Starfish Therapies

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.

March 10, 2016

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’!

March 1, 2016

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

Filed under: Developmental Milestones — Starfish Therapies @ 3:30 am
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Power vs control

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…)

February 25, 2016

Participation and Children with Coordination Challenges

A walk in the rain to dance class

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.

February 15, 2016

Low Tone and Growth Spurts

Low Tone Growth Spurt

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!

February 4, 2016

Childhood Occupations

Filed under: Developmental Milestones — Starfish Therapies @ 12:50 pm
Tags: , , ,

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 2nd Edition. The American Journal of Occupational Therapy. Novemeber/December 2008, 62:6, pg. 631-633.

June 1, 2015

Therapeutic Benefits of Swimming on MamaOT

Filed under: Developmental Milestones — Starfish Therapies @ 2:55 pm
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swimming

We are lucky enough to be participating in a series on the Therapeutic Benefits of Recreational Activities over on MamaOT.

Our post is the first in the series and we are discussing the Therapeutic Benefits of Swimming.  Growing up as a swimmer I was beyond excited to get to discuss this activity that is near and dear to my heart.  I hope you enjoy the read and it encourages  you to ‘take the plunge’ and go for a swim!

May 5, 2015

Motor Groups and RTI

Motor Group

May is Better Hearing and Speech Month and Speech Language Literacy Lab has organized this blog hop with multiple professionals to discuss RTI.

Being a physical therapy provider in the school district does not always provide the opportunity to become involved in Response to Intervention (RTI).  We were lucky enough to be involved in with a school district that allowed us to get involved to help address the motor needs of children at the pre-school level.  We were finding that there were a lot of referrals to physical therapy because some kiddos were not at the same gross motor level as their peers.  While a lot of the teachers implemented gross motor time, they often felt unsure if what they were offering was optimal for the kids they had in their class.  We were able to go in and support them with gross motor groups in the classroom, where the teacher is actively involved and can ask questions about why we are doing different activities, how they can carry those activities over, what else we would recommend for common challenges they were noticing with their kids, and it allowed us to have eyes on all the kids and offer suggestions to the classroom as a whole if we noticed certain skills were at various levels of mastery for the kids.

What has been great with this is the teachers are feeling empowered and supported when they do motor groups every other day of the week that we are not there.  They also have a person to talk to for their questions about motor development and if something is concerning or not.  Most importantly it opens a line of communication between the teachers and us as the physical therapists.  My experience in the school system has been that if a service provider and the teacher and teaching staff can have great lines of communication, the children benefit even more.

Besides these benefits as a therapist and teacher, the students get one extra set of eyes on them as they move through a period of time in their life that is ripe with gross motor development.  At that age, play is where they do their learning and interacting with their peers that sets them up for each successive school year.  While it may not look important whether or not a kiddo is able to keep up with his peers in play, it is a critical part of each child’s development and by implementing structured motor groups, we are setting the teachers and the students up for success.

On a different note, in terms of actual physical therapy services provided for kids, we have found that it has cut down on the number of referrals that were occurring just because the teachers weren’t sure how to help the child.  For children like this we were finding that some education to the teaching staff on how to best support the child would make the difference and they were able to continue to progress with their peers.  The motor group allows us to be proactive in providing teaching staff this support so that the children benefit sooner!

BLOGhoplogofrog

Please be sure to check out the other blogs that have participated in the Blog Hop on RTI for May’s Better Hearing and Speech Month:

Here is The Schedule (Links may take you to the author’s site as opposed to directly to their blog since this post is being published at the beginning of the month):

5/1/2015 Kick Off to Better Hearing and Speech Month!

5/2/2015 RTI for the R sound! Badger State Speechy

5/3/2015 Response to Intervention in High School– A Journey from Abject Frustration to Collaboration and Student Success Stephen Charlton Guest blogs on Speech Language Literacy Lab

5/4/2015 Technology and RTI  Building Successful Lives Speech & Language

5/5/2015 Starfish Therapies

5/6/2015 Orton Gillingham Approach & RTI  Orton Gillingham Online Academy

5/7/2015 Evidenced-based writing that works for RTI & SPED SQWrite

5/8/2015 RTI/MTSS/SBLT…OMG!  Let’s Talk! with Whitneyslp

5/9/2015 RtI, but why?  Attitudes are everything!  Crazy Speech World

5/10/2015      Consonantly Speaking

5/11/2015 Universal benchmarking for language to guide the RTI process in Pre-K and Kindergarten      Speech Language Literacy Lab

5/12/2015 Movement Breaks in the Classroom (Brain Breaks)   Your Therapy Source

5/13/2015 How to Write a Social Story   Blue Mango LLC

5/14/2015 Some Ideas on Objective Language Therapy    Language Fix

5/15/2015 Assistive Technology in the Classroom  OTMommy Needs Her Coffee

5/16/2015 Effective Tiered Early Literacy Instruction for Spanish-Speakers Bilingual Solutions Guest blog on Speech Language Literacy Lab

5/17/2015 Helping with Attention and Focus in the Classroom   The Pocket OT

5/18/2015 Vocabulary Instruction  Smart Speech Therapy, LLC

5/19/2015 An SLP’s Role in RtI: My Story Communication Station: Speech Therapy, PLLC

5/20/2015 Incorporating Motor Skills into Literacy Centers   MissJaimeOT

5/21/2015 The QUAD Profile: A Language Checklist  The Speech Dudes

5/22/2015 Resources on Culturally Relevant Interventions  Tier 1 Educational Coaching and Consulting

5/23/2015 Language Goals Galore: Converting Real Pictures to Coloring Pages  Really Color guest blog on Speech Language Literacy Lab

5/24/2015 Lesson Pix: The Newest Must-Have Resource in your Tx Toolbox Speech Language Literacy Lab

5/25/2015 AAC & core vocabulary instruction Kidz Learn Language

5/26/2015 An RtI Alternative Old School Speech

5/27/2015 Intensive Service Delivery Model for Pre-Schoolers   Speech Sprouts

5/28/2015 RTI Success with Spanish-speakers     Speech is Beautiful

5/30/2015 The Importance of Social Language (pragmatic) Skills guest post on Speech Sprouts

5/31/2015 Sarah Warchol guest posts on Speech Language Literacy Lab

February 3, 2015

Understanding Terminology: Ankle and Knee

Filed under: Developmental Milestones — Starfish Therapies @ 5:17 am
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legsOften in physical therapy, we use certain terminology to describe the position or alignment of the legs at rest or during activity.  You have probably seen these terms in your child’s evaluations or progress reports and they probably didn’t make much sense.  Even if your therapist explained the meaning to you, it still might not have made much sense. Hopefully this article can help clear up the meaning of these strange words and what they indicate.

FOOT/ANKLE:

Kids Advnetures
Pronation – This is a term used to describe the sum of three different motions that together cause the heel to slant inward, the arch to collapse toward the floor, and the foot to turn outward during standing and walking.  A certain amount of pronation is normal during the walking cycle. However, if there is an excessive amount present it can lead to stress on ligaments and muscles and can cause other alignment issues throughout the rest of the leg over time.  Excessive pronation is most common in individuals with low muscle tone but can also occur individuals with high muscle tone.
supinationSupination – This term is used to describe the sum of three different motions that together cause the foot to point downward and turn inward. This foot position is common in individuals with increased muscle tone and in certain diagnoses such as Cerebral Palsy.
Pronation and supination can be present during standing or during isolated times of the walking cycle.
KNEE:
Genu Valgum (knock knees)- This term describes knees that are touching or close to touching while the lower leg is bent outwards and the ankles are separated more than normal (see picture below). This alignment is a normal part of development around 2-3 years of age and in most cases will naturally straighten out by 5-6 years of age. However, it may persist when other impairments are involved.  It is often seen in combination with ankle/foot pronation described above. Very severe cases may require surgical intervention.
Genu Varum (bow legs) – This term describes the opposite of genu valgum.  The knees are separated while the ankles come closer to the midline of the body (see picture below).  This alignment is normal in infants and during the first year but should decrease as weight is introduced through the legs with standing and walking.
From infancy to childhood, a typically developing child should progress from genu varum during the first year of life to a relatively straight position with the onset of walking and then into genu valgum around 2-3 years.  The legs should then again realign themselves into a relatively straight position by around 5-6 years.  Females will tend to have slightly more genu valgum than males due to the greater width of the pelvis.
genu valgum and varum
From left to right, the pictures represent genu valgum (knock knees), normal alignment, and genu varum (bow legs).

December 31, 2014

Top Ten Posts of 2014

Starfish_Star_NewYears

Happy New Year everyone!  Thank you for continuing to enjoy our blog as much as we enjoy producing it.  Here are the ten posts that were the most popular over 2014.  We can’t wait to see what 2015 produces!

10.  Encouraging Rolling – From Back to Stomach

9.  What Does Low Tone Mean?

8.  Core = More Than Just Abs

7.  My Child Isn’t Rolling Over:  Should I Be Concerned?

6.  Easter Egg Hunt for Motor Skills

5.  A Glossary of Sitting

4.  Having a Ball with Core Muscle Strength

3.  A Multi-Tasking Activity

2.  Motor Learning:  Stages of Motor Learning and Strategies to Improve Acquisition of Motor Skills

And the number one post this year was this amazing Guest Post from the folks over at Milestones and Miracles!

1.  Avoiding the ‘Container Shuffle’ with your Baby

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