Movement-based Pediatric Therapy

credit/Julie Toney

Group learning activities leverage the brain-building advantages of physical play.

Physical therapists are movement specialists, and in the school setting they not only help children navigate their school environment, they’re expected to help them access their curriculum as well.

Additionally, the physical therapist should also be the champion for the physical well-being of all students in the school setting. The obesity epidemic is wreaking havoc on gross-motor development, and with more children entering schools who are overweight or obese, there is greater difficulty on the playground and during physical education class.

Having low aerobic fitness and being obese have also been associated with poorer performance on standardized test scores in fifth, seventh and ninth-grade schoolchildren.1 Even children as young as pre-school with higher aerobic fitness levels and motor skills demonstrated better memory skills and/or attention.2

With the childhood obesity epidemic coupled with a predilection for sedentary learning, it’s even more important to help teachers incorporate movement throughout the school day. Researchers of Kenyan children who move while they learn proposed making time within curricula to include movement as free play, but also as a method for learning.3 It’s also been proposed that physical activity could be used not only as a break between lessons, but during the lesson itself.4

School-based physical therapists have an opportunity to use their knowledge of kinesthetic learning to help formulate a movement-based academic environment. This would increase physical activity, improve gross-motor skills and meet academic needs. Children must move, and children who move can learn while they are moving.

Examples of Active Games

One example of an active learning group game is playing catch with large dice. In a large circle, children take turns tossing a die to one another while calling out the name of the person and a color description of their clothing. For example, “I am tossing the dice to Jamison in the blue shirt.” This cooperative learning activity stresses eye-hand coordination, throwing skills, language development, color recognition and turn-taking.

Next, children take turns tossing the die in the center of the circle and counting the dots to determine the correct number as the instructor calls out the movement activity. For example, five jumps forward, hop six times on each foot, or balance for four seconds on each foot.

Another active learning group activity is alphabet movements using activity cards. Children identify the alphabet letters and then march like alligators for the letter A, crawl like bears for the letter B, and crab walk for the letter C. You can purchase or make your own activity cards based on the needs of the children on your caseload.

The Lucky Ducks game reinforces academic skills such as matching and memory, but can also be used in obstacle course and hide-and-seek activities for higher-level developmental skill-building.

Either way, this fun activity facilitates the development of gross-motor skills while children practice bilateral coordination, strength, and crossing midline. If you’re a DIY therapist, you can turn many favorite childhood games into active learning opportunities — for example, Lucky Ducks® reinforces academic skills such as matching and memory, but can easily encourage many more developmental skills.

You can create an obstacle course and place the duck pond at the end of the course. Each child is given a duck, asked to identify the color or shape on the bottom of the duck, and then instructed to crawl, hop, gallop, etc. as they carry their duck through the obstacle course to the pond.

You can also play hide and seek with the ducks to work on visual tracking and mobility. Instruct the children to hide their eyes and place the ducks in plain sight around the room (on the floor, on a shelf, on a chair). Once the ducks are “hidden,” invite the children to open their eyes and take turns finding a duck. For additional ways to play with this game visit

Ideas for Older Children

An idea that would work well for older children is to have them sit on the floor in a circle during a teacher-led question-and-answer session. They can begin by sitting on the floor with knees bent and hands supporting them behind their body. Next, encourage them to hold a crab position, bridge, or yoga boat pose while the teacher is asking the question. They return to the resting position once the question is asked, and in order to answer the question, they raise their foot.

Some classrooms with older children have purchased therapy balls or ball chairs to be used instead of chairs to actively engage students’ core muscles. Strengthening and engaging the core increases students’ level of alertness and attention to task.5

Another idea for those a bit older is to arrange all desk chairs in the center of the room with backs of chairs to each other and seats facing out. Then place the desks along the wall of the room.

On each student’s desk should be a series of academic questions or math tasks, with the same question/task on each runner’s desk. The idea is for the children to run to their desk, read the question, write the answer, then run back to their chair as fast as possible (splitting the class into two groups may help make the learning session less noisy and allow for the resting group to monitor and change to the next question).

Children continue to run back and forth until all questions/tasks are completed, encouraging them to move as quickly as possible. Questions and answers could then be checked. The two groups can then switch positions and repeat the exercise with a different set of questions or tasks. Running is another great activity that increases circulation as well as level of alertness, and teachers should be made aware of how beneficial it can be, decreasing the stigma associated with a noisy classroom.

These are just a few examples of large group learning activities that can assist pre-school through early elementary-aged children in learning gross-motor skills while incorporating academic concepts. School-based therapists are encouraged to provide input on how to make the school day more active to enable children to develop strength, balance and coordination without sacrificing academic learning opportunities.

Wouldn’t it be great if therapists at their schools promoted a plan called “movement across the curriculum,” similar to writing across the curriculum that language arts teachers support!


  1. Roberts C, Freed B, McCarthy W. Low aerobic fitness and obesity are associated with lower standardized test scores in children. J Pediatr. 2010;156(5):711-718.
  2. Niederer I, Kriemler S, Gut J, et al. Relationship of aerobic fitness and motor skills with memory and attention in preschoolers (Ballabeina): A cross-sectional and longitudinal study. BMJ Pediatr. 2011;11:34.
  3. Kentel J, Dobson T. Beyond myopic visions of education: Revisiting movement literacy. Physical Education and Sport Pedagogy. 2007;12(2):145-162.
  4. Donnelly J, Hillman C, Castelli D, et al. Physical activity, fitness, cognitive function and academic achievement in children: A systematic review. Med Sci Sports Exerc. 2016;48(6):1197-1222.
  5. Fedewa A, Erwin H. Stability balls and students with attention and hyperactivity concerns: Implications for on-task and in-seat behavior. Am J Occup Ther. 2011;65(4):393-399.

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