W-sitting

 

W-sitting is an ATYPICAL way of sitting on the floor;  the buttocks rest on the floor while the lower legs point outwards and back.  Toddlers and preschool kids are often seen in w-sit position while playing with toys. For the child, it is a stable position and hence w-sitting becomes a habitual behavior quickly. 

If a child w-sits for prolonged periods of time, the consequences would possibly be any or all of the following:

Hip joint distortion—muscles and soft tissues on the medial aspect of the joint would be hyper flexible, whereas the same on the lateral aspect of the joint would be tight and contracted. 

Knee joint and feet distortion—the abnormal position of w-sitting would naturally place the knees and ankles in an abnormal position with similar consequences as the hips. 

Pigeon-toe gait---the distortions at the hips, knees, and ankles lead to in-toeing or pigeon-toe walking. This gait deviation does not only matter cosmetically, but leads to abnormal bone development of the lower leg.

Core muscle stability—remains  under developed  as a result of prolonged w-sitting position, since the muscles of the abdomen and back have to work minimally during w-sitting rather than being challenged. 

Crossing midline and Bilateral coordination—remain poor secondary to lack of trunk rotation that characterizes w-sitting. 

Conversely, if a child is frequently observed to w-sit, one or more of the following could be suspected:

Increased internal rotation of the hips.

Laxity of the hip joint ligaments.

Low muscle tone.

Children with neurological conditions such as cerebral palsy,  hypotonia, autism, and ADHD are highly likely to assume the w-sit position. They should be encouraged to sit in cross-legged or long-sitting positions during floor time.  Tall -kneeling is another position that can be encouraged during table-top activities. Otherwise they are at risk of learning higher functions that involve reaching, manipulation of objects, as well as writing.

Therapeutic Use of the Forgotten Board Games

Snakes & Ladders is an ancient game of India that probably provided a moral lesson of life’s ups and downs as per virtues (ladders) and vices (snakes) respectively. There is a simple colorful grid of numbers 1-100, with a contrast of snakes (live being) versus ladders (inanimate gadget) drawn on it in a particular fashion and in different sizes. Its Western counterpart is Chutes & Ladders.

Growing up in 1970s India, abundant time was spent on playing three common board games, the Snakes & Ladders, the Ludo, and the Business. These games helped us to practice math learned in school and taught emotional regulation when your own token piece was not moving forward or had to come to a lower value number on the board.

As therapists or any professional working with children, we are aware of how challenging it is for a child with special needs to translate therapy and classroom gains to the external environment.

Therefore, I made a concerted effort to introduce the Snakes & Ladders to children in my clinic who were about 5-7 years of age. These are children who loved to work with any activity that included numbers. Over time, when their readiness to participate and engage with another child improved, and they had mostly overcome their rigidity or obsession with numbers, they were ready for their first board game of Snakes & Ladders.

Despite children being good at numbers 1-100, it came as a surprise to moms that the game was not as easy for their child. We came across the following challenges –

Taking Turns

For most young children, waiting for their turn is always a work in progress with any new activity.

Using Hands for Tiny Objects (dice)

The concept of rolling and throwing the dice had to be taught using cupped hands joined together.

Visual Recall and Working Memory

Remembering your own token piece and its position on the grid during their last turn needed verbal cues from an adult. Visually counting the number of dots on the dice and moving the same number of squares on the board required significant help.

Visual Sequencing and Directionality

Continuing from their last position was again a different concept for the child, i.e. sequencing from the number that they were on their last turn.

Sense of directionality while moving the token piece in increasing order of numbers was another difficulty. Their instant reaction was to move the token piece in any direction – backwards, forwards, or upwards. Although the child is good at numbers in terms of recognition and sequencing verbally, following the correct direction on the board becomes a challenge.

Moving from left to right in one row versus right to left in the immediate next row was difficult to comprehend.

The concept of going up the ladder or coming down the snake had to be reiterated multiple times. Some children initially had an emotional issue while coming down on the snake, hence this rule needed to be ignored for the time being.

Task completion

Patience to complete the game required sustained attention, and going up or down helped work towards building emotional control.

Take Away

In summary, Snakes & Ladders is a simple game that can be introduced in sensory motor therapy and can be continued with the child at home. It offers significant therapeutic value to children with special needs to boost working memory, vision-perceptual skills, and generalization ability.

The same goes for Ludo or Pachisi or Parcheesi which can be introduced after reasonable comfort with Snakes and ladders. The Business is another board game if parents wish to teach counting and exchanging money to a child.

These simple board games may look unappealing in this fast-paced, digital world. Once we understand their impact on family bonding and applications to the real world, they become indispensable.