Pediatric Vestibular Rehabilitation: Helpful Considerations for Clinicians Diagnosing Vertigo in Adults vs. Pediatric Patients

Inger Brueckner, MS, PT, ERI’s esteemed faculty member and vestibular rehabilitation expert, is eager to share with our community of therapists an informative article recently published in Italian Journal of Pediatrics that could be helpful when looking at a child vs. adult complaining of dizziness:

Neurological Vertigo in the Emergency Room in Pediatric and Adult Age: Systematic Literature Review and Proposal for a Diagnostic Algorithm: Pellegrino et al.  Italian Journal of Pediatrics (2022) 48:125

Inger says: 

This article uses a systematic review to describe the
differences between
adults and pediatric patients
presenting to the Emergency Room with vertigo. 

It highlights the difference in presentation based on age. They have developed an algorithm to help clinicians and I find it very useful to keep the different presentations in mind when looking at a child vs. adult complaining of dizziness.

Taking age into consideration when trying to determine causes for dizziness is important, but often over-looked. The summary of conditions is also a helpful review if you see patients of all ages.

Dive deeper into this important subject with Inger Brueckner, MS, PT at her upcoming live webinar with ERI: 
Pediatric Vestibular Therapy: Young Children Through Adolescents 
February 3 and 10, 2023
9:40 am EST • 8:40 am CST • 7:40 am MST • 6:40 am PST (US)

A hands-on lab, evidence-based lecture, videos, and case presentations are tailored to assess and treat
children 5-18 years old while maintaining their application/relevance for the adult population.

This course is appropriate for PTs, PTAs, OTs, OTAs and health practitioners that work with school-aged children and adolescents age 5-18. 

Browse course details, CEU information, download a brochure and register HERE. 

Join the ERI Facebook Discussion Group – Pediatric Vestibular Rehabilitation

Executive Function and How COVID Has Impacted Learning Executive Function Skills

Executive Function and How COVID Has Impacted Learning Executive Function Skills

If you are a physical, occupational or school-based therapist, you may have noticed your patients or students struggling with executive function skills. These might include procrastinating more and having trouble managing time effectively. The COVID-19 impact on executive function has been noticed across the board, mainly due to the shift to remote learning. 

Learn more about executive function during COVID-19 and how therapists can help their patients and students at this time.

What Is Executive Function?

Executive function refers to the cognitive and mental abilities that help people engage in goal-oriented actions. Executive function directs our actions, self-regulations, behavior and motivation to achieve goals and prepare for future events.

We begin developing executive function skills by age 3 and develop them fully in adulthood. Studies show that people with attention-deficit/hyperactivity disorder (ADHD) are 30% to 40% behind in executive functioning development, making them more likely to be motivated by short-term rather than long-term goals, impacting their overall functionality and progress. 

The loss of executive function has been noticed in relation to COVID-19, as well, which can affect skills like:

  • Working memory
  • Flexible thinking
  • Following directions
  • Solving problems
  • Managing long-term projects 

Students with executive function problems might have difficulties organizing their materials, setting schedules and sticking to tasks. They might misplace worksheets, reports and other school materials. They might also have trouble keeping track of personal items, regulating their emotions or keeping their bedrooms organized. 

How Has Executive Function Been Impacted by COVID-19? 

During the pandemic, many children began struggling with executive function in school, including difficulties studying, completing tasks and focusing on learning.

The COVID-19 impact on executive function can stem from: 

1. Disrupted Learning Routines

When students enter their classroom, their brains decide that it’s time to focus and learn. That’s why it’s no surprise that remote learning during the pandemic has become troublesome by disrupting the development of vital executive function skills.

State-dependent memory (SDM) refers to the scientifically observed phenomenon that memories are retained more effectively when conditions are consistent. Meaning humans are more likely to remember something when we’re in the same state of mind, location and time of day as when we first learned it.

That’s why the routine-heavy aspect of in-person learning is beneficial. To study most effectively, a defined study location can be explicitly designated for schoolwork. Studying in the bedroom, playroom or dining room won’t be as effective since the brain associates these spaces with relaxation. 

Children will especially struggle to force their brains to associate their homes with a place for learning. These new routines can make it difficult for the brain to develop as students attempt to recognize their homes as learning spaces.

2. More Steps for Turning in Homework

Students who struggle with executive functioning often have difficulties turning in homework. Completing tasks can be stressful for these students, and many forget to turn in assignments. During lockdown, this was incredibly challenging since so many schools were fully or partially remote. 

Students don’t get a built-in reminder of the teacher collecting homework in these cases. Instead, most schools require online submission that typically involves:

  • Completing the assignment
  • Taking a picture of it
  • Emailing the image to yourself
  • Downloading the picture
  • Uploading the photo to the school’s online portal

For people with fully developed executive function skills, the task is easy. But for children still developing executive function, it requires several steps, which increases the chance of getting distracted. As a result, many teachers during the pandemic have seen a loss of executive function skills, with many assignments going missing in the completion stage. 

3. Stress and Anxiety

The Centers for Disease Control and Prevention (CDC) has seen a significant increase in depression, stress and anxiety across all age groups throughout COVID-19. Children are far from immune to this surge. In fact, as many as 29% of students had increased anxiety symptoms during COVID-19. Stress and anxiety have a massive impact on cognition and executive functioning.

Since anxiety is the brain’s reaction to a perceived threat, it’s no surprise that it gets in the way of executive functions. While the brain’s response to threats may help us run away, it’s not as helpful for completing tasks. With remote schools and a constant cycle of uncertainty in the news, stress has disrupted children’s brains from developing executive function skills.

therapists can learn more about executive function with courses from ERI

Therapists Can Learn More About Executive Function With Courses From ERI

COVID-19 and executive function have been a struggle for children around the world. Whether your school year begins online or in person, there are several ways to support your students or patients after the pandemic.

At ERI we care about the empowerment of therapists and their patients. Our courses can help you learn more about executive function and how to support your student’s development of these essential skills. Our faculty consists of experts in the field. We provide dynamic, passionate and engaging courses that teach new strategies and tools to help improve the daily lives of your patients. 

Learn more about our courses or contact us today.

Trauma-Informed Care for Therapists

trauma-informed care for therapists

Trauma and adverse childhood experiences can significantly impact a person’s long-term emotional, behavioral and physical health. If you are a physical, school-based or occupational therapist (OT), you’ll likely work with many people who have a history of trauma. For this reason, health providers are calling for increased trauma-informed care and approaches across the health and educational sectors.

A trauma-informed therapy approach can help you best support your patients’ needs. Learn more about trauma-informed therapy, its principles and how to become a trauma-informed therapist.

What Is Trauma-Informed Care?  

Trauma-informed care is a therapeutic approach that considers a patient’s life situation — past and present — to provide the most effective services for their needs. Rather than asking, “What’s wrong?” trauma-informed care shifts the focus to asking, “What happened to you?” 

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) recognizes trauma as an event or series of events that could cause long-standing implications for a person’s health and functioning. Examples of trauma include exposure to violence, abuse, neglect, sexual assault, food insecurity or natural disasters. The definitions of trauma and treatment methods for patients continue to evolve, which is why it’s beneficial to stay up to date on types of trauma and ways to provide trauma-informed care for patients. 

Your services will be oriented toward healing, where you can potentially improve a patient’s engagement, treatment adherence and health outcomes. Occupational therapy and trauma-informed care can also help minimize avoidable care costs for social and health services. 

Essentially, as a trauma-informed therapist, you’ll seek to: 

  • Realize the significant impact of trauma and different paths for recovery
  • Recognize the signs and symptoms of trauma in patients, families and staff
  • Incorporate knowledge about trauma into procedures and practices
  • Actively avoid re-traumatization

What Are the 6 Principles of Trauma-Informed Care?

The Centers for Disease Control and Prevention (CDC) helped develop six trauma-informed care principles to lead training for health providers in public health emergencies. The training hopes to increase responder awareness of trauma and help them realize how it affects the communities where they work.

The six principles that guide the trauma-informed care approach include: 

  1. Safety: The first goal of trauma-informed care is to ensure patients and staff feel psychologically and physically safe. 
  2. Trustworthiness and transparency: Health providers should also ensure decisions are made with transparency and to build and maintain trust among patients. 
  3. Peer support: Individuals with shared experiences should be integrated into organizations and considered integral to service delivery.
  4. Collaboration and mutuality: Power differences between staff and clients should be leveled to support shared decision-making. 
  5. Empowerment and choice: The patient and staff strengths should be recognized, developed and validated, including the belief in resilience and the ability to heal from trauma. 
  6. Cultural, historical and gender issues: Historical trauma, biases and stereotypes, such as those based on race, gender, sexual orientation, ethnicity or age, are recognized and addressed.

Remember that a trauma-informed approach won’t be accomplished through any single technique or checklist. It requires ongoing attention, awareness, compassion, sensitivity and sometimes cultural change at an organizational level. 

Why Therapists Need to Know About Trauma-Informed Care

There are several reasons therapists should learn about and take a trauma-informed approach to care. According to the CDC, just over 60% of American adults have experienced at least one traumatic event in their childhood. 

Therapists are responsible for being trauma-informed and responding to each patient’s needs in the most comprehensive way possible. Doing so helps create a safe and supportive environment for the patient’s rehabilitation journey. 

By learning more about trauma-informed care, you can help your patient:

  • Avoid re-traumatization: The experience of reliving trauma can result in physical, emotional and psychological health conditions and hinder therapeutic rapport and the patient’s safety.
  • Increase overall health and well-being: When a therapist is aware of a patient’s history of trauma, this can help them develop specific goals and treatment approaches. By taking a trauma-informed approach, therapists can help their patients heal and recover holistically.
  • Feel empowered and safe: Therapists can make their patients feel supported by empowering patients, ensuring they feel safe in the development of their treatment. 
  • Be informed: By informing your patients regarding treatment options, it helps them feel they have more control over their treatment. Creating an environment of collaboration is essential for establishing trust between health care staff, patients and their families. 

Trauma has lasting implications on an individual’s health and well-being. By learning more about trauma-informed care and switching up your approach, you can more holistically support your patients on the journey to improve their physical, mental and emotional health. 

over 60% of American adults have experienced at least one traumatic event in their childhood

How to Become a Trauma-Informed Therapist

A therapist that approaches each plan of care with function and their patient’s emotional well-being first demonstrates the effectiveness of physical, occupational and school-based therapy in trauma-informed care. 

Trauma-informed care for physical therapy might involve changing approaches when informed of a patient’s trauma history. For instance, some patients may prefer sit-to-stand assistance with equipment rather than a hands-on approach. 

Trauma-informed care for occupational therapy will take a similar approach. OT trauma-informed care might involve communicating the purpose and process of the activity before providing manual help. It also consists of identifying and respecting a patient’s gender preferences for close interactions like bed mobility tasks. 

A trauma-informed therapist will use person-centered care practices like:

  • Telling clients what is going to happen
  • Asking about their concerns
  • Giving them as much control as possible
  • Asking what can be done to make them more comfortable

All health care providers should create safe environments, recognize symptoms of traumatic stress and shift their responses to support patients in distress. Educating yourself, staying aware and being compassionate go a long way in your patient’s care. You can be a trauma-informed therapist by considering your patient’s thoughts and feelings first and foremost. 

learn more about trauma-informed care from ERI

Learn More About Trauma-Informed Care With Courses From ERI

Being a trauma-informed therapist can help your patients feel safe, empowered and supported. The best way to become a trauma-informed therapist is through education and awareness. ERI has the evidence-based practices to inform and inspire you on your career journey and improve outcomes for your patients.

ERI was founded to reveal how continuing education courses can benefit your career and standard care practices for your patients. We provide hands-on, experiential learning for occupational therapists, physical therapists, speech-language pathologists, special educators and more. With our courses, you can even spread awareness of trauma-informed care to your staff to transform your workplace and support patients more holistically. 

Register with us today for live in-person courses, live virtual webinars and recorded online courses, or contact us to learn more. 

Strategies to Improve Self-Regulation and Executive Function in Your Students

Do you have students who have difficulty sitting still, initiating tasking, organizing assignments, or attending to the details of their work? Do they have difficulty applying active listening and memory strategies while in the classroom?

ERI’s esteemed and veteran faculty member, Jocelynn B. Wallach, MS, OTR/L, will present her popular, 1-day live webinar for school-based therapists: Practical and Effective Strategies to Improve Self-Regulation and Executive Function
January 30, 2023
8:40 am EST • 7:40 am CST • 6:40 am MST • 5:40 am PST (US)

This course teaches tools and effective strategies to address a wide range of executive functioning challenges directly while measurably tracking the student’s progress in a school-based or clinical setting.

Learn more and register for this 1-day course!

See what else Jocelynn has to say about the concept of responsibility and chores on her blog.

A Look Back at 2022 – ERI’s Year in Review

Whew…what a year! So many exciting things happened at ERI in 2022. As therapists ourselves, we understand that finding new, effective ways to treat patients is a top priority. That’s why this past year we worked hard to bring you over 160 live webinars, and over a dozen in-person courses throughout the country. ERI continued to grow it’s on-demand library, launching 7 on-demand courses with many more in the works for 2023.

We were able to add new faculty members and new topics to our ever-growing course list, and provide our therapists with the most up-to-date and relevant educational content. A highlight was our virtual 23rd Annual Therapies in the School Conference that welcomed school-based therapists from across the country, and we had our biggest ever turnout…over 400 therapists! It was two days filled with passionate speakers and interesting topics, plus lots of connections being made amongst attendees. We’re currently working on repurposing these conference sessions to on-demand courses for early 2023, so stay tuned!

As we look forward to 2023, we continue to stay committed to our partners and therapist community by offering world-class, exceptional learning for all of our PTs, OTs, SLPs and assistants. We plan to add new faculty members, new topics and more learning formats that suit your educational needs, including increased on-demand opportunities for our international audience. 

Looking back on this past year, ERI would like to thank our faculty, staff and the loyalty of our many participants who have continued learning with us over the years. We’ve already started working on big things for 2023 and can’t wait to share them with you. It’s going to be a great year!

Happy holidays and best wishes for a healthy and successful New Year. 

The ERI Team