Tag Archives: occupational therapy

The Interactive Metronome

By: Kara Lyons, OT

blog12TIMING IS EVERYTHING
Did you know that precise timing is responsible for the synchronous interaction within our brain that connects physical movement and cognitive processes?

Why is timing important? To name a few, timing is responsible for a person’s ability to walk without falling, catch or throw a ball, jump, climb a ladder, play music, and speak without stuttering.

Research suggests that training with the Interactive Metronome, or IM, supports the interaction between critical brain networks, specifically the parietal-frontal lobes, which are often associated with general intellectual functioning, working memory, controlled attention, and executive functions (McGrew, 2002).

What is the Interactive Metronome (IM)?

The IM is a computer based interactive program that provides a timed rhythmical beat, or metronome, which works to pace an individual’s movements.

In this program, an individual synchronizes a variety of upper and lower extremity exercises to a precise computer-generated tone heard through headphones.

The IM responds to a client’s physical movement by providing real-time auditory and visual feedback in milliseconds, indicating whether they are in sync with the beat, or they are too early or late.

blogggg1What skills does the IM target?

• Improved timing, rhythm, and synchronization in the brain
• Motor planning, motor control, and bilateral coordination
• Attention, working memory, and processing speed
• Speech/language and social skills

Who could benefit from the IM?28321120_Unknown (1)

Pediatric population
Individuals with ADHD, Autism Spectrum Disorder, Sensory Processing Disorder, children with developmental delays or learning disabilities, cerebral palsy, auditory processing disorder, and dyslexia.
Adult population
Post brain injury, stroke, or concussions, adults with ADHD, Parkinson’s Disease, Alzheimer’s/Dementia, and amputees

How do you get started with this program?

• The first step is to be evaluated by an occupational, speech, or physical therapist that is also trained and certified as an Interactive Metronome Provider. You may find a provider in your area through the Interactive Metronome’s locator index.

• The assessment will consist of a comprehensive speech, occupational, or physical therapy evaluation, including an IM assessment, information sharing with the family and evaluating therapist, clinical observations, and other objective measures or evaluation tools (which may provide additional information regarding strength, coordination, fine and visual motor control, and/or speech and language abilities). At that time, the evaluating therapist will identify concerns expressed by the family and work to establish functional goals for the child.
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• The IM assessment provides data on the child’s current level of functioning, including their timing tendencies, attention to task, their ability to motor plan, sequence, or coordinate the movement patterns.
• The evaluating or treating therapist will determine if the client is appropriate for the program before customizing a treatment plan and program.

• REPETITION and FREQUENCY are critical for making lasting, functional changes in the brain.

• It is recommended that a client participate in the program at least 3 times per week for a minimum of 30 minutes of training per session.

THE IM HOME UNIT

blog123The IM home training unit is an option for families to meet the minimum recommended frequency or if the client is unable to attend therapy in the clinic setting.

To purchase and utilize the IM home program, a client must establish a relationship with an IM home certified therapist (also available through the IM Locator Index). The treating therapist will customize the child’s treatment plan, provide ongoing feedback, and adjust the plan as needed.

Overall, the IM is an excellent adjunct to traditional therapy services as it provides objective data (the child’s performance over time, measured in milliseconds) to support functional outcomes. If you are interested in the Interactive Metronome or feel it may be appropriate for your child, speak with your treating therapist.

For more information on the Interactive Metronome, including evidence to support the program, please visit https://www.interactivemetronome.com

To learn more about Interactive Metronome services at Easter Seals DuPage & Fox Valley and set up an evaluation contact us.

 

 

References:
McGrew, Kevin (2002). The Science behind the Interactive Metronome: An Integration of Brain Clock, Temporal Processing, Brain Network, and Neurocognitive Research and Theory. MindHub Pub, 2.

Climbing and Bouldering Therapy: The Benefits to Rock Climbing

By: Laura Van Zandt, OTR/L

This summer, physical and occupational therapists are excited to provide therapy on the walls as part of our summer outreach program “Climbing and Bouldering.” The varied terrain offers countless opportunities for physical and sensory challenges.

Rock climbing has so many benefits for kids of all ages and abilities.15_Patrick_Krueger

  • Strengthening and endurance: Climbing walls require strength and flexibility to
    successfully maneuver. Kids develop hand and finger strength as they grasp and hang onto holds of all different shapes and sizes. Some of the holds are tiny and don’t have much to grasp. Making your way up a climbing wall also requires a great deal of core strength and leg strength as your hold yourself in space. All that movement and use of your arms, legs, and core will help develop endurance for other gross motor activities.
  • Sensory processing: Kids get great proprioceptive input (sensory input to the muscles and joints) and vestibular (movement-based) experiences as they power themselves up and over while using the different holds as well as glide back down to the floor from the top of the wall! For kids who experience gravitational insecurity, rock climbing can be an extreme challenge but can be graded to meet their needs. For example, kids who are reluctant to climb high up on the wall can work on moving from side to side first. Children who also experience tactile sensitivities could also be help by all the proprioceptive input into their hands to help desensitize prior to working with different textures.
  • Motor planning and visual spatial/perceptual skills: Climbing is an awesome way to help kids develop motor planning skills. Indoor rock climbing is a great puzzle just waiting for your child to solve! The holds are all different shapes and colors. Most climbing walls also have colored tape markings that show climbers different paths they can take up the wall. This makes it easy to give a child instructions (e.g. “step your right foot on the blue hold” or “find the next hold with green tape next to it”) to challenge their abilities. Also, climbing walls usually have “routes” with
    a variety of difficulty levels, making it easy to adjust the activity depending on the skill level of the child.

    15_Brady Pembroke

  • Bilateral coordination: When kids are rock climbing, they must use both sides of their body together, usually in an alternating pattern — right hand and right foot move up to the next level, followed by the left hand and left foot. Also, kids have to learn how to differentiate between the movements on either side of their bodies. They stabilize themselves with one foot/hand while motor planning how to grasp onto and step on the next holds with their other foot and hand.
  • Confidence: Allowing kids to move outside of their comfort zone in a safe and controlled environment will undoubtedly help to build their confidence and promote development of positive self-esteem.

If you think your child might benefit from this outreach group, please visit our website for more information on Climbing and Bouldering Therapy and check out other Community Based Therapy Programs for Summer 2017!

Executive Function Skills: CO-OP Model

By: Laura Van Zandt, OTR/L

GOALPLANDOCHECK.

Executive functioning skills seems like the new ‘buzz’ word for therapists and parents working with children of all ages. Executive functioning skills include the ability to pay attention, recall a series of information, manage your time, be flexible, self-monitor for your emotions and impulses, initiate tasks, problem solve, persist as well as plan, organize, and sequence. One of our former speech therapists, Jennifer Tripoli, wrote a nice blog in August 2014 which you can refer to for more information regarding the definition of executive function skills.

One strategy that I like to teach children is a concept from the Cognitive Orientation to Occupational Performance or CO-OP model by Helene Polatajko and Angela Mandich called GOALPLANDOCHECK.

The CO-OP model is a “client-centered, performance based, problem solving approach that enables skill acquisition through a process of strategy use and guided discovery.” Occupational performance is what we do and how we do things throughout our day. Cognitive orientation implies that what we do and how we do things involve a cognitive process. The approach is designed to guide individuals to independently discover and develop cognitive strategies to meet their goals. That sounds like a lot of executive functioning skill development to me!

The use of self-talk is key with GOALPLANDOCHECK. When we require children to walk us through their plan and teach us their steps by talking aloud, they engablogge in more effective approaches to learning.

When teaching children, we start with the GOAL. We teach the child to understand the word GOAL as being something we are working towards completing. One strategy that has been helpful for visualizing the end GOAL is the concept of “future glasses.” Have the child wear funny glasses or simply make your hands in the shape of glasses. Then close your eyes and visualize the completed GOAL and what it might look like when completed.

The word PLAN implies there are a series of steps we need to do in order to meet our GOAL. To me the PLAN is critical for developing our problem solving skills.

Next we DO our goal.

Finally, we CHECK. The CHECK is really important for developing and strengthening our meta-cognitive skills. It is very important to understand how we can do better next time based on what we did today. CHECK gives the opportunity for feedback control by finding and correcting a mistake before the plan is final. It allows for incorporating flexibility and the ability to shift strategies when the current plan is not working.

KevinThis process helps children strengthen their executive function skills in the areas of working memory to pull from previous experiences, planning and prioritizing steps involved, persisting to achieve goals, and reflecting back by checking in with the plan to see if it was successful. If not, make alterations in order to be successful, eliminate time robbers to help with impulse control, and manage their time. Remember, initially it is about the practice and not the end result. It is okay to make mistakes. We all learn from mistakes.

Parents and family are an important part of the CO-OP approach. The effectiveness of the intervention is greatly increased when everyone is involved. Parents and family help the
individual child to acquire and practice these skills. It also helps them to transfer and generalize the learned strategies into everyday life. By providing explanations as well as guidance and asking questions at an appropriate developmental level, we provide just enough support necessary for the child to be successful. The more you can help children think about what they do and why, the more they will be able to use that thinking in any problem solving situation. The overall goal is to teach a child how to work through a problem using a planned approach instead of acting impulsively.

To learn more about Easter Seals DuPage & Fox Valley’s occupational therapy services visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

What is Occupational Therapy?

By: Laura Van Zandt, OTR/L

I’ve been an occupational therapist for seven years and it’s taken a long time to perfect the answer to the question “What is OT?” from people I just met. Today, I think I finally have a good answer.

To begin, occupational therapists see individuals across their lifespan and in a variety of different settings. We work closely with medical staff, parents, and educators. Typically there is some underlying problem that has initiated a meeting with an occupational therapist.

Depending on their training, there are a number of different approaches an OT may take to solve the problem.  One approach is the “Person, Environment, Occupation” (PEO) model. The PEO model (Law et al., 1996) is a well-known and established conceptual model of practice within occupational therapy. It offers a foundation for guiding assessment and intervention across all practice settings and client populations.
peos
This model of practice helps an OT consider the whole child…their roles, activities, where their performance may need help, areas of strength, and more. Since I work with children, I am going to define the person as a child. The environments are the places a child interacts (e.g. home, school, community) and the occupations are the things he/she does in those places (e.g. get dressed, feed themselves, learn to write/color/draw, play). It is an occupational therapist’s job to evaluate a child and determine what makes it hard for those occupations in all his/her environments. It could be strength, sensory, visual, etc. or a combination of all those areas. It could also require a team approach, short term services, or long term services.

Let’s look at an overview of the assessment process with a simple case study to make it easier to understand:

ASSESSMENT PROCESS (Person, Environment, Occupation)

Referral: A 7-year-old is referred by a doctor for occupational therapy services based on her parents’ concerns with difficulty sitting still at home and completing homework tasks. She also has difficulty focusing and getting ready for the morning.

Occupational Roles:
An OT would consider the child’s role as both a developing child, sibling, daughter, student, and friend. What is preventing her from participating fully in those roles? We would also consider the family’s values, interests and daily roles. We try to look at the client’s pattern of engagement in occupations (i.e. getting ready) and how they changed over time.

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Photo by Marita Blanken

In the example above, we would consider the entire family. This child has many roles. She is not only a child of a two parent working family, but she is also a sibling with a younger brother. She is also a first-grade student. In further conversations, we discover she also participates in gymnastics after school. In order to best support this child and her family, we would need to consider each of those roles and how they contribute to the overall profile of this child.

Occupational Performance Areas:
Then we consider the areas of occupational performance (e.g. activities of daily living, instrumental activities of daily living, rest and sleep, education, play and leisure, and social participation).

In the example above, this child is possibly presenting concerns with activities of daily living. Specifically, we might look at her ability to dress herself and completing grooming/hygiene tasks. Her mother, also mentions the child is having difficulties with staying focused and managing her assignments in school. Is this also impacting her social participation both at home, school and community where she does gymnastics?

Occupational Performance Components:
What components need to be addressed that may explain underlying difficulties?

Body Structure and Function – This may include muscle tone, range of motion, posture and alignment, postural control, strength, joint stability, endurance, fine motor skills, manipulation and dexterity, gross motor skills, coordination, bilateral coordination, etc. We may also evaluate her nutrition, respiration and gastrointestinal background to make referrals.

Sensory motor – This may include a child’s under or over responsiveness to touch, movement, sight, sound, taste and smell as well as their visual perceptual skills and body awareness. This may also include a child’s behavioral responses to activities.

Cognitive – This may include perceiving, understanding concepts, learning, and executive function skills (initiating, planning, organizing, sustaining, sequencing, flexibility, problem solving, managing emotions, etc.). We may make referrals to further understand the role cognition plays in your child’s abilities.

Social-Emotional – This may include self-regulation, self-esteem, as well as inner drive and motivation to participate in activities. It could also include the ability to relate to other children and adults.

TakeThreePhotography_05202010-102In the example referral above, we would need to determine what areas of occupational performance are making it difficult for her to participate to the best of her abilities. We could evaluate her strength by having her climb to see how she manages her body in space and uses her arms to support her body weight. We might also look at her core strength to see if she is weak and if that is causing her to feel unstable while sitting which impacts focus (e.g. if she is having to concentrate hard on keeping her body upright to be able to use her eyes and hands, then it will be hard for her to also concentrate on math facts).

We will also look at her hand skills. There might be concerns with weakness, grasp, manipulation, etc. that make it hard for her to use writing tools to complete tasks.

We can create a sensory profile, by asking questions, having a parent fill out questionnaires, and observing a child during activities. We would use our background in sensory integration too during our observations. For example, perhaps the feeling of clothing is too irritable to this child and she is having trouble focusing because she is needs to move to readjust how her clothing feels on her skin. We can evaluate vision to determine if we need to make a referral to another doctor. By planning some activities to do together, we can look at how her sequencing and planning behavior.

Finally, occupational therapists are mindful of the social-emotional development of children and how difficult things impact his/her daily function. We might ask the parent further questions if we notice that she is getting frustrated easily during a task and has trouble managing her frustration.

There are many hats that an OT wears in this therapeutic relationship….another adult, parent, teacher, friend, etc. When we begin, we often know very little about each other. However, we work together and figure out plans that best help a family address their wants for their child. In the process, we may not know all the answers yet and it may take time to figure them out. That is one of the hard parts of an OT’s job but also a fun aspect too. Wearing these different hats while at the core serving as an occupational therapist, is what I love about my job. To learn more about Easter Seals DuPage & Fox Valley’s occupational therapy services visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

Getting Ready For Fall by Teaching Your Child to Dress a Coat

By: Maureen Karwowski, OT

As the leaves begin to turn, it will soon be time to break out those sweaters and coats. This is a great time for your child to practice dressing their coat independently.

As an occupational therapist, I am always looking for ways to help my clients reach their maximum independence. As children become more independent, they develop more confidence and are more likely to try other challenges as well. For my clients that have fine motor difficulties, practicing dressing skills is a natural and routine way to help them develop their fine motor abilities.  Independence with dressing occurs one step at a time, so we can start with dressing a coat as the first step.

Once a child is able to stand securely, or sit securely if they have postural difficulties, it is a good time to start. Here is the “over the head” method that I would start with:

  1. Place the coat on the floor or a low table
  2. Lay the coat flat with the inside facing up
  3. Stand facing the top or collar of the coat
  4. Bend over and place the arms in the sleeves
  5. Lift the entire coat up and overhead
  6. When the arms come down you are all set!

Zipping up a coat requires more precise fine motor skills and strength. I would start by having the child zip up the coat once you have engaged the zipper. When assisting your child with any fasteners, always stand behind them to give them perspective on how their hands should work. You can use a zipper pull to make it easier for your child to grasp the zipper. A quick online search yields many cute options, but you can also use a key ring that you have at home. A magnetic zipper is also a nice alternative while your child is working on manipulating a zipper. Several clothing companies offer this.

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It is important to assist your child, while not jumping in too soon. Be sure to leave extra time, and focus on one step at a time. Once they are independent with this, then you can focus on promoting another dressing task. Good luck and stay warm!

To learn more about Easter Seals DuPage & Fox Valley occupational therapy services, visit eastersealsdfvr.org.

A Super Sensory Summer

By: Laura Bueche MOT OTR/L

Summertime is the best time for some creative sensory play outside. Your child will have a blast learning and exploring with these sensory summer activities that won’t break the bank.

IDEAS TO INSPIRE YOUR LITTLE SPROUT

Garden Party!

Fill a tub with soil. Hide plastic bugs, coins, or dinosaurs.
Use shovels or hands to find the treasures.

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Paint pots, plant seeds and watch them grow.
Overturn rocks to search for bugs and worms… or play with fake worms. Recipe here.

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Photo Credit: Learning4kids.net

Is real mud a difficult texture for your little one?  Start with “ghost mud”.
Recipe here

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Photo Credit: TreeHouseTV.com

Make a Splash with these Water Activities

Water Fun!

Fill a tub with water beads and ocean animals for an awesome, hands-on aquarium.

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Freeze toy animals, foam puzzle pieces, or pretend jewelry in ice. Have your kiddos use squeeze bottles, and eye droppers of warm water to get them out. Instructions here.

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Photo Credit: LittleBinsForLittlehands.com

Green gross swamp sensory table. Recipe here.

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Photo Credit: NoTimeForFlashCards.com

 

 

 

 

 

 

 

Shaving Cream Car wash. Recipe here.

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Photo Credit: TreeHouseTV.com

 

 

 

 

 

 

 

Let’s go to the Beach!

Feel the sand between your toes with these fun tactile activities.

Sand Slime. It’s ooey, it’s gooey…and sandy? Recipe: Here

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Photo Credit: GrowingAJeweledRose.com

 

 

 

 

 

 

 

Drawing letters in the sand, a perfect pairing of visual motor and tactile. Recipe here.

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Photo Credit: AnyGivenMoment.com

 

 

 

 

 

 

 

Kinetic Sand…semi sticky, and super moldable sand. Get it here.

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Good old sand box play…because nothing beats the classic, pale and shovel.

For more summer sensory ideas, or ways to adapt these activities to your child’s needs and goals, ask your occupational therapist at Easterseals DuPage & Fox Valley. For more information about occupational therapy visit our website.

Have a great summer!

 

Teaching Your Child How to Tie Their Shoes

By: Laura Bueche MOT OTR/L

Teaching your child how to tie shoes can be frustrating for parent and child. This tricky dressing task relies on a variety of different components to work together such as: fine motor skills, bilateral hand skills, visual perceptual skills, sequencing, and attention.

Here are some easy tips and tricks I’ve picked up over the years to help your child be more successful with this tricky self-help task.

 SET UP FOR SUCCESS

Practice Off the Foot

tie a shoe

It is much easier to learn how to tie a shoe when the shoe isn’t on your foot.  You can lace up an old shoe for your child to practice on, or you can make a “learning shoe” with cardboard or an egg carton.

Different Color Laces

Buy two pairs of laces of two different colors. This will help your child with the visual perception piece. She or he will be better able to see the laces and differentiate, and avoid a tangled mess.

Visual Check List

Print out the sequence pictures from this blog to make a flip-book and follow along as you teach. This can help your child sequence through the steps.

One or Two Steps at a Time

Learning all the steps at once can be overwhelming. Read your child’s motivation and/or frustration levels to know when to push forward and when to call it a day.

Don’t Rush

Set aside time to practice. Rushing out the door is NOT the time for learning. Set aside a time to work on shoe tying when you can go at a slow and stress free pace.

Ok great! Now you are set up and ready to learn the magic formula to teach your child how to tie their shoes…

MISS LAURA’S MAGIC FORMULA

  1. Hold the laces

shoe_1

2.  Make an “X”

shoe_2

3.  What lace is on top? (blue)

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4.  Top Lace (blue) goes through the tunnel

shoe_4

5.  Pull Tightshoe_5

6.  Make a loop

Not too big… Not too small…Not too far away

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    7.  Blue lace goes aroouuund town

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     8.  Drop it!

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    9.  Thumb pushes bunny through the hole

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   10.  Grab both bunny earsbunny

           11.  Pull tightshoe_11jpg

DONE!!

Other Tips

Elastic shoelaces

Elastic shoelaces are great because they look just like regular laces and allow your child to slip on their sneakers without untying. This can be used as a great compensatory strategy or a temporary substitute while your child is in the process of leaning to tie shoes.

Hemiplegia

Here’s a resource for kids who need a one handed alternative.

Still having trouble?

Despite your best efforts, if your child is still having difficulty, perhaps it’s worth an occupational therapy screening or evaluation to determine if there is an underlying fine motor, visual motor, bilateral coordination, or visual perceptual problem. An occupational therapist will be able to adapt this shoe tying task to better fit your individual child’s needs.

Learn more about occupational therapy and other programs at eastersealsdfvr.org.

 

 

 

 

 

Can your child benefit from Constraint-Induced Movement Therapy?

By: Emily Muzzy, Occupational Therapist

What is Constraint Induced Movement Therapy (CIMT)? 
Constraint-Induced Movement is a therapeutic approach for children with one sided weakness such as hemiplegia, brachial plexus or other unilateral impairment. CIMT was originally utilized in the adult rehabilitation setting to treat post-stroke patients.  However, it was found that children with one-sided involvement could also benefit from this type of treatment. Numerous research studies have shown that by restraining the unaffected limb and intensifying  use of the affected limb, pediatric constraint induced movement therapy produces major and sustained improvement in motor function in children.

Children with one-sided involvement often experience “learned non-use” of the affected side.  Forced use of the affected side helps to regenerate neural pathways back to the brain, increasing awareness of that side.  This leads to increased spontaneity of use of the arm and improved function.  The forced use is attained by the child wearing a constraint cast on his/her uninvolved arm for a period of time each day (preferably a minimum of two hours).  The cast is made by an Occupational Therapist and is removable.  When the cast is worn, this allows for mass practice of therapeutic activities with the involved arm.

What should a child hope to gain in an intensive program utilizing CIMT?

  • Typical goals of a CIMT program include improved quality of gross and fine motor skills and improved bilateral hand use for daily living tasks.
  • Family education will be provided on use of the cast at home, and home program activities will be provided to promote successful use of the involved arm and hand.
  • A skilled occupational therapist will help to develop specific functional goals for your child based on his/her specific needs.

Who is appropriate for constraint therapy?

  • Typically, children with a diagnosis of hemiplegia, cerebral palsy or brachial plexus injury (though any child with one-sided involvement could be considered).
  • This is generally used with children from 18 months to 10 years of age.  Younger children have a more plastic neurological system and greater gains may be seen with them than with older children.

CIMT

After finishing a session of CIMT, one parent couldn’t believe her child’s progress after four weeks of therapy.

My child’s time in constraint camp improved his fine motor skills and he had fun while doing it!  He will always use his right side, but by putting on the cast, it strengthened his weak side and now he uses it more to support activities.

What does a session of constraint therapy look like?

  • At this center, a child is seen for 4 weeks of intensive therapy, 3 times per week.  Each session lasts 2 hours per day.  The fourth week focuses on bilateral training without use of the constraint cast in order to practice functional activities with both hands.
  • The therapy sessions of the CIMT program offered at this center should look like FUN!  We work hard to provide a variety of play-based activities that promote repeated use of the affected limb.
  • Messy tactile play is used to promote increased awareness.  Activities like giving farm animals a bath in shaving cream, building sand castles, and finding play bugs in dirt are just some examples of the way kids can get messy with their involved hands.
  • Activities to promote shoulder strengthening are incorporated through climbing over obstacle courses with ladders, slides, and tunnels.
  • A variety of grasp and release activities are used.  Use of the “just right” size of objects is needed so the child can be successful.cimt2
  • Activities on a vertical surface such as finger painting on the wall are beneficial for getting shoulder movement along with wrist and finger extension.
  • The child will be constantly engaged in activities that will require use of his/her affected arm.

Two sessions of CIMT are offered this summer as part of our Community Based Therapy Programs.  For more information on registering, contact our Intake Coordinator at 630.261.6287. Check out the additional Community Based Therapy programs like Aquatic Therapy, Fun with Food and social skills programs  here.

Toe Walking in Toddlers…is it Normal?

By: Bridget Hobbs, PT, DPT

Walking on the balls of the feet or “toe-walking”, is quite common in children just learning to walk. The good news is that many children out-grow it within a few months of walking.  However, if your child is toe-walking beyond the age of 2, it is worth talking to your pediatrician about it, as there may be an underlying cause associated with this.

There are a few main reasons why children toe-walk:

  • Shortened Achilles tendon

A shortened Achilles tendon (bottom part of the calf) can cause less flexibility at the ankle, making it more difficult for a child to get his heel down when walking.  When this is thetoe walk case, physical therapy can help stretch the calf muscle group and strengthen muscles in the core and front part of the lower leg. This therapy can help the child learn to walk with a more typical “heel to toe” walking pattern.  Sometimes your therapist will recommend a brace to wear during the day and/or at night in order to help get a child’s heel down when walking and stretch the Achilles tendon at night.  In some cases, a series of casts may be used to help gain range of motion at the ankle.  Surgery may be recommended for correction in rare cases or when “toe-walking” persists into later childhood.

  • Sensory Processing

“Toe- walking” can also be a sensory-seeking behavior. Children who need more proprioceptive input will lock their knees and ankles. Children may also lock these joints to feel more stable and better prepare them for physical activities, such as running. Some children walk on their toes as they are hypersensitive to different textures or temperatures on the floor. “Toe-walking” can become a habit and if done frequently, can lead to tight Achilles tendons. This is why, if you or your pediatrician feel like your child has sensory concerns, that they are evaluated by an occupational therapist to help with strategies.

  • Underlying Medical Diagnosis

If “toe- walking” persists beyond the age of 2 or if it is accompanied by muscle stiffness, difficulty with communication or language delays, coordination problems, or if your child toe-walks just on one side, it is a good idea to speak with your pediatrician about it so you can find out if there is an under-lying cause.  Diagnoses including Cerebral Palsy, Muscular Dystrophy, Spinal Muscular Atrophy, Charcot-Marie Tooth and Tethered Cord have all been linked with early “toe-walking”. Some (but not all) children with Autism and other Pervasive Development Disorders (PDD) have also been noted to toe-walk.Caroline-PE Selected Photo

  • Idiopathic “Toe-Walking”

Idiopathic “toe-walking” is used to describe a child who toe-walks without any known reason.  Children who walk on their toes may have frequent falls, lean more forward when they walk, and show more difficulty with balance. “Toe-walking” may also be hereditary, where more than one child in the family toe-walks.   Early recognition and intervention is fundamental to prevent a shortened calf muscle and help develop a normal walking pattern and balance reactions.

Many children “toe-walk” as they learn to walk, and with a proper heel-to-toe walking pattern, they learn fairly quickly. However, if you are concerned that your child is toe-walking beyond the age of 2, or is showing other difficulties with development, it is important to speak with your pediatrician.  They may refer you to a physical or occupational therapist who can further assist you and your child.

Learn more about Physical Therapy services at Easter Seals DuPage & Fox Valley: http://eastersealsdfvr.org/physical.therapy.

Go Ahead, Play with Your Food!

By: Maureen Karwowski, OT

In my house growing up, meals were serious business.  My parents had rules around “dawdling”, and playing with food was an absolute “no no”.  Now, in my work as a pediatric occupational therapist, I advise the families that I work with to break these rules (and for good reasons).

Many of the children that I work with have sensory processing difficulties.  Sensory processing challenges occur when a child has difficulty interpreting and responding to the sensory experiences in daily life. It is estimated that 1 of 20 children are impacted by a sensory processing deficit (Ahn, Miller, Milberger, McIntosh, 2004).

For some children with sensory processing difficulties, they have heightened sensitivity to textures, smells and tastes. These sensory over-reactions negatively impact a child’s ability to tolerate diets with a wide variety of textures, looks, smells and tastes.  I have clients who eat foods that are similar in color, for instance all shades of white (crackers and chips).  Other children eat foods that are munchable in texture, so graham crackers, chicken nuggets, and macaroni and cheese.  One little boy that I worked with could not even be in the kitchen while his mother was cooking because the smells were so offensive to him.    I remember clearly that he told me “food is not fun for me like it is for you”.  That was a profound statement from a child of 5 years of age.

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Photo by Steven Van Dyke

The good news is that I have seen great results in helping a child to expand their diet with work in therapy, and with the parents’ work at home.  Many children do well with an individual while others do their best in a group with other children.  I always start with a thorough occupational therapy evaluation, and assess the child’s sensory processing skills, motor coordination and fine motor skills.  I work closely with speech therapists and a dietitian who specialize in working with children with feeding challenges. I want to rule out any oral motor and medical concerns before starting any kind of therapy with feeding.

The goal of my therapy sessions is to explore foods in a fun and low pressure manner. So dawdling and playing with food are an integral part of the work with my clients.  Picture making towers of cucumber slices, while my client knocks them over repeatedly.  Picture using those cucumber slices as goggles to look through.  How about blowing peas off the table and into a bowl?  I love making shapes and letters with cooked spaghetti noodles.  These types of games provide my clients with the sensory experience of the food, but in a way that is very low pressure.  The goal is not to eat the food initially, but to explore the foods in any way that the child can tolerate it.  As the child is more comfortable with the touch, smell, look and taste of a food, the more likely they would be to eat the food.

For parents at home, I do suggest a time where the parent and child are having fun with exploring food, in any way that they can.  I encourage families to have the child help with carrying food to the table, or pick out the vegetables at the market.  Can the child mash potatoes?  How about toss a salad?  A child is much more likely to explore a food if they know that their parent is not expecting them to taste it.

Consult your child’s therapist to determine if your child would benefit from a sensory approach to feeding or contact Easter Seals DuPage & Fox Valley for information about our summer feeding groups.

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If you are interested in learning more about sensory feeding work you can look at the following resources:

header photos by Amanda Grabenhofer