A Chance to Shadow in the Home Environment

I had the chance to shadow PT today as she worked with the two previous children in their home environment- both children come from the same household. It was great to be able to see them in their natural environment as they work with their physical therapist. As I watched their interaction and spoke to Janet, some key information stood out to me that might influence my future design.

Child A – 9 months old; low muscle tone

PT started out working with Child A on a carpeted floor. She explained to me that she starts off on carpet because it will cause resistance when he tries to move and she will then put him on the hardwood floor to help him turn on his own more easily. He begins lying down on his back with his arms reaching above him. PT holds out two small plastic toys that he is able to grab from her and bang together; this simple act shows the improvement that has occurred over the past few months thanks to the physical therapy sessions.

When the physical therapist turns him on to his stomach, he still struggles to hold his head up on his own but is making slow progress. He also has trouble lifting his body into a sitting position, so she will put him in a hands and knees position (think of when you’re leaning on all fours) and slowly shift him into a sitting position from there. One fun thing that she does is place a mirror in front of him when he is finally sitting up. It completely grabs his attention and he is so distracted that he can sit up on his own, even if just for a little bit.

One drawback to the hardwood floor is that even though it is easier for him to move himself, the hard surface will cause him to hit his head harder if he gets more tired and his head drops downward. Also, he can flip onto his side more easily but the slippery surface makes it extremely difficult for him to transition from that position onto his stomach.

Child B – 2 years old; high muscle tone

PT proceeds to work with Child B using a device that she brought with her. She sets him up in a suspension walker, a physical therapy device used to aid children who have struggles walking on their own:

suspension walker

The walker holds him in place with a detachable harness and holds him up from above, but it gives him a little freedom to use his own leg strength to stand and walk. He is very hesitant to walk forward so the physical therapist stands in front of him with an object, such as a toy or an iPad playing a song that he loves, to coerce him to move forward. He takes a few steps in her direction but quickly gets frustrated and starts crying. It does help him with his strength but he is clearly not enjoying it at all.

I asked PT if his crying was caused by pain. She told me that even though he is visibly struggling, it is most likely not due to pain caused by the act of walking. It is just that he is not used to doing these sort of movements so it is uncomfortable and even scares him a little bit each time he progresses.

After giving him a little break to calm down, PT sits on the floor with Child B so that they are facing each other with their legs open and their feet touching. They hold hands and she slowly moves back and forth, pulling him towards her and then slowly letting him lean back. All of this is happening while she is singing a song that he loves so he is not as much paying attention to the act of moving as he is to the singing. She uses this technique as they go through different activities, either singing a song that he likes or making a song on the spot about the action they are doing at that very moment. Her voice seems to be calming him, causing him to have a momentary distraction from what they are working on.


Since this shadowing session was a home visit, it gave me the chance to speak to one of the child’s mother while I was there. She has been really supportive in my design pursuit since my last visit and it has been helpful to be able to bounce ideas off of a parent of children with abnormal muscle tone. When I explained my overall thesis goals to her, she agreed that if I could find a way to enhance their motor skills, keep them engaged, make it more meaningful for her, and make it fun for them then that would be an extremely impactful in-home design.

This visit gave me inspiration for a few general design elements that I might incorporate into my design:

Design Idea #1

A device that can alter the amount of resistance the child needs to exert in order to cause something to happen. One that can take more force and pressure in the beginning and gets progressively easier as the child plays and gets tired, but it can also start off easy to use and get harder as the child plays in order to build endurance.

It can be gone about mechanically using mechanisms or adjustable parts, or I can use some sort of material that naturally possesses the quality of tension and resistance, such as water, air pressure, or sand. Maybe these can be used inside of the product to create a cause an effect that will engage the child in different ways.

Design Idea #2

A voice-recording element in which the parent can sing while playing with their child and having fun, but it can be recorded for them later and be replayed when the child is playing on their own. Perhaps an order of actions that have to be done, such as pulling a lever or pushing a ball through a hole, that is then rewarded with a recording of their parent singing the song that they love. Knowing it is something that will happen once the actions are completed can be persuasive.

Design Idea #3

A transitional material for a floor mat or play space. Material and textures are important sensory triggers that can be manipulated and used during certain actions to provoke specific outcomes. Smooth and hard textures or soft and bumpy texture surfaces might be able to be combined in some way. Maybe even removable pieces, such as those individual bath mat pieces for children that cause traction, can be used on a smooth surface so that there are multiple options.

The opportunities are endless.