Category Archives: Early Intervention

Early Intervention to support children’s development so they can move, play, thrive, and reach their developmental milestones.

When should a child hold their pencil correctly?

What is the correct way to hold a pencil? 

These are common questions that parents ask me so I have created this visual to show typical grasping development and its connection to the whole body.

Afterall, ‘it’s all connected.’

Have a look below to see how STABILITY leads to MOBILITY for typical pencil grasp development. Immature pencil grasp development refers to when your child acquires these ‘typical’ grasps at a later age. PENCIL GRIP MILESTONES Typical

To improve your child’s pencil control for writing, buy the mini-course here: 

Help Me Improve My Child's Writing

Tips for Left-Handers

How to Help Left-Handers with Writing and Fine Motor Tasks? 

I just learned that 13th August is Lefties Day.  I never knew this till now. 🙂 

So, in celebration of Lefties, I thought I’d share some of my top tips: 

  1. While sitting at a table or in a classroom, it is best when Lefties sit on the left side of the table or even the room as they tend to turn their body a bit to the right.  This way if seated on the left side, they can more easily turn toward others and the teacher to see what’s going on. 
  2. If you’re a rightie and want to teach your leftie an activity, have them sit in front of you and mirror you. 
  3. The top of their paper will be tilted about 20-30 ish degrees to the right.  You can put a piece of tape on their desk to show where to place the top of the paper.
  4. Make sure to have access to left-handed tools such as pencils (esp if using Stabilo etc), scissors, tools with handles, potato peelers, and sports equipment such as gloves and rackets.  If using pencil grips, just check if there’s a leftie version needed (some do and some don’t). **See note below. 
  5. Explore which pens and markers to use as there’s likely some ‘smudging’ due to the way the left hand will rub over the writing as it goes across the lines.  Explore felt tip markers versus fountain pens for instance. 
  6. Check out www.anythinglefthanded.co.uk for more information and to see their ‘store’ where everything is easily accessible in one place
  7. Note that lefties will sometimes cross their letters from right-to-left
  8.  Lefties will naturally hook their wrist a bit while writing, some more than others.
  9. Consider notebooks used when writing as any rubbing of binder edges will be uncomfortable on the left hand.  Perhaps flip-top ones may be better or turning the spiral bound so you write towards it instead.  

If children are able to figure out how to use ‘regular’ utensils, this may be ideal because then they can use whatever is available wherever they go.  E.g. Scissors.  However, for some children who struggle with strength and coordination, it may be easier for them to use special left-handed items.  For those who want to be very skilled in certain sports, they may also look for a specifically left-handed tool as this may allow them to be even more dexterous in that sport.  

There are lots of things to consider really while writing and manipulating objects based on the child’s strengths, needs, and interests.  

As always, there’s never just one way, and we must take into consideration the child’s individual needs. 

Hope this is useful. Do share if you have any other tips.  If you’d like to receive some free tips on fine motor and hand strengthening activities, do sign up here for my free tips and news. 

Free Resources & News

 

 

Writing Mini-Series till 9th August, ’20

Hi Everybody.

I’m offering a writing mini-series only for PARENTS and TEACHERS to help you learn how to identify the sensory and motor skills your child needs to develop to improve their pencil control for writing through the power of fun and connection.  

I have too often seen children being given pencil grips and writing worksheets to improve their writing, which ultimately causes stress and pain in their hands. 

I want to show a better way where we can work from the child’s foundational sensory and motor skills to improve their pencil control for writing in a way that will have a bigger impact and last longer, and most importantly, whilst preserving their self-esteem and confidence.  All this in a way that is fun for your child. 

I’d love to see as many teachers as possible sign-up for this mini-series so that we can better understand why kids are struggling.  

I hugely believe that children are not lazy or not interested in writing, and we need to dive deeper to learn why they are struggling with these skills.  

This mini-series will help you figure that out. It’s only available till 9th August.  

Sign-up above! 

Munira

OT for Babies – Never Too Young

Parents are often surprized I work with babies. I usually hear ‘aren’t they too young’ or ‘what do you do with a baby?’

Babies are always learning new skills and reaching new developmental milestones. As everybody says, they do mostly feed, poop and sleep, but they also, move, play and interact. These skills all develop from birth onwards.  An OT experienced in working with babies can evaluate which foundational areas the baby is struggling with and how to improve them

Here are three scenarios:

1) When a baby struggles with feeding, we would assess their tolerance for touch with their body and in their mouth, oral motor skills in their mouth for nursing or eating foods, muscle control in their core / neck / shoulders, and their body alignment and positioning for feeding.  See more here.

2) If a baby has a flat spot on their head or turns their head to one side (plagiocephaly or torticollis), we assess their core strength, body awareness on the weaker side, motor planning, eye movements, jaw alignment and oral motor skills, which muscle groups are weak or tight, tolerance for movement and motor skills using both sides of their body.

3) Another common scenario is when the child is described as a ‘lazy baby.’  Usually there’s a reason for this.  They may be sensitive or fearful of movement, have difficulty figuring out how to move their body, or have weak body strength and stamina.  Sometimes the baby could have a lower state of arousal and need more sensory input (touch, muscle / joint and / or movement input) to rev up their engines the so they feel the urge to move and play.

When we explore deeper, there are underlying areas we can develop. And as babies are changing and growing so fast thanks to brain plasticity, they have amazing potential to progress at a faster rate. Early intervention helps.

Babies whom I treat usually may have:
-Plagiocephaly (flatness on head)
-Torticollis (turn or bend their head to one side)
-Avoid moving to one side of their body
-Don’t use one arm or leg
-Dislike being on their tummy
-Have difficulties with breastfeeding or transitioning to foods
-Appear colicky or are described as a fussy baby
-Sensitive to sounds or being moved
-Not meeting motor milestones
-Feet tend to turn outwards
-Born prematurely so need extra help to catch up
-Have diagnoses such as Down’s syndrome, Cerebral palsy, Hemiplegia or other genetic syndromes

If you have any concerns about your babies’ development, feel free to contact me to have a chat and discuss further.

For more information:
Sensory and motor developmental milestones month by month by Pathways Awareness:

http://pathways.org/milestones/

What does a baby OT assessment with me look like?

http://ot4kids.co.uk/baby-evaluations-never-too-early

Infant red flags for sensory processing difficulties

http://ot4kids.co.uk/babies-early-signs-how-do-you-know

Baby Owned Movements

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Baby Owned Movements

My son crawled at 9 months, sat at nearly 10 months, and walked at 16 months. According to developmental charts, his sitting and walking are considered to be within the later range of ‘normal.’  Charts indicate that babies sit at six months when placed in sitting by an adult.  The baby does not own that movement of sitting by being able to move in and out of positions. Most are actually stuck in sitting and struggle to get ‘unstuck.’

When treating babies, my main goal is for them to figure out and plan how to move their own bodies in and out of rolling, sitting, crawling, standing and walking. For example, to stand, the baby must be able to get onto hands and knees and push off the floor into standing. To cruise along the sofa, they need to crawl up to the sofa to pull themselves up and then cruise.  I do not put babies in positions that they cannot get into themselves. There are so many benefits to this including:

1) Baby uses their own muscle strength to get into a position versus being forced to hold a position that their body can’t handle which can lead to muscle strain or locking joints for stability.

2) Develops body and spatial awareness. As the child uses their own body (muscle and joint) sense to get in and out of positions, they develop an innate body awareness and sense of space around them. This is much safer as the child can get their own body not only in the position but ‘unstuck’ to get out of it. When placed in a physical position by an adult, they aren’t required to use their own body sense to move.

3) Develops motor planning skills – the baby has to come up with the idea to move, plan how to move their bodies, and then make the move. These skills are so important for motor planning and the beginning to problem-solving, sequencing, and figuring out how to do new things – all skills children need for pretend play, being independent and school projects.

4) Increases balance – by completing movements actively themselves, balance and confidence improves. Active movement develops ones movement sense and stability more than passive sensory input.  The movement system has strong links to one’s ability to calm and self-soothe, be alert and focused and much more so it’s a good one to strengthen.

In my professional and personal experience, I find that children who can move in and out of positions on their own versus being placed in positions are more safe and stable, have better posture and are less slumped over, more flexibility and variation in their motor skills, less sensitive or fearful of being moved, and are comfortable getting in and out of different positions.

As a paediatric OT, I will use sensory processing, Neurodevelopmental, myofascial, socio-emotional or play-based strategies to help the child develop the skills they need to be flexible and functional in their motor skills so they own their own movements, and can be more safe and independent in their play.

Here are some other interesting reads on this subject:

http://mamaot.com/2013/07/14/to-sit-or-not-to-sit-developing-functional-sitting-skills-in-babies/

http://www.janetlansbury.com/2012/04/sitting-babies-up-the-downside/

http://www.janetlansbury.com/2009/12/dont-stand-me-up/

http://www.janetlansbury.com/2011/03/9-reasons-not-to-walk-babies/

Installing Sensory Integration Swings – Part 1/ 3

 

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**Please note all ideas shared in this blog post are to be done at your own risk or discretion. It’s recommended to have an engineer or contractor assess your ceiling structure to determine whether it is safe and sturdy.

During OT sessions, parents often want ideas they can replicate at home, especially activities their kids really enjoy.  Swinging often falls in this category.
 
Part of classical sensory integration therapy includes using suspended equipment and therapeutic swings. Although there are lots of other effective and fun ways for children to get movement input without swings, swings are an option for the home.
 
The following are some ideas of how to install a swing for your child at home:
 
1) CEILING
 
Here is a great resource explaining different ceiling hooks. This is where an engineer or contractor will help.
 
 
Nice step by step directions from the DIY Network:
 
 
This blog post is written by a parent describing the process:
 
 
 
 
2) DOORWAY
 
This is a good alternative if you can’t access a ceiling for swings, especially if you happen to have a double doorway. 🙂  Prior to my current clinic space, I used the Rainy Indoor Playground Support Bar, however now am fortunate to have a larger area.
 
See how these two parents have used their doorway for swings:
 
 
 
I can personally recommend the Rainy Indoor Playground Support Bar. It’s so easy to install and if you move or rent homes, the holes from the screws can very easily be patched up.  For those in the UK, it can be purchased from Sensory Direct here:
 
 
Many parents have also installed a pull-up bar in their doorway from which they’ve attached a swing or trapeze.
 
 
 
For those in the US, there’s an Indoor Gym which I haven’t tried but looks interesting.
 
 
 
3) LOFT BED 
 
I’d love to do this when my son is ready to sleep in a loft bed.
 
 
 
 
4) A STRONG TREE!
 
My neighbors are so lucky to have a great tree from which they’ve hung a cool IKEA swing for their kids. If you do too, consider attaching swings there.
 
Here’s a tree swing kit on Amazon.
 
 
For all of the above ideas, be sure to put down an old mattress, crash pad or gym mat under and around the swing for safety.
 
Happy Swinging! 🙂
 
Munira

Breastfeeding & Sensory Processing Difficulties

BREASTFEEDING AS A THERAPY

This is my first blog post in perhaps two years!  I’ve been pretty busy with my now-toddler-then-baby but this is a topic very close to my heart. I lived it and breathed it for a whole year which is how long it took for my little guy, M, to become ‘functional’ at breast feeding. It is also something that many of the families I work with have or do struggle with so I wanted to share our story.

Here’s our abridged story.

Following birth, M immediately struggled to latch on and nurse. He was only 2.2 kilos so we were kept in the hospital for a few days. We received a lot of advice from the midwives of which all were conflicting and really, although my Occupational Therapy head knew better, my new-mum head was a bit overwhelmed and second-guessed myself. I always tell parents to trust their own gutt instinct.

Some feeding difficulties my son had were:

-Gagging (I hated it when the midwives or GPs would say ‘big mouthful’ and to put a lot of breast in the baby’s mouth. This did not work for my baby who was sensory defensive and couldn’t organise his body, let alone his mouth)

– difficulty latching on

-struggled to mould or ‘snuggle’ during feed and other times

– hiccups, gasped for air, guzzled liquid down while bottle drinking

– difficulty getting in a rhythm of suck swallow breathe

– took over an hour to feed

– struggled to move one side of his face, tongue, cheek, lip

– lopsided wonky smile (one side didn’t turn up or move), drooled only on one side, preferred feeding on one side

– jaws seemed to wobble

– held up his head from birth (yes, this is a red flag as he had tightness in his neck and back muscles which led him to always lift his head and arch his back. He could not relax at all when on his back. This position also brought his tongue back so he couldn’t bring it forward to latch on and suck /swallow.)

Our Team:

I contacted a speech feeding therapist of mine whom I hugely respect at day 3! We were so fortunate to have her support as the NHS speech therapist said there’s nothing to do until M eats foods. Not only couldn’t we wait but I knew better. Please know this is so not true. It was important to strengthen and develop M’s jaws, cheeks, lips, and tongue so he could nurse and later, eat foods and talk.

At 4 months, we saw an osteopath I’ve known and worked with. She worked with M using a classical approach, loosening and mobilising tight areas, so he could be more comfortable in flexion and move his body forwards, ESP his tongue. She also worked on his gutt mobility so that his body could best absorb nutrients, digest, pee and poop.

A craniosacral therapist who treated me saw M and worked wonders on his cranial system so he could be less sensitive, relax his body, and again, bring his neck and tongue forwards for nursing

A Jin shin Jyutsu therapist worked with M on relaxing his body via different Asian flows.

I, OT mummy, worked with M to become more comfortable with touch, movement, and sounds, develop his body awareness to move with more flexion and be able to bring his head forwards, move smoothly in and out of positions, and coordinate both sides of his body versus only move via one side. We also worked on positioning M’s body so he could be more comfortable with feeds. Once his body was more comfortable, his mouth followed suit.

The oral motor therapist worked with us on different feeding positions for myself and M to support his breastfeeding needs, supporting and strengthening his jaw, how to strengthen the oral muscles using specific, targeted exercises on the tongue, cheeks, lips, and jaws.

Private DAN doctor inspired by Asian medicine – He confirmed he wasn’t concerned about weight and size, continue with breastfeeding versus formula, but was more concerned about gutt absorption of nutrients. So he prescribed us some chinese herbal supplements, vitamins, probiotics and MCT oil which apparently is a natural ingredient already found in breast milk.

By 10 months of age, breastfeeding had finally become very comfortable.

Later speech and feeding therapy sessions worked on spoon feeding, emerging munching, eating different textures and building interest in foods, working on chewing tougher foods, and developing sounds of consonants and particularly lip sounds such as ‘m’ and ‘n.’

Using breastfeeding as a therapy gave us the chance to work on M’s sensory processing and oral motor skills soooooo many times during and before every feed.

We were fortunate to receive a lot of amazing, private support from very early on. During times, we felt desperate so also tried many ‘wrong’ things before figuring out what they worked. But as they say, it took a village and I really believe we need to support families with breast feeding challenges using a whole body and a collaborative team approach.

What did I, OT mummy 🙂 do that helped?

-Worked on sensory defensiveness, flooding M with calm, sensory input. Deep pressure input, linear movement input, building tolerance for movement in different planes using music, rhythm and predictability, heavy muscle and joint work for added proprioception to his body and mouth, and building tolerance for multi-sensory input. ‘Baby wearing’ was a huge part of our life for all sorts of positive sensory input.

-Before every feed, we did some gentle body work to build motor skills and body symmetry and encourage flexion.

-Targeted oral motor exercises for cheeks, tongue, lips, and jaws before feeds and later, when starting solids, we had therapeutic feeding strategies.

-Used straw and open cups as no concerns with aspiration, or safety of swallow.

-Positioning – Swaddling for feeds was a huge help and he relied on this till 7 months. I laid semi- reclined so M kind of ‘fell’ into me and gravity could help.

-Music –I remember using classical 90-beat Baroque music for children feeding in the hospital so we tried this too.

-Mental stuff  – meditation, imagery, positive self-talk, trying to keep the feeds happy despite it being so stressful

-Surrounded myself by like minded and positive people

 

Resources:

Kellymom.com

-An invaluable source on breastfeeding and busts so many myths.

Dr Jen 4 kids

–http://www.drjen4kids.com/

www.talktools.com

Book-

Supporting Sucking Skills in Breast Feeding Infants by Catherine Genna Watson

It’s very in depth, but I love it’s team approach and whole body outlook

 

Babies – Early Signs: How do you know?

Does my baby need Occupational Therapy?

People often wonder how soon can you tell a baby requires early intervention therapies. I thought I’d share a little bit based on my experience with my own son and babies I treat as well as common red flags from other parents.  I hope it will help others.

First of all, parents just know!  They have a gutt instinct and are always right. Sometimes as a mum, I know it’s hard to follow your own gutt especially when others around you say it’s too early or your child will grow out of it. Please know that as a parent, you know your child best.

Secondly, babies’ main daily living activities are to move, sleep, feed, and poop. Usually, if these areas are a challenge, you will have an idea that they need some support.

For my son, I knew as soon as he was born and we were moved into the maternity ward. He was the only baby constantly crying, he had a hard time with breast feeding – struggling to nurse more on one side, startled at every sound that went by, only wanted to be on his tummy being very uncomfortable on his back, had too great head control for a newborn, and was unable to fall asleep.  Everybody, including strangers on the street, always commented on his head control (which was too good for his age because of tightness) and how alert he was (due to being in an over-stimulated state of arousal).

Babies benefit from Occupational Therapy when the following red flags are present: 

Sensory processing

– doesn’t mould their body to you when held, hates baby massage

– arches back, lifts head as a newborn (newborns should be able to turn their head and clear their airway but not hold up their head yet)

– only sleeps or soothes with intense movement input

– needs to be held all of the time

– startles to sounds easily, appears on edge or in distress, doesn’t like busy places

– very alert (as in sensitive to all sounds, sights, movements)

– difficulty sleeping, takes hours to fall asleep

– unable to tolerate sitting in car seat or stroller

– difficulty with car rides

– becomes upset when laid down on their back for diaper and clothing changes

– described as ‘colicky,’ upset or unable to settle

– doesn’t move and prefers sedentary play

– does not interact or make eye contact with parents

Motor

– only wants to lay on stomach and cannot tolerate laying on back (due to strong back muscles, weak flexors, and overall imbalance of muscles on front and back of body)

-arches body backwards

– flat spot on head, turns head more toward one side

– uses one side of body more than other side – babies do not have a hand preference or sidedness

– delayed motor milestones

– moves to one side only such as rolls or comes up to sit via one side

– tightness in limbs during dressing, diaper changes, or bathing – parents may feel arms are stiff to get into sleeves, or legs do not open for diaper changes

– motor milestones are a bit delayed

– doesn’t move, described as ‘lazy’

Feeding

– nurses better on one side or unable to nurse on both sides

– pulls away from breast

– difficulty figuring out how to latch on during breast feeding

– takes excessive time to nurse

– difficulty drinking from the bottle, liquid pooling out at sides

– drools on one side of mouth, smiles a bit wonky

– difficulty transitioning to foods, refuses to eat

– does not put toys in mouth for exploration

These are just some examples. If you have any concerns about your child’s development, please see an occupational therapist right away. Do not wait and see. Start early, there’s so much to do from the beginning versus when the child starts school and skills become ingrained. Babies are like sponges due to brain plasticity. Its really so encouraging to see how quickly they respond with the right support and early intervention.

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.

 

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/

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.

 

Follow Your Gut, part 2.

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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

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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.

Homemade Occupational Therapy Toys

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Isn’t it amazing that kids often love to play with what’s simply laying around the house versus a fancy toy?  I often find that babies and toddlers prefer to play with a cardboard box or kitchen towel roll instead of the flashing, music-making, popping-up toy.   🙂

I love homemade toys for two reasons:

1)    Recycle, Reuse, Renew!  It’s great for the environment.  Save those kitchen towel rolls, cardboard boxes, and empty water bottles to make fun toys or do interesting crafts.

2)    For children with sensory and motor impairments, it’s oftentimes easier to make a toy that is just right for their motor abilities and coordination.  For example, if a child who has limited fine motor skills, you can use larger objects such as making a giant pegboard with water bottles.   To add a sensory component, make a textured board with different sponges, fabrics and materials. Using objects found at home, you can make a toy that’s just the right size, shape, or texture to suit a child’s motor, sensory and cognitive skills.

A couple of my favourite resources for homemade toy ideas are:

1)   http://ohiodeafblind.org/assets/files/files/milestone_packets/0_2/hold_everything.pdf

Personal favourites are the ball board, curler board and eggs in a can.

2)    The Recycling Occupational Therapist – Check out her Facebook page or YouTube videos for ideas for homemade toys.

Go buy some stick-back Velcro, magnetic tape, and start saving those cardboard boxes and empty plastic bottles.  Have fun!

Early Detection of Learning Difficulties – Act Now!

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Guiding Questions for Doctors to help identify signs of learning difficulties – By Kathryn Burke from LDExperience.

Paediatricians have a huge role in identifying children who are at-risk of learning difficulties or developmental delays, and to set families in the right direction to have necessary supports in place. Early detection leads to early intervention which is crucial.

Doctors, teachers and professionals must be on alert when parents approach them with concerns, particularly about their child’s struggles at school. “Wait and see” or “every child develops differently” are NOT options. It’s important to know the signs and symptoms of learning difficulties amongst young children.

Read Kathryn Burke’s article for guiding questions for parents and children as well as early signs and symptoms of learning disabilities.

Common signs of learning difficulties that may warrant an Occupational Therapy evaluation include:
• Difficulty learning to read or write
• Poor pencil grasp or tires with handwriting
• Completes school work only with great effort
• Dislikes school
• Clumsy, accident-prone, gets lost easily
• Decreased gross or fine motor coordination
• Difficulty with new skills, sports, games
• Poor posture, slumps forward
• Easily distracted

Early school years are critical for creating a foundation for future learning. If a child struggles at school, let’s identify the problems NOW and refer these children on for the right support.

Treating the Cause, Not the Diagnosis

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Lilly, a baby gorilla, gets Occupational Therapy! Trainers noticed she had a weak grasp for climbing and self-feeding, her left side lagged behind, and she struggled to latch on while nursing. Medical experts found nothing. Disney switched their emphasis from diagnosis to quality of life.

I found this to be such a great story with good reminders for health professionals and parents:
1) Paying attention to normal developmental milestones is very important. If concerned that a child is struggling to meet milestones, it’s important to get an evaluation.
2) The earlier we detect a problem, the sooner we can help and the easier to correct or minimize. Early Intervention is critical.
3) Treating the cause not the diagnosis – I treat many children who have no diagnosis. We identify the child’s strengths and areas of difficulty, and then determine why are those areas a challenge. For example, a child may have a weak grip for many reasons. Perhaps they have weak core strength and can’t hold themselves up. Are their shoulders loose or stiff causing them to have difficulty lifting their arms to reach? Or does the child lack sensation of their body parts related to each other? Do they have limited eye-hand coordination so that tasks requiring a precise grasp and dexterity are challenging? Labels don’t matter— As Occupational Therapists, we assess the cause of actual areas of difficulty versus the diagnosis.

It’s fantastic that Lilly’s caretakers follow through with her home programs twice a day and are encouraged by her good progress. Hooray!

Sensory Processing and Babies

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1 in 20 children have sensory processing difficulties!   Clearly, this is very common and impacts on childrens’ behaviour, motor skills development, learning and confidence.

As an Occupational Therapist, I specialize in treating infants and younger children.  I’m often asked ‘what can you do with a baby’ or how do you know a baby has sensory processing difficulties?

Meet Ryder from Pathways Awareness’ newest video!  🙂

Ryder’s sensory processing difficulties were noted at FIVE months of age.  He had difficulty lifting his head, hardly moved, tired easily, and was anxious during new situations.  He was overwhelmed by sensory input leading to sensory overload.  Later on, this also impacted on his ability to communicate with peers, play with other children, and keep up with his motor milestones.

With Early Intervention therapies (OT, PT, and SALT) and a home program from very early on, Ryder showed improvements in his coordination, behaviour, confidence and ability to organize and respond to sensory information.  He was able to be in group settings, keep up with peers, multi-task, and have fun with age appropriate activities.  Hooray for Ryder.

Another great video by Pathways Awareness.  I admire their efforts in advocating for early detection and Early Intervention as well as raise awareness about sensory processing.