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by Dr. Tiffany Showalter

What parents need to know about occupational therapy in the school setting

November 6, 2012 in Ask the Occupational Therapist, Featured by Dr. Tiffany Showalter

By:  Dr. Tiffany G. Showalter, OTD, OTR/L

An occupational therapist or OT is a highly trained medical professional who evaluates and treats individuals of any age who have problems engaging in meaningful activities or “occupations” relevant to their everyday lives.  I can’t tell you how many times I have told someone that I am an OT and they want to know about getting someone a job.  In this economy, wouldn’t that be nice if I could get everyone a job?  The “occupation” in occupational therapy actually comes from the word occupy, and means any activity that “occupies” a person’s time.  This may include self-care, play and leisure activities, in addition to, work.  For a child, their job or occupation often involves playing, learning, and going to school.

Children make up a large part of the population receiving OT services and these services may be in the medical clinic setting or in the educational setting.  Not only are the settings different, but the priorities of each are quite different.  There are many children who require medically driven therapy services to participate in their relevant occupations and they can be referred for these services by a physician.  In the schools, children who have a medical need for therapy may or may not require therapy for an educational need. Additionally, a physician’s referral is not required nor does it determine need or amount of services provided.  OT in the school setting supports the student in meeting his/her educational goals; therefore, the level of OT support is driven by the student’s IEP. Educationally relevant therapy services may be indicated if the expertise and knowledge of the skilled professional (OT) is required for the student to meet their established educational goals and objectives.  It is important to understand these differences and why the goals are specific for outcomes related to the setting for which the student participates.

What is educational or school-based OT?

Educational or school-based OT is designed to enhance the student’s ability to fully access and be successful in the learning environment.  This might include:

  • working on handwriting or fine motor skills so the student can complete written assignments
  • addressing oral motor or swallowing concerns for eating while at school
  • helping the student organize himself or herself in the environment so that he/she can attend to activities appropriately and follow directions
  • working with the teacher to modify the classroom
  • adapting learning materials to facilitate successful participation within the school.

School therapy is provided in the natural school environment, meaning treatment and/or evaluation may take place in the classroom, library, cafeteria, playground, or other designated area within the school.

How do I get OT for my child?

Occupational therapy (OT) is considered a related service under Part B of the Individuals with Disabilities Education Improvement Act of 2004 (IDEA), and is provided to help students with disabilities to benefit from special education.  As such, OT is a supportive service.  If your child has a disability, as defined by IDEA, and needs special education and related services to meet their unique learning needs, then he/she might require an OT evaluation or services.

How are therapy services determined?

An OT will evaluate the student using both informal and formalized assessments.  They will also review the student’s current IEP, interview teachers and staff working with the student, review work samples, and/or observe in different school settings.  After completing the evaluation, they will then present the findings to the IEP team.  Next, the IEP team determines whether OT support is educationally necessary based on the evaluation findings and the recommendations of the therapist.  Finally, the team determines the amount, frequency, and duration of OT services.  OT may be provided individually or in groups and may consist of direct treatment, consultation, or monitoring.  Consultation with teachers and school staff is an essential part of occupational therapy services.  By providing information and training, the educational staff can integrate the recommended strategies and techniques with the student everyday.

Who should I contact if I have concerns about my child which I feel may need addressed by OT?

The best place to start is with your child’s teacher.  However, you may also contact your county school system’s special education department or your school’s occupational therapist with your questions.  The American Association of Occupational Therapy is also a useful resource.

Disclaimer: I hope you enjoyed reading this article.  Please remember you are reading this information of your own free will and are taking the information at your own risk.  The author is the legal copyright holder of this material it may not be used, reprinted, or published without my written consent.  This information is for entertainment and informational purposes only and is not intended to provide or circumvent medical, legal or other professional advice.

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by dianaglick

How Important is Your Child’s Designation?

July 17, 2012 in Ask the Special Ed Lawyer, Community Wisdom, Featured by dianaglick

As discussed in previous articles, eligibility is found when a student has one or more qualifying disabilities and the IEP team determines that special education services are necessary for the child to access his or her education. When a student has a single and very obvious disability, this is a very straightforward process and if you are not wondering about the designation (disability category) that will be listed on your child’s IEP, you are probably in one of these straightforward situations.

This discussion is geared towards those families who are struggling to identify an appropriate designation and wondering how the choice of one or another might affect their child’s ability to obtain services.

A Ticket to the Game

From a legal perspective, a designation is simply a “ticket to get into the game” and does not necessarily result in any particular placement or services. Further, students and parents are not legally entitled to any particular designation; rather, the right is to a free appropriate public education (FAPE). This is because special education is “specially designed instruction” that is supposed to focus on the unique needs of the child. If your child needs a specialized reading intervention, he or she can access these things through any of the qualifying disabilities on the list. The law does not assign specific services to certain designations but requires that any condition impeding the child’s access to his or her education be addressed. In other words, a child could have a vision impairment, but have “autism” checked on his IEP. As long as that child receives services to address his vision impairment sufficient to be considered a FAPE, the fact that he has a totally random designation means nothing in the legal world.

Back to Reality…

However, setting aside the legal framework of the IDEA and coming back to the real world, it is highly unlikely that a student who is hard of hearing will automatically be considered for mental health services or any other service that may not necessarily jump to mind when thinking about the needs of students with hearing impairments. It also means that a student who is eligible with a designation of Speech/Language Impairment (SLI) may not be offered more intensive interventions that would be considered for a child with a designation of Autism, even if the student with an SLI requires these services in order to access his education. In reality, some families face an uphill battle in obtaining all the services their children need and in those cases it’s important to have the most accurate designation possible.

In addition, some states have categories of “low incidence” disabilities, which are tied to a certain level of funding based on the ability to access federal funds for these particular disabilities. While in an ideal world, a designation determination would never be driven by the funding or services available, this often ends up being a factor in the IEP team’s decision-making process.

One of the most important things to remember is that designation is an IEP team decision, which means that everyone’s input is important, including that of parents, assessors and teachers. There is also a difference between a medical diagnosis and an educational designation. A doctor’s diagnosis can inform the team, but a student’s designation is determined according to educational criteria.

While there is no set formula for determining the proper designation, there are some key questions that can be posed to the team that will help frame the discussion:

1. What, if any, medical diagnoses does the student have?

➢ While the designation is an educational decision, a medical diagnosis in some situations is an excellent “jumping off point” for the IEP team’s deliberations.

2. What are the key areas of need demonstrated by the student?

➢ You will want to consider needs observed during evaluations, in the classroom and by the parents in the home and school settings

3. Of the challenges and deficits experienced by the student, which is the biggest impediment to his ability to access his education?

As a special education attorney, I saw many families face the “ED or OHI?” conundrum. This occurs when a child has a diagnosis of ADHD, which would usually point towards the Other Health Impairment (OHI) category. However, sometimes students with ADHD also have moderate to severe mental health issues and could also be considered Emotionally Disturbed (ED). There are many factors that go into a decision to opt for one designation or another, including the predominant behavioral challenges experienced by the student, his or her age, and in some cases the student’s preference.

Just When You Thought it Couldn’t Get More Complicated

Some District IEP forms contain spaces for a “primary” and a “secondary” disability category. Just as there is no legal right to a particular designation or a correct designation, the law does not distinguish between primary and secondary designations. In some cases, being able to put down more than one category can help resolve a conundrum, such as determining whether a child should be considered ED or OHI. In other cases, it can lead to more confusion and conflict as IEP teams feel compelled to identify which of two disabilities is primary and which is secondary. If you find yourself being dragged into a conflict about designation, take a step back and look at the big picture: what are my child’s needs as determined by the assessments and parental input and what services are being offered to address these needs?

Despite the fact that eligibility categories do not drive litigation, they can have a significant effect on the way a child and his or her needs are viewed by school professionals. The determination and agreement on a child’s designation is a key part of the IEP team’s process of identifying needs and matching services to satisfy those needs, with the goal of offering the child a free appropriate public education.

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Disclaimer:

This column reflects the views of Diana B. Glick in her individual capacity. Diana represented parents and students as a special education attorney for four years and is now a legislative analyst with the California Assembly.

The purpose of this column is to assist in dissemination of information about federal special education law, but no representation is made about the accuracy of the information. The information contained in this column is provided only as general information for education purposes, and topics may or may not be updated subsequent to their initial posting.

By using this column you understand that this information is not provided in the course of an attorney-client relationship and is not intended to constitute legal advice. This blog site should not be used as a substitute for competent legal advice from a licensed attorney in your state. This column is not intended to be advertising and Diana B. Glick does not seek to represent anyone desiring representation based upon viewing this blog site in a state where this blog site fails to comply with all laws and ethical rules of that state.

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by Dr. Tiffany Showalter

10 Ideas for a Fantastic, Fun Summer

June 5, 2012 in Ask the Occupational Therapist, Featured by Dr. Tiffany Showalter

Many parents dread the summer months. School is out for what feels like is forever and lots of children have nothing planned.  It seems all they do is watch television, play computer games, bicker and moan. It doesn’t have to be that way.  You can help your children have fun while continuing to work on their gross motor, fine motor, sensory processing, and cognitive skills. So, let a beautiful summer day be your motivation to get your child outside to play.  Coming up with activities is easier than you think; here are a few ideas to get you started…

This list is aimed at children 3-7, but remember every child develops differently so choose and modify activities based on your child’s abilities.

1.  Ride a bicycle (or tricycle)

Whether your child likes a tricycle or a “big kid” bike with or without training wheels, riding is a great way to help your energetic one develop gross motor skills and fine motor coordination.  Plus, it’s a fantastic activity to get the entire family moving.  Just be sure the bike is age- and size-appropriate and that your child is wearing the proper safety gear.  Also discuss bike safety and the rules of the road (even if you’ll be on a sidewalk or at the park).  Be patient!  Learning to ride a bike engages cognitive, gross motor, fine motor, visual motor, and sensory processing skills to name a few and can be difficult to learn even for the typically developing child.  Once mastered, try adding obstacles or play games where sudden starting and stopping is involved.

2.  Build an obstacle course

Kids love obstacle courses.  And what’s not to love…they have so many elements that children crave like running, climbing, jumping, crawling.  I would suggest 3-4 different “stations” at any one time and upon mastery either add an element or assemble three totally new stations.  For example, run around the house, jump over some broom sticks placed on lawn chairs like hurdles, and crawl through an old box.

3.  Have a dance party

Kids love to dance, either freestyle or through songs with movements.  Play music on a radio and make up dance routines together. Then perform your routine for older siblings or other family members.  Songs with movements are also great.  I like “ I’m a little teapot”, “Head, Shoulders, Knees, and Toes”, “Popcorn”, and “5 Little Monkeys swingin’ from a tree”.

4.  Play catch

Who doesn’t like a game of catch?  Well maybe your child, but maybe they would like it if you used a pillow or balloon?  Playing catch offers a variety of opportunities for kids to utilize different skills and includes throwing, catching, and kicking.  Generally speaking, many children don’t master catching and throwing until they reach five.  Visual motor coordination is essential to playing catch and may take a little time to develop.  In any case, practice makes perfect.  Use balls of different sizes and textures.  If you are really feeling creative try adjusting the amount of air pressure in a ball, less can make it easier to catch, or vary the weight of the ball.  Start off closer together and gradually move further apart.  Playing with a peer is great because your child will get many opportunities for turn taking; however a playmate is not always possible and let’s face it you have to do laundry or the dishes pilling up.  Try using a bucket or hula hoop as a target.  For the advanced child, try having the child or target move.  Your child could swing while throwing bean bags towards a bucket.  Really increase the complexity by having the child and target move.

5.  Make mud pies

Pull out some pots, pans, and kitchen utensils, and then head outside.  Add some dirt and water…voila!  Instant fun!  I recommend as few clothes as you feel appropriate and a nearby water hose for clean-up.  Digging, stirring, and pouring all involve not only fine motor skills, but visual motor as well.  And you get a great sensory experience.  It is OK mom, mud washes off and as my grandmother always used to say, “God made dirt, and dirt don’t hurt”.  Playing in sand can also be a great activity, or better yet mix the mud and sand together for an entirely new “sensory” experience.

6.  Blow bubbles

Sounds easy enough, but blowing bubbles involves all kinds of skills to master.  Children need to be able to accurately position their lips, blow with just the right amount of force, and manage what might be a slippery wand in their fingers.  Try adding food coloring for a different take or using different household items in a bucket of homemade bubble solution to come up with new bubble makers.  One of my favorites…a fly swatter!

7.  Make the outdoors your canvas

Art projects take on a whole new meaning when outside.  Try sidewalk chalk, washable paint, mud, or just plain water to help your child create hopscotch boards and race tracks.  Why not trace each other and then add the facial details and clothing?  Your budding artist might also enjoy spraying a water bottle filled with water and food coloring.  Best part of this creativity…no clean up!

8.  Go for a walk

Once again, get moving.  Take a walk around your neighborhood, Local Park, or through a sprinkler.  For variety, add marching, jogging, skipping, hopping, or even musical instruments to form a parade.  As you walk, sing the ABC’s, count, or tell stories.  When appropriate, get those shoes off!  Many little toes love the sensory experience of grass, sand, or mud.  Make a line with tape and pretend it is a balance beam.  Plan a nature hike in your backyard.   Grab some paper, crayons, and pencils.  Draw pictures and label things you find.   Pretend to be airplanes in the sky, ducks waddling, stiff legged robots, galloping horses, or fish swimming in the sea.

9.  Swing

This child favorite can be a little tricky.  Learning to pump requires balance, strength, and good timing.  I would recommend that you hop on first to demonstrate for your child.  Then when it is her turn, describe what it is that you want her to do.  For example, you might say, “Push your legs out and lean back.  Now pull them in hard and sit up.”  Move your position, sometimes standing behind your child, sometimes in front while you push her, encouraging the correct motion.  For advanced children, try twisting the swing then letting it untwist or let them experiment with different positions like lying on their stomach.

10.  Play classic backyard games

Remember how fun it was to play hide and go seek, tag, follow the leader, red light/green light, or Simon Says.  These games not only burn energy, but engage listening, sequencing, motor planning, and gross motor skills.

So grab a few water bottles, slather on some sunscreen and get ready to try some of these summer activities for yourself.  Who knows, you might be wishing summer would never end!

—-

Published originally in May 2011

 

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by Admin Dawn

Tips for Feeding Kids with Special Needs

May 24, 2012 in Featured, Insider Insight by Admin Dawn

By The Real Food Moms, Jeannette Bessinger, CHHC and Tracee Yablon-Brenner, RD, CHHC, www.realfoodmoms.com

For your child’s body and brain to function at their best, it is important to provide a diet high in amino acids, the building blocks of protein. But since the body is unable to store excess amino acids it’s smart to split up your child’s protein supply—ideally among the three main meals and two snacks. By feeding meals high in protein throughout the day, you help the neurotransmitters in the brain function better, and stabilize blood glucose levels—preventing hyperglycemia and reactive hypoglycemia—blood sugar “ups” and “downs” that can affect some children’s ability to focus and/or settle down.

One cardinal nutrition rule is to stay away from simple carbohydrates, which break down into glucose and release too quickly into the blood stream. Sugar and high fructose corn syrup are a few examples of simple carbohydrates to avoid. Children are affected differently by sugar, however many studies suggest that sugar negatively affects behavior, impacting aggression, attention, hyperactivity, mood and proper mental function. It is best to replace sugary drinks and snacks with healthy high protein snacks like veggies with hummus or nut or sunflower butter; smoothies with whey or rice protein or nut butter; nuts, seeds, sliced hard boiled eggs, fresh fruit with nut or sunflower butter, yogurt with granola or with nuts and seeds and a dash of honey. When serving foods with added sugar, it’s best to keep it below 15 grams per 100 grams. Cereals should have 3-5 grams of sugar per serving, max, and it’s best to include protein with breakfast, e.g., hardboiled eggs or yogurt with nuts and seeds and a dash of honey. Incidentally, organic honey has many beneficial nutrients—in addition to being a taste treat!

Another essential is to remove synthetic food additives from your child’s diet. For a food additive to be allowed in the diet, it must be certified as “generally recognized as safe” (GRAS), which means it will not have a significant negative effect on health. Unfortunately we don’t know the long-term effects of ingesting chemicals on our nervous, immune, respiratory and endocrine systems. There are 24 synthetic food additives, and we are going to address the four major categories: artificial colors, artificial flavors, artificial preservatives, and artificial sweeteners.

Artificial colors have been embroiled in controversy for some time. A November 2007 study published in The Lancet stated that artificial colors in children’s diets contributed to hyperactive behavior. The UK’s Food Safety Agency released this statement on July 20, 2010: “An EU-wide health warning must now be put on any food or drink that still contains the colours that are thought to cause hyperactivity in some children. This is following the Southampton Study, commissioned by the Agency, which suggested a possible link between consumption of six food colours and hyperactivity in children. The colours are Tartrazine (E102), Quinoline Yellow (E104), Sunset Yellow (E110), Carmoisine (E122), Ponceau 4R (E124) and Allura Red (E129).” There had been a voluntary ban on food coloring in foods in the UK. In the United States, Blue No.1, Blue No. 2, Green No.3, Red No. 40, Red No. 3, Yellow No. 5 and Yellow No. 6 are still permitted in our foods and medicines. Some of these chemicals trigger histamine release and create allergic reactions like hives (uticaria). In the September 2010 issue of the American Journal of Psychiatry, Stevenson, et al., found strong evidence that histamine release affects hyperactivity levels in animal models and also influences frontal cortex dopamine release. In this study, there was improved behavior when artificial color was removed from the diet. The research underscores the importance of avoiding food and medicine with artificial colors. Moreover, most artificial colors are made of a mixture of coal tar. The International Agency for Research on Cancer says that products with 5% crude coal tar are considered a Group 1 carcinogen. How’s that for a reason to remove artificial color from your child’s diet?

Artificial flavors are also a concern, especially (MSG) monosodium glutamate, an amino acid from glutamic acid. MSG is used in commercial cooking to enhance the flavors of many common processed foods including canned soups, frozen dinners, seasoning mixtures, and fast foods. Many fermented products have naturally occurring glutamate, like Worcestershire sauce, soy sauce and steak sauces. Glutamate is also in many other additives like soy extracts, protein isolate, hydrolyzed vegetable protein, hydrolyzed soy protein, hydrolyzed yeast, and autolyzed yeast. MSG is not always easy to identify on a label. Be on the lookout for words like “spices” and “natural flavorings” on a food label, which means it might contain MSG. Two food additives, “disodium guanylate” and “disodium inosinate” are only used with MSG, so if they’re on the label, there’s a high likelihood that MSG is in that product.

Glutamic acid, which MSG is made from, is classified as an excitotoxin. However, it is considered to be GRAS by the FDA. Many people are affected by MSG, and children who have special needs are especially vulnerable since they might not be able to communicate their discomfort, which may manifest as a headache or nausea. Removing artificial flavors from your child’s diet is the safe way to go, and could help to reduce behavioral problems.

Artificial preservatives, such as butylated hydroxytoluene (BHT) and butylated hydroxyanisole (BHA) are being investigated for provoking chemical sensitivities. These preservatives have been associated with causing broncho spasm, rhinitis and more particularly in triggering hives (uticaria). Many studies on mice have shown that these preservatives cause learning deficits, difficult sleeping, developmental delays, aggression, decreased orientation reflex. Key reasons in removing artificial preservatives from the diet because that could also relieve behavioral symptoms such as aggression, hyperactivity, developmental delays.

Artificial sweeteners are much sweeter than table sugar, “sucrose,” and can interrupt neurotransmitter balance, which could make behavioral symptoms worse.

The following sweeteners have been tested for their safety through the Center for Science in the public interest. Aspartame which goes by Nutra-sweet, Natra-taste and Equal, is one that people who have Phenylketonuria (PKU) have to avoid because they can’t break down phenylalanine which can accumulate to toxic levels. Sorbitol, xylitol, mannitol, maltitol, lactitol, isomalt, erythritol, and hydrogenated starch hydrolysates are sugar alcohols that can cause stomach discomfort and diarrhea. Acessulfame known as Sunnet, Sweet One, and acessulfame potassium, should have more testing and should be avoided because rat studies found that it caused tumors, mostly benign but some malignant. Saccharin, which is Sweet n Low, may cause cancer. Stevia can’t be metabolized in our bodies which is why it has zero calories. More testing should be done on its safety. Sucralose, which is Splenda, is actually sugar chemically combined with chlorine…Buyer beware! Tagatose, a very new type of sugar made from milk sugar lactose, can cause digestive issues such as gas, bloating and nausea because it’s not well absorbed. It can be found in Diet Pepsi, Slurpees from 7-11, etc.

These are a few examples of why package label reading is essential in today’s world. Many of the sugar substitutes mentioned are found in gum, yogurts, baked goods, and drinks, including iced tea, soda and juices. It is safest to use natural forms of sweeteners. Some of the best include organic honey and turbinado sugar, which is raw sugar crystals formed by spinning the sugar in a centrifuge. The juice released is crystallized to keep the rich molasses color and flavor, and it’s less processed than conventional table sugar. Sucanat is the trademark name for the turbinado process.

Trans-fat is the end result of hydrogenation, the process in which hydrogen is added to liquid vegetable oil. Partially hydrogenated fats contain Trans-fat, and are less expensive and have a longer shelf life than standard fats. Trans-fats interfere with an enzyme called delta 6 desaturase, which is important in converting essential fatty acids Omega-3 and Omega-6 fatty acids to the active form (ARA) arachidonic acid, (EPA) eicosapentaenoic acid, and (DHA) docosahexaenoic acid used by the brain. It is important to avoid Trans-fat and partially hydrogenated vegetable oils. A deficiency of 6 desaturase causes a deficiency of ARA, EPA and DHA, which are important for brain development, brain functioning, brain signaling and proper vision processing. Research has shown that children who have Autism, ADD, ADHD, dyslexia, and dyspraxia may have low levels of 6 desaturase so when they eat foods containing Trans-fat or partially hydrogenated vegetable oils, it can make these conditions worse (1). To increase the activity of the desaturase enzymes, it is important that the diet includes an adequate amount of vitamin B3, vitamin B6, vitamin C, magnesium and zinc which are available by eating local organic fruit, vegetables, whole grains, organic yogurt, and meat, nuts and seeds (2).

Including foods rich in Omega-3 fatty acids cannot be overemphasized. Some basic sources are wild Alaskan salmon, seaweed, eggs from hens fed a diet high in Omega-3’s, flaxseeds, pumpkin seeds, walnuts and algae. Caveat: To ensure food supplements are free of mercury, use either an algae-based or fish oil Omega-3 fatty acid supplement, which is third party-certified and molecularly distilled.

By purchasing organic-labeled products, you’re guaranteed that the foods you’re feeding your family are free of artificial color, flavor, preservatives, trans-fat and pesticides. Not all products have the USDA organic seal because certification is voluntary and expensive. So it’s important to read the labels carefully to know what you’re really buying. To have the USDA seal means a product is comprised of 95 percent organic ingredients. Foods that have at least 70 percent organic ingredients can use the phrase “made with organic ingredients” and list up to 3 ingredients. If the product has less than 70 percent organic ingredients the name of the organic ingredients can be included on the food label.

To get back to basics, incorporate the Real Food Moms three P’s: Plan, Purchase and Prepare real food! This takes a little organization, but you are ensuring delicious, unprocessed food for you and your family. You should definitely see some behavior and long-term health benefits for the entire family.

Get more from the Real Food Moms at their blog!

Stordy, B. Jacqueline. Dark adaptation, motor skills, docosahexaenoic acid, and dyslexia. American Journal of Clinical Nutrition, Vol. 71 (suppl), January 2000, pp. 323S-26S

Osmundsen H, Clouet P. Metabolic effects of omega-3 fatty acids. Biofactors 2000;13(1-4):5-8 2000. PMID:15800.

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Republished from January 2011

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by Julia Roberts

Special Needs and Eating…Free Webinar Series

April 18, 2012 in Ask the Feeding Specialist, Featured, From Julia by Julia Roberts

Just want to let you know of a webinar series that looks so interesting and one I could have used about 12 years ago!

Ellyn Satter MS, RD, LCSW, renowned childhood feeding expert and author of several books on feeding, including Child of Mine and Secrets of Feeding a Healthy Family, presents a free three part Webinar on the Trust Model of feeding for families dealing with special needs.

“Raising Children with Special Needs to be Competent Eaters”

A free three-part Webinar presented by Ellyn Satter and Guest Presenters!
Thursdays; April 26th, May 3rd & May 10th 1:00-2:00 p.m. Central Standard
Register once to attend all three Sessions! Register today!

Go and register here! 

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by Shelley Mannell

Round & Round the Garden…(for core strength)

March 15, 2012 in Ask the Physical Therapist, Community Wisdom, Featured by Shelley Mannell

This is a classic – professionals recommend that children who have poor core strength do wheelbarrows and planks as exercise but children can’t complete these activities unless they have good core strength.  I feel dizzy trying to sort my way out of this so I suggest we all hop off the merry-go-round and find out what the core muscles are and how they work.

1. Our inner core muscles turn on first.

We now know that the inner core consists of 4 muscles (the respiratory diaphragm, the pelvic floor, the transversus abdominis and the multifidus).  They function to give us a stable spine and pelvis before movement begins and they activate as a team in the same way before every movement that we do. During the process of development, the inner core muscles become active and efficient during the first 2 – 3 years of life. For our children with motor challenges, the inner core muscles do not become efficient due to neurological, sensory and alignment issues.  

2.  The timing of outer core muscles depends on the task.

Unlike the inner core muscles, outer core muscles activate differently depending on the task. Superficial abdominal muscles, hip and back muscles are all members of our outer core groups.  The inner core muscles create an anchor at the center so the outer core muscles have something to stabilize on and this allows the outer core to work efficiently.  We call this partnership of inner and outer core muscles the body’s “core strategy”.  When the inner core muscles are not active, children over-recruit outer core muscles instead and this causes clumsy/uncoordinated movements and can also lead to pain. (This happens with adults too.  Please go to www.juliewiebept.com for great information about core function in adults.)

3.  The inner core muscles are easily overwhelmed. 

The inner core muscles are easily overwhelmed by other muscles.  A sure sign that the inner core is not active is breath holding to accomplish a challenging movement.  Babies and toddlers do this naturally when accomplishing new skills but they move quickly through this as they develop. Children with motor challenges continue to use breath holding as their way of creating a stable center.

Now that we understand more about our core muscles, how do we apply it to help children with motor challenges?

1. Stop thinking about core exercise and start thinking about core strategy.

Core exercises (crunches, wheelbarrow, crab walk, planks, stability balls – the list is endless!) are something separate in a childs’ day but in reality core strategy is something that should be present throughout the day.  Building alignment builds core strategy, which is critical for endurance and strength. 

2.  A is for alignment.

Our children need to experience better alignment.  Many of our children tuck their bottom under (photo 1) and shift their rib cage back (photo 2) or pop their bellies out and shift their rib cage forward (photo 3) in an effort to keep their body balanced.  Alignment of the rib cage over a neutral pelvis is needed to be able to activate the inner core muscles (photo 4).  No amount of telling children to “sit up straight” will help; kids actually need to be able to breathe properly to activate the muscles and maintain the posture.   

 

3.  Everybody breathe.

When you are with a child, listen to their breathing.  If they are breath holding prior to/during a task, remind them to breathe. Many of our kids also overuse their shoulders or belly during breathing (when you ask a child to take a deep breath, do they lift their shoulders or puff out their belly?).  We need to retrain the respiratory diaphragm by encouraging a full breath with expansion of the lower rib cage; we call this an “umbrella breath”.  Then the inner core team can provide that all-important central stability.

4.  Movement should be fun.

Ultimately we want our kids to take their core with them wherever they go!  They need it sitting, walking, running, playing hopscotch, skipping rope, hula hooping, rock climbing and rollerblading.   If we train the inner core to come online first, then we can put that into play (and school and sports too!).   In that way, every activity becomes a core activity.  So in my practice you’ll find my clients working their core in everything they do – but the wheelbarrows stay in the garden and planks are just pieces of wood.

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For more information on Dynamic Core for Kids or Physical Therapy for children with special needs, please visit Shelley’s website at www.heartspacept.com/blog.  For continuing education workshops, visit www.heartspacept.com/workshops.  You can also find Shelley on Twitter @heartspacept, Facebook at HeartSpacePT or Pinterest at heartspacept. 

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by Dr. Tiffany Showalter

Thinking “Inside” the Bin

December 20, 2011 in Ask the Occupational Therapist, Featured by Dr. Tiffany Showalter

By:  Dr. T.G. Showalter, OTD, OTR/L

Close your eyes and think back to when you were a child.  Try to remember building a fort or getting into a tent and snuggling up with lots of blankets and stuffed animals.  Somewhere you could separate yourself from the bombardment of the outside world. Maybe you brought in your Barbie dolls or army figures.  Think about how nice it was to have your own personal space and how calm, simple, safe, and organized you were.  Wouldn’t that be nice if we had a way to mimic that feeling for students who are having difficulties in the classroom setting?

After attending a conference last school year, I decided to look up a webpage designed by a fellow OT in my area who I ran into.  On her page, she had pictures of a really neat seating modification that she was using in her private clinic as well as in some of her schools where she worked.  Instantly, I was taken back to my fort and Barbie days and couldn’t wait to share this with all of the creative teachers that I am so fortunate to work with on a daily basis.

Basically, it consists of a regular storage bin easily purchased at any discount department or home improvement store.  One half of the lid is cut and removed and then the edges are covered in thick duct tape for safety.  Cushions, pillows, towels, stuffed animals, etc. may be added to “soften” the inside.  I even had one resourceful teacher who filled the inside with packing peanuts.

So, why is this bin necessary you ask?  At my school, we are helping children of all abilities access their education and participate to the best of their abilities.  Sometimes students require different seating modifications because they physically lack the ability to sit unsupported.  Other times children physically can sit, but they have attentional and/or sensory issues which make sitting, focusing, and learning difficult.  This is where the bin comes in.  The bin provides a concrete boundary for that student’s personal space and much needed calming sensory input.  The student can retreat into the bin if they need a break or sit and listen to a story being read while manipulating fidget toys.  They can complete written work on the top part of the lid like sitting at a desk, and they can get into and exit the bin easily for participating in activities at the board.   More over, the bin has lots of room for affixing visual aides easily with Velcro.

The idea is so successful that even a leading therapy equipment company is making something similar for the bargain price of $115 dollars.  I purchased and made mine for less than ten.  I have seen amazing results not only in self-contained classrooms, but in some of my inclusions classrooms where even the neurotypical models often try to negotiate their “turns” to sit in the bin.  So, if your child is having difficulty sitting and attending consider this really cool modification.  It is cheap, easy to construct and just another example of how thinking “outside the box” by putting children “inside the bin” can be a huge success!

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Disclaimer:  I hope you enjoyed reading this article.  Please remember you are reading this information of your own free will and are taking the information at your own risk.  The author is the legal copyright holder of this material it may not be used, reprinted, or published without my written consent.  This information is for entertainment and informational purposes only and is not intended to provide or circumvent medical, legal or other professional advice.

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by Shelley Mannell

5 Practical Motor Planning Tips

December 7, 2011 in Ask the Physical Therapist, Community Wisdom, Featured, Featured Member by Shelley Mannell

We used to believe that motor skills developed in a very linear fashion and that most movements were pre-programmed in the brain.  Now we know that the brain constantly shapes our movements, before, during and after they occur, so that we can be successful in all our tasks. We also know that motor skills are based on processing of sensory information:  muscles, vision, hearing, vestibular and proprioception all combine to inform the brain about movement.  In some children with motor challenges however, the brain may not process this information as efficiently and this leads to difficulties with posture, balance and motor skills.  But there are ways to help.  Here are some practical suggestions:

1.  CALM THE NERVOUS SYSTEM

Increased stress/anxiety interferes with the “just right state” for learning motor skills. Strategies to calm the nervous system include:

Umbrella breathing: have the child sit or lay in a comfortable position.  Encourage them to take a deep breathe, expanding the sides of their lower rib cage (more than their upper chest or belly).  Let them breathe in and out easily, relaxing with the breath.  The iPod/iPad apps iBreatheFire and Balloonimals are fun for helping kids with a bigger breath out (that means they had to take a better breath in!).

Imagery:  Develop a very short story using an image that is calming for the child.  Make the story multi-sensory; feel the warmth of the sun on your face, the squish of the sand under your feet etc.  Re-tell the same story periodically and pair it with umbrella breathing for a calming effect.

2.  SUPPORT THE VESTIBULAR SYSTEM

The vestibular system is a powerhouse of the brain.  It assists in emotional self-regulation, anti-gravity muscle tone, central stability of the body, visual tracking and balance.  Difficulties with the vestibular system are common in children with motor challenges.  We can help to prepare for balance and motor skills by providing input to the vestibular system prior to movement.

Linear movements: large and small movements forward/back, side to side or up/down stimulate part of the vestibular system that is associated with muscle tone.  Running, swaying, or even head nodding/shaking can prepare the body for movement.

3. OPTIMIZE VISUAL INPUT

We’ve just talked about vestibular input but also visual input has a huge impact on balance and movement.  We use vision as our primary sense for balance until age 6 and many children with motor difficulties continue to use this sense as a primary source of information.  However they may also have difficulty using their eyes together and may also not be able to process visual information well.  Colour changes what information reaches the brain from the eyes.  Some children can benefit from using colour to enhance the visual information available during balance and movement tasks.

Coloured glasses: these are available in a rainbow of colours.  You can find them on the internet (www.colorglasses.com gives you a range of options) but you can also often find some colours at your local dollar store.  Experiment with what colour your child likes.  Children who are sensitive to bright light tend to prefer the blue/purple end of the colour spectrum and children who are sensitive to visual input in general tend to prefer the red spectrum.  The child can use these glasses when learning a task to assist with processing visual information for balance and when dealing with moving objects (throwing and catching balls).

4. INCREASE CORE STRATEGY

Many people talk about core muscles however our understanding of core stability has progressed a great deal in the past few years.  We now understand that 4 inner core muscles are wired to work as a team before movement begins; they prepare a stable trunk for all movements.  One of these muscles is the breathing/respiratory diaphragm.  When children don’t have a stable center they substitute breath holding to create stability.

“Blow before you go”: using the breath to support central stability is key.  Cue the child to take a breath in and then begin to blow out before they start to move. In this way, they are helping the body to use the inner core muscles for central stability rather than compensating with breath holding.

5. PROBLEM SOLVING PROMOTES LEARNING

Engaging more areas of the brain in the learning of a motor task assists with processing of more information.  Asking questions rather than giving solutions promotes this process.

Ask open-ended questions when learning motor skills: rather than providing solutions (“let’s try it this way”), ask questions that help the child think through the skill and consider the pieces that can be changed (“did the ball go where you wanted it to?”, “how did standing on one foot feel?”, “what could we change to see if that could work better for you?”).

Multi-sensory input movement usually works best, because this is how the brain is meant to function.  The key to success is finding the combination of inputs that works for each child as they learn about their posture, balance and movement.

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For more information about Shelley, Physical Therapy for children with motor challenges or workshops for professionals, visit Shelley at www.heartspacept.com

 

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Avatar of Julia Roberts

by Julia Roberts

Talk Throughout the Day for the Young Child!

November 28, 2011 in Ask the Speech Therapist, Insider Insight by Julia Roberts

By Susan Garrett, MS/CCC/SLP

For most of us, we talk our way through the day but if you are a child with a special need, you probably will need some help. Talking is something most of us do all the time and never think twice about it. You talk to your husband, your wife, co-workers and your children.  You talk to the clerks at the store and to people on the phone. Most of these people talk back to you and conversation is just a routine part of the day. That is not the reality for children with a variety of developmental disorders including but not limited to Cerebral Palsy, Downs Syndrome, and Autism Spectrum Disorder. For many of these children, reciprocal talk with others is not always apparent and as a result people forget to talk to these children. As a parent, caregiver or teacher it is most important to narrate the day for these children. Be their friend but also be their language or talk model and communication partner.

A conversation doesn’t have to involve talking! Children learn the basics of conversation well before they learn to talk. When children take turns while interacting, they are building their conversation skills. Therefore, when a child looks, reaches, gestures, makes a sound or uses facial expression, treat this as a conversational turn and respond to keep the conversation going. That conversation can continue with eye gaze, sounds, and even words. Remember however, the message is not just the words but all the facial expressions and gestures from you and your child. If your child is not responding to your talk, try putting your talk to song! Research indicates that many of our children will respond to talk that is sung.  Again, the most important thing is to continue to engage the child and have fun.

Morning time is a hectic and busy time for most families but it can also be a special time with your child. Dressing time and wash time are wonderful language opportunities. Talk about what the child is putting on and the parts of the body involved.  The bathroom is not a place to get in and out of as quick as possible. Time in the bathroom is wonderful talk time. Toileting can be difficult but talk and make it fun. And if you don’t like to talk or your child doesn’t respond to your talk…SING!!!  Sing a song about the potty and then washing one’s face and hands.  The foods for breakfast can also be a target for talk.  It is easy to talk about the foods we are eating. “Eggs, yummy, I like yellow eggs.” “Cereal, it’s crunchy, it tastes so good with milk!” Sounds of eating are always wonderful—mmmm…yucky…be creative. Just keep the words coming and keep your child engaged.

A trip to the super market can be a wonderful and engaging activity as long as your shopping list is not too long.  Choose a time, when you only need milk or juice not a two week grocery list. As you walk through the store, talk about what you see, the colors of the fruit and vegetables, the shapes of the boxes. The idea is to engage the child with the store and make it fun. There is lots of action in the store too. You can push the cart fast and push it slow. You can pick things UP and put things IN. The limited language child needs all these cues and this is a great time to introduce concepts.

Outside at the playground is a wonderful time to engage your child. Talk about going up the ladder and down the slide. Talk about spinning around on the merry-go-round.  The outside with the trees, leaves, flowers and grass are rich topics to talk to your child about and participating in the fun is even better.

Don’t forget to talk when in the car. Videos have their time and place but the car can be a wonderful time to engage your child especially if it is just the 2 of you. Again, it is a great time to sing and a wonderful time to explore the world around us.

My favorite time for talk with young children is bed time. Everyone can slow down and “chill.” Snuggle up close and read a favorite book. Many children want the same book day after day. Don’t be surprised when the child is reading the book to you! The American Academy of Pediatrics recently recommended limited if any use of media before the age of 2 and thoughtful use of media thereafter. They are strongly recommending “free” unstructured play to allow the children “to learn, problem solve, think innovatively and develop reasoning skills. Finally, the AAP also strongly suggests sitting down and reading with your children to foster their language and cognitive development.  It is truly refreshing that your child’s pediatrician is now recommending what SLP’s have been encouraging for years! Enjoy the talk time with your child whether he/she is 2, 12, 22 or beyond.

———

Susan Garrett, MS/CCC/SLP is a speech and language pathologist at a public, inclusive, early childhood school, the Coralwood School in Dekalb County, Georgia. Susan received a B.A. from Mercy College, Dobbs Ferry, NY and a MS in Speech Pathology from Teachers College, Columbia University. Her entire career has been in the public school system in NY and Georgia and it truly has been a journey. Speech therapy in the schools in the 1970’s focused on correction of   l, r, and s with some language intervention with a handful of children in a self-contained junior high school special education class. In 2011, the focus for all our children is communication, language and literacy. The primary goal for all children is successful communication at home, in school, in the community and basically in life. Speech/language therapy at Coralwood uses an inclusive model when appropriate. Children receiving Speech/Language therapy are seen in the classroom, in the therapy room, on the playground, in the cafeteria, anywhere that can support the child’s communication. Each child’s program is individual and based on their specific needs and is developed with both parent and teacher input.

Susan is married with 2 adult children, so she has also had some first hand experience with speech and language development.

 

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by Children's Healthcare of Atlanta

Holidays in the Hospital

November 16, 2011 in From the Hospital, Insider Insight by Children's Healthcare of Atlanta

By Ginger Tuminello

Child Life Specialist for Heart, Kidney and Liver Transplant Patients at Children’s Healthcare of Atlanta

The holidays can be stressful, especially if your child is in the hospital. Here are some tips on making the holidays in the hospital a little more bearable.

Acknowledge your feelings and the feelings of your child.

Being in the hospital, especially over the holidays, stinks. Recognize those feelings and say them out loud to your child. Once you’ve established that you’re both sad/upset/frustrated, focus on the things that can make being in the hospital over the holidays better. Just think, one day you may be telling stories that start, “Remember that Thanksgiving we spent in the hospital and had to eat turkey from the cafeteria…”

Continue established family traditions, or some variation of them.

As a family, identify what family traditions are most important to you and find ways to continue them. If your family always goes to church on Christmas morning, find out if the hospital chapel is having a service. If you always make holiday cookies, try making holiday ornaments instead. If your child’s favorite Thanksgiving treat is pumpkin pie, have someone make and bring it to her (if dietary restrictions allow). Or simply postpone Thanksgiving dinner until your child is feeling better and out of the hospital. There are no rules that say you must eat Thanksgiving dinner on Thanksgiving.

Create new family traditions.

Talk to your family about starting new holiday traditions. Make holiday ornaments to put on the hospital tree. Plan a holiday game night using either board games you love or finding new holiday games to play (check out http://www.coolest-christmas-holidays.com for some ideas). Make small gifts for the nursing staff. Organize a toy drive or fundraiser for hospital or organization. Your hospitalized child could always help design a flyer and plan other details.

Find out about special events and visitors offered by the hospital.

During the holidays, lots of folks enjoy volunteering and putting on special events for the hospital. Even though the local nursing home group playing hand bells may not sound very exciting, you might be surprised. Think of these events as opportunities to get out of the room, socialize, and make new holiday memories.

Start a special project with your child.

Take pictures and create a holiday scrapbook. Make holiday cards for other patients. Make gifts for family members. There are lots of inexpensive craft projects that you could do with your child that would provide hours of entertainment and bring a smile to many faces. Check out www.familyfun.com or www.craftbits.com for some great ideas.

Decorate.

Nothing says holidays like decorations. Bring a holiday blanket and pillowcases from home. Create holiday pictures and hang them on the walls. Get a small fake tree, decorate it, and put it on display. Get washable window paint and paint your windows. Wear festive clothing. If the room looks festive, you may find yourself in the holiday spirit. Just be sure to check with the hospital staff about policies regarding lights, hanging pictures, live plants/flowers, and window painting. And don’t forget to bring pictures of your loved ones at home.

Plan one small thing to look forward to each day.

The trouble with being in the hospital is that it gets boring and redundant. Plan something each day that you and your child can look forward to. Pick out an interesting location (i.e., gift shop, outdoor garden area) and plan for an afternoon walk there. Rent or borrow a new movie and plan for a movie night. Borrow a game you’ve never played and have a game night.

Create a schedule for visitors.

Hospital rooms can be tight quarters and too many visitors at once can be overwhelming. Creating a schedule for visitors can help limit the number of visitors and also allow you to schedule some quiet/alone time, which is important.

Find out the visitor policies.

During cold and flu season, some hospitals don’t allow siblings to visit. Find out these policies and ways to work around them. Is there a common area that the siblings can come to, like the cafeteria, so that you have time as a family? Could you use technology like Skype to communicate when you can’t be together? Try playing a game using Skype, making sure there’s a board on each end. Have your children at home and your hospitalized child write letters, send pictures, or record messages/stories often. Getting mail or email can really light up someone’s day.

Make time for yourself.

If someone offers to play with your child so that you can take a break, let them! Go for a walk, get a cup of coffee, or take a shower. Make sure that you are taking time to decompress and focus on yourself.

Use your team.

Your child life specialist, social worker, and chaplain are all great resources to help you and your family cope with hospitalized holidays. Be sure to let them know when you need something or just need to talk. They can be a great source of comfort and support.

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