angels in the snow/sand

Angels-in-the-Snow can be a useful demonstration of motor balance and laterality.

Ask the patient to lie on their back on the floor. Tell them they need to be able to spread their arms and legs out all the way. “Do you have enough space to move? Test it out.” Observe:

  • How do they center themselves in the space?

  • Is their alignment orthogonal or oblique?

  • Do they have the room they need to move?

Jes Felix demonstrates the developmental sequence which are typically explored as part of the Angels in the Snow/Sand VT activity.

Observations

  • Are the movements simultaneous or separate?

  • Is there sidedness confusion?

  • Does the person need to talk themselves through the problem solving? If so, ask them to think inside their head, not out loud.

  • Can the person control the speed of the movement?

  • Are the movements complete, or do some movements fall short?

  • Is there motor overflow to other parts of the body?

  • Where does your patient look when they are standing?

  • Can the patient execute the movements when standing without undue leaning?

Dr. Harris demonstrates the fundamentals of Angels in the Snow. This activity helps to set the stage for the control of movement of individual body parts with the rest of the body supporting the slow and smooth control of the single part involved.

Level 1 – Single movement

  • Ask the patient to “Move your right (left is OK) arm along the floor until it is up over your head.” Then have them return to the starting position. (If the patient does not understand “right” and “left” then touch the limb/s you want).

  • Repeat with the other arm.

  • Then ask the patient to move the right leg out to the side and back to the middle. Their leg should only slide out just far enough that the other limbs remain at rest. Return to the start.

  • Repeat with the opposite leg. Note: When a patient struggles to know their left and right, the therapist and home therapist assistant should touch the limbs they want the patient to move. Start with this technique. Transition to pointing to the limb/s during the session. Decease the amount touching/pointing to limbs throughout the sessions. Eventually, start a session just asking them to move the limb. 

Level 2 -  Both arms or both legs

  • Ask the patient to move the right arm and left arm at the same time (do not say “both arms”).

  • Ask the patient to move the right leg and left leg at the same time (do not say “both legs”).

Level 3 – Same sides

  • Ask the patient to move the right arm and right leg at the same time.

  • Ask the patient to move the left arm and left leg at the same time.

Level 4 – Opposite sides

  • Ask the patient to move the right arm and left leg at the same time.

  • Ask the patient to move the left arm and right leg at the same time.

Level 5 - Standing

  • Once the procedure has been accomplished when supine, it is possible to redo the series when standing.

  • The activity is somewhat differently applied when standing as there are significant shifts in posture needed to remain upright against gravity as the steps are completed