Follow-Up Observation/Shadowing Session

On January 6th, I had the opportunity to shadow PT on two physical therapy visits with two different boys. I had already shadowed these two boys twice in September, so having a few months in between visits allowed me to really see the progress that they have made with her. These were my observations:

Child A – 14 months old; low muscle tone


At this point, Child A is now able to sit upright unsupported, which is a huge step forward from where he was just a few months ago. He can also reach for objects while sitting upright and even bang two objects together. Once in a while he gets back into a side-lying position, so PT slowly aids him as he pushes to lift back into an upright position. When he plays upright with a toy, Child A mainly uses his left hand to play while he uses his right hand to stabilize himself to stay sitting up.

A big challenge that PT is dealing with now is getting him to move onto his stomach. She shakes a small toy near him that makes subtle noises, such as a plastic maraca or a ball with a smaller ball inside. When he hears and sees it, he slowly moves towards it by reaching his arms outward while lying on his back. From his left side, Child A does not need much support to sit upright when he is lying on the floor. He has to work a lot harder reaching up from his right side.


PT holds up a plastic ring stacking toy while he is sitting upright. She has him reach towards it and pull off the rings one at a time, then has him put them each back one by one. Child A puts on and takes off each one that PT tells him to and stays sitting upright the entire time. After this activity, she puts Child A on her lap while she sits on a floor mat. She places his legs in a 90 degree position and gently keeps them in this position with his feet planted firmly on the ground. As she holds him in this position, PT uses her other hand to place toys in front of him so that he reaches forward and grasps the toys with his hands.

Seeing this progress from the first session I observed really made an impact on me. It showed me that with enough time, patience and attention, children with hypotonia can progress at a steady pace and advance physically over time.

Child B – 2 years (+ a few months) old; high muscle tone


PT holds him and tells him to carefully lean forward into a hands and knees position. He leans forward slowly so that his hands are touching the ground and she carefully lifts him back up. They proceed to do this activity multiple times so that Child B gets used to it.

After this, PT puts Child B’s orthotics on, followed by his sneakers. The orthotics give him added support in the ankle and knee areas. Having a more stable base helps keep the rest of him stable. She then places a weight around his left ankle before trying to get him to walk across the room. He walks across the room towards an iPad playing a favorite song of his while she stabilizes him and slowly guides him there. Once he reaches his goal, Child B sits down on the floor and PT adds a weight to his right ankle. With both weights on, he is aided back across the room and goes into sitting position once again when he gets to the iPad. PT does this exercise multiple times with him, going from one end of the room to the other.


PT pointed out that Child B works more with his right side during every activity. If he pushes off the ground, he always uses his right side as support since it is currently his dominant side. PT is working with him to use his left side too in order to strengthen it so that he has no dominant side and uses both of them equally. Getting rid of this current dominance will help him use both sides during activities.


PT carefully sets him into his walker. He holds on to both sides and walks without the support of PT, but uses the walker to help him. He is able to walk out a fairly long distance on his own. He does not tire easily and pushes himself to keep moving forward for a fairly long time.


Throughout this entire time he has been looking around and taking in his surroundings. As he gets tired, Child B’s legs get less stable and the bottom of his feet are no longer planted firmly on the ground. He uses the walker to hold most of his weight towards the end of his walk. Once he starts fatiguing it is difficult for him to stand up straight. PT makes sure to take short breaks while walking once he gets tired. She continues to give him encouragement and support, telling him that he is doing a great job. She also makes sure that he is holding up his weight with not only his right hand, but his left one as well.

Once again, I was grateful to be able to see theses stages of progress with my own eyes. It showed me that although it might be difficult at times, these children want to progress physically for themselves but do not know how to do so on their. The help of a PT and development tools makes an extremely noticeable difference and I am hoping that my design will have the opportunity to aid in these milestones as well.


Progress is What Matters Most

Meeting with my Advisor: PT

Although I have been jumping ahead to researching materials and textures, I had to take a step back and focus on the actual form of what I will be designing. I had a meeting with PT to review the main developmental stages I will be focusing on and to find out how to go about designing the specific curves based on the necessary physical positions.

I had already narrowed down the age range I am focusing on, which is the 6 month to 14/15 month age range. Within this time, most of the physical development that takes place includes ‘tummy time’, sitting, crawling, creeping, balancing, climbing to get on and off of things, kneeling on objects and even walking. I had some trouble differentiating crawling and creeping until PT showed me the difference. Crawling is when the child pulls himself forward on his stomach, using his hands and legs to pull his body forward. Creeping is when the child moves into a quadruped position, moving forward on both hands and knees in order to move forward.

When working with a child, PT told me that there are overall guidelines for where the child should be at developmentally. However, it really goes according to the schedule of each individual child. When asking her what stage the child should be at during each age range, she told me that there is no set answer. Instead of forcing a child to be at a specific place at a specific time, physical therapists promote stages of progress. As long as there is progress occurring, that is what matters most. Therefore, there is no set developmental timeline for children with abnormal muscle tone. There are just stages that should follow one another and my design will help further this progression.

As a physical therapist, PT says that even when a child gains a skill, one must look at the way it is done. If the physical positioning is incorrect, it will put unnecessary pressure on the child’s joints. In addition, skipping over developmental stages will effect those that follow. A good, strong and stable core is key; the more stable you are there, the more control you have away from the body.

One very important position is known as ‘crossing midline’, which is when the child transitions from their hand and knees and then back into the sitting position. The child is moving off of their center line of axis in order to rotate, which is a big struggle since children tend to get stuck in a frontal position. It is a great transitional position in the earlier developmental stages to enhance their bilateral coordination, which is when they learn to use both sides of their body equally. If there is a dominant side that the child uses, a physical therapist will encourage the use of the other side as well so the dominance is balanced out.

CrossingMidlineCrossing midline develops the child’s hip muscles, core muscles, arm strength and visual tracking. For a child to keep their head midline, to weight bear on one hand and to reach out with the other hand is incredibly difficult for them. In addition, children who are still developing physically often keep their legs straight out in front of them. It anchors them for stability since it is a very broad base that is holding them upright. Once their legs are up in a crossed position, there is less surface area for support and a large bulk of their weight is placed on their bottom.

Learning about specific positions during the developmental process helps me understand the importance of each one individually and how they transition into the next positions. It is also incredibly useful learning about them from PT since she will sit next to me and demonstrate the positions step by step. Seeing them acted out physically allows me to understand them much more than I do by just viewing images on the internet.

Advice to Move Forward With

Meeting with my Advisor: PT

PT gave me some really positive feedback once I explained my new design concept to her. She liked that I am taking a new direction and thinks that the forms have the potential to be successful while also being fun for the child. She has been really good at keeping my concepts on the more functional side while I throw in the creativity aspect to come up with functional forms that can make a difference in these children’ lives.

Her main advice was to narrow down the age range. Although I started my focus on newborns until three year olds, my design has the ability to be more productive if it has a more focused direction. For example, I have been trying to create a form that has the ability to give head support to a newborn learning to use his/her neck muscles while also being able to rock back and forth so a toddler can work on his/her leg muscles. I think I am trying to get too much usage out of an object that can be designed in a ‘supernormal’ way. In other words, I do not want it to have any unnecessary parts or be over-designed.

PT suggested that I stick with the age range of about 8 months to 14 months, the age in which they already have slight development, so that the design can focus on the advancements from that point forward. I am unsure if this is the age range that I will be sticking with but I am going to take her advice and look at the stages of development so that I could narrow it down.

The first thing that PT really liked about my concept was that I broke away from standard, geometric forms that are often used in her physical therapy sessions. The organic forms reminded her of a product that she sometimes uses with the children and she immediately went to grab it for me so I can look at it in person:


Bilibo, which is available at, is a developmental tool used to increase gross motor skills and enhance creativity in children. It is such a simple form that it lends itself to endless possibilities in use depending on which direction it is placed and how the child chooses to interact with it. Although it is very different than the concept I am currently designing, it gave me confidence that a simple design has the same amount of opportunity as a more complex design, if not more so in some cases.

Looking at the form sketches, she thought that it was great that the child would be able to climb on and off the pieces to help with their motor development. When PT looked at my concept, she said she could envision a child using it that already has the ability to creep on hands and knees and is learning to crawl. She liked that I was trying to incorporate a slight rocking motion using the curved edges; that motion can help with balance, motor reactions, and visual development, specifically eye tracking. In addition, she suggested that if I create back support for a sitting position, the support should be upright, not leaning, in order to get the child’s main weight over his/her hips.

I mentioned the idea of using silicone as the final material. Choosing material for a product is extremely important, especially when it comes to a design for children. She agreed with me that it would make it a firm, sturdy structure while still managing to keep it rather soft and child-friendly. One piece of advice for me was that if I choose to use silicone in the end, I must make sure that it is hypo-allergenic. She also said that when designing the surface textures, I must make sure to not make the textures too fine. For example, although it is still made from silicone, adding a stringy texture on the surface would make it pretty hard to clean when the time comes. Especially since this product will require cleaning quite often due to the fact that it is designed for children and will be dealt with rather physically.

Playing With Different Forms

I am going to branch out from the current concept design in order to play with different possibilities for my future design. Although I might end up advancing on the first concept, I feel it is best not to limit my options at this point.

Sticking with three-dimensional shapes, I will be pursuing a concept that combines multiple texture options in the same form so that the overall number of separate pieces can be reduced. They will be multi-functional forms that have multiple angle and height options so that they can be used for different purposes.

Concept Development Sketch

The geometric forms on the left can be opened up and re-arranged to create new forms, as seen on the right, from the same number of modules. There can be increased surface area, a larger variety of angles to lean on, and greater height differences. This new combination of different heights and angles can be used for different purposes depending on what physical advancements the parent and child are working on at the moment. Having the ability to advance from simpler forms to more complex ones, the geometric shapes can be used for all levels of development.

Meeting with my Advisor: Stan Rickel


I sat with Stan, my thesis advisor, in order to gain some further insight into my most recent concept development. He advised me to break away from the standard, geometric forms that I have been inclined to using. In his opinion, these limited shapes are too common. Although I will continue to test out this concept using physical forms, Stan suggested that I try to find more irregular shapes to use, ones that can be used both individually and as a unit. Instead of creating forms out of the top of my head, Stan also said that it might be a good idea to look at already existing shapes in my surroundings and see how each of them could influence new forms for my design.

I have been drawn to using geometric forms since the beginning due to their straight edges and abilities to become modular. I did not consider using softer, more organic shapes because I could not see them being able to be used stably in different directions without having any flat edges to support them. In my mind, softer shapes were limited to completely rounded forms that had no ability to support and stabilize the child while they were being used. I did not consider that I could manipulate the forms to perform the exact functions that would be required, such as adding thicker parts to certain areas for greater support and creating curved edges so that they can be laid down and keep their stability while in use.

How can I create fun, curvy forms with no defined flat edges that can still be firmly positioned on the floor and can be used on all sides for different purposes? In addition, how can I manipulate various textures and densities with the use of specific forms and material choices?


In order to begin this new exploration, I started to look at previously existing abstract forms that contain zero flat edges and rely on curved surfaces to enhance their shape. I took the time to look at all of the possibilities that can occur when they are turned over in multiple directions and when different amounts of weight are added to alternate sides. I will continue to experiment with these more natural forms so that I can tap into their potential for my design concept.


Beginning to Toy with Physical Deliverables

I have continued to gain further insight about what can help children with abnormal muscle tone by continuing to read books about sensorimotor development and books that focus on why motor skills matter. All of my research, combined with what I have observed from watching PT work with different children, has taught me about the regular stages of physical development in a children compared to those who have hypotonia and hypertonia.

One big takeaway so far is the importance of engaging the senses during activity time. As I have mentioned before, different materials have different effects on the child, especially when used in the correct way. This insight triggered my first design concept, which combines the design ideas that I have previously mentioned.

Design Concept: Transitional Sensory Floor Mat/Play Space

A motor-skill enhancing play space that advances and keeps pace with the child’s development.

Design_Concept1BThis concept is geared towards newborns to 3 year olds with abnormal muscle tone, but it is a universal design that really any child can use and have fun playing with. It combines my end goals of advancing on physical therapy sessions at home, engaging the parent to play with their child, and making sure that the child has fun in the process. It also helps the child develop while learning different levels of motor skills and focuses on sensory integration.

The elements of this product would be a rectangular floor mat covered in velcro and three different stages of removable tiles. It is a modular piece that can be configured in many ways, making each time they use it exciting and new. It also allows the parent to be hands-on with the child, setting up a sort of “environment” that they can watch their child interact with, enabling the child to develop physically and creatively.


First Stage:

It focuses on the child when they are highly immobile, working on advancements such as turning their head and lifting their arms outward. The tiles come in different surfaces that contrast each other: hard and soft, smooth and textured. The tiles can be placed however the child needs it to be at that moment, taking up different amounts of surface area. For instance, softer textures such as carpeting allow increased resistance as opposed to a smooth and hard materials that have no grip. Depending on the resistance necessary for the activity that they are working on at the moment, the parent can adjust it accordingly. There are also various textured surfaces that can be used when the child is lying down. Due to their lack of mobility, children with abnormal muscle tone do not have the opportunity to explore their environment and feel different things in their surroundings. So I thought that bringing these textures to them within reach would be helpful to integrate them into what they would otherwise be missing out on.


Second Stage:

It focuses on the child when they are gaining some mobility, working on advancements such as rolling onto their side, sitting upright, lifting up into quadruped position (on hands and knees), and initial phases of crawling. The tiles used for this stage, developing from two-dimensional to three dimensional from the previous one, would incorporate different shaped, textured voluminous pieces that could be arranged by the parent to further advance on their child’s motor skills. Depending on what part of the body they are focusing on, the parent can adjust the shapes to either fit around their child or to give them different levels of support. They can be stacked and rearranged in different ways all over the mat and while the child slowly advances in their development, they will have a slightly easier time moving around it to use the different parts more independently. It will help them by giving them different amounts of support in different areas of their body, as well as allowing them to interact with the pieces of different shapes and sizes.

Third Stage:

It focuses on the child when they are have already gained more mobility, working on advancements such as creeping, crawling, and standing. There will be tiles with different parts coming up from the base, ones that can be arranged into a system that works on more focused motor skills. I imagine the parts interacting with one another to create different functions, such as having areas to grab on to, ones that a ball can be rolled through, and ones that have smaller parts to pull on. I invision it as a simplified version of the “Mouse Trap” board game I used to play as a child:Screen Shot 2014-10-07 at 11.59.03 AM

Different elements are combined to create a system that teaches cause-and-effect. The parent and child can combine them together and then the child can work his/her way around the mat trying different techniques. This stage is designed to enhance the skills that they have yet to focus on while having fun at the same time. Another addition I thought might be useful in this stage is to introduce an audial element. Children respond extremely well to different sounds, such as the voice of a parent or a favorite song. This could be used as a kind of reward when the child finishes one task. Once the task is complete, a trigger effect would cause a recording of the parent’s voice or a part of their favorite song to be played, giving them a larger sense of accomplishment. It will make them want to go through the process again so that this effect will be repeated.

While this concept is just an initial idea, I believe that it has the potential to be advanced upon to become a better, more focused design. I will be meeting with my advisors to show them my progress and to gain some further insight into how I can move forward with this design.