they are "good" at catching compared to the poor catchers. Their studies reveal that good catchers have a technique that they are comfortable and confident with. They are aware of technical pointers such as cupping their hands together, without being told what to do. They are also able to identify a technique that suits the task and will adapt this technique according to the task at hand. The poorer catchers do not make this adaptation and will stick to their learnt technique no matter what the situation calls for. They do not adapt to their environment naturally-which is important when in a game situation. The researchers hypothesise that perhaps these poorer catchers feel incapable of adapting or changing their technique. They then did a pilot study recently which revealed that Quiet Eye Training might be an effective intervention for improving the motor skill of typically developing children.

The study compared a ‘technical training’ intervention which included the normal instructions for throwing and catching (e.g. smooth throw, hands together) with the QET which used instructions such and take time to aim, track the ball closely. Results indicated that only the QET group had significant improvements in catching performance in an immediate retention task. These results suggest that QET may be an effective intervention to improve the catching performance of typically developing children. The researchers are now assessing the effectiveness of QET for children with DCD (developmental coordination disorder) in a larger study funded by the Waterloo Foundation. This is very exciting for us parents, teachers and therapists of children who have motor skill difficulties, as it could be a fun and specific way of actually teaching ball skills to these children effectively and perhaps more efficiently as to how we do it at the moment. If you have ever taught a child with motor coordination difficulties how to catch a ball, you will agree, it takes a lot of patience, time, encouragement and motivation for both parties! Perhaps we should start incorporating these techniques into our teaching, even whilst the research is not quite there to support it as a technique for these children. There certainly can be no harm in using it as one of the techniques we use when teaching our children?

 Klostermann, A., Kredel, R., & Hossner, E.-J. (2013, February 11). The “Quiet Eye” and Motor Performance: Task Demands Matter!. Journal of Experimental Psychology: Human Perception and Performance. Advance online publication. doi: 10.1037/a0031499

Wood, Vine, Wilson (2013). The impact of visual illusions on perception, action planning, and motor performance, Atten Percept Psychophys, DOI 10.3758/s13414-013-0489-y. Horn, Okumura, Alexander, Gardin, & Sylvester (2012). Quiet eye duration is responsive to variability of practice and to the axis of target changes. Research Quarterly for Exercise and Sport. 83, Issue 2, June 2012, Pages 204-211

Life can be tough for a child with difficulties

I have been fine tuning one of the parent evening lectures that I give to parents of children with gross and fine movement difficulties and I thought that it would be good to share some of the ideas on the blog page. My main passion about what I do is that I believe that knowledge and understanding of a child’s difficulties is the first and most important step towards helping them meet their difficulties with dignity, self-assurance and belief in themselves.  Not only is educating the parents and teachers important, but also teaching the child about themselves and how they learn and why they might find things trickier than others is key to maintaining their sense of self esteem. Life for a child with difficulties is tough and I don’t believe that we should pretend that those difficulties are not there.

So, what can be challenging for a child with a learning or movement difficulty? Sitting in class, writing, eating, getting dressed, playing in the playground are just a few things. Some children find one area particularly tricky and others find all areas a challenge. Every child is different and the environment that they are brought up in can affect what areas they find most challenging or the easiest.

Whilst sitting at their desk or on the floor, some children tend to: Have slumped posture, lean on others, lie down, wiggle, fall over or hold their head in their hands. The reason for these reactions could be that the child has a low resting state of the muscles and less resistance in their connective tissue structures. This presents as “low tone” which means that the muscles are less ready to contract and the surrounding connective tissue does not provide enough resistance for the muscle to work against. As a result the child may look floppy and loose.  A child with bendy joints often has this kind of “low tone” due to the lack of inherent stiffness in their connective tissue. This affects how well they control their muscles and as a result may often have decreased postural control (core control), which makes it hard to maintain a standing or seated position for an extended amount of time.  It is most difficult to maintain a posture when children are still. Some children need to keep moving in order to use the moving muscles to provide their postural support and stability, rather than their core or inner muscles.  Movement also helps increase the level of brain activity which send more messages to the floppy muscles to be stable. As you can imagine all of this activity takes up a lot of energy, which is why sitting still can be harder for many children than running a race.

Why is Writing Challenging?

In the same way that low muscle tone and postural control affects sitting, so does it affect writing, as we all need to sit upright, maintain our posture or even just stay seated in our desk in order to write. Similarly, if a child leans on their arms or cheek to provide their support, it creates a very tricky position to write from. If you don’t have a stable and controlled base of support, it is very difficult to hold your pencil effectively. It reminds me of a concept my science teacher taught me about fulcrums and levers. If you don’t have a secure fulcrum, your lever will collapse. (Imagine your shoulder blade muscles as your fulcrum and your arm and fingers as the levers). Finally, children with learning difficulties often rely too much on their vision and less on their sensations and ability to integrate their senses. Therefore they can focus more on the pencil than on the writing. Or, they cannot rely on the feel of the pencil in their hand and therefore can hold too tightly or too softly. This is exaggerated by the lack of shoulder control so they often press down too hard on the page or conversely, too softly. Once again, we have a scenario of a lot of energy being used up in order to perform a simple task, with most of the child’s attention being taken up with the background of writing rather than the writing itself. As a result, the child can become exhausted, bored, fidgety, deflated or frustrated with writing and all of these emotions can play out in a number of ways in the classroom.

The continued challenges that children with difficulties have with daily activities like dressing & eating and academic performance can impact on a child’s self-esteem. They can become withdrawn and shy or act out abrasively or aggressively around their peers. It is common for a child with a learning or academic difficulty to experience difficulties with physical activities as well (such as hopping, skipping, coordination, ball games, running) and as a result they do not include themselves in playground activities. This can further exacerbate the social difficulties these children have. They can become frustrated and upset with themselves or even embarrassed and the resulting social issues have the most impact on a child’s feelings of who they are and what they are worth.

I will write my next blog about instilling a sense of self efficacy in these children-parents, coaches, therapists and teachers: we all have a role to play!

Little and often

This week, my thoughts are on being a mom of a child with movement difficulties: not a therapist or an educator, but a mom.

Parents of children who have movement difficulties are often worried about their child's lack of interest in physical activity, sport, ball games and even "incidental" exercise, like walking to the shops, or playing tag or hide and seek with the neighbours. I have often felt that I am not doing my job as a mom properly, because my little girl didn't want to play in the park or go for a cycle. Being a medical professional, I recognised the fact that a child will often say they don't like doing something (or in my daughter's case, it was "boring"), rather than saying they find it hard or tricky, or that they are embarrassed that they keep falling over or bump into their friends, or they can't hop or skip. Thus, the cycle of avoidance of physical activity begins. I knew all of this. However, how could I stop this cycle? If I couldn't do it, how could I expect other parents to do it?

Now, I could go into all the research that is exploring what motivates children to participate in physical activity (and there is lots out there-refer to the research of Australians, Jeff Wakely and Tony Okeley, Dylan Cliff and Lisa Barnett or Cheryl Missiuna and her team at McMaster University and Can Child in Canada and Helene Polatajko's (University of Toronto) fantastic work with the CO-OP approach), but instead, I am going to blog about my experiences as a mom. In retrospect, I think the experience would have been exactly the same whether I knew about the research or not, but it is interesting to read the research and realise that it ties in with the reality of having a child with movement difficulties.

So, back to my quandary of how did I encourage my daughter to  be physically active? The first task was to "get in quick"-before she realised that she did things in a different way to her peers; also before her fears started creeping in-about falling, bumping, embarrassing herself. I tried to give her opportunities in stress free situations to practise things-walking along the white painted line on the pavement, the low brick wall, jumping off things, bouncing on the  bed-playing, playing and more playing. I asked her about what she wanted to "get good at". Being a little girl, she really wanted to learn how to skip and gallop in ballet and she hated tennis groups at school because she couldn't hit a ball. She didn't mind if she wasn't the best, but she didn't want to stand out as the one who couldn't do anything. She also wanted to join in with hopscotch and ball games in the playground. My daughter told me what the "tasks" were and together we embarked on a journey of learning and mastering them. However, it was always in her own time and I only ever gave her something achievable to work on-we practised little and often-whilst walking to the shops or to our neighbour, never for more than 5 minutes at a time, as she would get cross and frustrated. I have emphasised over and over again, that it takes time and effort to get good at things and constantly reward both my daughters for the effort they put into practising things that they are not good at. Both my daughters are starting to recognise that some people are just good at things-without trying or putting effort into them, but that does not mean that, because they, themselves, need to practise something, they cannot achieve the skill. Practise really does make perfect (well, not so perfect, sometimes, but nevertheless, the CAN learn to DO IT!).

Regarding the ball skills- the key for my daughter was having access to all my physio equipment that happened to be lying around the house. So, (nothing to do with me), she found my big gym balls (which are slower and bigger than normal balls, therefore easier) and started bouncing them, rolling them and throwing them. Everyday whenever she came into the dining room (which is where they were being stored), she would give it a go - little and often - most of the time, all by herself. Initially, we spoke it through and I demonstrated often by showing her with my hands over her hands, we spoke about how the ball moves and used imagery regarding the ball- "imagine it is a fairy and you want to push her gently to the ground for as long as you can keep your hands on her"- but once she had the idea, she just practised on her own. the more she practised, the better she became and now it is one of her favourite activities. It seems to be a cycle: the more a child learns to use the mechanics of their body, the more they get a feeling of success, and the more they experience success, the more they are motivated to keep practising.

One last thought, and that is to do with exposure. Children who are exposed to physical activity, more out of neccessity, rather than choice, the ones who perhaps do not have access to stationary leisure activities, like TV- from a young age- no matter what they baseline ability is; I wonder if they create their own opportunities for task perfection and taking the time to work out how to do things. I am thinking of my nephew who lives on a farm with no TV. He has a learning difficulty and poor core stability, balance and coordination, yet he is the most active child I know. He has learnt his way around his difficulties and compensated in other ways that did not neccessarily use all the perfect fundamental motor skills-yet he managed to achieve the task at hand. In his case, this was being able to play outside with his brother and cousin on the farm-climbing trees, driving tractors, swimming and cycling. The intrinsic (inner) motivation was there. If he didn't work out his own way of achieving these tasks, he would have been left out of the game and bored stiff! If only we all lived in paradise though...