Friday, October 23, 2009

Abnormal Muscle Tone: Functional versus "Pretty"

When children have abnormal muscle tone such as tight muscles (spasticity) or tremor-like motions (ataxia), then the motions that they make may not exactly look pretty. This is because there is damage somewhere within the neuromuscular system whether it be in the brain such as with cerebral palsy or at the cellular level of the muscles such as with muscular dystrophy.

Back when I had just graduated from therapy school, I went to numerous classes on learning how to improve a patient's muscle strength, tone, and movement patterns. It was my mission to help everyone look typical. That was soon found to not be so realistic. And although a difference can be made with mildly involved persons in a fairly short time, it may take a while for very involved patients such as those who have suffered a TBI- tramautic brain injury. This is because of numerous reasons (medical, neurological, orthopedic, cognitive, behavioral, etc.). So, until their movements look stronger what are we to do? Well, I believe the therapist's duty is to work on functional skills.

For example, I would love for a child with cerebral palsy to hold the spoon perfectly and not spill any food, but that may not be realistic in the short term...for some kids, it may never be realistic. The immediate goal should not be to not let the child feed himself unless he has used the "proper" movement patterns, but instead to make sure the child is functional, even if that means that the movements do not look "pretty". It may mean using a wide handled, curved, or swivel spoon. Although the ultimate goal as a therapist is for the most efficient movement patterns by each muscle group during a functional task, this can take time to develop, and requires daily strengthening. Maybe it can be practiced during snack or at the end of a meal, but it would only frustrate a child to be helping them move "properly" during every single bite. Yet, as a therapist why is it so hard for me to just sit back and watch a sloppy eater? I have had to chill out and realize that I am being a much better therapist by encouraging independence even if the movements aren't the prettiest.

Also, responsibility goes to the parents for carrying out daily activities and exercises to help the child improve. I wouldn't just go to the gym once a week and expect to gain a better figure, so how could we expect that a child with neurological damage is going to improve with tone and strength by only going to therapy once or twice a week? The therapist MUST train the parents to do easy activities and exercises to incorportate into daily routines. Examples include having the child push the siblings stroller to build arm and leg strength, buy toys that encourage manipualtion, carrying grocery bags, "rough house" with parents, taking the child to the park to work on climbing, sliding, and swinging, and the list goes on.

Finally, we as therapists need to know when it is time to discharge a patient from services and guide them to community facilities such as karate or gymnastic lessons. There are some children who have endured years of therapy at a high frequency and although overall they have made gains, there comes a time when those gains aren't so drastic. It could be due to hormones, growth, attitude, needing a change, or that there is just an extreme amount of neurological damage. No matter the reason, I completely believe that it is okay to discharge a child from therapy even if all of his movement patterns are not "pretty". Now, if the child is willing to do all of the work it takes to get stronger and change movement patterns, then I might keep them in therapy longer. But I would still emphasize function. If the child wants to be an artist, then we would work on movements that are made at an easel. If the child wants to be a secretary, then we would work on typing skills whether it be with two hands on a typical keyboard or with a device on an adapted keyboard. I would also work on movement patterns needed to play, cook, clean, dance, or participate in sports.

Sunday, October 18, 2009

Repetition of Simple Words When Learning Language

Yesterday at the grocery store my 16-month old son told every employee and other customers"Hi" no less than 100 times! It would have been slightly annoying after the 75th time if I didn't work with young kids with developmental delays. So, instead of rolling my eyes, I chose to smile and be glad he is wanting to talk to others. He has about 10 words that he uses, some on a daily basis and others at least every few days. But each word was used repetitiously in the beginning. Like the word "banana"; when at the store about 2 months ago, he said "nana" over and over throughout the whole grocery store visit as he pointed to the bananas I had placed in the cart. Now, he only says "nana" when he sees the fruit bowl in our kitchen or when he actually wants to eat one. Typically, kids do this. Kids with disabilities or delays, may only use a word intermittently or say it a couple of times, and not say it again for a few weeks.

During therapy with young children with delays as well as with my interactions with my own son, I purposefully keep my sentences simple and repetitious. When rolling the ball back and forth to a child, I may say the word "ball" 20 times or more. I also pause to let the child have a chance to say it or go after it if it rolled away. This is important because the brain may take multiple times to make that connection that the sound of "ball" matches the actual object. So, then next time the child wants to play ball, they just have to say it. Some kids with disabilities may use sign language or pictures instead of words, but even then, they need repetition of those approaches too. Also, if I start the activity out the next time by saying "Get the ball",...pause..."ball", I hope that the child goes to retrieve it. If not, then I help them go get it, and hope that the next time the child will remember what a ball is.

In addition to repeating the words multiple times, the other big thing to remember is keep the sentences simple. I don't have to describe every detail of an activity especially since the child doesn't understand all of those words. That also increases the chance that the child will tune me out. But if I keep is short, I am more likely to gain the child's attention.

Sunday, October 11, 2009

Knowing When Your Toddler Is Ready To Get Potty Trained

It sure is frustrating to try to potty train a toddler before he or she is ready. Knowing When Your Toddler Is Ready To Get Potty Trained gives you tips to know if your little one is ready. Often, special needs children are late with potty training due to weak muscles, delayed language, or medical complications; this is not always the case, as I once had an 18 month old client with mild cerebral palsy be successfully potty trained. As suggested, kids need some form of communication, but not necessarily words. I have worked with many kids with autism who indicate the need to go potty with pictures or sign language. So, don't assume that your special needs toddler may not be ahead of his peers with this skill!

Keeping Your Baby Happy While Shopping

I wrote this article for hub pages and give quite a few survival tips for Keeping Your Baby Happy While Shopping

Saturday, October 10, 2009

Helping Special Needs Kids Minimize the Risk of Contracting the Seasonal Flu & Swine Flu

Even though the swine flu is two words, these days it is as if it were a dirty four-letter word. If you have it or have had it, you know that people treat you as if you have the plague. Now, for you and I or people who are otherwise healthy, we are probably fine to catch it. But not so for many special needs kids especially those who are medically fragile or who have not-so-great immune systems. Knock on wood, I have had patients and relatives come down with it and even cough on my face as they were ill, and I still haven't caught it. Sure am glad I take my multi-vitamin and probiotics daily! Now, as sure as I type this I will start coughing and get body aches with a high fever, but I do think there are ways to minimize the chance that you catch it. Notice I said minimize, not a guarantee of not getting either kind of flu. I am not going to tell you anything awe inspiring that anyone else hasn't said: wash your hands many times throughout the day and after contact with a suspected or confirmed infected person, cover your mouth when you sneeze or cough, take your vitamins, eat healthy foods rich in vitamin C and anti-oxidants, etc, etc, etc.

But how can we minimize the risk of a kid with special needs getting either the swine flu or seasonal flu? Well, if you are a parent of a special needs child who is homebound, change clothes after coming home from work or the community, wash hands thoroughly with soap and water for at least 15 seconds, keep the house clean, and STAY away from hugging, kissing, or touching saliva if you have a fever, headache, body aches or any other symptoms. Doesn't this sound like common sense. You would think! But so many of us are so focused on caring for the children that we ignore a fever or body aches.

For children who aren't homebound, teach them to not lick/mouth on non-food items such as toys, because if they touch a toy after a sick child at preschool, church, or elsewhere has touched it, then "WHAMMO", the virus has a chance to attack the mouth! Teach the child to wash hands regularly or for the caregiver to remind and help the child wash hands. If you can avoid places with a bunch of children such as fast-food playgrounds, that might be smart to avoid during flu season. If you must go to those places, go at a slower time such as during the week as opposed to the weekend.

Getting the flu shot may be beneficial for some kids, but not an option for others. This may be due to allergic reactions to eggs or other vaccine ingredients. My children are allergic to eggs, so I can't really do much about that except to make sure they get lots of rest, water, fruits, and vegetables as well as supplements. This may help the immune system fight a potential invading virus. But if doing those things doesn't help your child, take him or her to the doctor at the first sign of the flu so Tamiflu (R) or other medications can be given if the doctor deems it necessary.

Wednesday, October 7, 2009

Take Time for Your Young Kids- Don't Be In Such A Hurry

My friends and relatives say that I am a high energy person. I have to agree, because I like to do things fast. I can clean the dishes, laundry, and other parts of the house in light speed. My paperwork is always (unless I am ill) turned in on time at work. I can blog, cook supper, and talk on the phone simulataneously. So, it does not come natural for me to "stop and smell the roses" with my two children; somehow, usually I do slow down for them. If I weren't an OT with lots of training in child development, I probably wouldn't slow down for them. Especially in this day and age of cell phones, internet, video games, etc.

It is during the everyday routines and activities that young kids are learning from their parents, caregivers, and the environment. This might mean a slow-paced walk in your backyard as your toddler points to the flowers and birds, or throws trash away. What a great opportunity for language development! It might also mean that the trip up the staircase takes 5 minutes as your little one stops to talk, sing, or go up-down-up-down. What a great opportunity for gross-motor development. Even though it might seem cumbersome to let them go at such a pace, it is at this time that they are learning. I am glad my kids don't move around as quick as I do, because I think that kids subjected to this think they always have to be doing something. That would leave little time for reading, "free play", naps, imaginative play in the child's bedroom, etc. It makes me sad when I see families out and about running errands, sports activities, or other things late at night when they have been going at that pace all day long for most of the week; one or two days a night is fine, but not every night like this! Not good for the kids, and not good for the adults. Our bodies need time to rest and relax. Many kids who live fast-paced lives think they have to be constantly entertained. Once again, not good. I think this contributes to impulsivity, inattentiveness, and hyper-activity.

Many times a child with a developmental delay can improve during everyday activities, that is if the families just take that opportunity. For example, not being in a rush in the morning, means that the child can help put his shirt and shoes on. If the family is in a rush, usually the child has clothing put on him and he doesn't have to help at all.

Think about how this information could impact your family routines. Could you let the kids help you prepare supper at home instead of preparing everything yourself or eating out at a fast-food place? Could you let the kids help you with the trash, laundry, or other chores? These activities help with problem-solving, motor, and language skills. I plan this weekend to make a huge fruit salad for the extended family. I could hurry up and do it myself, but I am choosing to let my daughter help me. It's a great time for me to have her use a measuring cup, stir, and count food pieces. And I have no doubt that when we serve it to our family members, she will have a huge smile on her face and be more than willing to tell them she made it!

Tuesday, October 6, 2009

The Most Common Infant Disablities and How to Recognize Them

I wrote this article on hubpages and I hope parents who are searching for some answers and resources find it useful: The Most Common Infant Disablities and How to Recognize Them

Egg Allergy in Young Kids

I could write a book on food allergies, but I won't. I will just stick to small articles and blogs. Both of my kids, several relatives, and many clients suffer from food allergies. This is a topic I wasn't too familiar with 6 years ago, but "wow" has 6 years changed what I know. I have given the long details in a previous blog how both of my children began having food allergies as small infants. I breastfed and refrained from eating what they were allergic to. There was limited choices of formula, only elemental (Elecare (R) and Neocate (R)); they were expensive, and I knew that breastfeeding was the best choice. So, if I had to eliminate these foods from my diet, you can imagine how much investigating I had to do initially. Now, I have so many recipes and know what can and can't be cooked.

Living with egg allergies means no flu shots or yellow fever vaccine (if severe allergy, no MMR shot), certain desserts are eliminated, and no country breaskfasts being served. My daughter's egg allergy used to be so bad that we couldn't even cook them in our home because her eyes would swell up just from the aroma. Now, she is still allergic but not as bad. Living with egg allergies also means that my kids aren't going to eat cake at another child's birthday party. I plan ahead and make a "special" cake. I use cake mixes that are egg, dairy, & nut free and sometimes also use the ones that are gluten free. Actually, the vanilla flavor ones are not too bad, whereas the chocolate ones require acquiring a taste for it; I spit out the chocolate cake the first time I bit into it 5 years ago at her 1st birthday party. Now, I can swallow it but am not gung-ho about it. So, I just usually buy the vanilla flavor that tastes similar to muffin mix. If your child only suffers from egg allergies and not others, you can most likely buy a regular cake mix and just use a substitute. Eggs are the binder, liquid, and leavening agent of the recipe, so the substitute needs to have those qualities. One suitable substitute is flax seed oil. Another is using 1 tbs of vinegar with 1 1/2 tsp of baking soda (or 2 tsp baking powder, but make sure it is egg-free) in place of one egg. Some of the nutrients found in eggs can also be found in meat, fish, poultry, legumes, grains, vegetables, and hemp products. I give both of my children various vitamins, probiotics, and cod liver oil everyday so they can get the nutrients they are missing out on because of food allergies. They also drink a hemp beverage which also contains calcium.

Living with egg allergies is manageable once you know what you can and can't eat. I teach both of my children to never take food from someone else and ask "Did my mommy say I can have that?". I drilled the staff at my daughter's preschool about only letting her eat from her lunch. It meant at holiday parties she didn't eat what everyone else ate, but "oh well", I just brought her "special" snacks. My son is too young to understand, but I am working on teaching him too. Any babysitter or relative that takes care of my kids knows not to vere from what I asked them to feed my children. Sometimes the person didn't listen which meant a dose of benadryl or a shot of epinephrine. But we have survived. Once you get a grip on what the child can have, you realize there are actually a lot of good foods and recipes out there. But it also means less trips to fast-food joints or restaurants; you never know if foods with eggs were cooked on the grill or oil vat, which means cross-contamination. One good source on food allergies is

My daughter is supposed to go to the allergist this week and get retested. She gets re-tested once a year, and has already grown out of nut and soy allergies. Cross your fingers for us that she grows out of the remainder of the food allergies including eggs!