Education Resources Blog

Toe Walking – the Clinical Challenge for Therapists


As a physical therapist, and a pediatric one at that, I get numerous referrals every year for children who toe walk. Often, that is the only information provided from the physician. Early on, I would look at these children and think, “Where to start?”

As with most cases, a good history is critical. Does the birth history suggest a neurological insult? Is there a history of autism or sensory processing disorder? Is there a structural deficit?

Following the history, evaluation is next. What is the range of motion and muscle tone?

When the child has a diagnosis of cerebral palsy, the treatment path is generally straight forward, including tone management, range of motion, and bracing. However, when there is no diagnosis, things are trickier. And this is where I used to get stuck. Especially if the range of motion and muscle tone were within normal limits. With some children, it’s easy to see that toe walking is a result of sensory-seeking. Walking on the toes provides increased proprioceptive input through the leg joints, thereby giving more feedback about the child’s position in space and his or her relationship to the floor. Sometimes, toe walking is the result of sensory avoidance, as the walker does not like input on the bottom of his or her foot.

Those are the “easier” sensory things to tease out. What about the children who are intermittent toe walkers? Or those who are not apparently sensory seeking or avoiding? Another aspect to consider is the integration of primitive reflexes. Children with unintegrated primitive reflexes, especially the tonic labyrithine reflex, can demonstrate toe walking as a sign. The retention of reflexes can also indicate an immature or neurological system that is under stress. The stress can activate the sympathetic nervous system, making the child function in a “fight or flight” state. A primary sign of the fight or flight state of arousal is toe walking. Other signs of this heightened state of arousal is increased respiration, decreased attention, increased visual scanning, and agitation.

Also, in the absence of sensory issues, a suggestive birth history, or a diagnosis of cerebral palsy, other neuromuscular disorders (Muscular Dystrophies, even in females) should be considered. This is especially important to follow through with when treatment does not change the toe walking, muscle length or muscle tone.



Why is it important to address toe walking? An equinus gait is energy-costly, as it causes the ankle and knee joints to lock out, thereby preventing the transfer of energy in the form of momentum through the legs. The forward movement of the body that is normally achieved by a heel-toe gait is absent. Additionally, toe walking causes compensatory strategies throughout the rest of the body that can lead to long term imbalances and eventually pain and dysfunction.

toe walking pathology

These postural compensations will impact lower extremity muscle length, posture, core stability, and vision. The postural implications can also play a role in scapular and shoulder function, thus setting the child up for a life time of dysfunction.

What challenges are you finding with your toe walkers? Are you getting referrals for toe walking? How are you treating it?


~Kathryn Biel, PT, DPT


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Announcing NEW Online Sessions for School Therapists

Online pictureFollowing the successful launch of our online course program last year we are thrilled to announce we have added six new online sessions.

We offer

  • Strategies to Implement in the Classroom
  • Professional Development On Demand
  • Convenient and Flexible Learning
  • Cost Effective Continuing Education

We are offering sessions (recorded live) from our highly acclaimed Annual Therapies in the School Conference. You can choose from six individual sessions, or choose the complete package of all six sessions; a great option to share with your colleagues or district:

Visual Strategies and Creative Collaborative Tools
June Smith
Goals That Drive Intervention: What is Relevant and Realistic?
Agnes McConlogue and Lori Quinn

Visual and Motor Tools for Integrative Learning and Teacher Collaboration
June Smith

Team Strategies to Make Limited Therapy Contact Have Lasting Impact: A Physical Therapy Perspective
Sara Harvey

Practical Tools to Address Sensory vs. Behavioral and Behavioral vs. Sensory Issues
Debra Dickson
Smart But Scattered: Helping Children Get Organized, Stay Focused, and Control Emotions
Peg Dawson

The Neurodevelopmental Classroom
Debra Dickson

Visual Thinking: A New Paradigm to Maximize Outcomes
Cathy Stern and Donna McCrorey

Complete Package: Therapies in the School Online – Series 2

$134 per session   
$34 per additional CEU certificate (up to 19)

$599 for all six sessions
$44 per additional CEU certificate (up to 19) 

Each session meets the criteria for 2.5-3 contact hours (0.25-0.3 CEUs)

CEU certificates will be downloadable following successful completion of a post test. Individual registrations are available online. Please call the office with any questions and for group/district registrations or click here for a Registration Form and mail or fax in the form with payment

We know that for some of you, it may not be possible to attend every conference you would like, and for others, supplemental materials will enhance your learning when attending our highly regarded live programs. Still others have told us that they want to share the material they have learned at one of our live courses with their colleagues, administrators and the families they serve. That is why we have enhanced our new e-Learning program taught by leading experts in their fields.     

Please visit our FAQ Page  and CEU Page   for more information.

We continue to strive to meet your needs as you develop your skills to meet the ever changing demands of health care and education. We welcome your suggestions for future online courses.

You may be interested in our other pediatric online courses, also available on our website

It’s the next best thing to attending live!

“The course was very informative and presented current research. Information was presented clearly and can be used in practice immediately. Presenter was knowledgeable and easy to follow”. 

“I attended courses with Education Resources Inc in the past, this is my first online class with them. I liked greatly the technology used for this class made very accessible even from my mobile devices. Thanks”. 

“This was a well-designed course with an extremely knowledgeable presenter. Information was presented at a even pace and clearly. Although I do not work in school environments, I will be able to transfer information from this course to my Early Intervention practice easily”.


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PT’s, OT’s Looking for Ways to Improve Head Control

GUEST BLOGGER: Kathryn Biel.


Patricia submitted this question:

So how do you improve head control? I have tried several courses and have left with no real answer to this question. Do you have any ideas?

Head control is a tricky thing. It is the result of the interplay of the vestibular system, the visual system, motor control, strength, muscle tone, and endurance. In theory, it is one of the first things to develop. Head control is developed through prone. The vestibular and visual systems are critical in developing the desire to lift the head and push up onto prone prop and eventually on to extended arms. At this point, the eyes develop convergence and divergence, and the Symmetrical Tonic Neck Reflex is used to assist in getting the child into quadruped.

I’m guessing that your patient is beyond this infant stage. Depending on the age of the patient, as well as the presence of co-morbidities, may impact your treatment strategies. A thorough visual assessment (by Developmental or Behavioral Optometry) is necessary to determine if the Visual Righting and the Vestibulo-Ocular Reflexes are intact. These are a major driving force in providing the motivation to lift the head to midline in the first place. Cortical visual impairments and visual field cuts can often result in a person holding their head out of midline, as that is how functional vision is accessed. It is important to determine where the functional visual field is so that you are not asking a person to function where he or she cannot see.

For strength development, go back to prone. Development of the back and neck extensors, as well as shoulder girdle strengthening, is critical in possessing head control in the upright position. If extensor control is not present to counter balance flexor strength (which is developed in supine), then functional midline co-contraction will not be realistic.

In terms of sitting, in order to gain head control, you must first tackle the pelvis. Trying for head control without a well-seated pelvis is like building a house from the roof down. The pelvis must be supported and neutral. Assuming that the patient you are looking to develop head control in is multiply impaired, in addition to controlling the pelvis, you are looking to fully support the trunk as well. This includes adaptive seating that supports the trunk laterally, and helps to correct any curves (forward/back as well as lateral). The feet and legs should be well supported to further provide a stable base of support. Remember, if you are asking a person to work on head control, then that is what they are working on. It does not include working on trunk control.

Over the past few years, I’ve used a few different trunk supports on wheelchairs that have helped to improve upper trunk and scapular position. These include the Stealth I2I head and neck support system and the use of two AEL Y-shaped trunk supports (one on each side). In the past, I’ve also used the Headmaster collar to work on very small range head control (lifting from the resting position on the collar to fully upright).

I would love to hear what other therapists are doing to work on head control. Please let me know, and Patricia, I hope this helps! 

~Kathryn Biel, PT, DPT


Posted in GUEST BLOGGER, Pediatrics | 6 Comments

Exciting News! We Would Like to Introduce our Guest Blogger – Kathryn Biel, Pediatric Therapist

Kathryn Biel

Kathryn Biel

Let Me Introduce Myself

I first found Education Resources, Inc. when I was a brand new graduate, way back at the turn of the century. At the suggestion of my soon-to-be-place of employment, I attended a School-Based OT/PT Conference. I was so green I didn’t even know what I didn’t know. But I did recognize two excellent speakers, a PT/OT duo. Without looking at my papers, (which after several moves, who knows where they are?), I can’t tell you what the course was, but I can tell you one of the speakers was Linda Kliebhan. I was so impressed with her that when I needed more continuing education, I looked her up. And thus, my love of Education Resources, Inc. was born.

Over the course of my career, I’ve taken several courses through ERI. Early on, I took several pediatric NDT courses. The last few years, I’ve been to five out of the last six Therapies in the School Conference. As a school-based physical therapist, this conference is, hands down, the best I’ve ever attended. Even when my company or school doesn’t pay for the whole course, I still attend. Why? Because it’s that good.

So this year, I was happy to be back at the conference, and even more delighted at the cocktail reception following the first day. It was a great time to chit chat, network, and brainstorm. Cheese and crackers were consumed, iPad apps were shared, and I met Carol Loria and Mandy Washington (she’s the lady who sends all the e-mails!), to whom I casually mentioned my side career as a novelist.

In addition to being a school-based physical therapist, I am the author of four women’s fiction novels. Before you ask, I don’t watch TV in the evenings and I don’t clean my house a whole lot—that’s how I have the time. I have website/blog which I use to promote my books, tell embarrassing stories which will make my children someday disown me, vent about things in society that annoy me, and discuss things I come across in therapy.

So that brings me to why I’m here. In working with Mandy and the great staff at ERI, in an effort to reach more therapists and help us network and stay connected, even as we’re spread thinner and thinner, I’ll be writing regular blog posts for ERI. I hope to provide information for clinicians on relevant topics and spark a dialogue between therapists across the globe. I have lofty goals. So, please go gently on me while I get into the swing of things. Feel free to let me know if you’ve had a different experience or have another angle to consider. Also, I’ll always be looking for new topics to cover, so please give me a shout out with ideas or questions. I’ll especially be looking for ideas outside of my realm of pediatric physical therapy.

We hope that Education Resources, Inc. will be your go-to spot for the latest in information, therapy trends, continuing education, and therapy connections.

I look forward to hearing from you!


~Kathryn Biel, PT, DPT


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New Toe Walking course for PTs and OTs Presented by our New Speaker: Liesa Persaud, PT, DPT, PCS, CKTP


Liesa Persaud

Liesa Persaud

Education Resources is thrilled to introduce a new member of our faculty:

Liesa M. Persaud, PT, DPT, PCS, CKTP has a wide range of clinical experience, organizational leadership, and proficient teaching skills making her an exciting and compelling instructor. Ms. Persaud is the lead physical therapist at Tulsa Sunshine Center in Oklahoma, and is also the owner of Know to Change, a thriving private practice in Skiatook, Oklahoma.  She has educated health care professionals, both nationally and internationally, in advanced treatment techniques, specialized practical training and consultative services.  She has worked in a variety of settings, including private pediatric and adult clinics, schools, private homes, hospitals and long-term care facilities.   Ms. Persaud earned her Master’s Degree in Physical Therapy from the University of Findlay in Findlay, Oklahoma and her post-graduate Doctorate from Rocky Mountain University of Health Professions and is a Board Certified Specialist in Pediatric Physical Therapy.  In 2007, Ms. Persaud served as Treasurer for the Oklahoma Physical Therapy Association and has been a member of the Oklahoma Foundation for Physical Therapy since 2004.  Ms. Persaud’s passion for helping others extends into her private life. She volunteers as a Call Rape Advocate, Salvation Army Volunteer, and is a member of the Fraternal Order of Police Auxiliary.

We are excited to be offering Liesas course:

Therapeutic Evaluation and Treatment of Toe Walking (Pediatric Equinus Gait) from a PT and OT Perspective 

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Education Resources Announces New Partnership with Illinois Occupational Therapy Association

IL OTA Partnership with Education Resources inc.In a continual effort to fulfill the professional development  and continuing education needs of  Occupational Therapists, Education Resources is thrilled to announce a new partnership with the Illinois Occupational Therapy Association.

The Illinois Occupational Therapy Association (ILOTA) is the official representative of the occupational therapy profession in the state of Illinois.  ILOTA acknowledges and promotes professional excellence through a proactive, organized collaboration with occupational therapy personnel, the health care community, governmental agencies and consumers.  Through membership, the association works to safeguard the practice of Occupational Therapy in Illinois.

We are pleased to welcome ILOTA members, and offer you our continuing education courses that are engaging, relevant, immediately applicable to your practice.

The following comprehensive selection of dynamic CEU courses  are coming to Illinois in 2015. Please click on a link for a full course description, faculty bio, course brochure including a schedule and registration information

The AEIOU Systematic Approach to Pediatric Feeding
Nina Johanson
February 20-21, 2015 – Orland Park, IL

Integrating Moment-Based Learning into Treatment: An Evidence Based Approach
June Smith
February 20-21, 2015 – Urbana, IL

Geriatric Neurology in the Medically Complex Client
Jennifer Bottomley
March 13-14, 2015 – Chicago, IL

Contemporary NDT Treatment of the Baby and Young Child
Suzanne Davis
March 20-22, 2015 – Glenview, IL

What’s New in Pediatrics:
Best Practices in Treatment of the Child with CP and other Neurologic Disorders
Ginny Paleg
March 27-28, 2015 – Rockford, IL

Children’s Brains, Neuroplasticity and Pediatric Intervention: What’s the Evidence
Patricia Montgomery
May 8-9, 2015 – Chicago, IL

Therapeutic Evaluation and Treatment of Toe Walking (Pediatric Equinus Gait)
Liesa Persaud
May 15-17, 2015 – Glenview, IL

Treatment of the Hypotonic Child
Linda Kliebhan
June 12-13, 2015 – Chicago, IL

Baby Steps: 
Building Ambulation Interventions for the 0-3 Population with Posture and Movement Dysfunction

Jan McElroy
July 17-19, 2015 - Glenview, IL

Praxis: Evaluation and Treatment of the Clumsy Child
Barbara Connolly
July 31-August 1, 2015 – Rockford, IL

Building the Brain:
A Neurobiological Approach to Assessment and Treatment
Robin Harwell
August 21-22, 2015 – Chicago, IL

Intervention for the High Risk Infants and Young Children (0-5):
Activities, Routines and Evidence Based Practice
Randy Fedoruk
August 28-29, 2015 – Orland Park, IL

Management of the Complex Acute Care Patient
Daniel Malone
September 18-19, 2015 – Springfield, IL

Torticollis and Plagiocephaly:
Assessment and Treatment of Infants and Children
Cindy Miles
September 18-19, 2015 – Chicago, IL

Practical Intervention Strategies for Children with Autism Spectrum Disorders:
An Evidence Based Approach
Stacey Szklut
September 18-19, 2015 – Aurora, IL

NDT and MFR for Children with Neurological Disabilities
Barbara Hodge
September 25-26, 2015 – Orland Park, IL

Cancer Rehab and Survivorship:
Evidence Based Treatment to Address Common Impairments
Lisa VanHoose
September 26-27, 2015 – Rockford, IL

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

Polly Tarbell
October 2-3, 2015 – Glenview, IL

Treatment of Children with Sensory, Emotional and Motor Challenges:
Getting the Beat with Music, Rhythm and Sequencing
Lise Gerard Faulise
October 9-10, 2015 – Chicago, IL

Yoga Therapy for the Child with Developmental Challenges
Anne Buckley-Reen
November 13-14, 2015 – Chicago, IL

The Whole Child:
The S.A.N.E. System of Pediatric Assessment and Treatment
Debra Dickson
TBA - Orland Park, IL



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CEUs for Florida Physical Therapists

Physical Therapy CEU courses for Florida Therapists

As you are planning to complete your CEU requirements of 24 continuing education hours by November 30th, 2015, Education Resources is pleased to bring the following cutting-edge, evidence-based continuing education courses to your area. Let us help you meet your professional development needs for re-licensure. 

Our courses are engaging, relevant, immediately applicable to your practice and are based on the latest clinical information and research available. 

We apply to Florida Physical Therapy Association for CEU approval.

Please click on a link for a full course description, faculty bio, course brochure including a schedule and registration information:

Pediatric Vestibular Rehabilitation         
Gaye Cronin
February 20-21, 2105 – Plantation, FL

Mobilizing the Medically Complex ICU and Acute Care Patient
(An Evidence-Based Model)
Ellen Hillegass
March 20-21, 2015 – Hollywood, FL

Pediatric NDT Treatment Intensive
Barbara Hodge
March 20-21, 2015 – Miami, FL

Taping to Improve Alignment, Strength and Function in Children
Jackie Grimenstein
March 27-28, 2015 – Orlando, FL

The Complex Shoulder: An Evidence Based Approach for Evaluation and Treatment
Megan Donaldson
April 17-18, 2015 – Tallahassee, FL

Torticollis and Plagiocephaly: Assessment and Treatment of Infants and Children
Cindy Miles
April 17-18, 2015 – Plantation, FL

Intervention for Complex Feeding Disorders: Infants and Toddlers
Amy Kageals
May 15-16, 2015 – Hollywood, FL

Management of Acutely Ill Patients: An Evidence Based Approach from a Cardiopulmonary Perspective
Komal Deokule
May 29-30, 2015 – Jacksonville, FL

Evidence Based Treatment in Patients with Neurologic Disorders
Kari Dunning
July 24-25, 2015 – Miami Beach, FL

Advanced Clinical Practice in the NICU
Beth McManus
August 21-22, 2015 – Miami, FL

Assessment and Treatment of Children with Oral Motor, Feeding/Swallowing and Respiratory Function Challenges: Children with Neuromotor Involvement
Rona Alexander
September 25-27, 2015 – Plantation, FL

Practical Intervention Strategies for Children with Autism Spectrum Disorders: An Evidence Based Approach
Stacey Szklut
October 2-3, 2105 - Tallahassee, FL

Sensory Integration Intensive
Jeannetta Burpee
October 15-18, 2015 – Miami, FL

Improving Outcomes for the Medically Complex Patient: Acute Care, Home, Rehab, SNF, OPD
Suzanne Clark
October 17-18, 2015 – Hollywood, FL

Treatment of the Severely Involved Child
Linda Kliebhan
October 23-24, 2015 – Plantation, FL

Practical Strategies for Treating Complex Pediatric Feeding Disorders: Treating the Whole Child
Polly Tarbell
November 20-21, 2015 – Ft. Lauderdale, FL

Cancer Rehab and Survivorship: Evidence Based Treatment to Address common Impairments
Lisa VanHoose
November 21-22, 2015 – Kissimmee, FL

Intervention for High Risk Infants and Young Children (0-5): Activities, Routines and Evidence Based Practice
Randy Fedoruk
December 4-5, 2015 – St. Petersburg, FL

Is it Sensory? Or is it Behavior? Assessment and Intervention Tools for OT’s, PT’s and SLP’s
Debra Dickson
December 11-12, 2015 – Hollywood, FL

Therapies in the School online sessions
Multi Faculty

Cervicogenic Dizziness
Richard Clendaniel

Call or email with any questions:

Please click here to join our mailing list to receive information on relevant courses coming to your area

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Anne Buckley-Reen – Yoga Therapy in The Classroom – a Popular Continuing Education Course for School Therapists

Anne Buckley-Reen

Anne Buckley-Reen

I am very happy to share these wonderful testimonials we received from therapists; physical therapists, occupational therapists, special educators, behavior specialists and school counselors who recently attended Anne Buckley-Reens continuing education course: Get Ready to Learn: Yoga Therapy in the Classroom

This was probably one of the best continuing ed. courses that I have attended. I feel as though I can go back to my district and present the material to teachers and make a real behavioral change. As well as improving students motor skills in the process“. Gina, PT

I am so excited to begin implementing GTRL. I have been wanting to incorporate yoga into the school day to help ALL students. The fact that there is a curriculum attached that is supported by data and research makes it an easier “sell” for administators to also buy into the program“. Heide, School Counselor

This was by far the best and most relevant workshop that I’ve ever attended. I only wish that more teachers had attended. This is a program that would benefit any classroom“. Debbie, Sp.Ed

Anne presents this information in a way that makes,  you believe a program would work no matter where you work, who you work with or the difficulties they face. The course is very complete with yoga labs/films of actual students performing the practices, data, testimonials and research based improvement“. Kelly, OT

We are thrilled to offer this course:
March 7-8, 2015 – Sewickley, PA with other possible dates in 2015.

Anne also teaches another dynamic workshop:
Yoga Therapy for the Child with Developmental Challenges
February 6-7, 2015 – New Brunswick, NJ
September 25-26, 2015 – Tualatin, OR
November 13-14, 2015 – Chicago, IL
December 4-5, 2015 – Hartford, CT

Please click here to learn more about our relevant courses


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NEW CEU COURSE – Neurologic Upper Extremity

We are thrilled to offer a new course:

Improving Functional Outcomes in The Neurologic Upper Extremity

LaMar Bolden

LaMar Bolden

Presented by LaMar Bolden, OTR, DPS, C/NDT an advanced clinical specialist at Kessler Institute for Rehabilitation, with 12 years experience treating patients with central neurologic dysfunction.   LaMar received the “Award of Merit for Innovative Treatment in Physical Disabilities Practice” from the New Jersey Occupational Therapy Association. 

In this highly interactive continuing education course, for physical therapists and occupational therapists, the focus is on improving functional outcomes in patients with upper extremity dysfunction due to central nervous system deficits using assessment and treatment strategies within a contemporary paradigm.  Designed as an integration of evidence-based treatment approaches, current neurophysiologic understanding of motor control, motor-learning, that can be immediately applied to practice in any treatment setting.  This course will incorporate selection of the best outcome measure to evaluate and document progress to support intervention approach. 

Course Objectives:  At the end of this course participants will be able to:

  • Determine treatment approach, reasonably predict targeted outcomes/goals based on current neuroscience and evidence.
  • Implement evidence based treatment strategies and techniques to improve functional outcomes.
  • Develop a comprehensive plan of care that addresses upper extremity function at participation level.
  • Choose appropriate standardized assessments to support measurable outcomes.
  • Analyze movement patterns and correlate to stage of recovery to select best practice interventions.

We are pleased to offer this course in multiple locations in 2015:
February 27-28, 2015 – Laurel, MD
March 27-28, 2015 – Fort Worth, TX
June 19-20, 2015 – Weymouth, MA
August 28-29, 2015 – Derby, CT
October 16-17, 2015 – Burlington, NC

Please click here for more information to download a brochure and to register

Please click here to join our mailing/email list

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My Perspective on Sensory Integration – John Pagano

Blog Post from Faculty Member John Pagano

I frequently use Sensory Integration/Sensory Processing Intervention in my work as an occupational therapist with clients who have severe behavioral, sensory processing and developmental challenges. I get criticism both by professionals who question the validity of sensory processing intervention and those who dislike my integrating it with other treatment approaches. It is time to transcend the polarizing debate about the sensory processing model and put it in perspective.

CoopPlayTheraband chairarm rotation

Like most occupational therapists my treatment grew from my clinical practice and the influence of many gifted teachers. I was introduced to sensory integration intervention in my entry-level occupational therapy training and studied it extensively at the post-graduate level. I spent thousands of dollars on my sensory processing training and although I’m frugal (my son says “a cheap skate”) it was worth every penny.

My sensory processing teachers have had so many students that they wouldn’t even know my name, but they transformed my professional and personal life through their mentoring. Among my most effective sensory processing teachers were the late Ginny Scardinia, Mildred Ross, Winnie Dunn, and Lucy Jane Miller. Each holds a distinct view of sensory processing intervention, is an occupational therapist, master teacher, and base their practice on the teaching of A. Jean Ayres the founder of Sensory Integration.

I first met Mildred Ross as a guest lecturer in my undergraduate occupational therapy class. Using sensory (e.g., touch, movement, smells) strategies she developed individual and group interventions that improve the functioning of individuals with severe psychiatric and developmental challenges. Disagreeing with the “experts” who viewed these clients as “hopelessly regressed psychiatric patients”, Mildred motivated her clients by respecting them as people, caring about them, and beginning at their current developmental level then gradually improving their functional skills. Mildred used a similar approach with occupational therapists, teaching us what an honor it was to help others and motivating us to improve our skills. I remember that the professors and conference leaders who invited Mildred to speak often set an egg timer for one hour before she began, and kept it ringing until she stopped speaking. Although they told me the timer was essential and I usually hate listening to people talk, I always hoped the timer would break so I could listen to her all day.

After five years as a school occupational therapist a unique experience introduced me to my next mentor Ginny Scardinia. I was watching my OT student treat a 6-year old girl who had developmental, behavioral, and PTSD challenges using a net swing when the girl suddenly spoke for the first time. I’d been treating that girl for half a year and gotten little response, but after that single half-hour session from my OT student the child was able to consistently speak in school. My OT intern told me that she’d learned sensory integration treatment during her previous affiliation with Ginny Scardinia at the Ayres Clinic. I soon located Ginny, took classes with her, and bugged her to teach me whenever she could from that day on.

Ginny Scardinia was unique in her ability to motivate me to do whatever it took to learn to help children like she could.  I recently learned that Ginny inspired many occupational therapists, and a research study was conducted summarizing her skills as a master mentor Over 25 years have past but I still remember that after she first saw me treat she said, “You’re off to a good start, but you need to learn a lot more about neurology and sensory integration and honey, I can teach you”.   I knew that she was right and although I never reached her level as a clinician I am still trying.

Ginny inspired me to take all the sensory integration courses I could and to take motor learning classes at Columbia University T C. The motor learning research taught me that clients have the ability to recover from neurologically based challenges through engaging in developmentally appropriate sensory experiences in their natural environments. My experiences with Ginny and Mildred Ross inspired me to lead a group for children with Autism Spectrum Disorders with the help of occupational therapy students and the children’s parents.


I met Winnie Dunn and Lucy Jane Miller at an AOTA symposium where they were mentoring new researchers by letting us help with their projects. I remember asking them both why they were developing assessments when new treatments were needed, and they told me that until we learned to measure sensory integration interventions we couldn’t improve and validate our treatments. Winnie Dunn developed the Sensory Profile, a reliable and valid measure of sensory processing Dr. Dunn also went on to develop an intervention model that used the sensory profile to coach clients on adapting their sensory modulation styles so they could function more effectively.  While I still do direct and group interventions I always include consultation to the client, family, and teachers regarding how their sensory styles impact their interactions and functioning.

Adaptive EquipmentWallPushBulBrd

By taking the Sensory Profile I found I had significant Low Registration and Sensory Sensitivity, at a level where only 2 out of 100 adults my age score. Being low registration influences me to often miss sensory input that others notice. Because I am also sensory sensitive I also frequently get overwhelmed by sensory input I do notice and take a long time to accommodate to touch (e.g., I’m bothered by neck ties, rings and watches).

I’ve learned to stomp my feet and look people in the eye when they are telling me something important, and to take an hour walk when I’m feeling overwhelmed so I don’t yell at anyone. I still can’t wear a tie when I speak but can tolerate wearing shoes rather than sneakers. Knowing my sensory profile helps me accommodate my behavior to the needs of my clients. I tend to talk loudly and quickly, but consciously speak softer and slower when working with clients who have sensory sensitivity and attention deficit hyperactive disorder.

As a new researcher who was a member of Lucy Jane Miller’s team I learned to be a better observer. Although she is arguably one of the most influential leaders in sensory processing intervention (helping to create the term) what inspired me most about her was her honesty. I was putting off getting my Ph.D. because I felt I wasn’t smart enough, but was inspired when Dr. Miller asked me for help changing her flat tire. I figured if someone that smart couldn’t change a tire I could try to get my Ph.D. even though I didn’t feel smart enough.

Dr. Miller has evolved from developing assessment tools to supporting sensory processing intervention research through the Sensory Processing Disorder Her organization presents workshops on sensory processing basic and clinical research. I refer parents and clinicians to her organization because it is both factual and parent friendly.

My clinical experiences have shown me that sensory processing intervention helps clients with severe sensory processing, behavioral and developmental challenges to improve their functional skills. I have discovered the value of sensory processing intervention through individual, group, client/family education, and environmental consultation treatment. My perspective on sensory processing and professional vision wouldn’t have been possible with out my teachers and mentors. To paraphrase Isaac Newton, “If my professional vision has expanded it is because I stand tall on the shoulders of giants”


Dynamic courses with John Pagano coming up in 2015:

Effectively Treat Behavior in Children: Traumatic Brain Injury, Autism Spectrum Disorder, Sensory Processing, Cognitive Limitations,  PTSD and Other Challenges
April 10-11, 2015 – Houston, TX
May 2-3, 2015 – Detroit, MI
October 23-24, 2015 – Monroe, NC
November 6-7, 2015 – New Brunswick, NJ

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