10 Things You Didn’t Know A Pediatric PT Can Help With

In honor of October being Physical Therapy Month, we wanted to share a list of things that you may not realize a pediatric physical therapist can help your child with. If any of these resonate with you, call your local pediatric physical therapist to ask questions. Happy Physical Therapy Month!

1. Yes we work with BABIES! Pediatric PT treats newborns for things like torticollis, plagiocephaly, and delayed achievement of milestones.
2. Yes we facilitate BREASTFEEDING! Pediatric PT can help you and your baby with the following things: positioning, range of motion and mobility for access (latching), relaxation, and proper trunk and pelvic stability.
3. Yes we support POSTURE and ERGONOMICS! Pediatric PT can analyze and teach both you (lifting safety) and your child (posture, backpacks, handwriting, and more).
4. Yes we address challenges related to TOILETING and BEDWETTING! Pediatric PT works with your child to strengthen the pelvic floor, develop routines, and educate in all areas that affect toileting.
5. Yes we provide NUTRITION SCREENING! Pediatric PT does nutritional screening to promote health and wellness, address obesity, and enhance rehabilitation.
6. Yes we address CONCUSSIONS! Pediatric PT performs pre- and post-concussion screens including subsequent vestibular rehabilitation.
7. Yes we analyze FOOTWEAR! Pediatric PT assesses proper fit and function of shoes for sports, everyday use, and even picking out their first pair.
8. Yes we facilitate development of COORDINATED PLAY SKILLS! Pediatric PT helps your child keep up with their peers by working on body awareness and coordination for skills such as bike riding, monkey bars, skipping, jumping jacks, and more.
9. Yes we support YOUTH ATHLETES! Pediatric PT not only treats injuries but prevents them through running and movement analyses, and performance enhancement training.
10. Yes we perform GROSS MOTOR CHECK-UPS! Pediatric PT helps ensure your child is on track with their gross motor skills by recommending annual check-ups just like you go to the dentist every 6 months.

 

Developmental Playgroup – Self-Help (Part 1)

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

Developmental Playgroup – Cognition (Part 1)

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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Developmental Playgroup – Communication

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

Educational vs Medical Based Physical Therapy

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.

Priming the Muscles

 I was giving a presentation the other night on Strength Training for Children with Developmental Coordination Disorder and it led to an interesting conversation with the attendees.  It was actually a really great conversation because it was a collaboration amongst a mix of pediatric and adult therapists.

We were discussing children who have hypotonia (low muscle tone), and how they have a harder time turning their muscles on and keeping them on.  Strengthening helps them to be more efficient with turning their muscles on but their low tone never goes away.  It came up that they often become tired easily, and this can show up in school, because they have to focus on their posture (staying in their seat) as well as whatever activity they are doing.

One therapist shared a great story about a child she was working with who was struggling with a specific test that he had to take every week at school because he was focusing on staying in his chair, writing on his paper, and answering the questions in a timed fashion.  His scores were not very good.  They came up with a strategy (that the school approved) for him to do a modified plank on his knees before the test.  Immediately his test scores started to improve because he was priming his muscles to turn on during the activity.  It was easier for him to keep himself in his chair because he reminded his muscles that they need to work.  A few weeks later, the teacher reported that all of the kids wanted to do this and started doing the modified plank with him (so now he doesn’t look any different than his peers).  I thought this was a great example of how to support education through physical activity.

I know myself, when I do a 10 minute yoga routine I put together, my posture is better (without me thinking about it) for the rest of the day.  This is because I have reminded my posture muscles that they are supposed to be working.

So how can we use this?  For kids that have lower muscle tone, we might want to consider giving them a physical activity at the start of their day that can prime their muscles.  This could be modified plank or bear walking or some simple yoga poses.  Or if not at the beginning of their day maybe before a test at school or before they start their homework or before PE or other physical activity.

I know families who have kids with low tone who have been able to move on from physical therapy and get their kids involved in martial arts, swimming, or gymnastics (to name a few).  This is great because these activities help with whole body muscle activation as well as provide a social way to keep active.

I’d love to hear other ideas you have for ‘priming the muscles’!

Power vs Control (or why going up stairs is different than going down stairs)

Muscles can work in several ways: they can get shorter, they can lengthen, and they can stay the same length.

Generally when a muscle shortens it is generating power.  For instance, when you ‘make a muscle’ you are bending your elbow and moving your hand closer to your shoulder.  Your biceps is getting shorter to make this happen.  It is generating power so that you can lift your hand (or a weight if you were holding one).  That is why it looks like you are ‘making a muscle.’

When a muscle lengthens it is producing control.  For instance when you are carrying a sleeping baby and you want to slowly lower them into their crib so they aren’t jostled, and they stay asleep you are moving your hands further away from your shoulder.  Your biceps (and other muscles) are getting longer and they control how quickly they lengthen to help to make it a smooth transition and landing so your baby continues to sleep.

When a muscle stays the same it is usually holding something static or still.  The muscle has to stay partially contracted so that it can keep your body part in the same position.  If you have ever carried a grocery bag by the handle, with your arm partially bent, you have probably experienced this.  I know my arm is screaming for relief by time I get back to my apartment!

I want to focus on the shortening and the lengthening, also known as power and control (at least in the way I describe them).  We often have families who ask us why their child can go up the stairs without a problem but they still want to scoot or crawl down the stairs, or just want to be carried.

Going up the stairs requires the generation of power from their legs.  When they step up, they are shortening their calves, quadriceps (thigh muscles) and their gluts (bum muscles) so that they can lift their body weight up to the next step.

Going down the stairs requires control.  The calves, quadriceps and the gluts are slowly lengthening so that they are controlling the body weight for the foot will land on the next step.  If there is no control, the muscles just release and the foot/body drops down onto the next step.  This is especially scary for kids going down stairs because they see all the stairs in front of them that they might fall down.  A great way to work on this is to break it into one or two step chunks so it is more manageable for them.  You will also often see kids turning sideways to lower down to the next step.  This does not require as much control as going forward down the stairs as you don’t have to move your leg over your foot so the calf does not have to do as much work.  Going down a step backwards also takes out some of the control needed by the calves so you may see kids using this as an alternative method.

And, as kids grow, strength, power, and control will change with each growth spurt and the muscles will need to get used to the new dimensions of the body and get caught back up again!

I’m not sure if anyone else out there has ever started working out again and your thigh (quadricep) muscles are really sore.  If you try to sit down gracefully in a chair, it is not pretty, but standing up out of the chair, while sore and painful, doesn’t look nearly as bad.  That is because sitting down requires control and standing up is power.  (My legs feel like this at this very moment…)

Participation and Children with Coordination Challenges

I was recently at our Combined Sections Meeting for the American Physical Therapy Association and I sat in on a talk called ‘Developmental Dyspraxia: Sensory Considerations for Motor Skill Development’.  It was presented by a PT and an OT.  It was a great presentation and looked at some of the various types of dyspraxia that are out there and how they are similar and how they are different.

Here is the definition of Developmental Dyspraxia that they used: ‘the failure to have acquired the ability to perform age appropriate complex motor functions.’  The definition of Participation they used is: involvement in life situations and includes physical, social, and self-engagement in activities.’

What struck me most about this talk, and my biggest take-away was the fact that kids with Developmental Dyspraxia, or coordination challenges, can find a back door into Participation through social engagement.

We talked about Participation in a previous blog post but I wanted to revisit it for a second.  Participation is one of our main focuses when we work with kids.  We are helping them with various skills so that they can find a way to belong and contribute to their community throughout their development.

In this day and age, a lot of kids are enrolled in a plethora of after school and weekend activities. For a child who struggles with gross motor or other aspects of development, this may not be fun for them and they may feel isolated or left out, they may also not want to go or participate.  And this is why I loved the take-away I had from the talk.  If we alter the activity so that the child finds it enjoyable and they find a sense of belonging or community, they will enjoy participating in the community.  As they enjoy participating they will want to participate more, and they may even be willing to try activities that are challenging for them.  And now you have started to create a cycle of success.

An example could be: your family loves to go bike riding in the park but your middle child struggles to ride a bike and doesn’t want to do it.  What if you switched to taking a walk in the park as a family so that you were all able to participate and have fun?  If they enjoy it they are going to want to go the next time.  Maybe one of the times they will want to ride the bike for part of the time.  You have just helped them to enjoy being outside with your family, so they are active, even if it isn’t riding a bike, and through this enjoyment you are fostering their desire to continue to be engaged in this activity.

I’m not sure if I’m making sense. I’ll try again with another example.  You really want your child to be on the soccer team.  Whenever they play soccer they struggle to keep up and they end up sitting on the sidelines or they feel that their teammates get frustrated with them.  They start to push back when it comes time for practice and games until all of a sudden they just want to stay home.  What if you got them involved in brownies or cub scouts, or informal play groups, or maybe some type of martial arts?  They could develop a sense of belonging with a group/community that they enjoy belonging to.  With enjoyment they may be willing to try playing soccer with their friends or siblings just for fun.

The key is, we want kids to want to engage in their community and with their families and peers.  Finding social outlets to get kids involved can be a great step in this direction and then introducing the activities they find to be challenging.

I hope I didn’t make this too confusing, I was just so excited when I heard it that I wanted to share.  I would love to hear stories of how you have successfully navigated supporting your child to participate meaningfully in their community, however they define it.

Low Tone and Growth Spurts

We frequently have children of all ages in the clinic who have been diagnosed with low muscle tone (hypotonia).  This can often be confusing for parents and difficult to explain to others so we wrote ‘What Does Low Tone Mean?’ to help with that explanation.

Recently, my coworkers and I were talking about a few babies/children who we were seeing who have low tone and how we could see the progress they were making but it was often hard for the parents to not only see but to understand why it might possibly be taking ‘so long’ or longer than other children.

As a sidebar, I love having other therapists around to discuss the kids we are lucky enough to work with.  By discussing the kids, we are able to help pull the pieces of information and ideas we have in our head and synthesize them into something that makes sense and we can explain to others! What came out of our discussion is:

When a child has low tone, we have already acknowledged that they have to work harder to engage their muscles and keep them turned on to complete activities.  As the child uses their muscles they are helping to get them stronger so that they can generate more force and maintain that force generation for longer periods of time (endurance).  For instance, when a baby is working on tummy time they have to turn their muscles on to lift their head up off the support surface – to do that they need to be able to generate enough force so that their muscles can turn on and lift the head.  Once they have their head lifted up, they need to be able to keep that force turned on long enough so that they can look around.  With practice it gets easier to lift their head and they can do it for longer periods of time.

That is until they grow.  A child in their first year of life is in a constant growth spurt for the most part.  Not only is their body changing, but they are constantly learning new skills for their development.

If you think back to when you were a child in elementary or middle school and you hit a growth spurt (or to other children you have seen if you can’t remember yours!), it was as if you woke up with a whole new body.  You were probably a little bit clumsy (in my case a lot clumsy since I was already clumsy to begin with) and your movements were not very coordinated.  I often visualize a baby lamb or horse or giraffe taking their first steps when I think of young kids going through growth spurts.

Now, put that same awareness on a little baby who is changing every day.  Especially if that baby has low muscle tone.  Our muscles learn to work in a certain way and they get really efficient at it.  If you change their length or change the weight that they have to move, all of a sudden they are a little less efficient.  For kids with low tone, they are playing a constant game of catch up.  They are working hard each day to get stronger and become efficient but then someone goes and changes the parameters of the game on them.  Now they have to learn how to work at a new length with a new weight, and very often a new activity.

And, each time they grow or are faced with a new developmental task, they need to find their stability again before they can work on their mobility.  For instance, its very hard to reach for a toy in sitting, if they are having trouble generating the strength to hold themselves in sitting, or its hard to crawl if they can’t hold themselves in a hands and knees position.  So, with each growth spurt, they will need to relearn how to find stability before they can go back to working on their mobility.

Hopefully I helped to explain things a little and didn’t just make it more confusing!

Childhood Occupations

We often get asked ‘What is Occupational Therapy,’ especially when we are talking about it in reference to a child.  As a result we thought we would publish a breakdown based on the Occupational Therapy Practice Framework to help give people a better understanding.

As Occupational Therapy refers to how one occupies their time, it is a profession that believes in daily participation in occupational routines. As defined by the Occupational Therapy Practice Framework, a child participates in the following occupations including: Activities of Daily Living, Rest and Sleep, Education, Play and Social Participation. Each occupation is taken into consideration during your child’s treatment and as such obtaining an understanding of these areas will contribute to the families ability to work in collaboration with the OT and develop the ability to transfer skills into the child’s daily routine to foster independence. The following descriptions are taken from the Occupational Therapy Practice Framework.

Activities of Daily Living: Activities that are oriented toward taking care of one’s own body. These activities are, “fundamental to living in a social world; they enable basic survival and well being.” They include:

• Bathing/Showering: obtaining/using supplies, maintaining positioning, transferring to and from bathing position
• Bowel/Bladder Management & Toilet Hygiene: intentional control, obtaining/using supplies, clothing management, transferring on/off the toilet
• Dressing: selecting appropriate clothing, obtaining clothing from a storage area, dressing/undressing in a sequential pattern
• Eating: the ability to keep and manipulate food or fluid in the mouth/swallow
• Feeding: the process of setting up, arranging and bringing food/fluid to the mouth
• Functional Mobility: moving from one position in space to another during performance of everyday activities such as those listed in this post
• Personal Hygiene/Grooming: obtaining and using supplies to brush hair, groom nails, wash hands, clean mouth etc

Rest and Sleep: Including activities related to obtaining restorative rest and sleep that supports healthy active engagement in other areas of occupation.

• Rest: quiet and effortless actions that interrupt physical and mental activity including identifying need to relax to restore energy, calm and renew interest in engagement
• Sleep: a series of activities resulting in going to sleep, staying asleep
• Sleep preparation: engaging in routines that prepare the self for comfortable rest including grooming, reading, setting an alarm etc.

 Education: Includes activities needed for learning and participating in the environment.

• Formal educational participation: including categories of academic classes, nonacademic (e.g. recess), extracurricular (e.g. sports)
• Informal personal education participation: participating in classes, programs, and activities that provide instruction/training in identified areas of interest

Play: A spontaneous or organized activity that provides enjoyment, entertainment, amusement or diversion.

• Play Exploration: identifying appropriate play activities, which can include exploration play, practice play, pretend play, games with rules, constructive play and symbolic play
• Play Participation: participating in play maintaining a balance of play with other areas of occupation; and obtaining using and maintaining toys, equipment, and supplies appropriately

Social Participation: Organized patterns of behavior that are characteristic and expected of an individual or given position within a social system.

• Community: engaging in activities that result in successful interaction at the community level (i.e. neighborhood, organization, work, school)
• Family: engaging in successful interactions in specific required and/or desired family roles
• Peer, Friend: engaging at different levels of intimacy

 

Reference: Occupational Therapy Practice Framework: Domain & Process 2^nd Edition. The American Journal of Occupational Therapy. Novemeber/December 2008, 62:6, pg. 631-633.