Pediatric Yoga: A Growing trend among Practicing Pediatric OTs

Yoga has become a growing, common practice amongst all sorts of people across the age span in the United States. In recent years, occupational therapists have taken a heightened interest in using yoga with children. According to Moyer (2014) as well as Feeney and Moser (2014), yoga provides a holistic approach that can address multiple functional needs for a child. Below are some of the following:

Motor Planning
Although the roots of yoga revolve around uniting the mind, body, and spirit, techniques require certain levels of intentional movement. The child would be imitating movements conducted by the instructor, which encourages them to plan out and mimic the steps. Such movements are slow and methodical, allowing the child to safely try challenges to his/her balance and coordination.

Relaxation
Since yoga focuses intensely on purposeful breathing, the practice at its very nature is soothing. Yoga is currently being used by therapists to provide a safe outlet to release unwanted stress and anxiety.

Self-Regulation
Alongside relaxation, yoga has become a great way for children to self-regulate their emotions or reactions to unwanted stress or uncomfortable stimuli.

Attention
By having to focus on the instructor's voice and movements, the child is working on attending to a task in order to process planned movements and breathing strategies. An environment that fosters effective yoga strategies is typically quiet with dim lighting, which eliminates distractions for the child so that he/she can focus on the instructor.

Strengthening and Endurance
Yoga techniques, if conducted correctly, can tone the muscles, improve flexibility, and increase a child's endurance for movement-related tasks. Strengthening and endurance that is built up through yoga can translate to other tasks in which the child participates in throughout the day.

Social Skills
More often than none, pediatric yoga is frequently conducted in groups which allows a child to interact with other peers coming from similar backgrounds. The exposure allows for appropriate social interaction, as well as corrections of inappropriate interactions during a fun exercise session.

class="g5-color-primary"Increase Self-Esteem
A child who doesn't handle stress or anxiety well, or struggles with coordination/balance and social participation will often lack the ability to think positively about themselves. Yoga provides a safe activity in which children can feel like they have surpassed obstacles and leave with a sense of accomplishment. Additionally, groups of children participating in yoga get to struggle and succeed together.

As far as home health is concerned, it is more than appropriate for parents and OTs to create yoga sessions for the child to complete at their own house. If your child struggles with any of the following (but not limited to), it wouldn't hurt to discuss the option of pediatric yoga during in-home sessions:

  • Short attention span, trouble sitting still, issues with completing homework in a timely fashion.
  • Sensory-processing and/or self-regulation issues
  • Frequent temper tantrums or unexplained melt-downs, fights at school, at home, or in other community settings
  • Movement-related disorders or conditions (cerebral palsy, muscular dystrophy, clumsiness, frequent falls, muscle tightness or laxity, etc).
  • Depression and/or anxiety
  • Breathing difficulties

When consulting with an in-home pediatric OT as a parent or guardian, don't be shy about bringing up this topic. If it peeks your interest and you feel that it might be beneficial to at least try it with your child, talk about it. More importantly, find out if the OT who is treating your child has any experience in performing pediatric yoga.

Be ready to actively participate in yoga sessions with your child. Since an in-home health OT will only come into the house for short number of days per month, carrying out yoga techniques consistently will be mostly your responsibility. Be proactive and ask questions about any confusing or new yoga techniques. Talk about how frequently your child should be participating in yoga and for what purposes. Together, you can create a yoga routine that bests suits your child's needs and therapy goals.

References

  1. Moyer, L. (2014). The Power of Yoga for Children. North Shore Pediatric Therapyhttps://nspt4kids.com/parenting/the-power-of-yoga-for-children/
  2. Kathryn Feeney MOTS & Christy Szczech Moser PhD, OTR, FAOTA (2014) Yoga in Pediatrics, ournal of Occupational Therapy, Schools, & Early Intervention, 7:3-4, 161-171, DOI: 10.1080/19411243.2014.966014

Physical Handling: OTs Skill Set for Promoting movement in a child and what it means for Parents

As a parent of a child who requires physical or occupational therapy visits in their home, do you ever wonder why therapists constantly have their hands on your child? This goes for children who are being seen for therapy due to some type of movement-related disorder or dysfunction (i.e., cerebral palsy, pediatric stroke muscular dystrophy, etc.). Do you ever wonder what details go into handling your child, or does it look like the therapist is providing the movement for them?

Physical handling, sometimes referred to manual handling or therapeutic handling, is exactly what is says: using hands-on contact with an individual in order to promote safe, functional movement within the environment. Physical handling is frequently used because visual and verbal cues aren’t enough to get a child going. Verbal cues include examples such as “Come over here”, “walk to the door”, “go grab your coat”, “Go get the toy”. Visual cues include pointing, flashcard or handwritten commands, nodding/shaking the head, etc. Here are some observable reasons why a child may not be able to move or complete a functional movement to perform daily tasks, even when provided verbal or visual commands:

  • The child has complete or partial paralysis of one or more muscle groups.
  • The child is in pain and is unable to verbally communicate the problem.
  • The child is blind and/or deaf.
  • The child has reduced cognition, which impedes his or her ability to comprehend visual or verbal cues.
  • The child is in their infancy and has yet to understand visual or verbal cues to prompt movement.

Physical handling comes in many forms depending on what the therapist is trying to accomplish during intervention in order to meet the child’s goals. Examples may include:

  • Stretching or ranging tightened muscle tissue from atrophy or lack of movement.
  • Manual therapy in the form of massage or lymphatic drainage.
  • Filling in missing components of movements that the child is not able to complete independently (i.e., neurodevelopmental treatment).

Confused yet? If you’re not a trained occupational or physical therapist, than most of these terms like “neurodevelopmental” and “lymphatic” aren’t going to make much sense…and that’s fine. Your job as a parent or a guardian is to find out where you fit into the intervention equation. Run yourself through these series of questions and openly communicate with your OT about how you are to carry out this intervention once the therapist leaves for the day.

  1. What are your child’s goals or your goals for your child? Do any of your goals have anything to do with getting your child to move better? Maybe your child is not meeting motor milestones on time (i.e., rolling, crawling, sitting, standing, walking) or can’t perform certain movements because of obvious muscle tightness or laxity. If your goals have anything to do with improving fine (hands) and gross (large muscle group) motor movement or coordination, then you might be expected to use physical handling techniques.
  2. What interventions does the OT plan on using? Have a very open discussion with the OT about what types of treatments they plan on introducing. Ask them any question you like before or while your child receives intervention. Furthermore, ask them if he/she plans on using any types of hands-on treatments in order to get your child to move better.
  3. If there is physical handling, what purpose does it serve? Once you find out if the OT plans on using physical handling techniques, openly ask them what it’s for. Such questions may include, “Why place or hands there instead of there?”, “What movements are you helping my child do and what are they doing on their own?”, “Are you stretching them, lifting them, massaging them?” From a bystander view, it can be difficult to visually distinguish what the therapist is doing with their hands, so please ask!
  4. If I’m guiding my child’s movements, what precautions should I be aware of? Before the therapist leaves, make sure you receive complete education about the do’s and don’ts of physically handling your child specifically. Ask about what movements to avoid, proper hand placement to minimize or eliminate painful movements, use of skilled movement in order to avoid injuring your child, etc.
  5. How often should I be physically handling my child? Each therapist will have an exercise and handling regiment tailored specifically to each child’s needs. Consult with your therapist about how often, as a parent, you are expected to use physical handling with your child and for what movements or activities.

Kids who won’t keep clothes on to save their lives: An OT’s perspective

Anyone who has been a parent of toddlers has inevitably experienced this situation, the one where after several months of persistence your child finally has come to terms with the fact that getting and staying dressed in clothes is a normal practice. This includes all head-to-toe apparel from the tiny hair-bands to the Velcro shoes. As a parent, you might feel more accomplishment because your child can dress themselves and in under 20 minutes.

In reality, not all parents and their children comfortably reach this milestone. In fact, some children come within reach but due to underlying factors retreat backwards. This results in challenges that may seem "adorable" at first, but gradually morph wreak havoc on social obligations. Examples may include:

  • Constantly running late to scheduled appointments or school because your child refuses to dress or has ripped off their outfit numerous times in the morning
  • Being called to your child's school because he/she strips down in the middle of class
  • Managing full-fledged meltdowns every time you tell or help your child get dressed
  • Telling your child he/she can't wear pajamas to school or church, which results in them barricading themselves in the house.
  • Trying to persuade your child to wear jeans instead of sweatpants but they adamantly refuse to make the switch.
  • Dealing with a tantrum every time you ask your child to take off an outfit they've worn every day for the last 3 weeks so that you can finally wash it.
  • Not being able to convince your child to wear shoes and socks for outdoor activities
  • Taking off your child's shirt for every little drop of food or water that lands on the fabric
  • Handling overly complicated shopping trips to get new clothes for your child

Depending on how long their child fights it, parents can be at a loss for what to do next or if they should do anything at all. Should I wait it out? Will my child grow out of it? Kids go through this all the time, like a phase, right? In some cases, these thoughts are fully justified because some kids do grow out of it and move on. Refusing to dress in clothes becomes a problem when it strongly impacts the child's life, functionality, and social participation.

An occupational therapist can become a key player in a child's life when it comes to dressing tasks because he or she might be able see things that parents aren't able to catch on their own. Through assessment and clinical observation, the therapist might be able to help brainstorm with the parents the causal factors as to why dressing in clothes is so difficult for their child:

  • Sensory-related factors: A child may have a serious dislike for certain clothes based on how the fabric and seams feel or how loose or tight the material sits on their body.
  • Behavior-related factors: Some children can be very strict about what types of clothing they will wear while it has nothing to do with the actual fabric. Instead, clothing preferences are based on thought or logical processes that parents are unable to readily see. Examples include perseverating on favorite outfits (i.e., wearing a Super-Man suit 24/7), having specific color preferences, time of day, etc.
  • Lack of exposure to variety: Factors might be unrelated to the child's behavior and preferences. Parents might, without intention, might clothe their child in a limited type of clothing due to reduced time, fatigue, or financial constraints. So, when the time comes for the child to try different types of clothing (dresses, suits, swimsuits, costumes, etc.) for different occasions they can't comfortably make the transition.
  • Lack of or too much clothing expectations: Everyone parents differently, thus creating different rules or expectations about how a child is supposed to go about their day. Some parents may have no schedules or rules about dressing while other parents have too many rules, both resulting in the child not living up to a certain clothing standard.

Occupational therapists are trained to visualize the entire picture when it comes to participating in daily living tasks such as dressing, including parental, environmental, and child factors. Together with parents or guardians, the therapist can identify and breakdown the barriers to daily dressing for a child and then create a resolution (sensory diet development, behavioral modification, environmental adaptations, schedule creation and management, parent/guardian education, etc.) to meet the family's goals.

Toilet Training: Can a Pediatric Home Health OT Help?

There are numerous professionals as well as parents who are perfectly capable of potty-training a young child. So, first things first: do not think that this article is implying that an occupational therapist is the best recruitment pick for the job. Instead, think of the following information as offering you a small glimpse into what a task like toilet training would look like through an OT's skilled eye. By their very nature, experienced OTs are constantly breaking tasks apart in their mind in the hopes to reorganize and add in adaptive factors in order for a person to successfully complete activities. In a way, the breakdown looks like absolute chaos on paper for readers who are not certified OTs. Take great comfort in that OTs can decipher the information and use it towards a productive therapy session. For instance in toilet training:

  1. Task Requirements: Toilet training for one young child will not look the same for another. When teaching the child, there is much more to consider than just sitting on the bowl, relieving urine or fecal matter, wiping with the toilet paper, and then standing back up to pull clothes back on. Remember that the child is probably trying this task for the first time. Therefore, the therapist has to think about clothing complications, (i.e., buttons, zippers, elastics, leggings, pull-ups, diapers, underwear), sitting on a bowl at a certain height (in the event that a stool should be brought in), duration of the task (how long the child is expected to try for urination or for a bowel movement), how much toilet paper is appropriate for a good wipe, and what to do if a mess is involved. In cases where children have special toileting needs, the therapist would have to calculate how to manage catheter and colostomy/iliostomy equipment.

    Additionally, the OT would also have to track other tasks that the child has participated in during the day and how those tasks will affect his/her toileting schedule. Examples include timing when and how much food and liquid was ingested. A larger-than-usual intake would mean the child's toileting visits might have to take place more quickly. On the other hand, forcing the child to use the toilet when they haven't consumed much would make the fruitless efforts frustrating for both the trainer and the child.

  2. Environmental Considerations: The environment has EVERYTHING to do with successful toilet training because most children will not be using their home toilet every single time they need to relieve themselves. A therapist may acknowledge all of the different types of bathrooms and toilet bowls that the child would have to use throughout the day: at school, at a friend's house, at a community center/facility, at a department store, at roadside rest stops, etc. Public bathrooms mean that the child will now need to now the social courtesies and use of a bathroom stall, and for male children knowing how to use a less-than-private urinal.
  3. The Participant: There's an underlying assumption that children who are in need of OT services may have disorders or conditions that are negatively impacting their ability to complete functional tasks such as toileting. Therefore, the OT needs to evaluate the child's specific medical and health challenges relevant to therapy. Examples may include urinary or bowel pathologies (i.e., spina bifida), paralysis or atypical movement (i.e., cerebral palsy, spinal cord injuries, hemiplegia, etc.), and cognitive and behavioral issues (i.e., traumatic brain injury, Down syndrome, autism, ADD/ADHD, etc.).
  4. The Available Assistance: The OT, in a home health setting, would automatically have to consider what type of caregiver assistance is available for the child in order to see toilet training tasks through. Primary caregivers would include available parents, foster parents, guardians, school teachers, and/or respite care and home health aides. Since a home health OT is not at the child's disposal for a 24/7 schedule, it is essential that primary caregivers carry over education and training from OT during treatment sessions in order to help the child succeed.

The concluding point is that pediatric home health OTs can view and facilitate child-appropriate daily tasks including dressing, feeding, hygiene, bathing, AND toileting. If task, child, and environmental factors are more complex than usual for toilet training due to medical or developmental conditions, parents are welcome to consider consuconsultation with a pediatric OT.

A Parent’s Guide to Cerebral Palsy

Cerebral palsy is loosely defined by impaired motor function (body movements) due to an injury to the brain before, during, or immediately after birth.  People diagnosed with cerebral palsy can have impairments that span a wide range from very mild to very severe. There are several different types and a plethora of information on cerebral palsy that can be difficult to navigate through. Here we will take a look at an easy guide to cerebral palsy.

What is Cerebral Palsy, and How Does it Happen?

Cerebral palsy is considered a neuromuscular disorder, meaning that it disrupts how the brain and muscles of the body work together to produce body movements. Damage to the brain occurs while in utero either through abnormal brain development or injury during the birthing process. As a result, a child can be left with impairments such as paralysis, spasticity, and contracture that inhibit functional mobility. Cerebral palsy can be classified in a few different ways.

Nonspastic Cerebral Palsy

Also known as extrapyramidal CP, is broken down into two categories: dyskinetic and ataxic. Dyskinetic CP is characterized by uncontrolled body movements and muscle tone that can be hypotonic or hypertonic. The involuntary muscle movements can make it increasing difficult for a child to perform functional tasks.

Ataxic cerebral palsy involves lack of coordination and control throughout the entire body. Lack of coordination can negatively affect gross motor patterns and poor fine motor control can impact tasks such as dressing and writing.

Spastic Cerebral Palsy

Spastic, or pyramidal, cerebral palsy involves contracted or tight muscles that are incapable of relaxing. This spasticity can make many tasks difficult to complete due to difficulty moving stiff body parts, controlling movements, and coordination deficits. Spastic cerebral palsy is broken into four subgroups:

  1. Monoplegia: in which only one limb is affected.
  2. Hemiplegia or diplegia: either one side of the body—one arm and one leg—or both arms or both legs are affected.
  3. Triplegia: three limbs are affected; both arms and one leg or both legs and one arm.
  4. Quadriplegia: both arms and legs are affected.

How Can I Help My Child with CP?

Fortunately, with the techniques, knowledge, and adaptive equipment available, many children with cerebral palsy can live an independent life. Physical and occupational therapists can work with your child to increase mobility and independence. Strengthening, stretching, neuromuscular re-education, and manual techniques can aide your child in adapting activities to perform them independently. Therapists will work with you and your child on appropriate adaptive equipment and braces that will increase independence. Additionally, carrying over the home exercise program designed by your therapist will help your child achieve their goals.

While a diagnose of cerebral palsy can be scary and overwhelming, therapy staff are happy to help answer any questions and work with you to develop the best treatment plan to set your child up for success.

Prenatal Substance Abuse: The Functional Consequences and How Occupational Therapy Can Help

According to the National Center of Substance Abuse and Child Welfare (NCSACW, 2016), approximately 15% of infants in the United States are prenatally exposed to alcohol or illicit drugs. Common types of substances may include the following: cocaine, heroin, inhalants, marijuana, MDMA, methamphetamine, nicotine, and prescriptive (i.e., opioids) or over-the-counter drugs (National Institute on Drug Abuse, 2018). Expecting mothers who allow any dangerous chemical into their body will cause harm to the baby, whether it be short-term or long-term damage. The following consequences should be expected with substance use while pregnant:

  • Prematurity and low birth weight
  • Neonatal abstinence syndrome - the baby is born addicted to the drug they were exposed to in the womb.
  • Fetal Alcohol Syndrome - a disorder that develops in the womb when the fetus is exposed to alcohol.
  • Cardiovascular issues
  • Behavioral challenges - impulsivity, attention deficits, poor judgment, decreased reasoning skills.
  • Lung or respiratory damage - such damage can be short-term or permanent
  • Muscle cramping and weakness
  • Movement abnormalities
  • Stunted growth - substances literally make the bones stop growing.
  • Kidney and liver damage
  • Mental health problems - depression, anxiety, hallucinations, and paranoia (National Institute on Drug Abuse, 2018)

From a functional standpoint, prenatal drug exposure can severely disrupt a developing child's life and their ability to participate in meaningful tasks as they age. Example tasks may include:

  • Playing with Toys: Physical, cognitive, and emotional disruptions from prenatal substance exposure can drastically warp how an infant interacts with objects in their environment. This may refer to an inability to grasp toys in one or both hands, to initiate grabbing a toy, to understand cause-and-effect with buttons, transitioning from one play task to another, etc. Poor play skills in infancy can lead to delay in reaching pivotal milestones (i.e., rolling, crawling, walking, speaking, coloring, etc.).
  • Social Participation: Children with prenatal substance exposure may struggle with creating friendships and appropriately interacting with family members and friends. Causes can include displaying unacceptable behavior (i.e., tantrums, dominating conversations, inattentiveness, etc.), mental illness (i.e., depression, anxiety), and speech or communication delays.
  • School Attendance and Assignments: If the child sustained brain damage due to substance exposure in the womb, he/she will most likely experience some escalated challenges in school. Due to inattention, impulsive behavior, poor judgment, and reduced emotional regulation (to name a few), sitting in a desk to listen to a teacher or to complete an assignment becomes more difficult than usual.
  • Daily Living Tasks: Behavioral problems, cognitive delays, and developmental milestone deficits can reduce a child's ability to accomplish necessary living tasks at home. Examples include toileting, self-feeding, dressing, and hygiene tasks.

Pediatric occupational therapy can offer so much for infants and children with prenatal substance exposure.  Of course, such OTs are present from day 1 if the newborn goes through the neonatal intensive care unit (NICU). For time's sake, let's focus specifically on home health pediatric OT services. Home health OT can occur within the home or in a community setting. Depending on what the child's goals for therapy are and what their functional deficits look like, OT can offer any of the following: therapeutic exercises, motor learning techniques, gross motor/fine motor activities, daily activity interventions, daily schedules or systems, and caregiver education.

So, how does a child with prenatal substance exposure get started in home health OT? The child is already home from the hospital. Two scenarios will usually play out: the child goes home with the biological parents or the legal and welfare systems place the child into foster care. No matter where the child is placed, intervention services need to begin immediately. It is essential for parents or legal guardians to conduct the following once the newborn comes home:

  • Note Observations of the Newborn: For brand-new parents (and even experienced ones), it can be very difficult to visualize what "typical" development looks like. For a newborn with prenatal substance exposure, side effects can be obvious (inconsolable crying, low levels of arousal, breathing problems, movement issues, etc.) or not so blatant in the slightest. If the newborn was exposed to illicit substances or alcohol in the womb, then it is essential to consult with early intervention services so that clinicians may or may not identify problems that you don't notice.
  • Contact Your Local Early Intervention Services: Give early intervention services a call and set up an appointment as soon as possible. Your pediatrician may have some referral information or resources for early intervention care.
  • Participate in Free Consultation and Evaluation: Since early intervention services are typically government-funded, the first visit and initial evaluation of your newborn is free. Occupational therapy along with physical therapy, speech therapy, psychiatry, and social work will want to assess your child in order to determine the deficits (if any) and appropriate services for your child.
  • Actively Participate in Home Health Services: If your child qualifies for early intervention services, proactively schedule and attend appointments that will usually occur in your home.

Fine Motor Developmental Milestones

Fine motor activities require skilled use of the hands as well as coordination to perform a task. Early fine motor skills set the stage for many tasks in life that require well developed fine motor skills and coordination such as handwriting, computer skills, and feeding. Fine motor development can often be overlooked as parents watch for gross motor milestones such as sitting, crawling, and walking. Using this guide can help you to monitor your child's fine motor progress and ensure that he/she stays on the right track.

Birth to 3 Months

One would think that there is nothing in the way of fine motor skill development happening for a tiny newborn. However, there are a few tricks that your little one will be developing over this time. Around 1 month old, babies should be tightly grasping objects placed in their hand, such as your finger.  At two months, babies can hold small toys for short periods of time and may begin to swing at objects such as dangling toys from a mobile. It is around this time that babies will start to notice their own hands.

4-6 Months

Between four and five months, infants are able to reach and grab a small toy with both hands as well as bang objects on a table, such as the spoon as they sit on your lap at a restaurant. At around six months, the raking grasp emerges. The raking grasp is when a child uses their entire hand and all fingers to "rake" or pick-up small objects.

7-9 Months

The critical fine motor skill that emerges during this time frame is the development of the pincer grasp. The pincer grasp entails using the thumb and index finger to pick up small objects. This is a critical fine motor skill to develop for self feeding. To help your child with the pincer grasp, allow opportunities to pick up small but appropriate foods such as Cheerios or dissolvable puffs or yogurt bites.

10-12 Months

During this time, an infant will begin to place smaller items into a larger container such as blocks. At around 12 months is when a child really develops the skill to pick up an object and throw it. So, all of those pacifier and sippy cup chases are not in vain—it just shows that your baby is developing those fine motor skills. Around 12 months is an excellent time to introduce large peg puzzle boards to your baby.

While it may not seem that babies are doing a whole lot in regards to fine motor development, the first year is a critical stage to lay the foundation for higher level fine motor skills as a child gets older. If you have concerns about your child's fine motor development, consult with their pediatrician or an occupational therapist. An occupational therapist can work with you on ways to facilitate fine motor development and ensure your child is hitting all of their milestones.

Pediatric OT: Home Health for Children with Cerebral Palsy

Cynthia is a 4 year old female with spastic cerebral palsy. Ever since she was born, Cynthia has been having profound trouble getting around because both of her legs are affected. Her mother, Jana, started Julia off in early intervention services once it became clear to her that Cynthia was falling behind in her developmental milestones. At age 2, she could hardly stand on her own without the assist of her mom or a piece of furniture. Her hands are mildly affected by her cerebral palsy, making it very difficult for her to hold a crayon or a pencil, zip her own pants up, tie her shoes, and play with her toys. Cynthia is going to be turning 5 soon and will be enrolled in kindergarten in about 6 months from now.

For some parents, defining cerebral palsy is like preaching to the choir. However, and short overview may be helpful for parents who are experiencing it for the first time and don't know what to expect for their child over the next few years. Cerebral palsy describes a group of disorders that impact typical movements and posture. Because of damage to or dysfunction of the brain, the body shows abnormalities in muscle tone, muscle control, muscle coordination, reflexes, and overall posture. Some forms of cerebral palsy come with speech and language impairments, epilepsy, visual deficits, and intellectual disabilities https://research.cerebralpalsy.org.au/what-is-cerebral-palsy/.

There are three main subtypes: quadriplegia (all four limbs affected), diplegia (usually the two lower limbs), and hemiplegia (same side arm and a leg are affected). Motor control abnormalities include spastic (tight), dyskinetic (involuntary movements), and ataxic (shaky or tremor-like movements). Review Cerebral Palsy Alliance Research Foundation's chart for further details about subtypes at https://research.cerebralpalsy.org.au/what-is-cerebral-palsy/types-of-cerebral-palsy/.

Cerebral palsy for a young child means that their participation in daily activities at school, at home, and in the community will change drastically because it is a life-long condition. Like Cynthia's situation, the following examples strongly reflect what those changes look like (worst-case scenario):

  • Inability to run around the playground and climb gym equipment and recess
  • Inability to dress, shower, and toilet themselves
  • Inability to self-feed at home or in the cafeteria
  • Inability to sit up in a desk to complete school work
  • Inability to communicate and make friendships at school
  • Inability to walk from classroom to classroom
  • Muscle pain and tightness negatively distracting them from other tasks
  • Increased number of falls and injuries

Each child with cerebral palsy as a unique set of limitations, but it is still possible for them to live a fulfilling life with the right help. Occupational therapy (OT) is only one of the many professions that can offer relevant services for children with cerebral palsy. More importantly, OT takes a specific approach in which they address the child's goals, carefully assess the activities they want to or must complete, and then helps the child revamp their lifestyle so they can complete tasks as independently as possible. Home health OT is especially effective because the therapist is allowed to work with the child in their home and community environments in which they are familiar and comfortable with. Here are some examples of interventions OT has used with children with cerebral palsy:

  • ADL interventions: Eventually, young children in many families are expected take care of their own personal needs including dressing, toileting, showering, and self-feeding. All of these tasks require refined fine motor strength and coordination as well as the ability to stand, sit up, and change positions without support from others. OT can specifically work with children in breaking down each task, discover the barriers, and then eliminate the barriers with restorative (improvements to the child's physical movement) and compensatory (introducing adaptive equipment) interventions.
  • Neuro-developmental Treatment: Some OTs are highly knowledgeable or certified in Neuro-developmental Treatment (NDT) in which past theories were based off of working with individuals with cerebral palsy http://www.ndta.org/whatisndt.php. It's a fairly complex treatment that is useful for addressing muscle strength, range, and coordination.
  • Splinting/bracing: Given that the majority of children with cerebral palsy are of the spastic type, this means that many clients are dealing with heightened muscle tone. In other words, children experience limited abilities in voluntarily moving their arms and legs in full range and strength in order to walk, sit up straight, stand, change positions in bed, crawl, climb the stairs, and the list goes on. Over-time, muscle tissue is some cases can atrophy and break down. Some OT's may recommend a rigorous splinting or bracing program in order to prevent breakdown and loss of movement.
  • Range-of-Motion and Therapeutic Exercise: Often times, an exercise program is paired with a splinting program in order for the child to maintain as much joint range and strength as possible. For home health programs, OTs will usually train family members on how to assist the child in carrying out daily splinting and exercise programs.
  • Adaptive Equipment and Durable Medical Equipment: Some children may benefit from having some external supports which include: walkers, adaptive feeding equipment (plate-guards, weighted spoons, etc.), wheelchairs, and communication boards just to name a few. Such adaptive equipment should be useful across several environments including the home, school, and the community.

How to get OT services for my child at Home: Tips for Parents

How to get OT services for my child at Home: Tips for Parents
Kimberly became a brand new mother to a baby girl a little over a year ago. Labor and delivery was typical, and there wasn't anything to indicate that there something developmentally wrong with her child, Camille. Recently, Kimberly has realized that Camille seems to be behind in her ability to get around and to feed. Camille is about 16 months old and has trouble sitting up without support, which makes it very difficult for her to learn how to walk. She has trouble with spoon-feeding Camille with simple, pureed foods because her mouth won't conform around the spoon to keep food in. Kimberly has never had any experience with early intervention services, has never heard of occupational therapy (or had any first-hand experience with other therapies), and is at a loss for where to start.

Parents have one thing in common: we are all raising children through new stages of life for the very first time. Unless we've read several volumes on parenthood and pediatrics, most of us are flying by the seat of our pants as we guide our children's growth. Some of us are fortunate enough to raise one or more children who have no developmental dysfunction. For other parents, it is a shocking reality to learn that through their own observation their children are struggling with the basics: rolling, crawling, walking, talking, and eating. Some of us won't catch anything off at birth, but might discover some problems a few months or years down the road.

Fast forward past your regular pediatrician visits. You and the doctor have already confirmed that your child is not meeting the typical developmental milestones. So, what can a parent or guardian do to seek appropriate services for their child?

  1. Look up your local Early Intervention Programs: Early Intervention are services provided by law via Part C of IDEA (Individuals with Disabilities Education Act). Clinicians in early intervention programs provide education and treatment to children ages 0 to 2 years old. The child is evaluated, and if found to have an established condition (physical or mental) that could potentially cause developmental delay, they receive services for a set period of time http://www.wrightslaw.com/info/ei.index.htm. Depending on what program you enroll in, services could include physical therapy, speech therapy, occupational therapy, social work, nutrition, and psychology to name a few.

    Furthermore, early intervention programs are to conduct treatment in the child's natural environment including the home or the community: "to the maximum extent appropriate to the needs of the child, early intervention services must be provided in natural environments, including the home and community settings in which children without disabilities participate." (34 CFR §303.12(b), Part C IDEA). Since early intervention addresses a small part of the lifespan (ages 0-2), it is essential for parents to get on the ball, talk to a doctor, and contact services immediately.

  2. Set up a consult and an Evaluation: Initial evaluation helps clinicians determine whether or not your child has developmental delays that need to be addressed. It also gives providers a chance to determine which clinician will best be able to help with your child's needs. If you look back at Kimberley's case, if Camille is found to have developmental delays according to standardized testing, then Camille could potentially receive physical, speech, and or occupational therapy to address her movement and feeding needs.

    The initial consult and evaluation are free. This gives parents a chance to figure out whether or not their child is in need of help, or if it's all in their head. Parents who have no previous education in health and pediatrics are not expected to know everything. Thus, it never hurts to check before the opportunity passes you and your child by.

  3. Develop a game plan for therapy: Once your child qualifies for early intervention services, clinicians will walk you through the next steps. This includes financial questions, scheduling appointments in the community or in your own home, and determining which specific services will best suit your child's needs.
  4. Look ahead for when your child ages out: Remember, your child will age out of early intervention once they turn 3 years old. For some, maybe early intervention is all that is needed and your child will be fine without any additional services. For others, developmental delays could still carry on and impact home and school activities. While your child attends early intervention services, thoroughly research what programs would be included in the next step including pediatric home health services, pediatric outpatient clinics, and school programs.

Intervention Carryover: What Parents/Guardians Can Do to Help their Child reach their Therapy Goals

Occupational therapy, due to its very nature, is a flexible discipline that can work in just about any setting. Examples include outpatient clinics, skilled nursing facilities, inpatient hospital units, transitional care units, school districts, community clinics, and home health companies to name a few. Treatment is tailored to fit the needs for anyone across the age span, from neonatal care to hospice. Out of all of the possible clinical combinations, pediatric home health OT has a unique format filled with a variety of approaches for children:

  1. Therapy occurs at home: The OT physically shows up to conduct treatment in the child’s own home. This allows for the child to comfortably participate in an environment that is familiar, which eliminates the stressors that come with working in a sterile and intimidating clinic. The OT has an advantage because he or she can create treatment based off of the child’s interests, which is incredibly easy to observe in a safe, home environment.
  2. The child is the focal point of treatment: Although adults including parents, caregivers, or additional family members will be heavily communicating with the therapist, it is the child who steals the stage for therapy. Working with a young client is rewarding, but it can be tricky for children to communicate their needs and goals to a stranger. Therapy looks a lot more like a play group rather than treatment. Additionally, children may not see the barriers (physical, cognitive, behavioral) keeping them from succeeding in meaningful tasks.
  3. Scheduled appointments are different: There are some settings in which an OT will see a patient 7 times a week, and for other settings maybe just twice a week. In the case of home health care for children, there are some organizations (i.e., early intervention) that will only allow for two or three appointments per month. This means that OT has time to cram in tons of clients per month, but at the expense of not getting to know the child very well.
  4. Caregiver input is essential for success: In order for children to meet their goals in therapy, parents, guardians, foster parents, or other relevant caregivers need to take the reins. Being proactively involved in your child’s therapy sessions is essential, especially if home health therapists only show up a couple of times a month.

The following are some tips that parents/caregivers should consider if they need assistance in participating in their child’s OT treatment (or really any other rehabilitation treatment for that matter):

  1. Be present: Be awake and at the house at the time of each appointment. Make sure your child is ready for treatment. This doesn’t necessary mean that your kiddo needs to be spit-shined and properly dressed; however, it does mean that the child is away from other distractions in order to focus on therapy (i.e., meal-time, naps, bath-time, etc.).

    Remember that the therapist is not hired to be a babysitter. In fact, most therapists will expect parents to stay in the room where the child’s sessions will take place. Put your phone away so that you can actively engage in the sessions as well.

  2. Create a productive working environment: Being a parent of young children usually equates to a messy household, so please don’t think that therapists expect to arrive at the home while it is in pristine condition. Instead, concentrate on eliminating distractions that you know your child will try to go after during therapy. Examples include electronics, toys (other than ones used in therapy), blaring music or televisions, snacks, etc.
  3. Involve siblings if necessary: Consult with the therapist about whether or not it is a good idea to have siblings present during sessions because you may be surprised by their answer. Depending on the goals, therapists might want siblings around as playmates for the child in order to carry out treatment (i.e., sharing toys in order to get the child to crawl, stand, or walk).
  4. Communicate treatment ideas to others: Realize that although treatment occurs at home, what the child learns from therapy will translate to other environments including school, community centers, friends’ houses, etc. If the child’s treatment creates changes that could impact other settings (i.e., coping skills, transition techniques, schedule changes, etc.), it is important for parents to communicate those changes with teachers, aides, and other parents or adults in which the child has frequent contact with.
  5. Actively carry out treatment outside of therapy sessions: When you sign on for home health, be ready to take on some changes to your own day-to-day schedule. If the child only completes therapy requirements during the few days per month in which he or she is seen by the OT, no long-lasting changes will occur. Parents or caregivers will be expected to carry out intervention as instructed by therapy in order for the child to positively benefit from services.