Adaptive Circus
Improving Gross Motor Skills
with Physical Therapy
Perspectives and Circus Themes
Professional Credentials

Masters degree in physical
therapy
 Currently specialize in Pediatrics
 Trained in Neurological
Developmental Treatment and
Handling Techniques
 Taught two after-school special
needs classes in adaptive circus
skills at the South Brunswick
Recreation Center in the spring of
2003
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Worked my way through
graduate school as a
performer
Worked as house juggler at
the Taj-Mahal Casino
Studied with performers from
around the world (jugglers
from Cirque du Soleil and
mimes from the Peking
Opera)
Have a one-man
professional variety show
called Comedy Cascade
Introduction
Therapy principles to help students
improve their gross motor ability
1. Developmental Sequence
2. Motor Learning
3. Gross Motor Group Activity
Introduction
Specific techniques and activities
using circus themes and props
1. Ball Handling
2. Scarf Juggling
3. Balance Training
4. Mime
Why Is Gross Motor Play Important ?
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Sedentary lifestyle is a major concern for today’s youth.
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Active physical play is essential in developing gross motor
skills.
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Children who are not exposed to physical recreational activity
are less likely to engage in exercise as they get older, putting
them at risk for obesity and health concerns.

Guided active play for children with disabilities fosters
increased balance, coordination, and strength.
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Active play improves social interaction and self confidence.
Rising Obesity Rates
Table 1.
Prevalence of Obese
Children
(Ages 6 to 11) at the
95th percentile of
Body Mass Index (BMI)
Table 2.
Prevalence of Obese
Adolescents
(Ages 12 to 19) at the
95th percentile of
Body Mass Index (BMI)
1999 to 2000
15.3%
1999 to 2000
15.5%
1988 to 1994
11%
1988 to 1994
11%
1976 to 1980
7%
1976 to 1980
5%
American Obesity Association
Copyright © 2002. All rights reserved.
Skill Types
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Gross Motor Skills: Activities that require large
movements and/or coordinated activity of major
muscle groups. (i.e. walking, climbing, standing,
balance, lifting arms to put on shirt)
Fine Motor Skills: Activities that require small
precise movements (i.e. handwriting, holding utensils,
tying shoes, buttoning shirt )
Most activities have fine and gross motor
components
Physical therapists primarily work on gross motor,
while occupational therapists work on fine motor.
Some training overlaps.
Juggling helps to develop both types of skills.
Developmental
Sequence: A general
time table shows when kids generally
develop specific skills required to interact
with their environments.
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- If children are delayed, they may need
therapy.
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Motor Learning- a set of processes
associated with practice that leads to
changes in performance capability
(Campbell, 173)
Match Activities with Capability

Knowing normal development helps to understand
how to monitor and guide children with impairments.
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Children typically acquire gross motor skills in a
specific chronological pattern called The
Developmental Sequence.
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When guiding physical play, understand where
children fall on the developmental sequence and
encourage activity at or just above that level, so as not
to bore or frustrate them.
Normal Developmental Milestones The First Year
Age 0-1
Gross Motor
0-2 months
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Head Control at midline
Props up on elbows on prone (belly)
3-4 months
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Holds head from side to side
Back legs come together
Rolls from back or stomach onto side
Begins weight bearing
Squeeze grasp
4-6 months
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Bears weight on extended arm in prone
Reaches for toy with open hands
Rolls
Sits propped on hands
*Protective extension anterior
Bears weight when held in standing
Extends in prone lifting, chest, chin, and thighs
Sits up on floor
Sits and plays with toys
Creeps forward on belly
Protective extension side to side
Pulls self up to standing
Stands holding onto furniture
Crawls on hands and knees
Protective extension posterior
Stands alone momentarily
Walks 2-3 steps
Palmer grasp
6- 8 months
8-10 months
10-12 months
1 year
Fine Motor
Side to side wrist movement
Inferior pincer grasp
Fine pincer grasp
Age 1-2
Gross Motor
Walks independently,
Stoops to pick up objects
Runs immaturely
Seats self on chair,
Jumps up to 1 inch
Fine Motor
Toileting,
Uses spoon and fork,
Turns pages,
Attempts to dress self,
Builds tower of six
cubes
Social Development
Solitary play,
dependent on adult guidance,
plays with dolls, refers to self
by name,
little concept of others as
"people."
May respond to simple
direction.
Age 2-3
Gross Motor
•Walk and run
smoothly
•Stands on one foot
up to 1-3 sec ,
•Climbs
•Rides tricycle,
Bounces and catches
Fine Motor
Social Development
•Unbuttons and
buttons,
•Builds tower of 10
cubes
• Pours from pitcher
• Feeds self well,
• Parallel play,
• Enjoys being by others,
• Takes turns,
•Enjoys brief group
activities
• Likes to "help"
• Responds to verbal
guidance.
Age 4
Gross Motor
•Stands on one foot 5
sec,
• standing broad jump,
• Throws ball
overhand
•Kick rolled ball
•Hop once
•Walk up and down
stairs alternating feet
•Pedal tricycle
Fine Motor
Social Development
• Dress self
• Stacks blocks
• Cut straight
• Beginning drawing
Cooperative play,
•enjoys other children's
company,
•highly social, may play
loosely organized group
games - tag, duck-duckgoose,
•talkative,
•versatile
Age 5
Gross motor
•Hops and skips,
•Dresses without help,
•Good balance
•Rides scooter
•Swings self on swing
•Imitates 3 movements
Fine Motor
•Prints simple letters,
Handedness established,
•Ties shoes,
•Cuts circle
• paperclip
•Colors in lines
Social Development
Highly cooperative play,
has special "friends",
Highly organized, enjoys
simple table games
requiring turns and
observing rules,
feels pride in
accomplishments, eager to
carry out some
responsibility.
Age 6
Gross Motor
Fine Motor
•Walks 12 feet on 4 inch beam
•Walks up and down stairs carrying
object
•Jumps rope
•Dribbles basketball
•Rides bicycles
•Sharpen pencil
•Prints name
•Ties shoes
•Handles bread knife
Motor Learning- a Set of Processes Associated With
Practice That Leads to Changes in Performance Capability
(Campbell, 173)
6 Steps of teaching motor skills
1. motivation
2. presentation
3. response guidance
4. practice
5. feedback
6. transfer
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Skills and Practice Patterns
Motor skills can be classified as…
• Continuous (i.e. tracking with eyes,
sitting)
• Discrete, (long jump, swinging bat)
• Procedural movements. (i.e. typing,
operating instruments, or maintenance
Presenting Skills: to facilitate
learning
(1) Slow down the rate at which
information is presented.
(2) Reduce the amount of information that
needs to be processed.
Teaching Strategy For special need populations:
1. Break down the gym activity into smaller parts while ensuring that each part is
meaningful and achievable
2. Try to choose activities that will ensure success for the child at least 50% of the
time.
3. Reward effort, not skill.
4. Try to incorporate activities that require a coordinated response from arms and/or
legs (e.g.,skipping, bouncing and catching a large ball). Also encourage children
to develop skills using their hands in a dominant/assistant fashion (e.g., using a
baseball bat or a
hockey stick).
© Cheryl Missiuna, 2003; CanChild, Centre for Childhood Disability Research 10
5. Keep the environment as predictable as possible when teaching a new skill
(e.g., place a ball on a T-ball stand). Introduce changes gradually after each part of the skill has been mastered.
6. Make participation, not competition, the major goals. With fitness and skill-building
activities, encourage children to compete with themselves, not others.
7. Allow the child to take on a leadership role in activities (e.g., captain of the team,
umpire). The child may develop organizational or managerial skills that are also useful.
8. Modify equipment to decrease the stress and risk of injury to children who are learning a new skill.
9. When possible, provide hand-over-hand guidance to help the child get the feel of the
movement. This can be done, for example, by asking the child to help the teacher
demonstrate a new skill to the class. Also, talk aloud when teaching a new skill, describing each step clearly.
10. Give positive, encouraging feedback whenever possible. describe the movement changes specifically
Practice Patterns
Long-term retention of motor skills
depends upon regular practice.
However, continuous practice results in
less forgetting in the absence of practice
than discrete or procedural skills
 Sensory-motor learning appears to be
the same under massed and spaced
practice
 Repetition after task proficiency is
achieved and refresher training reduce
the effects of forgetting.
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Constructive Feedback
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Start with a lot of hints and feedback during trial and
error phase, and slowly reduce feedback as they
progress.
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Use continuous feedback if you are helping students
master new skills that must be performed accurately
in specific settings.
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Have children problem solve if the task is to be
recalled and transferred to a new situation.
Teaching Tips
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There is evidence that mental rehearsal,
especially involving imagery, facilitates
performance
Group Structure
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Start group activities with a warm up, followed
by lesson plan, ending with Cool Down
Review all activities visually and verbally
before beginning
Bring a floor marker for each student
Use a signal to initiate control and quiet
listening time, I.e. two claps or lights out. do
not shout over students
Pause between activities to regain focus
Give one direction at a time
Environment
Set up ahead of time
 Both low and high levels of arousal
produce minimum performance
whereas a moderate level of arousal
results in maximum performance.
 Music can help. Get songs with
complimentary tempos that do not
compete for their attention.
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Ball handling Sequence
Ball handling sequence
Trap= gabbing a thrown ball by cradling it between hands and forearms and chest
Catch = grabbing a thrown ball with two hands only
Reaching for object in different planes
Hand ball back and forth
Roll playground ball back and forth
Ball on string
Throw with underhand toss ( 17 months)
Bounce a ball and catch it, ( 3 years)
Throw with overhead toss ( age 3.5-4), throwing form begins to mature at (4.5-5.5)
Catch a bounced playground ball with two hand trap (4-4.5)
Trap a tossed playground ball
Kinking a rolling ball (age 4-6)
Catch a playground ball
Throw with proper form 9-10 feet (age 5)
By age 5.5-6.5 a child should be able to …
Throw a bean bag or ball with accuracy ,
Throw a ball in air and catch it
Begin working on juggling
Throw and catch a ball tossed from further away
Work from a larger ball to a smaller ball
Throw and catch a ball thrown in from side to side (20-35 degree planes)
Dribble (age 6)
Throw and catch a ball while standing on one foot or uneven surfaces
Throw and catch while moving and multitasking
Therapeutic benefits of scarf Juggling!!!
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PNF diagonal
patterns,
Crossing midline,
Eye hand
coordination,
Sensory integration,
Works of different
grip and hand
strengthening,
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Develops ball
handling skills
 Rhythmical patterns
reduce tone
 Improves balance
 Self confidence
Age equivalent 0-1
Sensory stimulus
Use to attract upward gaze for head control
Peek-a-boo
Reach for scarves
Introductory Levels (ages 2-5)
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Hand strengthening games
 Move scarves up and down, back and forth
 Use scarves for body part identification, more
eye catching than simply pointing “i.e put scarf
on your nose”
 Trace shape
 Throw and catch
 Move scarves in diagonal pattern
 Throw, clap, and catch
 Sensory stimulus for under aroused student
 Jumping jacks
Mid level Age 4-7
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Diagonal throw and
catch with opposite
hand
Throw clap catch,
Tricks throwing one
scarf (make shore to cross your body
and lift scarf as high as possible before
letting it go)
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Stand on one foot throw
and catch
 Clap under leg and
catch
 Clap behind back
 Clap under both legs
 Back and legs
 Pirouette
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Blow scarf in the air,
keeping it up without
touching it
 Two scarf tricks
 Crisscross the scarves
and catch them so they
change hands
(crisscross apple sauce
pattern, make shoe
scarves switch hands)
 All tricks with one scarf
can be done with two ,
 Two in one hand
Advanced levels (Age 5 and up)
 Scarf
juggling introduced at age 5
(start with 3 catches and build as able)
 Column pattern
 Reverse cascade
 Under leg
Feather Balancing skill sets
Beginning skills
 Sensory stimulation
 Balance feather in palm looking at top of feather, use
hand over hand assistance if necessary
Intermediate skills
 Balance feather while walking
 Bend knees and strengthen them while balancing
Advanced skills,
 balance feather on tip of nose or chin
The Circus lends itself to
Balance beam activities to represent the
high wire
 Animal walking
 Obstacle course
 Tricycle riding (Circus parade)
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The Circus theme also lends itself to
Spinning plate to encourage hands to
midline
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Mime Works On:
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– Performing ADL in a fun setting,
– Isometric strengthening,
– isolation,
– breaking synergies,
 The
possibilities are endless!!!
So
Have Fun !!!!
Bibliography/ Sited Sources
Campbell, Suzann. Darl Linden, Rober j Palisano; Physical Therapy for Children, second Edition cr 2000 WB
Saunders co, Ny, ny
Finigan,Dave; The Complete Juggler, cr 1991, jugglebug Edmonds, Wa
Ogeraldine Borrelli November 2nd and 3rd 2002 Lecture Notes Creative Movement Treatment Based on
Sensory Integration for Learning Disabled Children, from the Hampton Care’s Pediatric Symposium
Kane, Koren; Anderson; PT Activities for Pediatric Groups 1995, Psychological Press, San Antonio
Preschool Gross Motor Activity Guide compiled by Tricia McCloskey, OTR and Jennifer Agresto, OTR
Mrs. Weiss, Gross and Fine Motor Lesson Plans 1992
Adams, J.A. (1987). Historical review and appraisal of research on the learning, retention, and transfer of
human motor skills. Psychological Bulletin, 101, 41-74.
Singer, R.N. (1975). Motor Learning and Human Performance (2nd Ed.). New York: Macmillan.
Marteniuk, R. (1976). Information Processing in Motor Skills. New York: Holt, Rinehart & Winston.