Child Won't Chew: Any Tips

Beth Posts:

DEAR ERI COMMUNITY: I have a client right now that I am having trouble teaching how to chew. He was on stage 2 baby foods at 14 months old when I first started working with him. He is now eating mashed table foods, but often needs pudding or appleasuce on the spoon with the foods to tolerate. His mother has done the Therapressure Protocol with him in the past and we saw great improvements with tolerating touching foods, diaper changes, etc. I have asked his mother to start the Therapressure Protocol again. Now that we are gradually making his food chunkier, we have noticed that he does not chew. I gave his mom a NUK brush and gave her suggestions on working on tongue lateralization to improve oral motor skills. He will briefly hold something between his front teeth, but he pushes the chewy tube forward with his tongue when I place it on his back molars. I have his mother inserting the spoon to the sides of his mouth so the food is placed on his molars and she said she thinks he chewed one time over the past week. Any tips or suggestions would be appreciated! Thanks!

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Demystifying CEUs (Continuing Education Units) for physical therapists: State Requirements

Did you know that the APTA does not have an approval process for CEUs for continuing education courses? What this means is that it is up to each Board of Registration in Physical Therapy to set (and sometimes administer) its own requirements for re-licensure. At last count, while 12 states have no CEU requirements for re-licensure, 38 others were left to figure out whether or not they needed a pre-approval process for their CEU requirements. In addition, some states have chosen to require “continuing competency”, and thus they include giving credit for writing and publishing research quality papers, giving in-services, and the like.

Education Resources keeps up with each state’s requirements and any changes. We apply for approval to either the Board or to the state chapter of the APTA for pre-approval in the state where our live courses are being held. In addition, we are pre-approved in certain states (Texas, New York, California, North Carolina) and some other states will accept another state’s approval, (Rhode Island, South Carolina and Virginia).

What does this mean?

If you are licensed in: TX, NY, CA, NC, RI, SC or VA you may take any of our courses no matter where they are, and receive CEU credits.

Stay tuned for more specifics about each state and how to tell if the course you are taking will provide you with the CEUs you need for re-licensure. As always, feel free to call us (508-359-6533) or blog with any questions you may have about CEUs and we will try to answer them.

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Down's Syndrome: Case Question

Jennifer Posts

DEAR ERI COMMUNITY: I am a new pediatric occupational therapist and I can’t wait to hear some suggestions. A fellow physical therapist and I have been struggling with a patient: 16 month old female, Dx with Down’s syndrome. I have been seeing this pt. for around 5 months. The physical therapist and I whom are working with this little one feel as if we have hit a wall for about the last month. The patient was making excellent progress, including independence with sitting balance and improvement with functional transitions. The patient now begins to cry the second she leaves her Mother’s arms. We have tried having the mother observe unseen through a one way mirror, using the mother as a distracter, and even utilizing Mom for much of the handling. The other therapist and I have begun testing a variety of sensory strategies along with private rooms, large treatment gym, natural lighting, low lighting, music, etc. We have backed off with handling and tried moving off of the floor to platform swings, swiss ball, & even mother’s lap to no avail. The patient immediately closes her eyes, throws herself into extension, begins to cry, and is unable to be calmed by Mom or therapist. The patient has been cleared by her MD for GI, cardiac, and any other factors we could think of. Mom and Dad report the Pt does not demonstrate any difficulties at home. Any suggestions would be greatly appreciated!

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Evidence Based Practice and Osteoarthritis

In honor of May being Arthritis Awareness Month we wanted to alert you to a promising study looking at which subgroup of patients with OA benefits from physical therapy.

Few studies have investigated or identified common clinical tests and measures as being associated with progression of hip osteoarthritis (OA); fewer still are longitudinal studies exploring prognostic variables associated with long-term outcome following physical therapy treatment.

The focus of this study: http://www.hookedonevidence.org/searchresults.cfm?process=1&ReviewID=15375 (APTA members will need to log in to read the article) was the identification of factors to identify those who responded to physical therapy interventions. The authors report their results are the first step in the development of a preliminary cluster of baseline variables that identify patients with hip osteoarthritis as positive responders to physical therapy interventions. This study showed that selected combinations of unilateral hip pain, age of < 58 years, pain of > 6/10 on the NPRS, a 40-m SPWT value of <25.9 seconds, and a duration of symptoms of <1 year were associated with a favorable response to physical therapy treatment in patients with hip osteoarthritis. 

Share your thoughts with how consistent your clinical experience is with these findings.

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Feeding Dilemma – 5 month old

Jennifer Martin Posts:

DEAR ERI COMMUNITY:  I am an SLP working with a 5-month old, full-term baby, who was born with a duplication of chromosome 7. She is feeding using a Habermann feeder right now. She is not able to use a regular bottle, as she does not use suction, but only compression to express the formula. When using a pacifier for non-nutritive sucking, she is able to hold it in her mouth for less than a minute by herself. When checking her sucking ability with my finger, she is not wrapping the sides of her tongue, but only using compression to feed. One of the symptoms of this duplication is low muscle tone, and she mainly demonstrates this with all muscles from the waist up.

Does anyone have suggestions on how to improve her sucking ability? Also, when she is able to transition to a regular bottle again, what are some suggestions for bottle brands/types? Thank you!

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