Tag Archives: physical therapy

All About Adaptive Bikes

By: Bridget Hobbs, PT, DPT

img_7454.jpgWant to see pure joy in a child’s face?  Put him on a bike!  Children of all abilities love the freedom, weightlessness and fun that bicycles (and tricycles) provide.  Just like children, bicycles come in all varieties and can be adapted for children with special needs.

Bicycle riding provides not only the physical benefits such as leg strengthening, increased balance, coordination and endurance, but also the social benefits of riding with family and peers.  Below are just a few examples of modified cycles that are made to assist children with special needs in their bike riding goals.

bike

Adaptive tricycle: The three wheels on this tricycle provide a wide base for increased stability which helps children feel safe not only when riding the bike, but when getting on and off it as well.  The high back and seat belt also provide proper trunk support to help a child stay upright and midline.  There are also Velcro foot holders to prevent feet from sliding forward.

Rhys

Tandem bicycles: Tandem bicycles allow for a parent to propel the bicycle with the option to turn the child’s pedals on or off, which enables a child to rest and enjoy the ride when they are tired. The tandem bicycle also allows for communication while simultaneously enjoying the benefits of exercise.

IMG_2952

Bicycle Trailer: A bicycle trailer is a good option for longer family bike rides where everyone in the family can be included.  The bicycle trailer allows for a lot of leg room and a child or adult can be easily transferred in and out of the trailer and positioned in many different ways.

cycle

Hand and Foot Cycle: A hand and foot cycle can be used for children who have lower extremity weakness, spina bifida, cerebral palsy or low muscle tone. This type of tricycle has the ability to be propelled with either arms and/or legs.   A benefit of this type of tricycle is that children can increase their range of motion in their arms as well as work on a reciprocal motor pattern of their upper extremities.

Your child’s physical or occupational therapist is a great resource to help you and your child learn what kind of bicycle or tricycle would be good for your child.   A few companies/websites that may be helpful in adapted cycles are below:

jonathan-goers-logo.png

Thanks to a generous donor, we are pleased to launch the Jonathan Goers Bike Club at Easter Seals DuPage & Fox Valley. This program was established to share Jonathan’s joy of biking with children who have developmental delays and/or disabilities and may not otherwise have the opportunity to ride or own a bicycle. The program will provide a child with an adapted bicycle free of charge.

Any family of a child with a developmental delay or disability is eligible to apply to this program. The bike must be returned to Easter Seals DuPage & Fox Valley if the child outgrows or no longer uses the bike. This will allow another child to enjoy the benefits of biking. Speak with your Easter Seals DuPage & Fox Valley therapist for more information on the application.

The first bike giveaway will be at our 2nd Annual Bike for the Kids event on September 17 in Elgin. Adapted bikes and trailers are welcome and all ages and abilities are encouraged to participate. Choose your distance from 100 Miles to the 2.5 Mile family ride. Learn more at www.EasterSealsDFVR.org/BikeForTheKids.

Advertisements

Begin to Bike

By: Cassidy McCoy PT, DPT

Summer is a great time of year to get back on your bike.  Here are a few key concepts to help your child ditch the training wheels!

The key to learning how to balance and ride on a two-wheeled bike is to ensure proper stability at the trunk, allowing your child to move their arms and legs freely for steering and pedaling.  Here are some tips to help bring the physical components of bike riding all together.

  1. Balance bike
    1. A balance bike is a bike with no pedals. A balance bike can be purchased, or balance bikeyou can simply remove the pedals from your child’s current bike until they get the hang of it.
    2. First, start with having your child sit on the bike, lower the seat so their feet touch the ground. Have them walk the bike with their feet to begin to learn how to balance without training wheels.
    3. As this gets easier, progress to using both feet at the same time to push the bike and pick their feet up off the floor to glide while maintaining their balance.
  2. Catching themselves
    1. Another way to work on balance is to teach your kids how to catch themselves by placing their foot down when they feel like they are tipping over. Hold the bike stationary for you child as they place both feet on the pedals. Let go of the bike, allowing it to fall to one side or the other. Your child should place their foot down in order to catch their balance.
  3. Steering
    1. Using cones or other objects, set up a pattern for your child to steer around. This can be done with a balance bike while scooting/walking it through or with pedaling if your child has mastered their balance.IMG_5042
  4. Start to Pedal
    1. When your child is ready to pedal, have them start standing with their feet flat on the floor. Have them lift one foot onto the pedal that is lifted at around 2-3 o’clock. As they push down on the pedal to get the bike going, they will lift their other foot onto the other pedal and push down to maintain momentum. If needed, you can help steady the bike by gently placing your hands on your child’s shoulder or the bike seat.

 

Bonus Pro Tip:

tricycleAvoid the discomfort of hunching over to push young riders along on their tricycles. Lace a sturdy rope around the bike’s structure, careful to avoid the spokes and pedals.  This allows you to help pull the trike along, adjusting the resistance to match the child’s ability.

 

Remember to always practice safe cycling. Wear a helmet, and obey the rules of the road.

 

Help your child develop their cycling skills at Easter Seals DuPage & Fox Valley’s Bike for the Kids on Sunday, September 17 in Elgin, IL.  This long-distance bike ride includes a 2.5 mile family ride, pedal parade and kid-friendly entertainment!

To learn more about Physical Therapy programs to improve strength, balance and coordination at at Easter Seals DuPage & Fox Valley visit:
http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/physical-therapy.html

 

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!

Gross Motor Play- Why Some Kids Won’t Participate

By Laura Znajda, PT, C/NDT
Manager of Community Based Therapy and Continuing Education

Summer is the ideal time for outdoor play, and children who love to run and climb are in their element. But children with very mild developmental challenges– or even no diagnosed problem at all— can have a great deal of difficulty learning new motor skills and keeping up with their peers on the playground.  Some children are mistakenly thought to be “clumsy” or “lazy” when they don’t try the advanced motor skills other children their age are mastering.

Physical and occupational therapists sometimes receive referrals to work with these children to strengthen their bodies so that they can gain skills more easily and keep up with their peers.  However, there is more to motor skills than just strength.  Pediatric therapists must analyze a child’s performance and consider all factors that might be impacting their success:Hannah_T

Flexibility
:  We all need normal range of motion in our joints to perform daily tasks, but outdoor play can require extreme ranges of movement as kids stretch their limbs to make that great play of the game or to access new parts of a play gym.  A restriction in range of motion at the hip or shoulder might make climbing the slide ladder difficult.  A neck range limitation could make it challenging for a child to scan the playing field for a teammate that is open for a pass.

Motor Planning:  Paraphrased from Jean Ayres, PhD, motor planning is defined as the act of planning movements inside the brain to complete a series of actions in the proper sequence.  Before a child even starts to move, the sequence of action is planned out in the brain.  When the child lacks experience with a particular skill, like pumping herself on a swing or hitting a ball with a bat, she might hesitate in order to give her brain time to make a plan for this novel task.  Typically, the time it takes to get started will decrease as the task becomes more familiar, but for some children this motor planning component does not come naturally and needs assistance.

Emmett_T.jpgBalance:  Children need to be able to balance on one leg long enough to lift the other leg to a raised surface or to kick a ball.  Even more importantly, they need dynamic balance—that is, control of their bodies while they are moving and balanced on one limb in order to reach out to the side to catch a baseball or make a soccer save.  A child with balance difficulties will seek out stable objects to hold when he has to lift a foot for any length of time or will avoid these activities altogether.

Coordination:    According to CanChild, a research center at McMaster University that organizes clinical  research concerning children with developmental conditions, coordination is a sequence of muscular actions or body movements occurring in a purposeful, orderly fashion (smooth and efficient).  We often think of coordination as the ability to use both sides of the body at the same time.  We need coordination to make the same movements with both arms and legs when we do exercises like jumping jacks.  And we need coordination to do different things with each body part, but all at the same time, such as dribbling a basketball while walking or running.  A child with coordination difficulties might need these advanced motor skills to be taught in a more graded manner before she can master them.Robbie_T.jpg

Motivation:  It might seem obvious that a child must be interested and motivated in an activity in order to be successful with it, however this important component of motor skill performance is sometimes overlooked.  Although research is inconclusive as to exactly how many repetitions are needed, we do know that a new skill requires at least hundreds of repetitions in order to become proficient.   If a child is not motivated to play a particular sport, he will not have the determination to practice a skill over and over and will not see the success that comes from that critical repetition.

Finally, strength is important. Just as necessary as all of these motor skill components; but not the only factor to consider when a child is hesitant or unsuccessful with outdoor play.

Easter Seals DuPage & Fox Valley therapists are expanding their ability to get to the bottom of why children don’t participate in outdoor play and develop new strategies to help them through a continuing education course taught by Lezlie Adler, OTR/L, C/NDT and Jane Styer-Acevedo, PT, DPT, C/NDT on September 22-23, 2016 at our Villa Park center.  Registration is open to all therapists at:  http://www.eastersealsdfvr.org/ce

References

Can Child, Institute for Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada L8S 1C7  www.canchild.ca

Ayres, A. Jean, Sensory Integration and the Child, Western Psychological Services, 2005.

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.

Could Changing our Thinking about Ankle-Foot-Orthotics (AFOs) Help Children Walk Better?

By: Laura Znajda, PT

This is a question many in the pediatric therapy world have been pondering and practicing for a number years.  Elaine Owen, MSc SRP, MCSP has completed quite a lot of research through her work as superintendent and clinical specialist physiotherapist at the Child Development Centre in Bangor, Wales, in the UK.  Through her careful study of the gait cycle, she has inspired us to think differently about the way the segments of the foot and leg are aligned at various times in the cycle, and she encourages us to replicate normal gait more closely through the use of not just an AFO, but AFO/footwear combinations.

AFO
The Old Paradigm: 0 degree plantarflexion AFOs and Flat Shoes. Photo from Beverly Cusick.

In her paper The importance of being earnest about shank and thigh kinematics especially when using ankle-foot orthosis, Elaine points out that contrary to the common belief that the lower leg is vertical at midstance (the way many solid-ankle AFOs are designed), the lower leg is actually inclined 10-12 degrees at this time in the gait cycle, and this inclined position places the knee joint over the center of the foot, which provides stability in single limb stance.  This information begs the question, are we actually causing more work for our clients, as they struggle to move their center of mass forward over an unnatural vertical lower leg position?  Could we increase efficiency and more closely approximate normal gait by adjusting the pitch of the AFO at midstance through the use of specific footwear or external additions to the brace?

AFO graphic
An example of a New Paradigm AFO. Photo from Beverly Cusick

Beverly Cusick, PT, MS, COF/BOC has done much to bring this, among other current concepts, to the attention of practicing pediatric therapists and orthotists.  In her paper, Help Patients Manage Equinus Deformity, Use Orthoses to teach children to optimize body weight carriage on the feet, Ms. Cusick describes a paradigm shift in brace design for children whose ankles are plantarflexed (toes pointed downward) while walking.  In addition to the concepts brought to light by Ms. Owen, Ms. Cusick considers the sensory benefit of gaining full heel loading in the brace as an essential component of the effort to improve postural control in standing and – when feasible – walking all day long. Modified AFOs combined with modified footwear can provide the wearer with a strong biomechanical training tool.

To get acquainted with these concepts, click on the references above and the Progressive Gaitways, LLC website:  www.gaitways.com.

To learn a lot more about how to bring them into your practice, attend a joint education course from Easter Seals DuPage & Fox Valley and Shriner’s Hospital presented by Beverly Cusick, PT, MS, NDT, COF/BOC in May:

For more continuing education information including the course schedule, please visit:  www.eastersealsdfvr.org/continuingeducation.

 

What’s Wrong with W-Sitting?

By: Bridget Hobbs, PT, DPT

Many parents and teachers know that w-sitting is bad for a child’s development, but they might not know why.   So, I am going to shed some light on what w-sitting is, what proper sitting positions look like and how best to encourage little ones to sit with correct posture.   W-sitting is sitting with bottom on the floor, knees in front and legs splayed out to the side, making a “w” or “m” shape depending on which way you look at it.

When babies are learning to crawl and transition in and out of sitting, they often go into w-sitting momentarily, which is completely normal and fine.  However, when a child sits in this position for longer periods of time, that is when you need to take action and help them to learn to correct their sitting posture.

Some children sit in a W because it is comfortable for them.   Other children with low muscle tone or weak core strength w-sit because it gives them a wider base of support to help keep their sitting balance.  This W-sitting position makes is difficult for a child to reach across midline and rotate their trunk which can lead to coordination and writing problems down the road.   W-sitting can also have negative orthopedic ramifications.  W-sitting puts strain on the knees and hips and can cause pain and tightness to these joints and muscles as well as to the back.  It also can affect the child’s sitting posture as it makes it difficult to sit up straight which is important for developing strong trunk muscles.   Children who have hip dysplasia also have a higher risk of hip dislocation if they w-sit.

Benny_T

How to Help Your Child Correct W-Sitting

Correct sitting postures include: tailor sitting (cross-legged sitting), long sitting (sitting with legs straight in front of you), or side sitting (legs to one side).

Tailor Sitting                          Long Sitting                  Side-Sitting

To encourage your child to sit cross-legged, try verbal cues such as “criss-cross applesause.” “pretzel sit”or “fix your legs.” Some children respond well to a simple tactile cue, such as a gentle tap to their knees.  If your child needs more motivation, you can have them earn a sticker or a small treat for every time that you catch them sitting the correct way.

For pre-school and early grade school when children are often sitting on the floor, using cube chairs can be helpful for children that have a hard time sitting correctly.  An added bonus is that these types of chairs help kids who are fidgety or wanting to move around more likely to stay put for story-time.

TakeThreePhotography_05202010-62

Cube Chairs

Proper sitting positions, such as tailor, long and side-sitting, help your child develop their core muscles by sitting up taller and enabling them to rotate across their body.  They also encourage proper weight shifting to allow a child to reach for toys outside of their base of support and also let a child use both hands at the same time on one side of the body.  If you are concerned about your child’s sitting posture, feel free to seek out a physical or occupational therapist at Easter Seals DuPage & Fox Valley for ideas and feedback on how to help your child play in different positions.

The Best Developmental Toys for Toddlers

By: Bridget Hobbs, PT, DPT

Perhaps you have a toddler’s birthday coming up or with (I can’t believe I’m saying this) the holidays just around the corner, you may be thinking about finding gifts for the little ones in your lives.  As a pediatric physical therapist, I often get asked about best toys for development.  Since I have a soon-to-be toddler at home, and because this age can sometimes be difficult to buy for (past rattles but not quite to the Barbie stage), I thought I’d share the best toys to encourage their development.

Blocks: Toy blocks might not be as sparkly or fancy as the tech-geared toys on the market.  However, they have stood the test of time for a reason.  Dating back to Piaget, numerous studies have proven the positive effects of block play with math skills later in life.  An author of a recent study that was published in the journal Child Dblocks2evelopment states “Research in the science of learning has shown that experiences like block building and puzzle play can improve children’s spatial skills and that these skills support complex mathematical problem solving in middle and high school,” explains Brian N. Verdine, one of the studies’ authors. You can read more of the study here. 

Play kitchen: I love a play kitchen not just for the imagination and sequencing aspect of preparing a meal, putting it on aplay kitchen plate and serving it to others, but for the gross motor benefits as well.  As seen below in the picture, there are many different levels to a play kitchen.  A child has to stand up to get a plate, squat down to put a pretend pie in the oven and walk side to side to put things in the sink.  All of these are dynamic movements that help to incorporate balance, stability and agility and helps toddlers build their confidence while navigating their environment.

Sound puzzles: Puzzles give little ones a jump on hand-eye coordination, help develop grasp as well as sequencing skills.  A bonus is the sound puzzles that make a sound, such as a helicopter motor or a cow mooing.  These puzzles teach cause and effect and can help TakeThreePhotography_05202010-62develop early sound development.

Small table and chairs: Children this age want to start coloring, drawing and delighting in their masterpieces.  An ideal chair for a little one would be one that helps their feet be firmly planted, with their hips and knees at 90 degree angles.

Shape sorters and stackers:  Shape sorters help a child with discriminating between different shapes, and figuring out how things fit together (think early engineering skills).  Shape sorters are a great way to encourage problem solving skills starting at a young age. Stackers, such as the cups shown below, assist a child with important concepts of placing things into a container and taking them out again.  shape stackers

Ride-On Toys: Try to avoid the expensive ‘power wheels’ type of toys that lose their battery after a week and take up loads of space in your house or garage.   A classic ride on toy will last riding toyyears or decades and will provide your child with balance and strengthening through propelling the toy and coordination through steering.

Often it’s the simplest, tried and true toys that are the best for child development.  So, if you recognize toys in the store that you had a kid, it’s likely that they are good for your child’s learning and motor development.   All of these toys listed above are enjoyable, educational and affordable.   They assist with gross and fine motor skills, language development and social engagement.

For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.

How to Prevent Your Baby From Getting a Flat Head

baby helmet

By: Bridget Hobbs, PT, DPT

You probably have seen them on babies in the mall, grocery store and at the park.  Baby helmets are everywhere!  Helmets have been used for a long time for safety with children that have seizures, but more recently they are also used to help mold babies’ heads that are flat back into a round shape.

Babies can have flat heads from crowding in-utero, which is very common with multiples.  However, there is an increasing number of cases of babies with flat head from positioning (or lack there-of) after they are born.   In fact, according to an article in the August 2013 issue of Pediatrics , 46.6 % of 440 infants studied from 7 to 12 weeks of age had positional plagiocephaly, or a flat head. Granted 78.3 % of children in the cohort study had a mild form of the condition; it does reveal that positional plagiocephaly is a very common occurrence these days.baby helmet

When your baby is born, her skull is very soft which has allowed her to travel through the birth canal.  They flexibility of the skull also allows for brain growth in the first years of life.  Because of this softness, the skull is very moldable.  Spending long periods of time in one position can lead to flatness of the side of the head (plagiocephaly) or back of the head (brachycephaly).

Print

The good news is that positional plagiocephaly is preventable.  Here are some tips that can help you manage your little ones’ head shape from day one.

  • Alternate the arm in which you carry your child. If you are right handed, it’s really tempting to just hold your baby in your left arm so it frees up the right hand to grab your cup of coffee or something out of the fridge.  However, when you just hold your baby in one arm, they are likely just using their neck muscles to look outward to one side.  Alternating which arm you use for carrying your baby encourages them to look both ways often, making their neck muscles strong and less likely to be tight on one side. Tightness on one side of the neck, otherwise known as torticollis, makes it difficult for your child to change their head position, which can lead to flat head.    In fact, many babies that have torticollis (tightness on one side of the neck) also have plagiocephaly (flat head).
  • When placing your baby down to sleep, alternate what side of the crib your baby’s head is on. This way, if baby is looking toward the door of the nursery or at a night light, they are alternating which side they are looking each night (or nap).  You can also switch which side of the changing pad you place your babies’ head when changing their diaper so they are looking both ways equally.  As a reminder, always place your child on their back to sleep.
  • Limit the time that your baby is in a container, for example car seats, strollers, bouncy seats and swings. Your baby does not have the ability to move her neck very much when placed in these containers, which can lead to tight neck muscles and flatness of the head.  As a mom of an infant myself, I know it is tempting to leave your child in the car seat when they fall asleep after being in the car.  Once in a while it is fine, and I am certainly guilty of it myself.  However, repeated naps in car seats can quickly become a problem.
  • Tummy time! I can’t say this enough…start tummy time early and do it often with your baby.  Some babies really don’t like it, but stick with it and they will gradually get used to it.  If they are really fussy, wait 1 hour after feeding to give their tummies time to settle after a meal.   For more tips on how to make tummy time easier for your child (and you!), refer to my previous blog “Yes! We Want Your Baby to Crawl!
Tummy time is important Photo by Lorae Mundt
Tummy time is a good way to prevent positional plagiocephaly. Photo by Lorae Mundt

Because of the “back to sleep” program, which started in 1992, babies are not on their tummies as much.  The back to sleep program has done an excellent job at reducing SIDS, but the tradeoff is that many children get plagiocephaly (flat heads) and torticollis (tight necks) from not spending enough play time on their tummy.   This often leads to physical therapy and a possible appointment at your nearest orthotist or baby helmet clinic.

Luckily, there are many clinics in the area that treat children with torticollis and plagiocephaly.  There are even specialized clinics that just fit babies for helmets and monitor their progress with head shape.  Most children have to wear baby head shaping helmets for a few months before they see good results with their head shape.

Pediatric physical therapy helps with stretching out tight muscles and strengthening weak neck muscles.   It also helps your child with their gross motor skills, such as rolling, crawling and standing, which can often be impacted by tight neck muscles and/or a flat head.   If your child has a flat head and/or tight neck muscles, schedule a physical therapy evaluation with a pediatric physical therapist at Easter Seals Dupage & Fox Valley by calling 630.261.6287.

Why Treat the Rib Cage?

By, Laura Znajda, PT,  Manager of Community Based Therapy and Continuing Education

Photo by McKenzie Burbach
Photo by McKenzie Burbach

When I went to Physical Therapy school, the entire unit on respiration and the musculature that supports it consisted of a self-study chapter.  With so little importance placed on this subject in school, I was surprised to see what an impact treating the rib cage has on my pediatric clients.  Learning about the way the rib cage changes in structure and function through normal development, and then what happens when a baby is born prematurely or has poor trunk strength, was a big eye opener for me.  Delving into this topic, the most important thing I realized is how rib position could affect not just breathing, but so many other areas of development, including motor skills like sitting, dressing and talking.

If you have put off learning about the rib cage because you think it won’t have a productive impact on your clients’ outcomes, ponder these reasons to add rib cage treatment to your repertoire:

  • The ribs are connected to the spine and need to move properly in order for the spine to move in all directions—we all know spinal movement is needed for everything from sitting up straight to swinging a baseball bat.
  • The ribcage needs to move downward, usually between 8 and 24 months of age, in order to gain a more efficient breathing pattern.  (the newborn pattern uses the diaphragm only; this normally changes over time to include using muscles all around the trunk to expand the ribcage in 3 directions, which allows the lungs to expand fully.  When the lungs can expand fully, the child can take deeper breaths and move air in and out more effectively.)
  • The rib cage is connected to the shoulder via the collar bones and shoulder blades.  The ribs need to move downward after infancy in order to allow the shoulders to work properly for activities such as reaching overhead and dressing.
  • Normally, a baby or child can change his breathing pattern when the body needs more stability for difficult tasks or when he needs to breathe faster under stress.  If the ribs do not move normally or are not in the right position, the child will only have one breathing pattern and might learn to hold his breath to gain stability.

    Photo by Petra Ford
    Photo by Petra Ford
  • The lower ribs need to move inward when lower trunk musculature contracts to produce an effective cough, which clears secretions from the lungs and upper airway.  When mucous is not cleared from the lungs, it can become infected and cause a pneumonia.
  • When trunk musculature is working properly to contract the rib cage with control, airflow over the vocal folds is controlled in such a way that allows the ability to produce sounds properly for voicing.

Normal development of motor skills that typically occurs from birth until the age of 2 facilitates the muscle lengthening and strengthening that moves the ribcage into its mature position and provides effective breathing patterns for the child.  When motor skills develop atypically, muscle lengthening, strengthening, and rib mobility must be provided by a Physical Therapist, Occupational Therapist, or Speech-Language Pathologist trained in this type of therapy.  The therapist must also instruct parents in exercises to do at home for the very best result.

The therapy staff at Easter Seals DuPage & Fox Valley are invested in learning more about this frequently overlooked area of treatment and are hosting a continuing education course this month to expand our skill base. Click here to learn more from Rona Alexander, PhD, CCC-SLP, BCS-S, C/NDT.

For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.