Education Resources Blog

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

Posted in Feeding, Pediatrics, Professional Development | Tagged , , | Leave a comment

Treatments for Rocker-Bottom Foot


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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WIN A FREE ONLINE COURSE – Help us to Name a New Advanced Vestibular Online Course

Vestibular Rehabilitation

NEW Advanced Rehabilitation online courses

We need your help!




As our new Cerviocogenic Dizziness online course is proving to be popular
we are excited to add two more sessions to our Advanced Rehabilitation Series, filmed live and taught by internationally respected expert, Dr. Richard Clendaniel:

Advanced BPPV 
Special Topics

We are trying to come up with a meaningful title for the new Special Topics 3 hour digital course series that covers these topics:

Post Concussion Syndrome
PPPD (formerly known as Chronic Subjective Dizziness)
Canal Dehiscence
Meniere’s Disease

We would value your thoughts and ideas on a title that would attract you to take this course

and in May we will randomly choose a winner who will receive free access to this new session

Thank you so much for any input as we strive to meet your needs.

Posted in Adult and Geriatric Rehabilitation, Professional Development, Vestibular Rehabilitation | Tagged , , , , | Leave a comment



As a school-based physical therapist, this issue comes up for me every year. Children are referred for physical therapy (and occupational therapy) evaluations because they are obese. Every year, I wrestle with my clinical decision making regarding these children.

The CDC posts some alarming statistics about childhood obesity:

  • The prevalence of childhood obesity has more than doubled in the past 30 years
  • In 2012, more than ½ of children and adolescents were overweight or obese
  • 70% of obese children (age 5-17) have at least one risk factor for cardiovascular disease

Children who are obese are at high risk for the following medical conditions: pre-diabetes, cardiovascular disease, and orthopedic or joint problems. Additionally, obese children are at high risk for depression and social difficulties.

In school, we see these children as having difficulty participating in P.E. class and recess with their peers. Getting up and down from the floor can be difficult. Self-care, like shoe tying, can be challenging. Additionally, personal hygiene is often difficult. And this sounds like a silly point, but many obese children have trouble with properly fitting clothing, often leaving either stomachs or rear ends exposed.

Schools are doing their part by reforming school lunches (at the government’s doing). P.E. teachers are encouraging participation in before and after-school running clubs. Posters about healthy eating line the school and cafeteria walls. Schools are trying.

I’ve been documenting Body Mass Index (BMI) in IEP’s for students in which weight may be acting as a barrier to education. This can be a controversial practice. My purpose in doing this is to have data points in which to track a student’s progression. A child who has a BMI above the 99th percentile and then drops to the 95th percentile at the following review has shown significant improvement, even if the improvement is not apparent visually. Also, for children with whom weight management is an issue, I try to take measurements at the beginning of the school year, midway through, and right before summer vacation. It does become a delicate balance when taking these measurements and reporting on them to be very mindful of the child’s self-esteem. 

In the past, some parents have been hotlined (Child Protective Services has been contacted) because of a child’s obesity and the resultant physical concerns. This is not common practice, and there has been little follow through when it was done.

However, I still struggle with the idea of pulling a child out of academic time to exercise. Firstly, it is not skilled physical therapy (or occupational therapy). Much of the time the issue is not that a child cannot perform a skill (i.e. shoe tying), but that they cannot perform it on their body. Secondly, will one session a week make a difference? Can we justify more therapy because of a lifestyle?

I often feel helpless in these cases. The teachers want PT and OT for these students. Some parents are insistent, while others are not. The meetings are usually uncomfortable.

So, as clinicians in the school environment, how are we handling this epidemic? Are you keeping these children on your caseload?


~Kathryn Biel, PT, DPT


Posted in GUEST BLOGGER, Pediatrics, School Based Therapists | Tagged , , , , , | 7 Comments

Celebrating World Autism Awareness Day

The Eighth Annual World Autism Awareness Day isAutism Awareness month
April 2, 2015.

World Autism Awareness Day is one of only three official health related United Nations Days and will bring the world’s attention to autism. The World Autism Awareness Day encourages all to raise awareness about autism throughout society and to encourage early diagnosis and early intervention. 

Education Resources offers many relevant CEU courses for Physical Therapists, Occupational Therapists and Speech Language Pathologists and assistants. Join us to learn creative, effective, evidence-based strategies.



Register for one of the following courses during Autism Awareness Month
and be entered to win a
($435 value)

ENTER “AUTISM2015″ in comments box
(this is not a promotional code)
Valid April 1- April 30, 2015

(Enter code in comments box when registering online and we will be record all entries or please mention promotion when calling, mailing or faxing in your registration.)

A winner will be randomly chosen and announced in May

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

Please visit individual course pages below for full details, dates and venues, to download a brochure, or to register:

Linking Play to Function: Utilizing NDT and SI
Lezlie Adler

Solving Complex Pediatric Feeding and Swallowing Issues (Intermediate-Advanced)
Joan Arvedson

Get Ready to Learn:
Yoga Therapy in the Classroom

Anne Buckley-Reen 

Sensory Integration Intensive
Jeannetta Burpee

Is it Sensory? Or Is It Behavior? Assessment and Intervention Tools for
OT’s, PT’s, and SLP’s
Debra Dickson

Interventions for Infants and Young Children (0-5): Activities, Routines and Evidence Based Practice
Randy Fedoruk

Treatment of Children with Sensory, Emotional and Motor Challenges
Lise Gerard Faulise

Building the Brain: A Neurobiological Approach
Robin Harwell

The AEIOU Systematic Approach to Pediatric Feeding
Nina Johanson

Complex Feeding Disorders: NICU, EI and Home
Amy Kageals

Yoga and Pilates Therapy for the Child with Special Needs
Angelique Micallef-Courts

Children’s Brains, Neuroplasticity, and Pediatric Intervention: What’s the Evidence?
Patricia Montgomery

Effective Ways to Manage Behavior and Increase Functional Outcomes
John Pagano

Integrating Movement Based Learning into Treatment:
an Evidence Based Approach
June Smith

Practical Intervention Strategies for Children with Autism Spectrum Disorders
Stacey Szklut

Practical Strategies for Treating Complex Pediatric Feeding Disorders:
Treating the Whole Child

Polly Tarbell

Picky Eaters vs. Problem Feeders:
The SOS Approach to Feeding

Kay Toomey and Erin Sundseth Ross

The Pediatric Brain: Treatment Applications
Janine Wiskind


Posted in News, Pediatrics, Professional Development, School Based Therapists | Tagged , , , , , , | Leave a comment

PT Needing Advice on Autistic Child with Particular Behavioral issue

GUEST BLOGGER: Kathryn Biel.

Jacqueline submitted this clinical question:

I am a physical therapist working with an autistic child who continues to throw toys and other items constantly. He will throw items over, under and thru railings, in his sister’s crib and pack and play. This behavior happens all day in his home and other relatives’ homes. Parents and team members have tried several strategies to prevent this but nothing seems to help. We have tried ignoring the behavior, getting him to pick up the item each time he throws and try to distract him when we know he is about to throw an item. He has been doing this for over a year and now parents are concerned because he is beginning to throw larger toys and he now has a little sister and parents are concerned about her safety. Any suggestions to stop this behavior would greatly be appreciated.

This is a tough one. The behavior is meeting a need for this child. What is it? Is it simply fun and now it became a habit or a routine or is it somehow meeting an underlying issue? If such, then it would need to be replaced with another habit/routine (and finding one that is less harmful may be difficult). How you go about doing this will be challenging.

The other thing that I can think of is to help sculpt the behavior of throwing into a more limited activity. For example, he can throw, but it has to be into a large bucket (like one of those rope-handled beverage buckets). Putting several of this same container throughout the house so he has a place in each room to throw into may eventually channel this behavior. If part of the enjoyment is throwing through things, then how about putting a grate (or slots, like in the crib rails) over the opening to the bucket/container could help carry this behavior over to the buckets, rather than his sister’s crib.

I’m going to turn this question over to the experts out there. What else would you do to help with this behavior? Looking forward to hearing what you have to say!

~Kathryn Biel, PT, DPT

Posted in GUEST BLOGGER, Pediatrics | Tagged , , , | 1 Comment

Concussion and Other Brain Injuries in the Headlines

MARCH 23rd 2015

“Concussion, Other Brain Injuries Continue to Grab Attention

Whether in academic research journals, political advocacy reports, or the sports page, discussions about concussion and traumatic brain injury (TBI) weren’t hard to find last week.

The common thread? Something APTA has been stressing for years: more attention needs to be paid to all aspects of brain injury diagnosis and management…………….

The need for broad understanding of youth concussion management—and, in fact, all mild brain injury as well as TBI—was what brought APTA advocates and staff to Washington, DC, last week to participate in congressional briefings and provide information to legislators and congressional staff during a “Brain Injury Awareness Fair” on Capitol Hill. APTA representatives also spoke with lawmakers about the importance of the SAFE PLAY Act, now in congress, that aims to improve concussion management in schools. The act includes physical therapists in the list of professionals qualified to make return-to-play decisions”.

Please share your thoughts, and experiences with concussion management

Education Resources is offering a new course:


This course will help clinicians apply the latest research on diagnosis and management of concussion and post concussion syndrome.  This course will focus on the latest relevant assessment and treatment strategies for adults and children with prolonged visual, vestibular and sensory complaints as a result of concussion.  Effective treatment strategies to improve visual skills, balance and sensory integration for optimal return to all daily tasks will be highlighted.  Participants will engage in clinical problem solving via group case analysis and discussion.

May 1-2, 2015 – Fort Worth, TX
July 31-August 1, 2015 – Lee’s summit, MO
October 16-17, 2015 – Washington, DC
November 20-21, 2015 – Matthews, NC

Posted in Acute Care, Adult and Geriatric Rehabilitation, Pediatrics, Therapy in The News | Tagged , , | Leave a comment

How to Document Co-Treatments in IEP’s

GUEST BLOGGER: Kathryn Biel.

Marcia submitted this clinical question:

We’ve had some discussion around co-treatments and how best to document them in IEP’s — I’d love to get some input as to what is happening in other districts — is it being specifically documented on the service delivery page, additional information, and if so how?? (ie: for a 1 hour co-treat small group with PT & SLP — how is that documented in the IEP?? Is it in the grids as 30 minutes for each?? 1 hour for each??). Thanks in advance — I look forward to getting feedback from this group! 

This one I think will vary, depending on state regulations and reimbursement issues. I’m in New York, so I can only speak to what we’re doing in my region. This is also my understanding, so please feel free to jump in and tell me if I’ve got it wrong. I’ve never been allowed to put a co-treat on an IEP, mostly due to Medicaid reasons. Medicaid does not allow co-treats. According to most districts I’ve been in, if the service is on the IEP, it should be reimbursable. I’ve worked in districts with a very high Medicaid-eligible percentage, so every IEP was treated as if it were being submitted to Medicaid (also because you can retroactively claim Medicaid as well).

So, let’s try this example: A PT/SLP co-treat that is 1 hour long, which takes place one time per week. PT sees the student one more time individually and speech has two more individual sessions. On the co-treat day, PT and SLP would each bill for 30 minute individual sessions but at different times (10-10:30 for PT, 10:30-11 for SLP). The Related Services would be listed at PT two times per week, individual, 30 minute sessions, and SLP would be listed as three times per week, individual, 30 minute sessions.

Personally, I would then add in a PT and an SLP consult under Support for School Personnel and describe the consult to include the co-treat. This way, you have the accountability in the IEP to carve out the time in your schedules to include the co-treat. I would also state the need for/purpose of the co-treat somewhere in the Physical Development Section of the IEP.

Co-treats are a vastly underutilized service, in my book. Sometimes, to get around this, the OT and PT staff (because we share treatment space) will plan one activity that we do together with our students. This doesn’t help with the PT/SLP or SLP/OT co-treat. Obviously, scheduling becomes another issue as well.

I would love to hear how other therapists would or do document co-treats. Please let me know, and Margie, I hope this helps! 

~Kathryn Biel, PT, DPT


Posted in GUEST BLOGGER, School Based Therapists | Tagged , , , , , , , | 4 Comments

The AEIOU Systematic Approach to Pediatric Feeding – Dynamic CEU Course for OT’s, SLP’s and Dietician’s

Nina Johanson

Nina Johanson

We are thrilled to offer this dynamic pediatric feeding course, presented by Nina Ayd Johanson a highly regarded clinician and renowned teacher.

This course teaches a step-by-step approach for helping children learn to explore food, enjoy eating, and participate independently in social mealtimes. The AEIOU approach – acceptance, exposure, independence, observation and understanding – offers a new and highly successful method for integrated treatment of infants and young children with challenging feeding disorders using sensory, oral motor, biomedical and environmental strategies. Five factors in this holistic approach emphasize active participation, independence and shared control. This course will arm participants with knowledge and practical information to achieve functional outcomes for complex etiologies, improve quality of mealtime, manage tube dependency and transition to eating solid foods, treat sensory aversions, improve oral-motor skills, achieve home carryover, and more. This course is presented in a dynamic learning environment, using case studies and videos to engage and instruct participants. Extensive resources are provided. Many special populations are discussed including: prematurity, GERD, allergies, autism, failure to thrive, tracheostomy, picky eaters, and children with various syndromes.

Courses coming up:
March 27-28, 2105 – Las Vegas, NV
September 26-27, 2105 – Hartford, CT
October 23-24, 2015 – Edison, NJ
December 11-12, 2015 – Lafayette, LA

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

What others are saying:

I learned so many applicable treatment and evaluation strategies that I am excited to implement in practice…..Brittany, OT

This was a wonderful educational course. I like the way this approach addresses the “Whole” Child and family, and not just a symptom. Nina was an engaging presenter and very capable of sharing her knowledge and experience in an easy to understand way. I would recommend this course for all clinicians who work with children with feeding disorders. – Jordan, SLP

Fantastic feeding course – it really focuses on treating the whole child and family dynamics, whilst respecting both and moving at an appropriate pace….. picked up some tips on sucking, drinking, chewing and messy mealtimes. Thanks Nina – Rachel – dietician


Posted in Feeding, Pediatrics, Professional Development | Tagged , , , , , , | Leave a comment

Asking for Input for Therapies in The School 2015

We are fine tuning our agenda for this year’s Therapies in the School conference inMassachusetts and would value your input.

Based on feedback from last year’s conference we are excited to announce that we will have sessions on current best strategies to support students with sensory and motor challenges, tools to address problematic reflexes, bilateral coordination,  promoting mental health, visual-spatial strategies to embed, collaboration to support differentiated instruction, dealing with the severely involved child, hot practice issues and  much more!

We are continuing to build our course schedule for 2015, and would like to bring you education materials that are most applicable to your daily practice.

    • Are there any specific speakers who you would love to hear?
    • Are there any specific topics that you would like to see covered? 

 Which Session Would You Prefer:

Multi-sensory Approach to Handwriting:  How to Adapt the Handwriting Approach Used in Your District to Meet the Student’s Individual Need
Intervention for Fine Motor Skills:  Beyond Standardized Tests

In the following session are there specific tools that you would like addressed?

“No Longer A SECRET:  A Toolbox of Sensory and Motor Strategies for Student Success “
Presented by Doreit Bialer, who co authored the book No Longer A Secret, Successful Strategies for Children with Sensory Processing Disorders with Lucy Miller

  • Movement-based learning 
  • Ocular motor/visual strategies
  • Auditory and Listening Strategies
  • Other tools


We are considering offering a limited enrollment one day pre-conference,
highlighting one school based topic

Would it interest you to add on a third day ?

Please e-mail Mandy:
with your replies, and any suggestions for topics or speakers, or please comment on the blog below

The course will be held in November again
November 19-20, 2015– Framingham, MA

Thank you so much for your time


Posted in News, Pediatrics, Professional Development, School Based Therapists | Tagged | Leave a comment