Sunday, October 24, 2010

How to Choose a Halloween Costume for a Child with Autism |

Choosing the "just right" costume can make or break the Halloween holiday for children, especially children with sensory processing disorder (SPD) or an autism spectrum disorder (ASD). Here are some suggestions on choosing a costume:

How to Choose a Halloween Costume for a Child with Autism |

A Halloween costume could be new with some of the considerations listed in the link above, or it could be something the child wears often such as a sports team uniform or "dress-up" play clothes. I would love to hear what worked for your child as a Halloween costume and what made it so successful!

Tuesday, October 19, 2010

Free Downloads on Sensory Processing Disorder

Since October is Sensory Awareness Month, I thought that I would share an awesome resource which is a link to free downloads on sensory processing disorder (SPD):

SPD free downloads

Let's do all we can this month to make more people aware of the symptoms of SPD! One easy way to do that is to share handouts that are written in simple and precise language. More people are likely to read a one to two page handout than a long book. Go ahead, print some of these handouts off and pass them around to teachers, friends, parents, caregivers, and anyone else that could benefit from the information.

Friday, October 15, 2010

Nutritional Guidelines for Toddlers - iVillage

Today I went to a 6 hour workshop on the topic of nutrition. The speaker presented on how important good nutrition is for exercise and muscle building. So, nutrition is on my mind! Since tomorrow is my assigned day to take snacks for my daughter's soccer team after the game, I couldn't help but analyze what snack would be the best post-exercise snack as I was listening to the speaker. I decided to bring G2 (Gatorade) and granola snacks. Getting carbohydrates, proteins, and hydration within 30 minutes of a work-out or sport activity is very important, as well as drinking fluid every 10-15 minutes during the activity. It's a good thing this soccer club blows the whistle in 10-15 minute increments for mandatory water breaks!

Good nutrition is not only important for active children participating in sports, but it is important just for normal growth and development. Many of the clients I work with need more calories than what is expected of their peers with no medical problems. This might be because of cardiac problems, prematurity, spasticity of the muscles, mitochondrial disorders, or various diagnoses that tend to burn calories at a higher rate than is normal. So even though this link I'm including is nutritional guidelines for typically deveoping toddlers, the information gives a baseline of what is necessary:

Nutritional Guidelines for Toddlers - iVillage

Many of the kids I work with are blessed enough to be seen by our dietician, but unfortunately not every facility has a dietician. So, I hope the information in the above-mentioned link is helpful to those who don't have access to a dietician or nutritionist who specializes in pediatrics. If the child you are concerned about (may be your child or a client) does not have a dietician or nutritionist because there are none in your area, it might be worth the drive and money to a facility in a nearby town (or even a far away town!), even if it is just once every month or two.

Wednesday, October 13, 2010

Children's Hemiplegia and Stroke Association

Many children have hemiplegia due to cerebral palsy, a stroke, or any other injury to the brain. Hemiplegia is when one side of the body has abnormal muscle tone and tightness due to a brain injury or stroke on the opposite side of the brain. In comparison, hemiparesis is when the person has muscle weakness and "floppy" tone (AKA flaccidity) due to the same reason. This means if the person has a stroke on the left side of the brain, then the right side of the body will be effected. The person loses not only muscle strength, mobility of the joints, and coordination but also sensation. When a person doesn't have full sensation in a limb, then they tend to not use it. For adults with this problem if they have normal cognitive skills, they can force themselves to use the arm and leg on the involved side of the body. Also, an older child might be able to do this. But for infants, toddlers, and young children this is not typically the case especially if they had the brain injury in utero and never had typical movement of the involved side of the body. Physical and occupational therapists have strategies they can teach the child and parent to aid in the child using the arm and leg, but sometimes this just doesn't work, because the child wants to use the other side because it is easier to use and it has full sensation.

Some children who have hemiplegia may benefit from constraint Induced Movement Therapy (CIMT) which is the technical word used for "forced use". The following link has links to various articles and research that has been conducted on the effectiveness of this approach with children.

Children's Hemiplegia and Stroke Association

I had a co-worker about 6 years ago who was conducting her thesis on CIMT. She set up a summer CIMT camp at the clinic we worked at in which several school-age children with hemiplegia participated. They had their non-involved arm casted so that they weren't tempted to use it. This "forced" them to use their involved arm which was hypothesized to build strength, coordination, and sensation. Certain criteria had to be met just to participate, because if the child had too much spasticity or other problems then CIMT wasn't going to be able to help. CIMT is not for children who can't use the arm at all (complete paralysis); there has to be at least some movement.

The end results of the project were good. Although every child made progress, I am not sure that any of them achieved completely "normal" use of the involved arm, but I do know they all continued to receive weekly OT and PT to build upon the progress that was made over the summer.

I have not ever used CIMT with the toddlers that I work with at early intervention (ECI), because I think they would just be frustrated and confused. Maybe a child in preschool or early elementary age would better understand the purpose of CIMT and not get so frustrated. However, I do "hold" the involved arm down for an activity as well as place toys to that side of them so they are more likely to use the involved hand instead of ignore it. Other techniques I use with young children with hemiplegia or hemiparesis include: NDT handling, bimanual activities, electrical stimulation, dynamic and static splinting/orthotics, kinesiotaping, adaptive equipment, infant massage, and sensory integration therapy. My favorite dynamic splint for infants is the Joe Cool (TM) splint, but they tend to not be as effective with the toddlers because they have figured out how to unstrap the velcro! The most important thing in helping infants and toddlers with hemiplegia/hemiparesis is teaching simple therapy techniques to the caregivers and parents because they are the ones who are primarily with the child all day long. For some of my kids who attend daycare in large classrooms and have parents who work long hours, the techniques asked of the caregiver might be simple such as making sure the child wears his hand splint during table-top and "centers" activities. I also suggest that at snack and lunch time that food and drinks be placed to the center and each side of the child to increase the chance that he may use his more involved hand; if the food and drinks are placed only on the non-involved side, then the child is not likely to use the hand that needs to get stronger. These are simple and do-able suggestions! If I give complicated strategies, the caregivers are not likely to have the time to perform them.

Sunday, October 10, 2010

Turning Everyday Items Into Therapy Tools

This week has been one of those weeks that just flew right by: doctor visits, allergy shots, soccer practice and game, birthday party for my daughter (7th), work, and all of the normal things that happen in a week! So, I was just realizing that I haven't blogged since last week. I couldn't even think of anything interesting to blog about not that nothing interesting happened, but because it was such a busy week that everything that happened work-wise seems so long ago. It was about that time that I started the last load of laundry and realized what I should write about: laundry baskets and other everyday items. "Laundry baskets" are not ordinally the most interesting topic, but I'm going to discuss how they can be used as a therapy tool to help children with meeting their developmental milestones.

Laundry baskets:
1. When inverted they are an excellent item for children to push around the room. If the child can stand but not yet walk, this is especially a great activity because of their wide base of support the child gets lots of stability. For those children who can already walk and need upper body strengthening, pushing the basket across carpet can give some extra resistance.

2. Have the child sit in the laundry basket and take him/her for a ride. For children with a language delay, you can encourage them to say/sign "more" or "stop" as you push them across the floor. For children who need to work on social engagement, have another child push the basket and then they can switch rider-pusher in order to work on turn-taking and talking to a peer.

3. Have the child sit in the laundry basket as the basket is on an adult's lap. The adult can tilt, bounce, or rock the basket for vestibular input to work on balance/equilibrium skills.

1. Magic Carpet Ride: Have the child lay on a blanket as you grab one end of it and run across the floor. This is a perfect opportunity for the child to say he wants to go slower, faster, more, or "all done" with words or sign language. It can also be a turn-taking activity if there is another child; the child pulling is getting lots of proprioceptive input whereas the child who is lying down gets vestibular input.

2.Hot dog: Have the child roll up in the blanket as if he is the weiner and pretend that the blanket is a bun. Then, give the child deep pressure as you pretend to put different condiments on the "hot dog". Give joint compressions to the feet as you "shake on salt and pepper".

3. For infants and toddlers (or light-weight preschoolers), a blanket can be used as a swing. Two adults can each grab an end as the child lays in the center. They can bounce the blanket up and down or rock it side-to-side. The child can have his body perpendicular to the adults and then switch to being parallel to the adults in order to give input to different receptors of the vestibular system.

Large Bowls:
1. When inverted, they make wonderful drums! If you have plastic or wooden spoons, those make great drumsticks. But if you only have a bowl, the child can bang it with his hands as if it is a bongo drum.

2.Put a ping pong ball in a large bowl, then move the bowl in a circular direction (clock-wise). Stop, then move the bowl in the opposite direction (counter clock-wise). This is a great activity for eye tracking in a circular direction. For children with low vision or poor attention span, use contrasting colors such as a black bowl with a white ball. For eye-hand coordination, the child can try to stop it with his hands and grab it.

3. Have the child jump over the bowl pretending it is a "candlestick" while you repeat: Jack be nimble, Jack be quick, Jack jumped over the candlestick!

1. Wad a pair of socks up to the size of a bean bag and use them for bean bag toss at a target such as a bowl, box, or any other item around the home. If you bounce them off of an exercise ball or mini-trampoline, they will go flying across the room...usually guaranteed to make the child laugh!

2. Empty a clean load of laundry out onto the bed or other clean surface and have the child sort the socks by color and/or design. This is great for oculomotor skills and the visual perceptual skills of figure ground, visual memory, visual discrimination, and form constancy, especially if there are other items in the pile besides just socks.

3. Put potatoes or other items similar in weight within larger socks and use them as weights for the lap or over the shoulder; good for proprioception and/or muscle strengthening.

There are SO many more everyday items that can be used therapeutically. What are your favorite activities to do with household items? I would love to hear your ideas!

Sunday, October 3, 2010

October is National Sensory Awareness Month

I have been happily surprised lately while talking to some of the staff at daycares and Mother's Day Out (MDO) programs where I work with some children for occupational therapy services. They ACTUALLY have heard about sensory processing disorder (SPD)...yeah, it is not a foreign concept to them! At one MDO program I was at last month, the teacher even asked me if I thought she should refer another child for an OT evaluation due to him possibly having sensory processing problems. Now before you get overly elated that the OTs in our community have done the most amazing job ever, I have to let you know that this woman has a nephew with Asperger's and SPD. But still, it was exciting to have her initiate the topic.

I live in a suburban area outside of a large city with a school district that is well known for its great support of children with special needs. In fact, there is a special program just for children with Autism Spectrum Disorders. You know what that means don't you? It means we have people moving into our district at increasing rates each year. It also means that many community members are more aware of learning disorders and other special needs than in some of the other places. Many of the preschools/MDO programs, daycares, and babysitter organizations go out of their way to be inserviced on learning problems and in particular SPD. Now, I am not going to go so far as to say us OTs and special education/ early intervention staff have done everything we can do to educate our community. Of course we haven't! Everyone can always do more.

If you would like some ideas on how to raise awareness of sensory issues in your community, go to this link that provides contact information for a free electronic packet full of ideas to help you:

S. I. Focus

Since October is National Sensory Awareness Month, I will be doing a little extra educating on the topic. I've already done a 90 minute presentation to the new staff at my job last week, and I plan to do something at least once a week this month to bring awareness to SPD.

I do public speaking quite a bit on various therapy related topics including SPD. One thing that I have learned is to keep it simple when explaining SPD to people who have never heard of it, but don't over-simplify it either. If you plan to go out in the community and speak to groups about SPD, then make sure you know your audience. A group of doctors may not need the same explanation as a group of elementary school teachers. Doctors tend to want to know about "proof" through research whereas teachers like to know the functional implications and simple strategies to help the children.

Good luck with spreading the word about Sensory Processing Disorder!

Friday, October 1, 2010

Occupational Therapy for Feeding Skills During Family Mealtime

I have a lot of therapy strategies up my sleeve when it comes to pediatric feeding disorders. Some of them include fancy positioning equipment, oral-motor devices, stretches, and textured teething toys. Some of my strategies even require that I become "certified" just to use them. Yet, the most effective strategy that I have found so far is to show up during family meal or snack time for children and during a scheduled bottle feeding for infants. It sounds SO simple, but it works!

For many of the children I work with they can perform a certain skill such as munching a soft diced vegetable if I was to give them just a couple of pieces in between some mouth exercises at a time in which they were not even hungry. They might even be able to hold a spoon if we practiced scooping up toys out of a sand box while we are playing in their room. But that doesn't mean they have the muscular endurance and sensory processing abilities to chew three different foods on the plate while using utensils to feed themselves. It is hard for many children with feeding disorders to handle more than one food due to the various flavors, temperatures, resistances, and textures. Additionally, they may be able to chew the food, swallow the drink, and manipulate the cup and utensils when sitting alone, but can't handle it when there are more people present. Why is that? Well, every child may have a different reason, and I am not going to know "why" unless I directly observe the meal within the natural setting: family meal time. If that isn't possible, then I observe snack time.

What does family meal time look like? It is different for everyone. I tell the families to set everything up as if I wasn't there. The meal may occur in front of the TV on the couch with one of the three siblings next to the child I am working with or it may occur at the dining room table with every household member present. I just want to see what naturally occurs during the meal time routine...there is no right or wrong. For some children they may not be able to participate in family meal time because of the noise level. For others it might be that they are sitting too close to a sibling that keeps inadvertently touching them. Even after I observe family meal time, I may still not know why the child is having difficulty with eating. That is when I watch the child eat a variety of foods while he is alone. If I figure it out, then we may work on specific skills separate from meal time, but even then the intention is to include the child in family meal time. Some children may need some 1:1 work with oral motor exercises, fine motor play, a "sensory diet", and other strategies immediately prior to family meal.

For those kids who can't handle eating with their family, maybe they could at least sit and socialize or just "be" there, even if they have to eat before or after everyone else. Just "being" with everyone else at the table might be the only way a medically-involved or tube-fed child can participate, and that is okay.

It breaks my heart when I find out that the child with the feeding disorder is not included in any form or fashion just because he has a feeding disorder. If the child's sensory processing abilities don't allow him to be with the rest of the family, then maybe he could help with meal preparation or setting the table.

For babies with feeding disorders, I show up for occupational therapy at one of their scheduled feedings and watch the parent (or caregiver) feed the child. I offer suggestions if needed. I may follow up with stretches and ideas for pacing, positioning, burping, and nipple/bottle changes. If the child is having alot of problems, then I may feed the child. But the problem with that is that babies that are oral feeders get usually 6-8 bottles a day and I am not going to be present for all of those feedings! So, the natural routine of the meal is going to be the adult holding the baby (or placing them in a device) while feeding him. Sometimes I do the first half of the feeding process for training purposes, and then after the baby has burped I will have the parent try to do the same things I did. After all, feeding your baby is the most basic thing that every parent wants to do successfully!

I guess my biggest "take home point" from this blog entry today is try to work with the child within the natural routines. If the strategies given to the family aren't meaningful to them and feel like extra work, then they will not work on them between the therapy visits. On the other hand, if the strategies are purposeful and occur within routines they already have, then the family is more likely to use the therapist's ideas.