Baby Occupational Therapy Assessments – Never Too Early!

People are often surprised that I work with babies. They wonder whether it’s too early, do all babies just develop at their own pace, or how does one work with a baby.

Fortunately we now know a lot about early intervention and milestones tell us about a child’s development. Early detection and early intervention can minimize or in some cases, eliminate issues that arise. I know this both professionally and personally as a mum to a 15-month old who has thrived due to having early intervention support from his very early days.

As they say, babies mostly sleep, eat, poop and I add, move. 🙂 If any of these baby ‘occupations’ are a challenge, occupational therapy may help.

What’s involved in an Occupational Therapy Assessment with Babies? 

Generally for infants, this is what I look at in an assessment:

  • Sensory processing skills – alertness, activity level, response to touch and movement, internal body and spatial awareness for motor skills, visual and auditory processing, motor planning and problem-solving skills
  • Gross motor skills – head control, shoulder and pelvic stability, core strength, respiratory muscles activation, arm and leg movements, and transitional movements (how the baby moves in and out of positions)
  • Fine motor skills – reach, grasp, release, object manipulation, two-handed play, eye-hand coordination, how the child moves and plays with their hands at the same time
  • Social-emotional skills – how the baby calms, self-soothes, copes with multi-sensory input and either everyday or novel experiences, relates to and interacts with familiar or new people
  • Neuromuscular development – muscle tone, strength and coordination, body alignment and movement patterns, are there any asymmetries, positioning and posture in seats and equipment at home and whether modifications are required
  • Oral sensory and motor skills particularly related to feeding and daily hygiene skills

Based on the assessment findings, we do different exercises to address areas of need. I show parents various carrying techniques, positioning and therapeutic handling strategies to develop sensory and motor skills, as well as ideas of how to address sensory, emotional, motor and play skills for the baby’s age. Parents are given a home program of exercises to complete with their baby and we address skills during therapy sessions.

Prior to the assessment, I ask parents to send me information regarding the child’s birth and medical history, services to date, general concerns, any medical reports, and a completed questionnaire. I also love to see photos of the baby in various positions to help me get to know the baby and plan for the session accordingly.

If parents are concerned about their babies’ development, I suggest do not wait and see, early intervention is critical, and better to address areas of need now versus waiting till the child is older and struggling in school.

 

 

Intensive Treatment Blocks

Why we provide an intensive model of treatment at ot4kids, London? 

Traditionally, Occupational therapists treat children 1-2 times per week, oftentimes for years.  We prefer to provide intensive blocks of treatment for children receiving OT.

Research from the SPD Foundation indicates that children actually benefit more from intensive blocks of treatment.  This is the chosen model of treatment at Lucy Miller’s STAR centre in Denver, Colorado.  I am a huge FAN of this model.

Since 2011, I have also been providing intensive blocks of OT treatment sessions followed by a break, and then another intensive block.  The frequency of the intensives vary based on the individual child and family’s situation, however they can for example run from 2-4 times per week over a 3-5 week period.  Children then have a break for 4-8 weeks followed by another intensive block of treatment.  In time, the breaks tend to be longer and longer.  The break is a fantastic time for children’s to solidify their new skills and integrate them into daily life.  During this break, kids often participate in their favourite activities whether it is going to the park, swimming, horseback riding, learning to ride a bike, cooking or having play dates.

Benefits of intensive blocks of OT treatment:

Personally, this model of treatment has been beneficial in my clinic for many reasons:

  • Due to the plasticity of the child’s brain, kids are making faster progress and skills are integrating better
  • For school aged children, intensive blocks can take place during holidays and half-term breaks
  • Families from out-of-town or overseas can access services
  • Parents find it encouraging that they can do other fun activities with their kids during the breaks and continue to see progress
  • Less burn-out from therapy and kids are excited to come to OT

OCCUPATIONAL THERAPY ASSESSMENT – What’s it all about?

Parents often wonder what’s involved in an occupational therapy assessment?  This really varies amongst Occupational Therapists based on our experience and interests, what the parents want  the child’s individual needs.  In my practice, this is how it generally goes.

 

PHONE CALL:

Initially, parents call and we have a phone conversation where they tell me about their child, their concerns and reason for an occupational therapy assessment. I prefer to talk about any sensitive topics during this time versus discuss in front of children, particularly older kids.  We then determine whether or not an assessment is necessary.

 

INFORMATION AND DATA COLLECTION:

Next, I send parents information regarding scheduling, what the assessment entails, and any questionnaires to complete. For children who are in school or have other therapists and support team members, I attempt to get as much baseline information I can prior to the assessment such as:

Birth history and medical history

Report cards

Drawings or handwriting samples

Photos of younger children in various positions to give me an idea of their motor skills

Reports from other therapists including educational psychologists, consultants, and speech therapists.

Completed questionnaires or sensory profiles by parents and school.

 

ASSESSMENT:

The actual assessment varies based on each child and their needs. No two children are alike.

For the first part of the assessment, I usually chat with the child and parent to get to know each other. During this time, the child often explores the clinic and engages in free play while I make initial observations of how they move, interact, and play. For older children, I ask about their hobbies and interests, how they find school, and what they’d like to do. Both parents and children are involved in this discussion as appropriate.

We then complete formal and informal tasks (standardized testing and clinical observations) to assess the following as it applies to the child:

-*****Child’s STRENGTHS.  This is so important as we will want to continue and encourage these in the child and also, use this to build on areas that need help. We are not trying to change the child but want to embrace them for who they are.

-Sensory processing: tactile processing, body and spatial awareness, balance, motor planning, organizational skills, does the child avoid or seek sensory inputs, how do they play with and figure out new toys

-Gross motor skills (head control, trunk control, body alignment, core strength, movement patterns)

-Shoulder and pelvic girdle stability, joint stability, upper and lower extremity strength and coordination, endurance

-Postural control, bilateral integration, rhythm / timing / coordination of movements

-Fine motor skills (reach, grasp, release, object manipulation, in-hand manipulation, 2-handed use, hand preference / dominance), eye-hand coordination

-Self-help and self-care skills

-Visual motor and perceptual skills, visual processing (eye tracking, motility, convergence / divergence, how both eyes are working together)

-Auditory processing, following directions, attention and focus

-Sensory regulation, how the child transitions, manages multi sensory input, copes with daily challenges and demands, attends and focuses during self- and adult directed tasks.

-Social skills – how the child initiates interactions, joint play / reciprocal interactions, recognizes their own feelings and how to manage them

-Organizational skills and executive functions for child’s age

-Consider adaptations, strategies, sensory supports for home or school

-Provide ideas of useful and meaningful sports, extra curricular activities and games are provided according to the child’s individual needs

 

Throughout the assessment, parents are involved and present. I provide suggestions of exercises and activities to try at home. We will try some exercises and activities together.

 

Summary and recommendations: Towards the end, we review findings of the assessment, prioritize concerns of parent and child, discuss home exercises, and come up with a plan of what to do and how to work together with the child’s home and school team.

Based upon the child and parents, the initial assessment can take from 1-2 hours.

Finding an Occupational Therapist or Health Professional

As a mum of a little guy who has needed some extra help, I know it’s hard finding the right support for your child.  Parents often ask me how to find a good occupational therapist and make sense of their qualifications.  Here are my suggestions from both personal and professional experience:

1)   ****FOLLOW YOUR GUT*****:   You will have a feeling by talking to a therapist whether they are right for you.  Personally, I prefer to talk via phone to potential therapists for my child versus emailing or texting as it has given me a good feel for them.  Also, by watching my child interact with the therapist and see how comfortable they are, I just know! 🙂

2)  BASIC REGISTRATION:

In the UK, occupational therapists must be registered with the Health Professions Council.

In the US, occupational therapists are registered with the National Board for Certification in Occupational Therapy.

3)    ADVANCED CERTIFICATIONS:

Pediatric occupational therapists can go for many higher level intense accreditations based on their special interests.  Personally, my treatments and assessments became much more thorough and effective after undergoing these certifications, resulting in faster progress.  Two main certifications to look for are:

-Sensory Integration – In the UK, there are a series of four courses offered through the Sensory Integration Network.  In the US, these courses may be offered by either Western Psychological Services or Sensory Integration International.  Have a look here to learn more.   It can take years to complete the coursework and all the requirements to pass and become certified in Sensory Integration.

-NDT (Neuro-Developmental Treatment) Certification also known as Bobath Approach.  This is an 8-week course for children with Cerebral Palsy or any motor impairment.  For me, the course was a labour of love & rather intensive.  Therapists often make some sort of life compromise to complete the certification such as temporarily moving to the town where the course is being held, or leaving their families for long periods of time.  For therapists who are NDT certified in the US, this requires a continuous process of updating information via ongoing continuing education and professional development.  You can learn more here

Personally, I moved to Chicago to complete my coursework and had a brilliant time exploring the city and enjoying stuffed pizza whilst studying during every other spare moment. 🙂

– NDTA Advanced Baby Course – 2 to 3 weeks – This certificate course can only be taken after the 8-week course above and is an add-on to specialize further into baby treatment.  I took mine in what felt like the boonies, Allentown PA, however it was completely worthwhile to have spent this time with baby guru, Lois Bly.

4)    CONTINUING PROFESSIONAL DEVELOPMENT – I would look to see that the therapist takes ongoing continuing education courses in a variety of areas.  I list most of my CPD on my ‘About Me’ section under CV for others to see how I stay current.

5)    EXPERIENCE:  What’s their experience?  How long?  Where?  What population do they work with?

6)    SPECIAL INTERESTS:   Do their special interests relate to your child’s needs?  E.G. Baby treatment, pediatrics, splinting, kinesio taping, seating and wheelchairs, assistive technology, home modifications, oral motor / feeding therapy, listening therapies, yoga, brain gym and so much more.

7)  LISTENS TO YOU:  I find it encouraging when our team members listen to and involve us.  After all, parents know their child best.

8)  CREATIVITY:  Fancy clinic equipment is great however I have seen great therapists do so much while working in a shoebox or with very little.  Creativity goes a long way.

9)  COST – Personally, I have found it so worthwhile to have fewer sessions with a more skilled therapist versus more sessions with less skilled ones.  It’s important to look at the therapist’s credentials, approach and personality to find a good fit.

 

Holiday Presents

When I moved from NYC to London, half my boxes must have been full of toys and books!  Whenever I see a new toy shop I must see what’s inside. Usually, I love the old classic toys mostly in thrift shops or on eBay now.

Occupational therapists love toys, activity analysis, figuring out what skills toys are working on, or how to adapt them to suit a child’s individual sesorimotor needs while offering just the right challenge.  We also love finding interesting ways to use these games such as via an obstacle course, combined with therapy ball exercises, or from various gross motor positions. Talk to your OT to learn how best to adapt games to address your child’s goals.

I often use games from my childhood. 🙂 How many of you remember playing thumb war, French skipping, throwing balls against the wall, playing Jax, or making cootie catchers and cats cradle.

For birthdays and holidays, parents will often ask me for gift ideas that will address their child’s areas of need and that they will find fun. I love doing this. It’s like making a secret special super wish list for the child.

I have now created an Amazon store open to everybody.  Toys and equipment are broken down by age group into the following categories with my anecdotes:

Sensory Processing
Gross Motor
Motor Planning
Fine Motor
Visual Motor and Perceptual
Prewriting

I receive a little something should you buy from my store.  All proceeds will be used for charity or therapy toys for those in need.

Have a look. I’d love to hear if you have any favourites.

http://ot4kids.co.uk/therapy-toys-shop

 

Meltdowns – Sensory NOT Behaviour

Children have an inherent desire to please. They don’t intend to be naughty or mean.

I work with many children who are punished at school for acting out or being ‘naughty’ however their ‘behaviour’ is actually in response to sensory overload. It’s important to put on our detective hats for these children to determine the cause of their behaviour and how we can help the child be more comfortable with their bodies and environment. An Occupational therapist trained in sensory integration can help.

For children with sensory processing disorder, the demands of school can be over stimulating resulting in a meltdown.  During this time, their nervous system enters a fight-or flight response as a protective measure.  Noises can be too loud, lights too bright, classrooms too busy with ‘decorations,’ kids sit too close, it’s hard to sit still, and large spaces such as gyms or playgrounds are overwhelming.  Dealing with this all day long often results in a meltdown either at school or by the time the child gets in the car or home.

Check out this wonderful diagram on Facebook’s Autism Discussion Page describes ‘Stress Overload at School.

So, how can children be helped?

During a meltdown, find a quiet retreat where the chid can calm down.  This may be a corner of the house or class with pillows, fidgets, or a beanbag.  It could even be under the teacher’s desk.  Do not treat it as behaviour!  Here are some ideas of quiet spaces.

To pre-empt a meltdown, try:
-Providing breaks for movement and proprioceptive inputs during the day.  Have your OT help figure our what works for the child.
-Help the child identify when they start to feel overstimulated.  What is the trigger? Touch, sound, novel activity, going to the cafeteria?
-Teach the child how to label their emotions so they can verbalise when they feel stressed.
-Provide forewarning when possible to prevent anxiety or stress (eg. Review schedule in morning.)
-Good sleep and nutrition (another subject in itself)

Here is a brilliant handout to share with teachers and professionals about sensory overload and meltdowns.
http://asensorylife.com/how-to-handle-a-meltdown-in-the-classroom.html

This article helps explain children, stress and learning. http://movingsmartblog.blogspot.co.uk/2011/02/understanding-children-stress.html?spref=tw

Therapeutic Benefits of Babywearing

 

I’ve an 8-month old baby with sensory processing difficulties and who has had a bit of a rough start from a traumatic birth.  Babywearing has been a huge part of our lives as he struggles to tolerate any seating devices especially strollers and car seats.  We started with a ring sling when he was home from the hospital, then a hop tei (a modified mei tai Asian carrier), and now as he is older, we also use a more supportive Ergo carrier. It’s our favourite therapeutic, ahem “fun, ” activity. 🙂

 

I have found many therapeutic benefits to babywearing and often recommend it to parents for these reasons:

 

SENSORY:

 

1) Deep pressure input, warmth, and comforting smell of parent are calming and organizing. This is particularly helpful for babies who are sensitive to touch, movement, or sounds, who have had long NICU / SCBU stays, or who need support settling into the big, outside world.
2) Boundaries of the carrier give body input and awareness for comfort and motor skills development such as babies with low tone, sensory motor difficulties, or prematurity.
3) Vestibular / movement input – the gentle bouncing, rocking and swaying motions provide movement input which is again soothing but also helps stimulate tone for balance and coordination and make sense of one’s body. The vestibular system is also strongly connected to the visual, auditory, and emotional centres of the brain. Movement helps kids focus, learn, and coordinate both sides of their bodies.
4) Powerful way to bond after a traumatic birth and from personal experience, so fun to interact with baby wherever you go.
You can see how it can either help decrease sensory overload for sensitive babies or provide extra input to babies who need more sensory information.  By integrating, touch, body and movement input, we are helping develop multi-sensory processing.
MOTOR:

 

1) Encourages flexed  positioning – oftentimes babies with traumatic births, brain bleeds, prematurity, low tone, or sensory processing disorder assume an extended posture due to tightness, arching their back or sensory overload.  Heathy, full-term babies are in a flexed curled-up position from the womb. Extension is a red flag. Slings and carriers can be used to help encourage this flexed position.  Have your occupational or physical therapist help with positioning.
2) For positioning, remember it is important to face inwards and assume a squatt position. See this article:

http://blog.ergobaby.com/2012/02/facing-inward-or-outward-the-physiological-aspects/

3) Alternative to tummy time – many babies struggle wit tummy time for varied reasons. Baby carrying can be a gentle step towards tummy time by holding your baby against you.
4) Upright positioning can be more comfortable for babies with reflux, gutt, or respiratory problems.
Resources:

 

UK Sling Libraries
Visit a sling library to try different carriers and find what suits you and your baby.

http://www.ukslinglibraries.co.uk/

Babywearing International

http://babywearinginternational.org/

Babies and Strokes

It’s Hemiplegia Awareness Week!

Oftentimes people associate strokes with the elderly.  Kids have strokes too, most often from a brain bleed / hemorrhage either while in the womb, at birth, or afterwards which causes tightness and difficulty using one side of their body, also known as Hemiplegia.
Red flags common for children with a stroke are:
-Inability or difficulty  using one side of body – the baby may hold their arm tightly at their side, fist their hands, or predominantly use one side.
-Early hand preference – Please know that babies are never right- or left- handed, they should not yet have any hand or foot preference.  If they do, it’s important to see a neurologist and be assessed by an OT and / or PT.
-Difficulty feeding, slurry speech,asymmetric facial features such as droopiness on one side of face or a crooked smil
-Stiffness in arms or legs while dressing or bathing
-Reaches with only one arm, head tilts to one side, body bends or cures to one side like a banana
-Delayed milestones
-Seizures
-Abnormal eye movements
-Extreme sleepiness, lethargy

 

I often hear health professionals say a baby with hemiplegia doesn’t need Occupational Therapy till they’re older and using utensils. This is a myth! Babies use their arms from the very beginning to self-soothe, find the breast for feeds, randomly move their body and then to reach for their parent’s face, bring their hands together, put toys in their mouth, push up on their arms or grab their feet. All these developmental experiences require core stability, strength, coordination, sensory awareness and more.  It is NEVER TOO EARLY.  An occupational therapist experienced with babies can help achieve these skills. This is so important because each skill creates a foundational building block for more advanced skills.

 

Infancy is the best time to intensely work with babes with neurologic impairments for several reasons:
1) Brain neural plasticity allows the best chance for change by developing new  neuronal maps and pathways for increased function
2) Develop good alignment and movement patterns from the very start so the baby can learn to roll to both sides, sit straight, crawl, walk with good balance, point, and clap their hands. Then the baby doesn’t need to compensate and only use their unaffected side.
3) Reduce chances of muscles becoming increasingly stiff over time
4) Collaborate closely with parents on handling techniques to encourage bilateral movements and incorporate exercises in a fun way into daily routines

 

The following treatments can help:
1) Baby massage – it’s calming, builds body awareness, and decreases tightness.
2) Neurodevelopmental Treatment / Bobath trained therapist.  Note that some have advanced training for babies which is a bonus.
4) Developmental play approach using therapeutic exercises to achieve milestones, ESP reaping the benefits of rolling and crawling
5) Kinesio taping, splints, orthotics, suits or compression garments to promote good alignment, posture and movement
6) Adapting daily activities and games
7) Sports and hobbies such as swimming, horse riding, gymnastics, yog
8) Baby wearing for many reasons including it’s comforting after a traumatic birth, provides deep pressure and boundaries for body awareness, movement input helps balance and is calming, and better able to promote body alignment.
9) Parent support groups – HemiHelp and HemiChat in the UK.

 

HemiHelp has a fact sheet and video to raise awareness about Hemiplegia here:

Homemade Sensory Equipment

 

**Disclaimer:  All content on this website is my professional opinion and for your information only.  It is by no means a substitute for medical or individualized input from an Occupational Therapist. 

I often encourage parents to use what they have at home for sensory input activities and obstacle courses.   There are many inexpensive items that may be used.  Here are some of my favourites.  Pease obtain input from your  OT of how to use these to help your child. Supervision is necessary for safety.

 

1)  Therapy Ball for trunk exercises, ball massages, throwing and catching games, or cross pattern brain gym activities.

 

2) Sofa Cushions and Pillows can be used as stepping stones, piles to jump and crash onto, or to crawl over for babies to older children.  For example, here are some fun stepping stones made from scrap cardboard. http://wendyjanelle.blogspot.co.uk/2010/05/sensory-steps.html

 

3) Crash Pads for gross motor or sensory input, or as part of a quiet, calming space.  You can make a crash pad by filling a duvet or quilt cover with pillows, blankets or scrap pieces of foam.  Use it to relax in, do homework or read a book, crawl or roll over, walk and climb over to improve balance, or hide objects under.

 

4) Boxes have endless potential. We know babies rather play with a box than toys. 🙂 Use different sizes for climbing in and out of. Open the box flaps to become a tunnel to crawl through.  Lay on a box and use it as a sled. Prop a huge moving box against a sofa and voila, you have a slide. A tight box filled with pillows can be used as a calming spot. For little ones, fill a box with balls or other textures for a sensory bin. Boxes can be used in lots of fun ways as an addition to your sensory tables.
Sand and Water Tables Blog

http://tomsensori.blogspot.co.uk/

Pre school play link

http://pre-schoolplay.blogspot.co.uk/2012/01/sensory-table-cover.html

 

5) Mattress or an air mattress can be used to jump on, crawl over, or prop up against the bed or sofa for a slide or a mountain to climb up.

 

6) Blanket swings for smaller, lighter children.

 

7) Step ladder for climbing practice to develop strength, bilateral coordination and motor planning.

 

8) Suspended Balls – You can either tie a string to a beach ball or place a tennis ball in panty hose and then hang it for lots of fun target practice.

 

9) Tires – Save those old car tires at your next car service. They can be used to sit or stand on, walk around or to step in and out of.

 

10) Plank of Wood as a balance beam. Alternatively fold a bath towel or blanket in the shape of a balance beam or put long strips of masking tape or string on the ground to walk on.

http://movingsmartblog.blogspot.co.uk/2011/08/smart-steps-walk-line.html

 

Have a look at these 2 blog posts for lovely ideas:

http://wecandoallthings.blogspot.co.uk/2012/07/parents-guide-to-diy-therapy-equipment.html

http://www.thegoodneighborhood.com/2012/06/20/a-place-of-joy-pulling-off-a-pop-up-playground-on-buffalos-east-side/

 

For those of you with carpentry and DIY skills, here are some projects I also hope to make…..well, some day. 🙂

 

Woven Wrap Hammock Swing (All you need is a wrap and a coffee table or bunk bed)
Tire Rocker

http://barefootnparadise.blogspot.co.uk/2011/10/tire-rocker-and-see-saw.html

http://www.crumbbums.com/?p=1934

 

Balance Beam

 

Balance Board

Movement = Increased Attention and Learning

I chose to become a pediatric Occupational Therapist because I’ve always loved kids but also, I can’t sit still.  I think best when I’m moving and doodling. I think doodling is a word? 🙂 Like kids, I struggle to sit still for long, let alone sit still and learn. I love when research shows that children who get more physical activity actually do better in schools.

It certainly takes creativity and flexibility on a teachers part to cater to each students  sensory preferences and what helps them learn.  Some kids need to move, others need to fidget or doodle, and some may need to chew. This improves the child’s processing, attention, memory and overall ability to learn.
 

 

Movement Breaks for the Classroom:
-Run /jog on spot, march, spin, do jumping jacks.
-Infinity Walk
-Yoga moves in chair or while standing
-Brain gym activities
-Pass out materials or tidy up
-Use a move ‘n sit cushion
-Sit on a balance ball
-Stand at the table instead
-Lay on floor to do work

 

Here are some fun ‘Brain Breaks’ for teachers to combine movement and learning:
 
 

 

Fidgets are also helpful for processing and learning.  Teachers can provide students with rules to safely use fidgets.  Items used could be:  ponytail bands, paper clips, Velcro under the table, key chain on trouser loops, stretchy bracelets, pencil toppers, koosh balls, balloons filled with flour or rice, or simply an eraser.  Consider the child’s sensory preferences when choosing a fidget and change it for variety.  Some children need feet fidgets. My friend Ida Zelaya from Sensory Street, Inc. suggested rolling cut-up pool noodles with the feet. Perhaps even having a beanbag to use with the feet.
 
 

 

Proprioceptive input, heavy work, can be calming and organizing.  The easiest way is by running an errand or doing chores involving heavy lifting, pushing or pulling.  A popular strategy is to tie theraband to the chair legs to stretch with legs or squeezing a stress ball.
 
 

 

Here are 3 wonderful articles to share with your teacher or school:
 
 
 

 

Due to every child having their own sensory and learning preferences, it’s important to have an Occupational Therapist advise on strategies, frequency and intensity of sensory input to help under various circumstances. Ultimately, the goal is for the child to learn this for themselves. 🙂

Backpack Awareness Day 2012

Kids schlep around huge backpacks these days so its not surprising that: 

-64% students from 11-15 years report back pain
-55% students carry backpacks more than the recommended 10% of their body weight
-how you wear a backpack can negatively affect your health

 

Backpack Wearing Guidelines: 
1) Straps should be worn on both shoulders
2) backpack should weigh no more than 10% of the child’s body weight
3) place heavier items closer to the back or on bottom of bag
4) Height of backpack should be 2-inches below shoulder to waist level
5) Use padded shoulder straps, hip belt as well as a chest strap

 

Here are some Backpack Strategies for Parents and Students by the American Occupational Therapy Association
Listen to Karen Jacobs share tips on choosing and packing a backpack.
 

Integrated Listening Systems therapy at ot4kids

I use Integrated Listening Systems (iLS) Therapy to improve children’s sensory processing, motor skills development, auditory processing, attention and regulation.

I have found that iLS and Occupational Therapy together make a good pair and help children progress faster.  It is also effective as part of a home program for many children.

iLS is unique in providing bone conduction in the headphones.  This is highly beneficial as it offers additional vestibular (movement) input to the child working on a neurophysiological level.

WHAT IS iLS?

iLS is built upon the techniques and theories developed by Alfred Tomatis, M.D., and has been refined by Dr. Ron Minson over many years.  It is based upon the theory of neuroplasticity, strengthening and creating neuronal maps that support sensory processing, movement, attention and learning.  iLS is a sound-based multi-sensory program that combines movement, visual and auditory input.

HOW DOES iLS WORK?

Classical music has been digitally manipulated to specific frequencies and vibrations that stimulate various parts of the brain to improve the neurological foundation for sensory integration.

Music is delivered via a portable iPod through specially designed headphones with bone conduction (a small transducer).  The bone conduction unit is inside the top of the headphones and provides specific vestibular and auditory stimulation.

In my practice, after I assess a child I determine whether iLS will benefit their program.  We then create an individualized listening program along with sensory, movement, visual and auditory exercises based on the child’s goals.  Generally, the program is administered approximately 3-5 times a week for 30-60 minutes.  For the first 15-20 minutes, the child participates in their home program exercises and for the remainder of the program, they either relax or complete fun projects.  I either use iLS during the child’s treatment sessions or offer units for rental for intensive home programs.

iLS HELPS:

Sensory processing, body and spatial awareness, motor skills coordination

Motor Planning, sequencing

Attention and following directions

Auditory Processing, sound sensitivity

Visual Motor Skills

Self-esteem

Sensory regulation, calming, sleep

iLS can be used for children who have various diagnoses including:

Sensory Processing Disorder

Autism, Asperger’s syndrome

Dyspraxia

Learning difficulties

ADD / ADHD

Neurodevelopmental delays

 

FURTHER iLS RESOURCES-

Research and case studies:

http://www.integratedlistening.com/research-science/

Free parent webinars:

http://www.integratedlistening.com/training/ils-webinars/

Online videos and talks by Dr. Ron Minson about iLS:

http://www.blogtalkradio.com/thecoffeeklatch/2011/10/24/dr-ron-minson–ils

http://www.autismsocialnetwork.org/community/72-ils/videos/video/46-ron-minson-md-a-edward-hallowell-md-qhow-integrated-listening-systems-ils-worksq

http://www.worldtalkradio.com/worldtalkradio/vepisode.aspx?aid=55628

Study by the Spiral Foundation regarding the effectiveness of home-based iLS therapy:

http://on.fb.me/S8eUjJ

How iLS influences sensory processing

http://www.integratedlistening.com/how-ils-influences-sensory-processing/

Parents’ account of using iLS and music therapy with their child:

http://www.autismsupportnetwork.com/news/feeding-hungry-brain-music-autism-2321452

Tips on introducing headphones to a sensitive child:

http://polaristherapy.com/2012/07/07/introducing-headphones-to-the-tactile-and-auditory-sensitive-child/

Kinesio Taping for Babies and Children

There’s a lot of buzz about that coloured tape now with Wimbledon and the Olympics approaching.  I am a certified Kinesio® Taping practitioner and have been using it to improve children’s body alignment, movement patterns, and muscle activation for motor skills development since 2003.  Being quite accident prone myself, I personally use it on myself for relief and to get up and moving again.

I have used taping for babies to older children, and have found it to be a fantastic adjunct to my Occupational Therapy sessions. It has been so helpful to have an understanding about development, children’s motor skills, and specifically, little bodies and then apply kinesio tape accordingly.  I have often used kinesio taping for babies who are struggling to reach their milesontes, and young children with hemiplegia, Erb’s Palsy, Down’s syndrome, Cerebral Palsy, and general low muscle tone although it can be used for any motor impairments.

Taping is a skill and must be applied correctly according to the child’s desired goals.  It is important to have Kinesio Taping done by somebody who has been properly trained, particularly for pediatrics.

For more, please see www.ot4kids.co.uk/kinesio-taping.

Last year, I wrote an article for PediaStaff which can be viewed here:

http://www.pediastaff.com/resources-a-look-at-kinesio®-taping-featured-may-26-2011

 

PARENT BLOGS-It’s always helpful to hear how other parents have found a treatment technique. Have a look at these blog posts.

Erb’s Palsy-

http://jadonsjourney2009.blogspot.co.uk/2010/10/kinesio-taping-success.html

 

Down’s Syndrome-

http://jendawnscowgirlup.blogspot.co.uk/2011/10/31-for-21-day-20-kicking-it-olympic.html

http://teal915.blogspot.co.uk/2011/10/kinesio-tape-for-baby-with-down.html

 

Cerebral Palsy-

http://cerebralpalsybaby.blogspot.co.uk/2006/05/kinesio-tape.html

http://cerebralpalsybaby.blogspot.co.uk/2006/05/kinesio-photos.html

http://www.octamom.com/2009/04/kinesiotape-baby.html

 

Parents’ Feedback about Kinesio Taping-

https://www.facebook.com/MommiesofMiracles/posts/344423925624665

 

ARTICLES:

Tales of the Tape – pediatric case studies

http://physical-therapy.advanceweb.com/Features/Articles/Tales-of-the-Tape.aspx

 

Uses of Athletic Tape-

http://physical-therapy.advanceweb.com/Features/Articles/New-Uses-for-Athletic-Taping.aspx

 

Taping in an Acute Pediatric Setting-

http://tapingbase.net/sites/default/files/level_4___pilot_study_investigating_the_effects_of_kinesio_taping_in_an_acute_pediatric_rehabilitation_setting._0.pdf

 

Taping for Abdominal Muscles-

http://www.advancemed.co.il/userfiles/file/kinesio/research/kinesio-taping-for-abdominal-muscl.pdf

 

Treatment of Brachial Plexus Injury using Kinesio Tape and Exercise –

http://informahealthcare.com/doi/abs/10.3109/09593980903578872

 

For very good articles with pictures on Kinesio® Taping for children with Brachial Plexus Injuries, check out the Outreach Magazine Spring 2005 Issue, Pages 8-10, as well as Outreach Magazine Fall / Winter 2005, Pages 8-9.

 

Write On!

I commonly get referrals for children with handwriting difficulties between 5-7 years old.

There are so many factors to consider when assessing a child who struggles with handwriting. Here are just a few:
1.  Core strength – Can the child sit upright long enough to do writing in class? Do they tire easily? How do they manage with gross motor and physical activities at recess or P.E.?
A child must have a strong core to sit in their seat and to support their arms for writing.

2.  Shoulder stability and arm strength – Imagine the shoulder to be like a hinge to hold a frame. It must be strong to support what hangs off it (i.e. the hand). Chances are if the shoulders are weak or unstable, it can’t support the hands.  This causes the child to tire easily and have poor grasp on their writing utensil.
http://movingsmartblog.blogspot.co.uk/2011/05/m-is-for-monkeybars-getting-ready-for.html

3.  Visual motor and perceptual skills – Does the child use the muscles of their eyes to visually track objects? Do both eyes work well together? Does the child spatially organise parts to draw a picture such as a house or a person? This is necessary on a finer level to form letters.
http://www.aota.org/Pubs/OTP/2011-OTP/OTP-082211.aspx?FT=.pdf

4.  Fine motor skills – Are the child’s thumb and fingers strong enough to grasp and coordinate the pencil? Do they have isolated control of fingers or use their whole hand to manipulate their writing utensil?

5.  Body and spatial awareness – Is the child aware of front/back, right/left, top/bottom on their own bodies, when given directions, or to draw and write?  These skills are first developed with gross motor skills, on the playground, when building forts from sofa cushions and dining room chairs, playing with blocks and then forming letters.

6.  Balance, midline crossing and bilateral integration – Can the child balance in their chair or when sitting on the floor at circle time? Oftentimes a child may slump over the table or have difficulty sitting still at circle time due to core weakness and poor balance.  Have they developed a hand dominance? To do this the child must comfortably be able to turn their body and cross midline without losing their balance? And lastly, do they use both hands to play, get dressed, open / close bags, cut, or hold the paper while writing.

7.  Motor planning and sequencing – Can the child follow a sequence, problem-solve, do a multi-step task?
http://www.apraxia-kids.org/site/apps/nlnet/content3.aspx?c=chKMI0PIIsE&b=788449&ct=464199

8.  Attention, auditory processing, and more.

Could we help these kids earlier before starting school? ABSOLUTELY!
Here are some difficulties children who struggle with handwriting often have when younger:

-Disliked tummy time
-Short or no crawling period
-Described as ‘lazy’ and lacking desire to move
-Delayed infant milestones
-Cautious with movement and climbing activities

-Avoided manipulative or constructive play (blocks, Legos)

-Difficulty with hand actions to nursery rhymes

Handwriting is very complicated.  There are early red flags and children do benefit most from receiving therapy input early.  It’s never too early or too late, however earlier the better.  If children have the chance for early intervention, they can focus their energies at school on attention, learning, and playing with friends.

ot4kids has an office!

I’m so excited to tell you that ot4kids now has its own office space in Southfields, southwest London.

Funnily when I first moved to London a few years ago, somebody mentioned that they worked in Southfields. I think I probably scrunched my nose as I had no idea where or what Southfields was. And now I’m working here. 🙂

At first I wasn’t sure what to call this practice.  When I was in California, we’d use the term ‘Sensory Integration Clinic’  and in New York City, ‘sensory gym’.  Either way, I’ve always wanted a practice that is in a home so that it’s comfortable, a natural environment, and parents can replicate what we do in a treatment session using what they have at home.  I will have specialized therapy equipment however I will also use what’s naturally available in one’s home. I hope this will be a cozy practice where kids can have fun, grow and reach their best potential.

I’m also looking forward to start some BABY groups for parents and babies who are:

  • at-risk due to having prematurity or a traumatic birth
  • have medical diagnoses such as Down’s syndrome
  • have developmental delay or aren’t reaching their developmental milestones
Groups will be hands-on, targeted to a child’s needs, and kept very small so parents and babies can get the most benefit.   Feel free to contact me at munira@ot4kids.co.uk to sign-up or for further details.
I will put up photos as soon as settled in. Stay tuned. 🙂
All the Best! Munira

SPD and Gifted Children

We know that at least 1 in 20 children have sensory processing disorder (SPD).  Research has also shown that 35% of gifted and talented children have features of SPD.  This is even more than the general population.  Most of these children have the most common subtype of SPD called Sensory Modulation Disorder (over-responsively, under-responsively, sensory seeking) and some also have dyspraxia.

I think that this is a huge deal and should be taken more seriously.  I work with many children who are so bright and intelligent, yet they struggle to cope with day-to-day activities such as tactile experiences, changes in routine, being in louder or busier environments, socialising with siblings or peers, or moving about the playground and playing physical games.  Simply, their cognitive skills are beyond their age however their emotional regulation and sensory processing are well below their age.  This mismatch can make it really frustrating for them.  Also, because these kids are so bright and look okay from the exterior, parents are often told that they’re reading into it and their concerns aren’t taken seriously by professionals and teachers.

If unrecognised, sensory processing difficulties amongst gifted kids can negatively impact upon their social and emotional development which carries over into adulthood.  It also causes difficulties in motor and cognitive abilities.

Being that 1/3 of gifted kids are found to have SPD, it would be wonderful if gifted and talented programs would screen their kids for SPD and teachers would be armed with supports and strategies to help their students.

Imagine, if this population were given the right sensory tools and strategies to help them be more comfortable with their bodies, environment and others, they would soar. Occupational therapists, parents, teachers, and the students must work together to support gifted students and make sure they can reach their fullest potential.

For more on the topic, look at this research in more detail as well as this website called Smart Kids with Learning Disabilities.

Check out the library of the Sensory Processing Disorder Foundation for more on this important research as well as other articles.

 

 

 

Follow Your Gut, part 2.

Mums and dads know their child best! They are their child’s biggest advocate.  In a recent post I had written to ‘Follow Your Mummy Gut’ or Daddy Gut.

Sadly, in my practice I’m often told by parents that they just knew ‘something wasn’t right’ from early on however their concerns were dismissed by their doctors, health visitors or even family members. They were often told to wait and see, let him / her (child) be a kid, or they’ll grow out of it. So, what can you do as a parent if you’re in this situation?

This article offers some great suggestions to parents including:

1) Get a second opinion
2) Keep a record of behaviours via either a log, journal, photos, or even videos
3) Research – nowadays the internet is full of resources and it can at times be overwhelming, however there are some fantastic parent groups out there with other parents who are in your same shoes
4) Don’t stop, keep asking questions and get a referral for a specialist
5) I’d like to add that if you have concerns with development, behaviour, learning, social-emotional skills, sensory processing or motor milestones, have your child assessed by an Occupational Therapist experienced in these areas right away. They can assess your child’s development, let you know how it is impacting on their functional skills and start working on these areas now versus later. It’s never to early to get help.

Sensory Processing – Early Warning Signs for Babies

In my practice I work with many children with sensory processing difficulties that are identified during their school years.  These children may struggle with concentrating in class, coping with transitions or changes, or playing with peers.  They can be clumsy, have difficulty holding a pencil or writing, awkward with their movements, or be either withdrawn or aggressive.  Oftentimes, they are very bright and as a result, their sensory processing difficulties are misunderstood.  Usually, warning signs were present as babies however parents were told to ‘wait and see,’ ‘your child will grow out of it’ or that their child is misbehaving.

Early signs of sensory processing difficulties I have seen amongst babies include:

  • Hates tummy time, prefers to sit or stand
  • Plays while sitting still versus moving around and exploring their environment
  • Tend to get ‘stuck’ with their movements, delayed milestones (e.g. rolling, crawling, clapping hands, waving)
  • Cautious with movement, dislike being laid down or moved
  • Fussy or irritable babies, cry easily sometimes for no known reason
  • Not a ‘cuddly’ baby, resists being held
  • Struggle to settle down or going to sleep
  • Difficulty with nursing, transitioning to other textures
  • Startles easily to loud sounds, distracted, avoids eye contact
  • Very easy going, described as a ‘lazy baby’, don’t know they’re in the room

These difficulties indicate that a child’s central nervous system is struggling to process sensory information.  It is a neurological problem that can impact on their movements and development, learning, and social-emotional skills.

Here’s a nice article that discusses the early warning signs of Sensory Processing Disorder amongst infants.

Due to the plasticity of a young child’s brain, there is hope and good potential for progress and improvement with Early Intervention.  If you are concerned about these early warning signs, seek advice from an Occupational Therapist who specializes in working with infants and younger children, particularly those with sensory processing difficulties.  It is never too early or never too late to get help.

Look here for links and books about sensory processing.

Follow your Mommy Gut!

I recently watched Holly Robinson Peete share her family’s story about their son who has Autism. Her story sounds so much like the stories of families I work with. I loved what she had to say as it applies to families and children with all types of special needs, not just Autism.

Follow your “mommy gut!” Nobody knows your child like you do.

As health professionals and therapists, we should be listening carefully to what parents are saying as they know their child best and in effect, are telling us their child’s diagnosis. Early Intervention is key.

Check out the video: