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MEAGAN POSTS:
DEAR ERI COMMUNITY: I have a high school student with cerebral palsy who is using ad UP and Free walker. He has been using it now for about 4 months. He continues to struggle with controlling it even when he holds on. HE was completely independent with a Kay posterior walker but now needs help even with steering and initating movement with this walker. Does anyone have any experience with this or any links to research? Any help is much appreciated!
Ask an expert:
Barbara Hodge
Barbara Hodge, PT, Coordinator-Instructor Pediatric NDT
Q. Is there value of “tummy time” for children with neuromuscular issues?
I do say for many children with neuromuscular issues the floor is not their friend.
The value of tummy time for typical children is undisputed. Among other things it helps elongate and activate the abdominals, especially the obliques, it gets mobility of the rib cage/ ribs to spine. It lengthens hip flexors as they extend away from the floor and activates the gluts, develops the secondary curves of the spine, and the one we focus so much on, shoulder girdle alignment and stability, early formation of the hand arches for fine motor, with appropriate scapular depression and adduction.
The documentation of the benefit of tummy time on plagiocephaly and also torticollis is all there, not mention all the sensory systems that are vital for development.
However, when we put the children we treat in prone on the floor we need to ask ourselves which of the above is being promoted by putting them there.
Are they getting what we want, or are they in fact reinforcing the very impairments we are trying to minimize. If what we see, particularly with the hypertonic children, is increasing adduction/internal rot of the humerus/ winging of the scapulae , the head in hyperextension, thoracic spine in flexion and the thoracic-lumbar junction in hyperextension, and adduction/internal rotation of the lower extremities, then compulsory tummy time , as in prone on the floor, is not a good plan.
For those with hypotonia who melt into the floor, lifting the head from this position (prone) is hard. Having them in upright and pushing their hands into the surface is a place they can often get some activation and is therefore a better position to begin in.
We definitely need to work on all the same components that typical children do when on the floor, but we need to find alternatives, such as on the therapist’s lap, on the ball, held supported against the mother, and pushing away from that surface etc. The foundation of much of our handling techniques will be in places where we can help them get alignment and activation for developing function.
In general, I think that if a technique or position works it’s fine to use, but what we need to emphasize is the observation and analysis skills to be able to ask: why are you doing this, are you getting what you want, and if not, how can you modify it to be productive?
I get many mothers who tell me that take the message that they have from therapists is that their child must be placed in prone on the floor as tummy time is vital. The components of tummy time are vital, but we would promote the thought that they often cannot be successfully achieved in prone on the floor, and may in fact be detrimental for their particular child.
We welcome your thoughts and experiences
PTA’s are you looking for a pediatric CEU course in Illinois?
Our popular CEU course designed for PT’s OT’s and Assistants is coming to Chicago in May:
Integrating NDT, SI and Motor Learning Perspectives in Pediatrics…Treating for Measurable Outcomes
Lezlie Adler
With renowned Speaker: Lezlie Adler
Are the goals you are setting for the children you treat, realistic? Is the treatment approach the most effective to achieve the outcome you want? This workshop will enhance critical thinking skills and hands-on skills to enable therapists to use a systematic approach to treating children with developmental challenges. Focus will be on problem solving to gain function for children with motor control, sensory processing and behavioral compromise. The unique approach will help therapists set realistic measurable goals, set priorities and determine frequency of treatment and exit criteria.
“Lezlie is fabulous. Her wealth of information, true love of play, and devotion to her clients is very inspiring. I love her sense of humor.
Patricia, Occupational Therapist
“What a superb course! The information was clear, useful, and interesting!
Lisa, Speech Language Pathologist
“Lezlie is an enthusiastic therapist and speaker. This class offered great ideas for treating children as a whole, considering all three therapeutic approaches (OT, PT, ST). Lezlie made sure that everyone got there money’s worth of this class by encouraging questions and involvement.
Cheryl, Physical Therapist
“Lezlie was very passionate and engaging…I would love to take another course from this instructor.” Suzanne, Physical Therapist
Please click here for more information, to download a brochure or to register
We wanted to share this pilot study from an Occupational Therapist.
What are your thoughts?
Efficacy of Sensory-based Interventions for Children with Autism Spectrum Disorders: A Pilot Study
An Occupational Therapist working in a pre-school program used the SymTrend data collection app to collect data about a student’s out-of-seat behavior during circle time activities. She wanted to record and report data about the effectiveness of interventions she was going to try to increase in-seat behavior. The child was in a substantially separate classroom for children with ASD ages 5-6 years. Her study demonstrated the effectiveness of her sensory-based intervention to increase in-seat behavior.
Should you be recommending tummy time for children with neuromotor issues?
Please share your thoughts and experiences and then hear from our expert.
Each year APTA honors outstanding achievements on the part of its members in the areas of overall accomplishment, education, practice and service, publications, research, and academic excellence. We are thrilled to announce that Education Resources Faculty Member: Barbara Connolly has been awarded the Marilyn Moffat Leadership Award
Nominees must have:
Barbara Connolly
Award recipients are recognized in June with a ceremony and reception
We are thrilled to offer Barbara’s course:
Praxis: Evaluation and Treatment of the Clumsy Child
April 25-26, 2014 – Cedar Knolls, NJ
July 25-26, 2014 – Columbia, MO
November 15-16, 2014 – New Brunswick, NJ
Charlotte Taylor, three, using a Firefly Upsee, a new standing and walking harness for children with motor impairment
We would love to hear your thoughts on this new invention out of Ireland. Designed by a Mother whose son is wheelchair bound, could this harness help children and families in the future?
Please share your thoughts and or experiences with us here, as this is about to be launched worldwide.
PTA’s are you looking for a pediatric CEU course?
Our popular CEU course designed for PT’s OT’s and Assistants is coming to Ohio in May:
3 Day Intensive on Treating the Child with Hypotonia
May 2-4, 2014 – Cincinnati, OH
This three day intensive workshop on treating the child with hypotonia will focus on specific strategies to improve motor control in this population. Techniques to improve proximal control, sustained postural movements against gravity, and symmetrical alignment will be demonstrated through use of videotapes, as well as patient demonstrations and practice labs. Participants will learn treatment strategies that can be applied in various practice settings to improve functional performance and independence in children with hypotonia: Down Syndrome, DCD (developmental coordination disorders), Cerebral Palsy, Genetic Disorders, Seizure Disorders
Barbara Hypes
Presented by Distinguished Faculty Member:
Barbara Hypes
“Very honored to have met Ms. Hypes. She brings wisdom & expertise in all she does.” – Rosanne, PT
“Barbara continues to be excited about pediatric physical therapy and passionate about her treatments and it shows in the way she presents. This course was realistic, informative, and treatment-focused. As a new therapist, I am leaving this course with a lot of new treatment ideas that I can immediately apply to my caseload”. Danika, Physical Therapist
“Barbara delivers a brilliant and captivating seminar”
Don, Physical Therapist
“Barbara is a very dynamic speaker. She provides practical and meaningful information that is easy to understand. I can’t wait to apply my new found knowledge to my caseload.” Laura, Physical Therapist
Erin Ross
We are very excited to announce that our esteemed faculty member Erin Ross has had her SOFFI Method© of feeding recommended by the National Association of Neonatal Nurses.
The National Association of Neonatal Nurses recently published the Infant-Directed Oral Feeding for Premature and Critically Ill Hospitalized Infants. They state “To optimize the use of this guideline, it is recommended that the Supporting oral Feeding in Fragile Infants (SOFFI) Feeding Algorithm ((C) 2013 by Erin Ross) be used concurrently.” They also state “the use of the SOFFI in conjunction with this guideline is highly recommended. The SOFFI algorithm is grounded in similar principles as described in this guideline.”
Erin offers her SOFFI Method© : Supporting Oral Feeding in Fragile Infants
March 21-22, 2014 – Ft Lauderdale Area, FL
April 5-6, 2014 – Cincinnati, OH
October 24-25, 2014 – New Brunswick, NJ
“Dr. Ross is a wonderful speaker who presented the information in an easy to understand format and answered all questions above & beyond my expectations. This course is wonderful for therapists of all levels. You can feel the passion Dr. Ross has for treating and teaching about infant & premature development and feeding. i was able to apply information to past & present clients/patients and leave with immediate confidence & supportive research for application in process.” – Jessica VanBrocklin, SLP
National Association of Neonatal Nurses
“This guideline offers evidence-based protocols that can be individualized to an infant’s abilities (infant-directed) and acknowledge the family as the primary caregiver and feeder (family-centered). Guidance is provided for nurses to help parents interpret infant cues during feeding, problem solve infant behavior issues, and explore interventions to support the infant’s self-regulation throughout feedings. Based heavily on the literature, this guideline offers a consistent approach and language for all caregivers, including family members, in the pursuit of optimal oral feeding outcomes.”
John Pagano
We would like to share this blog discussion from: John Pagano, a renowned member of Education Resources’ Faculty
John is teaching his popular conference: Effectively Treat Behavior in Children with Autism Spectrum and Other Sensory Challenges
May 2-3, 2014 – Las Vegas, NV
September 27-28, 2014 – Jacksonville, FL October 10-11, 2014 – Coon Rapids, MN
Please click above for full course details, to download a brochure or to register for the course.
Appropriate behavior for learning is enhanced by engaging sensory activities that teach rule based inhibitory movement control. Behavioral problems frequently involve inadequate inhibitory control of movement involving the arms (e.g., punching, slapping, scratching), legs (kicking) or mouth (e.g., spitting, biting, threatening, screaming, swearing). Teachers can collaborate with occupational, physical, speech/language, and mental health therapists to enhance self-control using developmentally appropriate movement activities with children and adolescents who have behavioral, mental health, sensory processing, and/or developmental challenges.
A major obstacle in teaching youngsters with behavioral challenges is motivating them to participate in challenging activities to enhance their development. Children and adolescents find movement activities engaging and fun. Involving students in brief developmentally appropriate movement brake activities enhances academic transitions, self-control and learning. Helpful activities include: playground tasks, parachute games, Simon says, red light, giant steps freeze dance, freeze shake, play plan, play review, obstacle courses, and movement to music (10 little hotdogs, Hokey-pokey, If your happy and you know it, Hot cross buns, We all need somebody to lean on).
Additionally, basic yoga and mindfulness activities provide sensory movement that is useful as a pre-correction technique (e.g., activity used before problematic situations like school assemblies or lunch time). Pre-school and elementary classes benefit from mindfulness and basic yoga tasks such as the: wall pressing, tensing then relaxing their muscles, mindful clock, body scan, feel your feet, feel your palms, stretching activities, and isometric exercises.
Children with behavioral and sensory processing problems often show improved behavior following movement activities involving slow linear movement and deep pressure (e.g., pushups, wall pushups, desk pressing, rocking onto their hands on their stomachs over a therapy ball). Helpful activities for students with behavioral and sensory processing challenges who are integrated into a regular education program include: setting the table, moving mats, moving tables, moving chairs, passing out books, and delivering notes or packages to teachers through out the school.
Finally, special accommodations can sometimes be made for children who are 
academically bright but have difficulty maintaining a sustained seated position. Sitting on therapy balls, sitting on disk-o-sit cushions, standing in a masking taped area, or using a sensory area in the back of the class where they can do there work without disturbing or being disturbed by others. Rolling to read and rolling to math are useful activities for children who can’t remain seated but are capable of academically advanced work. During resource room, occupational and speech/language therapy, and home work sessions they roll across the floor then read a chapter in a book or complete several math flash cards. After completing the reading or math they are reinforced then roll again and do the next chapter or flash cards.
Particularly for preschool, kindergarten, and all students who have behavioral, psychiatric, developmental, sensory processing, and/or trauma history challenges it helps to include movement activities in the classroom. Students are initially taught the cardinal rules for movement tasks: “Don’t touch any body or anything with out permission, and resume good learning after so we can do this activity tomorrow (if not we will skip this activity tomorrow then try it again the next day and I’m sure you will do much better”). Teachers and principles understand that students benefit from movement engaging the bodily-kinesthetic, interpersonal, and musical intelligences. While the teachers I work with and I am accused of “coddling students” and “wasting time” by using movement activities in the class room, no one can dispute our data showing this method results in increased academic goal achievement and decreased behavioral problems.
References:
Dunn, W. (2007). Supporting children to participate successfully in everyday life by using sensory processing knowledge. Infants & Young Children, 20(2), 84-101.
Flook, L., Smalley, S., Kitil, M., Galla, B., Kaiser-Greenland, S., Locke, J., Ishijima, E., Kasari, C. (2010). Effects of mindful awareness practices on executive functions in elementary school children. Journal of Applied School Psychology, 26, 70-95.
Koester, C. (2012). Movement based learning for children of all abilities. Reno, NV: Movement Based Learning Inc.
Riggs, N.R., Greenberg, M.T., Kusche, C.A., Pentz, M.A. (2006). The mediational role of neurocognition in the behavioral outcomes of a social-emotional prevention program in elementary school students: Effects of the PATHS curriculum. Prevention Science, 7(1), 91-102.
Warner, E., Koomar, J., Lary, B . & Cook, A. (2013). Can the body change the score? Application of sensory modulation principles in the treatment of traumatized adolescents in residential treatment settings. Journal of Family Violence, 28(7), 729-738.
