Advanced Pediatric Therapies

Kid-Powered

Get Outside!

Every summer, I’m asked to compile a list of outdoor activities for families.  Our service model changes over the summer from weekly visits to intensives.  During that time, we encourage families to get outside to play and to MOVE!  There are so many fun games and activities to choose from.  Here is just a partial list:

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For the little ones:

  1.  Crawl around with your mason jar and find some cool bugs and leaves.
  2. Dig in the dirt, use a shovel and get messy!
  3. Play in the sandbox, making sure to have buckets and cups to lift the sand.
  4. Water the plants with heavy buckets of water.
  5. Use an old sprayer to mist the plants or “paint” a brick wall.
  6. Dig up some rocks that you can then paint.
  7. Put some rags in a bucket of water.  Make a chalkboard target on an outside wall.  Throw!!
  8. Climb a tree.
  9. Help Dad wash the car.
  10. Take the dog for a walk, the more pulling the better!
  11. Play tug o’ war.
  12. Go on a nature scavenger hunt.
  13. Jump rope.
  14. Stack rocks and make a sculpture garden.
  15. Make a mud pie.
  16. Run through the sprinkler, then spin through the sprinkler, then jump through the sprinkler, get creative!
  17. Blow bubbles outside and watch them fly away.

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For older kids:

  1. Set up a zip line in the back yard.
  2. A slack line is also great for older kids.
  3. Ride your bike around the neighborhood, try to balance on a chalkboard line in the street.
  4. Go for a swim.
  5. Power wash the back deck. Take some before and after photos.
  6. Hang wet clothes outside on the line.  Or hang artwork, or photos. Host an art show.
  7. Go skateboarding or scootering around the neighborhood.
  8. Play bocce ball in the yard with friends.
  9. Play hopscotch or foursquare in the driveway.
  10. Bring fresh flowers or veggies to a friend.
  11. Deliver newspapers.
  12. With supervision, climb a ladder and wipe some windows.
  13. Play some kickball!  Or volleyball!  Or tennis!
  14. Set up a tent (by themselves) and sleep in it in the backyard.
  15. Do a potato sack race.

Give us some of your own ideas!

Jeanne

Update:  If you have younger kids, check out these cool articles from PBS Kids on Sneaking in Learning over the summer and Best Free Apps to get kids outside.

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Are Temper Tantrums and Sensory Meltdowns the Same Thing?

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Does this look familiar?

I read a great article recently about sensory meltdowns and it was a great reminder to talk to the parents we work with about a dynamic that can very easily be misinterpreted.  So what is a “temper tantrum?”  Most of the time,  temper tantrum is easily recognizable in toddlers and maybe even teenagers!  Your child is not getting their way, or what they want and they pitch a fit, screaming and crying.  They can roll around on the floor, sometimes even hitting their heads against a wall in the extreme.  A temper tantrum is often being characterized by a child being told “no.”

In contrast, a sensory meltdown could better be described as a “release,” or overflow of emotion as a result of being exposed to a sensory input that feels unpleasant or even intolerable.  In the article, the mom describes her 9 year old daughter as holding it together then crying in the car after cheerleading practice became intolerably loud.  Of course, when your child is younger and can’t tell you what the upsetting force was, it gets trickier.  If you see a meltdown coming on, you can ask yourself or your child a few questions, based on your knowledge of them and what sets them off:

  • Is it too bright in here?  Do you need your sunglasses?
  • Do we need to leave?
  • Does your body feel funny?
  • Are you uncomfortable?

Assure them you are there to help.  However, once your child is in a meltdown, they are already experiencing “fight or flight.”  This means that their nervous system has gotten involved, and you are less likely to be able to intervene. At that point, you can:

  • Talk as little as possible.
  • Give them space to breathe, cry, whatever they need to do.  This is what the mom inherently knows to do in the article.
  • Remove them from adverse environment.
  • Plan for next time!  Make a “retreat” in your home:  a quiet space with noise cancelling headphones, quiet music, dim lights and away from anything unpleasant. Maybe some gum, a quiet toy but no screens.

 

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OT Favorites you can DIY!

We often get requests from families for equipment that we use in the clinic.  When we refer them to equipment suppliers, they are often unable to afford the high price tag.  Here are some items we often use in the clinic that you can make at home (disclaimer: these have not been made by the therapists here, these are moms who are handy and want to share how they fabricated their own equipment).

THERAPY SWING:

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This swing was fabricated by a mom who has a blog about her child with autism.  It looks pretty simple to make.  Let us know if you give it a try!  Find the link here.

CRASH PAD:

Sensory hack for kids: how to make a DIY no sew crash mat using items from around the house from And Next Comes L

This mom explains how to make your own crash pad like we have in our gym.  I love her ideas for getting the kids involved.  Find the link here.

BODY SOCK:

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How about this cool body sock?  We have a couple here but if you have seen them, they are a fun way to incorporate heavy work into playtime.  This mom shows you how to turn a piece of lycra into your child’s very own body sock!  Fun!  Find the link here.

PRESSURE VEST:

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This mom made a pressure vest for her daughter.  If your therapist has recommended a pressure vest at any time, this may work for you.  We would like you to talk to your therapist before you make one so you know prescriptively exactly what your child would benefit from.  But if you can make it yourself, that would be great!  Find the link here.

STRETCHY RESISTANCE BANDS:

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This mom made stretchy resistance bands for her kids to help with heavy work play for her kiddos.  This is something that would be really fun for siblings.  Find the link here.

WEIGHTED BLANKET:

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This mom used polyfil to make a weighted blanket.  There are lots of links out there for making your own weighted blankets.  Etsy sells some too.  This seems like it would be good because of the individual pillows holding it all together.  Find the link here.

STRETCHY SHEET:

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So many of our kids have trouble quieting their bodies to go to sleep at night.  Sometimes  a super stretchy sheet can help.  This mom made one using stretchy material.  Seems pretty easy!  Find the link here.

If you have made something you would like to share, please do so below in the comments section or share with your OT.  Also if you try any of these, let us know!

 

 

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APT Hosts NDT Course

Despite slippery roads and kids home for an unexpected snow day, the course went off without a hitch.  Our course instructors were Gail Ritchie and Brenda Lindsay.

NDT stands for Neuro-developmental treamtment.  From the website:  NDT is a holistic and interdisciplinary clinical practice model informed by current and evolving research that emphasizes individualized therapeutic handling based on movement analysis for habilitation and rehabilitation of individuals with neurological pathophysiology.

Gail Ritchie is an occupational therapist who became an NDTA instructor in 1996.  Her career, spanning 25 years, focuses on supporting children and their families.  Brenda is skilled in a variety of areas including sensory processing disorder, but her focus is to also increase awareness of development and and facilitation of movement through handling in particular for children with autism.

Brenda Lindsay is a physical therapist who was certified in NDT in 1993 and went on to become an instructor in 2010.  Both she and Gail have extensive clinical experience in pediatrics and the autism population.  Both saw a need to bring developmental treatment into autism treatment and created the course to educate therapists about its powerful effects on this particular group of kids.

Members of the OT and PT community gathered over a couple snowy and icy days to take in their knowledge and observe treatment.  All of us came away with a better understanding and appreciation of NDT-based treatment with the kids we serve.  It was a fantastic course.

 

 

 

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Happy New Year!

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Advocate for Recess!

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“RECESS!!”
I remember being in school and the teacher calling this out to us in the lunchroom or class.  It meant (hooray!) it was time to get outside and get all our wiggles out.  Recess means a break from having to sit in one place, use our brains intensely and not having to listen closely to a teacher.  It meant fun, movement and a sort of freedom from the monotony of the school day.  What we didn’t know at the time was that our brains and bodies needed a reset button.  Recess was not a reward, but rather a reserved time just like art, math or lunch.  In our current test-driven educational environment, not only is recess in jeopardy, but it’s value has been called into question.  Recess is not a privilege for kids who are well behaved or get good grades.  Research has shown it to be essential to your child’s development.

Recess in recent years has been limited and even cancelled.  Schools are feeling stress to improve kids’ grades and test scores and the more time spent in the classroom, in their opinion, the better.  Leading educators have been calling this into question more and more in recent years, citing many studies that say that by doing so, we are putting the health of kids at risk.

Research has yet to prove that removing recess with raise test scores, but the following benefits have been proven for kids.  Kids who have recess:

  • Are less fidgety and more on task
  • Have improved memory and more focused attention
  • Develop more brain connections
  • Learn negotiation skills
  • Exercise leadership, teach games, take turns, and learn to resolve conflicts

The American Academy of Pediatrics put out a policy statement in 2013 advocating for the “Crucial Role of Recess” in the development of children.  It is required reading for parents and educators alike.  The paper discusses the cognitive, physical and social benefits of recess in great detail.  In addition, it states that the removal of recess should NEVER be used as punishment.

What can you as a parent do?  The excellent website Peaceful Playgrounds provides handouts, guides and presentations which are easy to download and offer lots of other resources too.  Together, we can take back recess!

Jeanne

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from an article I wrote for kidsmoveandtalk.com.
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Use Sensory Strategies to Make Mornings Less Hectic

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Chore Ideas for the Summer

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Ah summer!  Kids get to revel in their school free days.  They sleep late and play all day (depending on their age…your older kids may be more sedentary).  But kids should also be responsible for helping out around the house as well.  Developmentally, kids of different ages should be given appropriate tasks.  In previous posts, we’ve discussed the benefits of “heavy work” in growing a healthy body in terms of neuromuscular development.  Here’s an age by age guide to help you assign tasks that are doubly beneficial:  Both for your family and for the emotional/physical growth of your child.  For each age group, they can also do all earlier age group chores.

Ages two to three:

  • Make your bed with heavy blankets
  • Pick up and put away clothes
  • Collect dirty clothes and bring them to the laundry room.  (Can use a bag and drag them)
  • Wipe cabinets/tables/baseboards.

*Note to parents:  Please remember that your toddler, preschooler or school age child will not be doing these chores the way you do them (sometimes not even high schoolers!).  They will not be perfect. Don’t allow that to stop you.  It will always be easier to do it yourself.  But by allowing them to do these things themselves, you are showing them how to contribute, how to be part of a team and nurturing skills which will make them more independent in the future.

Ages four to five:

  • Put dirty dishes in dishwasher
  • Vaccuum or dust buster small carpets moving up to larger ones, then furniture cushions etc.
  • Roll out recycling bin and trash bin
  • Set and clear table
  • Roll out dough
  • Weeding the garden
  • Water plants inside and out
  • Carry their own books to the library

Ages six to eight:

  •  Meal prep assistance
  • Wipe down bathroom counters and tub
  • Sweep
  • Hang laundry on the line with clothespins
  • Rake leaves

Ages nine to eleven:

  • Fully clean tub and shower
  • Plan and make a simple meal
  • Clean out frig and freezer, wipe down and replace
  • Wash, dry and fold clothes
  • Clean toilets

Ages twelve and up:

  • Mow the lawn (older kids can ask neighbors to do theirs if they’d like to earn extra money)
  • Fully clean the bathroom
  • Shovel snow
  • Iron clothes
  • Vaccuum all floors, mop all floors
  • Straighten and organize closets

There are all kinds of chore charts and ways to keep track with a simple internet search.  Playtime is incredibly important, but so is being part of a family who all do things to help out.  Let us know if there are other chore ideas you have, the list is endless!

Jeanne

From my article in kidsmoveandtalk.com
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The Amazing Auditory System

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Like the other senses we have discussed in previous weeks, listening is much more than the simple sense it appears to be.  A sound is made, we hear it.  Right?  But listening is so much more than that.  It involves a subtle and and delicate dance between the organs involved in hearing and the brain.  It influences so many other areas of our responses and even our behavior.  Let’s take a brief tour of your auditory system and how it relates to how we perceive the world around us.

Sound is first received by the outer ear and then funneled into the tympanic membrane which uses vibration to transmit the signal.  After passing through a series of other intricately designed structures, the fluid-filled inner ear receives the signal into the cochlea.  The cochlea then separates the sound into frequencies, which travel on its basilar membrane.  Hair cells, in turn, convert the sound into an electrical signal which go on to the auditory nerve, then the brainstem.  Auditory information is then interpreted by multiple areas of the brain and on to the auditory cortex.  Here is where the magic happens, where the brain interprets the sound.  All of this happens in a split second!

This is when listening happens.  Listening is a more complex process in that it involves your child’s whole brain and their whole body.  It connects them to the world outside themselves.  Listening forms the groundwork for skills your child will need throughout their lives.  It helps them to interact with you, first by gazing in your direction when you speak or sing to them.  It helps them to learn to speak, after they have models of you, your family, friends and even radio or Sesame Street.  It is the basis for reading as well as writing and thus is the root of communication.  Listening, like the other senses, does not occur in isolation.  It needs them to give a whole body orientation to the world.

Listening begins in the womb.  The movement of the mother is felt through the fetus’ receptors and at the same time, they are hearing her heartbeat and breath.  The muffled sounds of her voice and other sounds such as music are linked with movements from dancing, vacuuming and laughter.  The sounds are conducted and “felt” through the fetus’ bones and joints.  Rhythmic sounds and movement are comforting to the developing fetus.  As the baby develops and after they are born, sounds are a constant motivator to move, whether that be by lifting their head to look at a sibling or crawling their way into the kitchen to find you as you make the noises of making dinner.

What you may not know is that listening is also instrumental in keeping us aware of space.  Think about the last time you played hide and seek. While your eyes were closed, weren’t you also listening for where the person went, and therefore where in the space they were hiding?  Listening also plays a part in arousal, or how well we are able to match our alertness to the task at hand.  Recent studies are pointing to listening to music as a helpful background to homework.  Listening, because of it’s close proximity to the vestibular system, is also involved in keeping us focused and able to concentrate.  The auditory and vestibular systems sit next to each other physically in the inner ear, but are also sidekicks in the neurophysiology of interpreting sound and interpreting the 3 dimensions of space that you and your child inhabit every day (Frick, 2009).

Listening has long been known to have survival value.  When you hear a sound like a siren, your brain interprets that sound, and you slow down and look in your rear view mirror.  If you heard a sound like the roar of a tiger, you would seek shelter!  Although your awareness of the process is subcortical, meaning you don’t have to actively think about it or do it, your auditory system is constantly scanning the environment for threats or sounds which may signal attention is needed (Frick, 2009).  This could be your baby crying or a child calling for help.  When your brain receives these sounds, your whole body responds.  You actively look for your child.  Your body jumps up from a chair.  The expression on your face may even change, reflecting your concern.  For your child, it could be the call of a teacher or the phone ringing or the sound of their favorite video game. Listening enables the body to react.

What you can do to encourage listening in your child: 

  • Dance!  Not only is it a great workout for you, it helps to integrate sound and movement experiences.
  • Play hide and seek.  Don’t be afraid to shout hints so they can localize where you are.
  • Keep instructions simple at first.  Sometimes visual instructions can help assist verbal instructions (make a map for a treasure hunt).
  • Play “telephone” with available props.
  • Simon Says.
  • Read books out loud and act out the scenes.
  • Rock your child while using comforting words when they are upset.
  • When you hear a sound, ask them what to do.  For example, “I hear rain, what should we bring so we stay dry?” or “I hear the bus coming.  Are your shoes on?”  or ” I hear your sister.  Where do you think she is?”

Listening, like all the other senses, connects us from within our bodies to the outside world.  It is a source of joy, of connection, of safety and attention.  I hope this serves as a reminder of just how vital the auditory system is, and helps us all appreciate our ears and our brains a little more.

 

 

Listening with the Whole Body:Clinical Concepts and Treatment Guidelines for Therapeutic Listening. Frick, Sheila and Young, Sally.  Vital Links, 2009.

 

 

from an article I wrote for kidsmoveandtalk February 2016
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Self Regulation 101

 Here is an article I wrote for kidsmoveandtalk.com about self regulation:

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Self regulation is the current buzz term in parent and developmental literature.  We’ve all heard of the famous “marshmallow study” where a marshmallow was placed in front of a child by an adult who also told them not to eat it, then left the room.  In the study, the kids who were able to control their impulses (and thereby earn a second treat) were followed up years later and found to have generally done well in life (think: good SAT scores and a lower body mass index).  The marshmallow study, originally done in the early 1960’s by Walter Mischel, has been called into question for it’s methodology, but it is still often quoted and referenced.  Mischel even recently wrote a follow up book about the study.  But the basic principle holds true through years of research: A child who is able to monitor and control their own behavior builds lifelong skills such as persistence in the face of challenge, ability to deal with anxiety and problem solve in an increasingly complicated world.

In a behavioral context,  self regulation refers to the ability to act in a long term context consistent with your deepest values (Psychology Today).  What does this mean for a child who is still developing a moral compass?  Primarily that they value the power of adults and morally want to please them.  It may also mean that they deeply value candy!  In either case, the child shows a resolute decision to forego the immediate pleasure to attain a greater reward.  In an emotional context, self regulation refers to the ability to calm yourself when upset or even keep yourself from getting upset in a the first place when some sort of trigger arises.  Kids do not have the full cognitive ability to self regulate at all times, their brains simply are not developed enough to do so.  Hence, tantrums occur.  Learning self regulation is a lengthy process that occurs throughout development and can still be learned into adulthood.

Developmentally, even newborns turn their heads away from things they perceive as noxious such as, loud noises or bright lights.  By about age 12 to 18 months, children are able to change their behaviors upon request, if not all the time.  They respond to social and verbal cues from their parents such as “blow kisses”. By about age two, if a known caregiver is not present, they are able to transfer these skills with people they don’t know as well.  From age 3 to 11, these skills continue to grow.  Kids are beginning to learn that they need to wait until mom is off the phone until they can receive that snack they want.  Of course, they are still not able to completely resist impulses at this age, as any parent of a young child will attest!

Older kids and adolescents, while better at self regulating than younger children, may still have problems curbing impulses.  As their brains develop, though,  they are better able to know what works for them and what doesn’t (parents also are learning these things about their own children).  For example, a child may decide to go outside and play when they are angry with a sibling simply because they internally know it will distract them from the upsetting incident.  Similarly, an adolescent may use that same intuition to reach out to a friend to help them calm their nerves before a tough test at school.

What might keep a child from being able to comply with requests or calm themselves down?  Many factors as it turns out.  A child who doesn’t want to play with a certain toy is more likely to help put it away.  Other factors such as fatigue or hunger can affect all of us in being able to keep our emotions in check.  Whatever the situation, kids who buy into the request have an easier time complying than those who don’t agree.  For this reason, it’s recommended to give the request a positive spin rather than a negative.  For example, instead of saying, “You can’t have candy for breakfast!’, say, “How about some delicious eggs for breakfast?” It’s always a good idea to help your child see, in as few words as possible, the positive aspects of a given choice.

The following are also great ways to help your child self regulate as they grow from infants to adolescence: (Gillespie, 2006)

  • Observe:  A baby will tell you she’s hungry by fussing or crying.  But an older child is harder to read.  They may come home from school out of sorts.  You may need to help them to regulate themselves by offering a snack or sitting down to talk with them.  You can also help identify their personal triggers such as crowded spaces or noisy areas.
  • Respond:  Be aware of your child’s particular needs.  Do they need some time and space?  Or do they need tighter routines and order? In the above example, a child may need to move their body to help them reorganize themselves after a busy day or a fight with a friend.
  • Provide structure and predictability:  Let your child know if things may change.  Give them an idea of what’s happening that day or week.  Keep a family calendar.
  • Keep it developmentally appropriate:  You can’t expect a toddler to sit quietly in a waiting room for half an hour.  Bring toys or games to keep them occupied.  For older kids, ask them if they need some space.  Let them know you are there when they need you.
  • Set age appropriate limits:  For younger kids, for example, they need to stay in line so the teacher knows where they are. Explain why teachers have the expectations that they do.  For older kids, develop contracts or agreements to let them know you respect their safety and their space.
  • Show empathy and caring:  For all kids, no matter their age, it’s vitally important that we as parents respect their needs and treat them as people of value.  In the long run, this is what helps them handle strong emotions.
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