Starfish Therapies

January 15, 2017

Ideas for ‘Weight’-Training at Home

Weight training is not usually the first thing that comes to mind for pediatric therapy but its a big part of it.  We are big believers in strength/weight training for our kiddos to help improve their function.  It helps them to more efficiently activate their muscles, improves muscle isolation, helps movement to be more efficient and cuts down on compensatory movements and strategies.  For some of the kiddos we see in the clinic based setting we are able to use the Universal Exercise Unit to help promote strengthening, however not all of our kids come to the clinic or are able to use this piece of equipment so I have had to get creative on ways to strengthen that is still fun for the kids.  Here are some of the exercises we do for strengthening:

Leg Press – To get a good leg press I like to use resistance tubing.  I have bought one that has handles already built in that work great.  I have the child lie down on the ground and wrap the tubing around a stable object at their head (a table leg can often work).  I then put their foot in the handles and I control their leg while they push out (making sure that they don’t hyper extend their knees).  Its easiest to do this one leg at a time.

Hip and Knee Flexion – To do this one, I just reverse the above exercise.  I have them lie down with their feet facing towards the table and put one foot in the handle (the band should be resting taut) and then have them pull their foot up by bending their hip and knee.  Again, make sure you control their leg to avoid and torque at the knee.

Scapular (shoulder blade) Retraction – Take the same resistance tubing as above and tie it around a door knob (make sure the door is shut). You can also hold it for them (like in the pictures).  Then have the child stand (or sit) across from it. They are going to hold one end in each hand and slowly pull back while squeezing their shoulder blades together.  Make sure they keep their elbows bent at approximately 90 degrees the whole time.  Once they have pulled back, then they are going to slowly bring their arms forward again.Their body should be staying still during all of this, and the only movement should be from the arms and shoulders.

Weighted Squats – You can use a weighted ball, heavy cans of food, a bag of flour, or anything else that your child may consider to be heavy.  Have them squat down to pick it up off the floor and then stand up and place it in your hands or on a table or other surface.  If you’re using a ball, my favorite way to get them to do more is to have them give it to me and then pretend I drop it and ask them to pick it up again.  They generally think its funny that I can’t hold onto it!

 

 

January 8, 2017

Righting Reactions

What are righting reactions you may ask.  Righting reactions are the reactions that help bring our head, trunk, and body back to midline so we can keep our balance.  They help us to be able to stand on a boat, or a moving train.  They help us to regain our balance after we catch our toe on something, or to be able to walk across an unstable surface.  Basically they are pretty important.

Righting reactions start to develop right away.  That’s what head control is all about.  When a baby can hold their head stable, their righting reactions are easier.  That’s because their inner ear sends messages to the rest of the body about where it is in space.  If it’s not where its supposed to be, the body is able to begin the correction process it to bring it back to where it should be.

After head control, trunk control follows.  This allows your baby to sit up and not fall over.  Initially they are like that house of cards you may have built, they have to be in exactly the right position and you can’t even breathe on them or everything might topple.  But as they learn to react to the messages being sent about their position, and their muscles get stronger and react faster, they are able to play and pivot and reach and do all sorts of things in sitting.

Standing follows sitting (yes, there are other places that righting reactions work such as hands and knees but for this purpose we will move on to standing).  In addition to the head and trunk control there are three general reactions to help keep you in a standing position: ankle, hip, and stepping.  The ankle reaction is when you have a slight instability and sway just a bit at the ankle to find your middle again.  The hip reaction is for a slightly bigger and faster balance disturbances and you bend forward or backwards at your hips to keep yourself standing.  And lastly, the stepping strategy happens when you need to adjust your base of support (foot position) so that you can stay upright.

Hopefully this gives you a general idea of what our bodies do to keep us upright and what your child is working on as they begin to navigate through the developmental milestones.

 

 

January 1, 2017

Tummy Time – Not Just For Babies

Filed under: Developmental Milestones — Starfish Therapies @ 11:53 pm
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Tummy time is a common activity that babies participate in while they grow and develop. Spending time on their tummy allows babies to help build neck and back strength. Being on their stomach gives babies an opportunity to spend time in a different position while they explore their surroundings. As babies grow up and become toddlers and children they tend to spend less and less time on their stomachs.
Tummy time is also a great position for older children and adults to use. As children start attending school they spend a large portion of their day sitting in chairs at a desk. Adults too tend to spend the majority of their time in a seated position. Spending a large portion of the day sitting can cause the muscles in the front of their hips to become tight; this is also very common in adults. When children spend some time on their stomach it can aid in stretching those muscles on the front of their hips and can help strengthen muscles of their back and neck.
Here are a few positive reasons to get your child to spend some time on their stomachs:
–       Can help improve flexibility of hip flexor musculature
–       Can improve back, neck, and scapular strength
–       Allows children to play and explore in a different position
Tummy time can become an activity that the whole family can participate in! Have the whole family spend some time on their stomach while reading a book, playing a game, or while watching a show on television. You do not have to have your child spend large amounts of time on their stomach’s to gain some of the great benefits of being in this position. Start with a few minutes a day until your child is able to maintain this position for a prolonged period of time. Try to aim for your child to stay in this position for the length of a short book or while playing a board game. Added benefit of playing a game is they are also working on weight shifting, upper extremity strength, hand-eye coordination, to name a few.

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August 1, 2016

Developmental Playgroup – Self-Help (Part 1)

Filed under: Developmental Milestones — Starfish Therapies @ 5:33 pm
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This past week we looked at Self-Help skills during our developmental playgroups.  Here is a brief overview of some of the things discussed.  We will provide more detail in coming weeks!

Birth- 4 months:

  • Express the need for food by crying
  • Signal the need for diaper changes
  • Express pleasure when placed in warm water (bathing)
  • Will eventually begin to help by using their own hands to guide the nipple

4-8 months:

  • Show interest in feeding activities
  • Can pull off their own socks
  • Can velcro closures on clothing

8-12 months:

  • Begin to hold their own cup and drink
  • Begin to eat finger foods
  • Begin to pull off soiled or wet diaper
  • Begin to sleep until 6 or 8 am.

12-24 months:

  • Use a spoon to some degree to feed themselves
  • Have good control of a cup
  • Begin to try and wash themselves
  • Begin to help with dressing
  • By age 2 they may begin to gain control of bowels and bladder

24-36 months:

  • Increasingly able to feed self and use cup/glass
  • Can generally undress themselves
  • Show signs of being ready for toilet training

Activities/ Things to remember when teaching or promoting self help skills:

  • Decreasing amount of assistance given during activities (ie less assistance with silverware during mealtimes)
  • Establish a routine/create a daily schedule
  • Focus on the learning instead of the length of time to finish the task
  • Rewards are best when naturally occurring in the environment

 

7 Self-Care Milestones to Look Forward To:

As the sense of self increases, so will your child’s achievements in self-care. He’ll naturally develop and fine-tune his motor skills over the next three years to master:

  1. Using a fork and spoon: Some toddlers start wanting to use utensils as early as 13 months, and most children have figured out this all-important skill by 17 or 18 months. By age 4, your child will probably be able to hold utensils like an adult and be ready to learn table manners.
  2. Undressing: While the ability to take his own clothes off may lead to lots of naked-toddler chase sessions, it’s a key accomplishment. Most children learn to do it sometime between 13 and 24 months.
  3. Toothbrushing: Your child may start wanting to help with this task as early as 16 months, but probably won’t be able to handle a toothbrush skillfully until sometime between her third and fourth birthdays. Even then, dentists say, kids can’t do a thorough job on their teeth until much later.
    • Pediatric dentists recommend that parents do a thorough brushing of their kids’ teeth every night until school age or later. As a compromise, if your child is eager to brush, let her do the morning brushing herself. Or let her brush first, and then you finish up.
  4. Washing and drying hands: This skill develops at 24 months or so and is something kids should learn before or at the same time as using the toilet – you don’t want your child spreading germs.
  5. Getting dressed: Your little one may be able to put on loose clothing as early as 24 months, but he’ll need a few more months before being able to manage a T-shirt, and another year or two after that before he’ll really be able to get dressed all by himself. Also at 24 months, he’ll probably be able to pull off his shoes.
  6. Using the toilet: Most kids aren’t physically ready to start toilet training until they’re at least 18 to 24 months old. Two key signs of readiness for a child include being able to pull her pants up and down by herself and knowing when she has to go before it happens.
  7. Preparing breakfast: Toddlers as young as 3 may be able to get themselves a bowl of cereal when they’re hungry, and most kids can do it by the time they’re 4 1/2. If your child wants to give this a whirl, make it easy by leaving kid-size containers of cereal and milk in the cupboard and fridge.

References:

  1. http://www.floridahealth.gov/AlternateSites/CMS-Kids/providers/early_steps/training/itds/module1/lesson1_3.html
  2. http://www.earlychildhoodnews.com/earlychildhood/article_view.aspx?ArticleID=676
  3. http://www.childcarequarterly.com/summer08_story2.html
  4. http://www.babycenter.com/0_toddler-milestone-self-care_6503.b

July 25, 2016

Developmental Playgroup – Cognition (Part 1)

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Cognition was the most recent topic at the Developmental Playgroups this past week.  It is broken down into: Cause and Effect, Spatial Relationships, Problem Solving, Imitation, Memory, Number Sense, Classification, Symbolic Play, Attention Maintenance, and Understanding of Personal Care Routines.  Because it covers such a wide range, for the purposes of the blog, we will break it into smaller components.  This post covers Cause and Effect, and Spatial Relationships.

Cause and Effect:  Cause and Effect looks at a relationship between actions/events and what the reslt is.  This concept helps infants/children to develop an understanding of object properties, relationships between and event and the consequences, and patterns of human behavior. By developing an understanding of this concept, infants/children are able to build their abilities to solve problems, make predictions, and understand the impact their behavior has on others.

  • Examples: crying and being picked up, shaking a toy and hearing it make noises, pushing a button on a toy and having music play.

Some milestones/age appropriate activities for this concept are:

  • 4-7 months:
    • Hear a loud noise and turn head in the direction of the noise
    • Explore toys with hands and mouth
    • Move body in a rocking motion to get the infant care teacher to continue rocking
  • 8 months: Children perform simple actions to make things happen, notice the relationships between events, and notice the effects of others on the immediate environment.
    • Shake toy, hear the sound and shake it again
    • Watch someone wind up a toy and then touch the toy trying to make it go off again
    • Push button on toy to watch it light up/something pop out.
  • 9-17 months:
    • Bang two blocks together
    • Keep turning objects to find the side that works (mirror or nesting cup)
    • Cry and anticipate someone to come help them
    • Continuously drop an item to have someone come pick it up
    • Watch someone perform an action and then try to imitate- squeeze water toys.
  • 18 months: Children combine simple actions to cause things to happen or change the way they interact with objects and people in order to see how it changes the outcome.
    • Attempt to wind up the toy after not getting the lid to open
    • Drop various objects from different heights to observe how they fall – what noise they make
    • Making tower of blocks and knocking them over
  • 36 months:
    • Demonstrate an understanding of cause and effect by making predictions about what could happen and reflect upon what caused something to happen
    • Communicates that they miss someone/cries after they leave
    • Make a prediction about what will happen next in the story
    • Ask what happened if they see a band aid

Spatial Relationships: Spatial Relationship looks at how an object is located in relation to a reference object.  Understanding this concept helps infants/children gain a better understanding of numbers as they get older as well as how things move and fit in space.

  • Examples: exploring objects with their mouths, tracking objects and people visually, squeezing into tight spaces, fitting objects into openings, and looking at things from different perspectives (Mangione, Lally, and Signer 1992).

Some milestones/age appropriate activities for this concept are:

  • 4 to 7 months:
    • Look and explore their own hand
    • Reach for nearby items
    • Explore toys with hands and mouth
  • 8 months: Children move their bodies, explore the size and shape of objects, and observe people and objects as they move through space.
    • Use vision or hearing to track the path of someone walking by
    • Hold one stacking cup in each hand
  • 9-17 months:
    • Roll a car back and forth on the floor
    • Dump toys out of a container
    • Move over and between cushions and pillows on the floor
    • Put the circle piece of a puzzle into the round opening, after trying the triangle opening and the square opening
  • 18 months: Children use trial and error to discover how things move and fit in space.
    • Go around the back of a chair to get the toy car that rolled behind it instead of trying to follow the car’s path by squeezing underneath the chair
    • Use two hands to pick up a big truck, but only one hand to pick up a small one
    • Put a smaller nesting cup inside a larger cup after trying it the other way around.
  • 19 -35 months:
    • Complete a puzzle of three separate cut-out pieces, such as a circle, square, and triangle
    • Turn a book right-side up after realizing that it is upside down
    • Fit four nesting cups in the correct order, even if it takes a couple of tries

We will go over the remaining concepts in some follow up posts!

References:

http://www.cde.ca.gov/sp/cd/re/itf09cogdev.asp#sr

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdcsr.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdps.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdimit.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdmem.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdclas.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdpers.asp

http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdattm.asp

https://www.healthychildren.org/English/ages-stages/baby/Pages/Cognitive-Development-8-to-12-Months.aspx

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July 14, 2016

Developmental Playgroup – Communication

Filed under: Developmental Milestones — Starfish Therapies @ 9:26 pm
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We relaunched our Developmental Playgroup this week and we broke it into smaller groups so that we could better direct our education and play activities.  The first group is pre-crawlers and the second group is pre/early(new)-walkers.  With our playgroup we spend time on a different developmental domain each week and this week’s topic was communication.

I wanted to share the information we gathered so that it can be passed along and shared!

6 stages of language development:

  1. Prelinguistic stage/ Pre-speech phase: first year of life.
    1. Development Aspects: development of gestures, making adequate eye contact, sound repartee between infant and caregiver, cooing, babbling and crying. Babbling is followed by jargon phrases- unintelligible strings of sounds with a conversation tone.
    2. Five stages of babbling:
      1. Phonation stage- 2mo: Cry, cough, grunt, sneeze- vocal cords are not vibrating with a smooth speech like quality yet. Vowel sounds.
      2. Gooing Stage- 2-3 mo: primitive movements of articulators (tongue and lips) become more coordinated- results in consonant like sounds- not fully formed. Start to coordinate sounds with eye contact. Start to take turns making sounds with caregiver.
      3. Expansion Stage- 4-5mo: ear fully resonant vowel sounds, explore pitch and intensity with squealing, yelling, growling, whispering and raspberries. Laughter emerges.
      4. Canonical Babbling- 6-7 mo: articulators, resonance and voice become coordinated resulting in real syllables. Quick to interpret this as attempts at words- Ba-Ba.
      5. Integrative/Jargoning 10-15 mo: complex babbling with a few real words thrown in. Intonation: gibberish with sound of comments, questions and commands. Well coordinated with gestures, body language and eye contact.
  2. Holophrase/ one word: 10-13 months
    1. One word can mean several different things- Dada (where is dada, dada come here, dada pick me up, etc)
  3. Two word sentence: 18 months
    1. Sentences are now a noun and a verb.
    2. Declarative: Doggy Big
    3. Interrogative: Where ball
    4. Negative: Not egg
    5. More milk: imperative
  4. Multiple Word Sentences: 2 and 2 ½ yrs
    1. Can use more prefixes/suffices, predicates in their sentences to change tense or meaning. Very common to have tense/grammar errors.
    2. Doggy is big, where is ball, this is not egg, I catched it, I falling.
  5. More complex grammatical structures: 2 ½ and 3 yrs
    1. Conjunctions, prepositions.
    2. Read it, my book, Where is Daddy, I can’t play, Take me to the shop.
  6. Adult like Language structures: 5 to 6 yrs
    1. Concepts such as ask/tell, promise, order in which words properly go in a sentence.

Milestones:

Year one

  • Recognizes name
  • Says 2-3 words besides mama, dada
  • Imitates familiar words
  • Understands simple instructions
  • Recognizes words as symbols for objects: car- points to garage, cat- meows
  • Understands no- 12-18 months

Activities: respond to child’s coos, gurgles, babbling, talk to your child throughout the day, read colorful books, tell nursery rhymes and sing songs, teach child names of everyday items and familiar people/label items, play peek a boo, pat a cake.

Between one and two:

  • Understands no
  • Uses 10-20 words, including names
  • Combines two words (dada bye bye) – telegraphic speech
  • Waves goodbye
  • Makes the sounds of familiar animals
  • Gives toy/item when asked
  • Makes wants known- states more
  • Can point to her toes, eyes and nose
  • Brings objects from another room when asked.

Activities: reward/encourage early efforts of saying words, talk to baby about things that you are doing, talk simply, clearly and slowly, talk about new situations before, during and after, look at your child when they are talking to you, describe what your child is doing/feeling/hearing, listen to music.

Between two and three:

  • Identifies body parts
  • Carries on conversation with self and dolls
  • Asks what that and where’s my
  • Makes plurals- adding s
  • 450 word vocabulary
  • Gives first name and uses fingers to tell age
  • Combines nouns and verbs- mommy go
  • Understands simple concepts- last night, tomorrow
  • Refers to self as me rather than name
  • Tries to get adults attention- watch me
  • Likes to hear the same story repeated
  • May say no when they mean yes
  • Talks to other children and adults
  • Solves problems through words not hitting/crying
  • Answers where questions
  • Names common pictures/things
  • Short sentences- me want more, me want cookie
  • Matches 3-4 colors, knows big and little

Activities: repeat new words over and over, play games with following directions- touch your nose, go on trips and talk about what you see before, during and after the trip, let your child tell you the answers to simple questions, read books everyday make it a part of your routine, listen to your child, describe what you doing, have your child deliver simple messages mommy needs you daddy, carry on a conversation with your child, ask questions to get your child to think/talk, show the child you understand by answering smiling and nodding your head, expand what the child says- dog big- that is a big brown dog.

Language development supports your child’s ability to communicate, and express and understand feelings. It also supports thinking and problem-solving, and developing and maintaining relationships. Learning to understand, use and enjoy language is the critical first step in literacy, and the basis for learning to read and write.

Interactive Reading: ask questions, use dramatic inflections, let them guess what will happen next, point to pictures and describe them- ask your child to do the same.

References:

1. http://raisingchildren.net.au/articles/language_development.html

2. https://childdevelopmentinfo.com/child-development/language_development/

3. http://www.asha.org/public/speech/development/language_speech/

4. http://www.asha.org/public/speech/development/01/

5. http://www.asha.org/public/speech/development/12/

6. http://edubloxtutor.com/language-development/

7. http://www.ldonline.org/article/6313

8. http://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=35:admin&catid=2:uncategorised&Itemid=117

9. http://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=34:ages&catid=11:admin&Itemid=117

10. http://www.sentinelsource.com/parent_express/pregnancy_babies/understanding-the-stages-of-baby-babble/article_611d18f4-a11d-11e1-8120-0019bb2963f4.html

April 23, 2016

Why Your Child’s Inner Ear is Important for More Than Hearing

Standing Vestibular

Imagine learning to stand for the first time, but everything around you appears to move. You can’t stabilize your gaze and everything sort of spins. Now imagine learning to walk for the first time, except you can’t focus on an object for balance. Either would be tough for anyone, especially a child.

That ability to focus your sight – That’s what’s called your vestibular system – and it’s not a part of your eye. It’s actually in your inner ear. It plays a large role in balance, telling you where your head is in space. In turn, your body responds to what you vestibular system is telling you.

But the vestibular system also plays a part in stabilizing your gaze. Try looking at an object in the room. While keeping the object in focus, shake your head from left to right – are you a little dizzy? Maybe… But were you able to keep that object in focus? Probably. That’s because, while you were shaking your head from side to side, your vestibular system was communicating with little muscles around your eye, telling them to respond, which allows you to keep your focus (known as the vestibular ocular reflex, or VOR).

And if you weren’t able to keep the object in focus? Well, it makes balance and development that much more difficult.

What could be a sign that your child’s vestibular system isn’t working properly? Some children may have trouble standing without holding onto a surface, and even fall when standing at a table without reacting to the fall (think of a falling tree). Others may have trouble walking without holding on to an adult or surface, with a tendency to rely too heavily on that support, at times appearing as an impulsive movement.

If you notice or are concerned about your child’s vestibular function, it’s a good idea to discuss it with your child’s pediatrician. They can make a good assessment or help refer you to a specialist.

April 15, 2016

To Flip-Flop or Not

Filed under: Developmental Milestones — Starfish Therapies @ 8:08 pm
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Flip Flops 3

So, you’re in the department store shopping for your kid, because they seem to be growing every week! They are in dire need of new shoes and it’s summer, which means it’s flip flop weather, right?!

Not so fast! Although, I love the cute sandals they have for kids now a days – I think it’s important to look at how sandals may be effecting your child’s walking.

When you think about how a tennis shoe is secured to your child’s foot and then think about how a sandal is secured to your child’s foot – they are very different. When you’re wearing a tennis shoe you don’t have to think about keeping the shoe on your foot, which allows your walking pattern to be similar to how you would walk barefoot.

Now, when you’re wearing flip-flops, you have to secure the shoe on to your foot by gripping your toes into the sandal. This creates some confusion for your body. As you’re swinging your leg through, your hip is moving up/forward, but your toes are pushing down trying to keep the flip-flop onto your foot – do you see the confusion? Not only is your body confused, but by gripping your toes onto the sandal it places pressure and tension onto parts of your lower leg and foot that were not intended for that purpose.

But it’s hot out and my child and I need summer shoes! Consider a shoe that is secured to the foot – something that cups the heel. It can have straps and openings, but when the shoe isn’t secured to the foot such as flip-flops and slippers – it places abnormal pressure and tension on your child’s body.

Just some things to think about as you are buying your next pair of summer shoes!

April 8, 2016

Hip Dysplasia

Filed under: Developmental Milestones — Starfish Therapies @ 7:41 pm
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swaddle

As parents of babies or young children you may have heard the term hip dysplasia or you may remember your pediatrician moving your little ones hips around at all those check-ups during the first year.  They are feeling and listening for clicks or clunks which, when felt may indicate hip dysplasia.

Hip dysplasia is the term used to describe a hip joint that is not properly formed so that either the hip can be dislocated and relocated with passive movement or is already in a dislocated position. The term developmental dysplasia of the hip (DDH) is used when the condition is present in a newborn or develops sometime around birth, usually in the first year of life. As physical therapists, we know that most of the time DDH is present at birth and can be attributed to the baby’s position in the womb. Specifically, the breech position is found to be a cause for DDH present at birth. While the exact cause of DDH in other cases is not known, there is an increased likelihood with a positive family history as well as in the female gender, with girls being 4-5 times more likely to have hip dysplasia than boys. However, we also know that DDH can develop over time in otherwise healthy hip joints or can further the amount of hip dysplasia in a mild case that is maybe yet to be diagnosed. Read the tips below so will know the signs of hip dysplasia as well as how to prevent it from developing or worsening by understanding how to position baby with swaddles, carriers, etc.

1. Signs of hip dysplasia that you can take note of and tell your doctor about:

  • Asymmetry of skin folds: when your baby is lying on his or her tummy, the gluteal and thigh folds should be symmetrical at the same height.
  • Loud, audible clicking or clunking felt during diaper changes
  • Limited range of motion available at one or both hips

2. Swaddling

  • Swaddles should be loose around the hips and thighs to allow for baby’s natural hip position (flexed and externally rotated). Baby should have free movement from the waist down.
  • Swaddles should not hold baby’s hips extended or close together.

3. Baby carriers

  • Baby carriers should support baby underneath the buttock and thighs and allow the legs to spread apart with flexion at the hips.
  • Baby’s hips are more at risk when they are allowed to dangle straight down or are held close together in a sling type carrier.

For more information as well as images that demonstrate proper hip positioning during swaddling, use of baby carriers and car seats, visit the International Hip Dysplasia Institute website here. If you have questions about specific products out there, let us know!

March 31, 2016

Educational vs Medical Based Physical Therapy

Filed under: Developmental Milestones — Starfish Therapies @ 5:00 pm
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Desk

If my child is receiving medically based physical therapy, why don’t they get physical therapy at school?

This is a question we are asked all the time. While some children may have both an educational and a medical need for physical therapy the answer comes down to the purpose of services.

When a physical therapist recommends services medically this is based on the child’s health and rehabilitating a prior level of function or a need for therapy in order to achieve something that will improve their health and decrease their need to access other medical services.

For a physical therapist to recommend services at school, the therapist has to document that the child needs to do something at school to be safe or access their school curriculum that require the services of a skilled therapist to achieve. When a child is on an individual education plan (IEP) this is driven by needing the services of a skilled therapist to meet the goals identified for them to indicate adequate educational progress. When a child is on a 504 plan, this means that in order to progress with their current group of peers, they require the support of a skilled therapist to meet educational standards.

This means that once a child is safely able to move around their classroom, the campus, and use the playground on site safely and as independently as they will able to given other factors like age, cognition, or behavior they frequently are found to not need educationally related physical therapy as they are successful in that environment. While this does not mean they’ve met their maximum motor abilities or that in a different model of service delivery, like the medical model, they would not have a need for the services of a physical therapist, it does mean that there mobility skills are no longer limiting their education.

We frequently try to explain it in the simplest ways, physical therapy in the educational environment is to support the student safely accessing their education.  In school, gross motor development generally falls under physical education.

This is just to help with a basic understanding of the difference in the models.  It would be easy to go further in depth but we wanted to help answer a question we get a lot of times.

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