Education Resources Blog

Concussion Management in your Area?


GUEST BLOGGER: Kathryn Biel

How are concussions being dealt with where you are?

Last year, my best friend’s son was catching in a little league game when he was hit in the head with a pitch. The helmet did its job and withstood the brunt of the force of the ball. Nevertheless, he was left with a mild concussion. His parents were given a rigid, structured program to help him rehab from the concussion. It included almost a week of complete physical and cognitive rest, followed by a gradual return to prior level of activity. If a headache recurred, he was to take a step back to the previous one. Within a few weeks, he was back to his prior level, with no residual complications (other than a mother who was reluctant to have him catch again).

Conversely, an acquaintance suffered a concussion this past year after being struck in the head (with something that had much less velocity than a baseball). She was out of work for a few days, and then returned. She was on the computer much of the time while out of work. Headaches plagued her, requiring multiple trips to the doctor and specialists over the course of months.

Thanks to researchers at my alma mater, Boston University, concussions and post-concussive syndrome are much more widely talked about these days. Post-concussion symptoms can last for three to six months after injury, and in about 10% of concussions, the injury is considered to be a traumatic brain injury. With professional football players retiring after a short career, the seriousness of concussions and post-concussive syndrome can no longer be ignored. Most coaches are now on board with not allowing players who have suffered a concussion to return in the same game.

Initially, concussions often present with headaches, neck pain, vertigo, mental sluggishness/confusion, and social-emotional disturbances. Concussions can have lasting vestibular, ocular-motor, sensory integration, balance, and visual motor implications. As therapists, we are seeing more patients across all settings who may present with concussions. Interestingly, the severity of the concussion is not a reliable predictor for who will present with lasting symptoms.

While the recognition and treatment protocol for concussions and post-concussive syndrome has gained some momentum, there is still much to be learned in terms of prevention, treatment, and long-term implications.

Please share your experiences in dealing with post concussion syndrome.  Who is your referral source?   Any helpful tips on screening, management and follow-up?  

~Kathryn Biel, PT, DPT

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FREE APP Found Helpful in Vestibular Rehab


As one of the founders of Education Resources, I often have the opportunity to attend one of the conferences that I have helped to develop and it is always a treat ( both from the perspective of learning new and exciting material, and meeting with participants and hearing the day to day challenges faced in the clinic, school or office) .  This past weekend I had the privilege of attending Dr. Rick Clendaniel’s Advanced Vestibular Rehab course.  Rick has been a colleague, professional friend and inspiration for nearly 15 years and his easy manner of clearly explaining very complex material is always  so refreshing and energizing.

It was really interesting to learn about some of the newer diagnoses/research related to vestibular dysfunction such as PPPD (persistent postural perceptual dizziness), vestibular migraines and anxiety related vestibular disorders. BUT what I especially want to share in this blog is a free app that Rick shared with us in this course.  You should download it today!

aVOR  (angular Vestibular-Ocular Reflex) is a teaching, training and test tool for the vestibulo-ocular reflex (VOR), vestibular system and its disorders, including BPPV. It demonstrates saccadic eye movements, including those caused by canalithiasis (free-floating particles in the canals), and both functioning and dysfunctional VOR. It shows how BPPV is caused and treated.

aVOR demonstrates how head movement has an automatic influence on eye direction, the impact of dysfunction of the semicircular canals, their size, shape and location in the head, and the causes of nystagmus.

https://itunes.apple.com/au/app/avor/id497245573?mt=8 

VEstibular Rehabilitation APPThis is a great teaching tool for patients of all ages and it is a great 3 D representation for clinicians who are learning the ropes of vestibular diagnosis.

I invite you to share any other tools that you have found helpful or to comment on your experience in using aVOR.

Rick also shared his thoughts on some very complex cases that were presented  and engaged us in critical problem-solving.  If you are dealing with challenging cases, please post them here and we will reach out to colleagues  for suggestions and discussion. 

Thank you.
Carol Loria, President, Education Resources Inc.

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Announcing Our New Advanced Vestibular Rehabilitation Series of Online Courses


Advanced Vestibular Rehabilitation Online CoursesAs a loyal member of our Vestibular Discussion group we wanted you to be the first to learn about the launch of our NEW Advanced Vestibular Rehabilitation online series.

Our new Cerviocogenic Dizziness online course is proving to be popular and we are excited to add two more sessions to complete the series, filmed live and taught by internationally respected expert,
Dr. Richard Clendaniel

 

Hone your differential diagnosis skills at your convenience!

Advanced BPPV 
This 3 hour lab course will focus on differential diagnosis, advanced assessment and techniques for treatment of patients with vertigo from BPPV
$100

Cervicogenic Dizziness:
Differential Diagnosis and Treatment
This 5 hour course will focus on the assessment and treatment of cervicogenic dizziness, one cause of vertigo, and how to distinguish it from central vestibular deficits.
$159 

What to Do When It’s Not BPPV:
Challenging Vestibular Disorders Including Post-Concussion Syndrome
 This 3 hour interactive course will focus on the assessment and treatment of patients with vertigo and disequilibrium from unusual vestibular causes. Course participants will distinguish among causes of dizziness such as Concussion, Chronic Subjective Dizziness (Persistent Postural Perceptual Dizziness), Anxiety, Superior Canal Dehiscence, Fistula, Migraine, and Meniere’s Disease.
$100

Register for the complete online series for $309
Add complete series to a live course registration to get a discounted rate of

$265 (save total $94)
OR
Register for individual sessions
Includes downloadable handouts & access for an entire year

 Recommended for individuals who have experience with or who have previously taken a two day course in vestibular rehabilitation

Please Visit our FAQ Page to Learn More

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Education Resources is Thrilled to Welcome Valorie Todd, Pediatric Occupational Therapist to our Faculty


Valorie Todd

Valorie Todd

We are all very excited to welcome Valorie back to the ERI faculty.

Valorie Todd, MA, OTR is a Pediatric Occupational Therapist who has worked in early intervention, preschool, and various school systems in NY and NJ over the past 35 years. She has taught Occupational therapy at Mercy College as well as in the Interdisciplinary Studies Dept. at Rutgers University.  She has provided continuing education programs for over 10 years through Education Resources, Inc. as well as the NYC and Los Angeles Departments of Education, by their invitation.  Her area of interest has long been on vision and perception and their effects on visual perceptual and visual motor assessments, as well as on classroom skills, especially handwriting. In terms of intervention, she has focused on developing a framework based on vision and learning strategies, while also incorporating principles of sensory integration and motor learning. She especially enjoys linking theory to practice and helps participants realize the importance of being able to describe the theoretical approaches they are using, how they work, and what else to consider when they no longer do so.

“Valorie was great! Fast, succinct, informed, knowledgable….. I have lots of thoughts about how to alter/modify my treatments” Teresa, DPT

“Valorie Todd is an unbelievable source of visual learning and her knowledge base keeps expanding, so see her more than once!” – Adrienne, OT

“Valorie held me captivated from beginning to end. I am totally excited to go back and begin to utilize not only her clinical strategies but her concept of helping us touch the students how to help themselves. I am taking away so much more than I expected from this workshop……..Thank you” Bryan, OT

Valorie’s Upcoming Courses:

Vision, Visual Perceptual and Visual Motor Skills: Assessment and Intervention for Children
August 28-29, 2015 – Puyallup, WA
October 16-17, 2015 – TBA

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Autism Awareness Month – Winner of Two Day Course


Autism Awareness monthThank you all for registering during the month of April and Autism Awareness month, and for entering our competition 

We are pleased to announce that Heather is our winner and she will receive free registration to a two day course.

CONGRATULATIONS HEATHER!

 

 

 

 

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Therapies in the School Early Bird Registration


Therapies in the School - Education Resources

We are excited to share with you the outline for our dynamic and popular annual school conference:
And we would like to offer you our:
Early Bird
Registration Rate of $415
Register for the TWO DAYS of the conference before July 6th, 2015
and get a reduced rate of  $415.  
Mention “Therapies Early Bird” when you register.

Must be used at time of registration. Cannot be combined with any other offers. Limited time Offer. 

Sixteenth Annual
THERAPIES in the SCHOOL Conference
November 19-20, 2015
Framingham, MA

Join us at this popular conference to learn creative, effective, evidence-based strategies that reflect the best practices for collaborative school based interventions. 
Network with therapists and educators from other school districts and learn how others are handling the very challenges you face each day.
Nationally acclaimed speakers will address best strategies to support students with sensory and motor challenges, motor issues in autism, gaining postural stability and bilateral coordination, visual spatial strategies to facilitate early literacy development, practical tools to handle aggression, intervention for fine motor skills, embedded interventions to overcome barriers to school participation as well as issues working with the moderately-severely involved child.
 
We look forward to seeing you at this year’s conference!
 
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SPRING PROMOTION – Discounted Registration Fee for PT’s OT’s and SLP’s


Spring flowersSPRING PROMOTION 
from
EDUCATION RESOURCES

Thank you for allowing Education Resources fulfill your professional development and continuing education requirements 

As a THANKYOU from us we would like to offer a 
$50 discount toward any live conference fee     

Register now through June 29, 2015 
Apply code: “Spring2015″ 

Not to be used in combination with other discounts or course credits. Non-Transferable. Only one discount may be used per conference. Must be applied at time of registration, not for conferences previously registered for. Not for online courses.  

 

You can register online, call the office or fax in your registration.
Just mention the code! 

Please call, email or visit our website with any questions

 Thank you Mandy 

  Please click here for our full listing of courses

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Rose Bigsby Honored for Contributions to Neonatal Care


Rose Bigsby Education Resources

Rose Bigsby

We would like to offer our congratulations to Rosemarie Bigsby, ScD, OTR/L, FAOTA, who has been elected as a recipient of the Pioneer Award for Neonatal Therapy.

Rose, renowned for her knowledge, skill and expertise, has worked as a pediatric occupational therapist and consultant for over 30 years, with over 20 years in the NICU, in the combined roles of therapist, educator and researcher. 

The Pioneer Award was created to honor neonatal occupational therapists, physical therapists and speech-language pathologists who contribute tirelessly to establish and advance the specialized field of neonatal therapy. This inaugural presentation of the award reflects decades of largely unrecognized work by those who established the art and science of neonatal therapy. 

She is Coordinator of NICU Services for the Brown Center for the Study of Children At Risk, Department of Pediatrics, Women & Infants’ Hospital, Providence, RI and Clinical Associate Professor of Pediatrics, Psychiatry & Human Behavior, The Warren Alpert Medical School of Brown University. She is a Fellow of the American Occupational Therapy Association, a contributor to the AOTA guidelines for NICU Practice, and the author of a number of journal articles and book chapters. She is coauthor of Developmental & Therapeutic Interventions in the NICU a book for NICU therapists, and The Posture & Fine Motor Assessment of Infants, and contributed to the development of the NICU Network Neurobehavioral Scale (NNNS). Her research focuses on motor development, behavioral cues, physiologic regulation and interventions and developing an interdisciplinary approach to initiating and progressing breast and bottle feeding. 

Rose received her bachelors of science in occupational therapy and biology at Western Michigan, her masters degree in advanced pediatric practice and occupational therapy education and her doctor of science in therapeutic studies at Boston University. 

Bigsby has also been a recipient of the American Occupational Therapy Association’s Service Award and the Service Commendation for her authorship of “Specialized knowledge and skills for occupational therapy practice in the neonatal intensive care unit.” She also is a co-investigator and co-author of a recent report documenting the benefits of single family room model of care for NICU patients that was covered by the New York Times, National Public Radio, Reuters and other new outlets at the national level.

We are honored to offer Rose’s course:

Intervention for the High Risk Infant: Providing Services in the NICU and During the Transition Home

June 4-5, 2015 – Edison, NJ
October 15-16, 2015 – Weymouth, MA

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Picky Eaters Course Receives CPE approval for Dietitians


Education Resources is thrilled to announce that the upcoming popular feeding course: Picky Eaters vs. Problem Feeders: The SOS Approach to Feeding has been approved by The Commission on Dietetic Registration for CPE’s (Continuing Professional Education) for  Registered Dietitian Nutritionists (RDN™) or Registered Dietitians (RD™); Nutrition and Dietetics Technicians, Registered (NDTR™) or Dietetic Technicians, Registered (DTR™); and Board Certified Specialists in Pediatric Nutrition (CSP), 

The Commission on Dietetic Registration administers rigorous valid and reliable credentialing processes to protect the public and meet the needs of nutrition and dietetics practitioners, employers and consumers.

Nutrition and dietetics credentialing protects and improves the health of the public and supports practitioner competence, quality practice, lifelong learning and career advancement.

The SOS Approach to Feeding is a Transdisciplinary Program for assessing and treating children with feeding and weight/growth difficulties. It has been developed over the course of 20 years through the clinical work of Dr. Kay Toomey, in conjunction with colleagues from several different disciplines including: Pediatricians, Occupational Therapists, Registered Dieticians, and Speech Pathologists/Therapists. This program integrates sensory, motor, oral, behavioral/learning, medical and nutritional factors and approaches in order to comprehensively evaluate and manage children with feeding/growth problems. It is based on, and grounded philosophically in, the “normal” developmental steps, stages and skills of feeding found in typically developing children. The treatment component of the program utilizes these typical developmental steps towards feeding to create a systematic desensitization hierarchy of skills/behaviors necessary for children to progress with eating various textures, and with growing at an appropriate rate for them. The assessment component of the program makes sure that all physical reasons for atypical feeding development are examined and appropriately treated medically. In addition, the SOS Approach works to identify any nutritional deficits and to develop recommendations as appropriate to each individual child’s growth parameters and needs. Skills across all developmental areas are also assessed with regards to feeding, as well as an examination of learning capabilities with regards to using the SOS program.

Coming Soon:
June 11-13, 2015 with an optional 4th day – Montgomery, AL

November 12-14, 2015 with an optional 4th day – Portland, OR

Please click here for more information , to download a brochure or to register

Please click here to join our mailing/email list

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Treatments for Rocker-Bottom Foot


GUEST BLOGGER: Kathryn Biel

This clinical question was received from Holly:

Is there anything that can be done for a severe rocker bottom foot? Child is 8, spastic diplegia, has heel cord contracture, but has had two heel cord lengthenings. Currently not using AFOs, does have a slight crouch gait (was a toe walker before most recent heel cord lengthening). His foot hits the floor flat, but the mid foot then bottoms out and heel lifts during early stance. Is there any way to stretch gastrocs? I’d obviously love to avoid further surgery. 

Rocker bottom foot can occur in a number of situations. It can be a congenital condition in which the navicular is malpositioned at the neck of the talus. This condition is rigid, with the foot in and equinus position with dorsiflexion. It is common in chromosomal abnormalities. Treatment recommendations include early plaster casting in plantar flexion and inversion to stretch ligaments (talonavicular, deltoid, and calcaneal cuboidal) and muscles (triceps surae and peroneous brevis) that are tight. Surgical reconstruction of the foot itself is also used as treatment.

However, rocker bottom foot can occur in cerebral palsy as a secondary impairment that results from spastic plantar flexors. In this condition, during weight bearing, the spastic plantar flexors pull the hindfoot upwards, resulting a weight shift forward to the forefoot. The center of gravity is moved forward as well. Over time, with the weight bearing surface stretches out and then eventually reverses the longitudinal arch, resulting in a rocker bottom appearance. Additionally, the spasticity through the gasctrocs over powers the inverters, which results in a collapse into valgus.

When stretching in PT, it is important to maintain stabilize the subtalar joint (through a firm hold on the calcaneus) so that it does not further collapse into valgus. Stretch should not be applied to the forefoot alone.

Orthotics may be the best bet to  stabilize the subtalar joint while resisting plantarflexion. Orthotics that do not stabilize the subtalar joint will contribute to a further valgus deformity. The orthotics must include sufficient support and sculpting to hold the calcaneus stable. A skilled orthotist and close collaboration is key to make sure the hindfoot is stable in weightbearing.

Also, due to lengthening surgeries, the triceps surae is often weak, resulting in the crouched gait. Strengthening may be something to consider. Also, on going tone management (Botox or Baclofen, for example) is important to monitor as it is the spasticity that caused the deformity in the first place.

Does anyone else have ideas for how to non-surgically treat rocker bottom foot in a child with cerebral palsy? I’d love to hear what works for you. 

~Kathryn Biel, PT, DPT

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