Pediatric Occupational Therapy

What is Pediatric Occupational Therapy?
Occupational therapy addresses a child’s ability to function in the everyday tasks that someone of the same age typically encounters.  For younger children, this may be learning to play with toddler toys, drinking from a bottle, and rolling over.  A pre-school child’s daily tasks are about learning to dress themselves, feed themselves, and play with other children.  As children get older, occupational therapy ensures that they can function as independently as possible in all their self-care tasks as well as during the school day.  OT may address a child’s needs through developmental activities, fine motor tasks, sensory integration, visual motor tasks, gross motor play, or other skill based tasks.

Our Pediatric Occupational Therapists (OT) work with children and infants who have problems in cognitive functions, movement and coordination.  These young patients could be living with a wide range of conditions such as neurological complaints, orthopedic injuries, spinal cord damage, muscular dystrophy or other motor disorders.

The work of a pediatric occupational therapist involves analyzing and treating skeletal, neuromuscular or cognitive restrictions of their young patients and helping them in developing their interaction and communication skills, refinement of motor skills and educating them in self-care skills, especially for older children.  Most of the patients are too young to understand verbal instructions, so games are often incorporated in the therapy.  This helps to engage their interest and cooperation.  It is imperative to have the commitment and support of the family as well.

Occupational Therapy Treatments

Activities of daily living (ADL) are the basic daily activities one does to be independent.  These activities include things such as bathing, dressing, eating, grooming, transferring to and from bed or chair, toileting, ambulation, shopping, cooking and housework.
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Aquatic therapy is water-based physical, occupational and speech therapy treatment. It includes exercise or therapeutic activity/movement that benefits our patients who exhibit difficulty with weight bearing activities or have an inability to move their bodies against the weight of gravity. This could have been caused by injuries or physical disability. The water allows buoyancy, helps reduce joint pain and provides resistance during therapy based activity. All disciplines have been trained including physical, occupational and speech therapists.

Each discipline uses this environment to help meet the outcomes specific to the goals set for the patient. We utilize many aquatic therapy techniques and principles including NDT-based aquatic techniques, Bad Ragaz Ring Method, Halliwick, Watsu-type movements and general swim stroke training modifications.

Fine motor (FM) skills are important to ensure proper development.  It is an important component of development in infants and children to practice fine motor skills for functional use of hands.  Examples of FM activities are: shoe tying, manipulating small objects such as buttons, zipping and unzipping, using scissors, pinching, opening and closing objects, handwriting, grasping items and being able to isolate finger movements to push buttons or type.

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Play is a vital part of a child’s learning.  If milestones are not met, it can signal to medical professionals and parents a more serious problem, or the need for further investigation to identify the underlying cause of the delay.  Often times, the first signals of motor skill, sensory or cognitive delays present themselves as delayed milestones.  It is important to address these delays as soon as they are identified to prevent secondary impairments or compensatory movements that may lead to further motor, sensory, behavioral or cognitive delays.

Occupational therapists address these delays during treatment utilizing play activities where the child may not realize they are working on skill development.  As occupational therapists, our goal in all treatments is to find meaningful and purposeful activities that motivate the child to reach their full potential.

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Due to medical complications, many of our patients do not develop oral skills required to coordinate sucking and oral exploration during early development.  A lack of oral skills development often leads to difficulties in oral feeding.  We work with feeding on all levels from enteral to oral feeds.  Some children are not born with feeding issues, but develop feeding problems as a result of NICU hospitalizations, sensory impairments, sensory-motor impairments or failure to thrive.  These children may have oral aversion, limited food choices, poor appetite, poor intake or weight gain.  After an extensive evaluation, the best-individualized treatment approach is chosen and implemented.
Handwriting Without Tears® is a program that evaluates and treats the child as a whole when looking at handwriting.  Handwriting problems may include difficulty with letter formation, letter spacing and sizing.  These problems are commonly addressed in occupational therapy by determining the underlying causes of poor handwriting or frustration with handwriting.  During a handwriting evaluation, it is important to consider a pediatric patient’s visual-perceptual and visual-motor skills as well as ensure that the child has all of the pre-writing skills necessary to be successful with handwriting. Go to www.hwtears.com for more information.
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Integrated Listening System, or iLs, is a multi-sensory program for improving brain function. It is an enjoyable activity or exercise which can be customized for all ages and skill levels for implementation in clinic, school or home.  iLs has a global effect on the brain and central nervous system, influencing the following systems: balance, visual, auditory, motor, coordination, behavior and emotional regulation.  As a result, it is successfully implemented for a wide variety of conditions: learning difficulties, reading, auditory processing, attention and regulation, sensory processing, speech and language, autism and other neuro-developmental difficulties.

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Based on clinically proven outcomes, iLs programs strengthen existing pathways and create new neural connections/pathways in the brain (“neuroplasticity”).  As these neurological connections grow stronger, language skills and emotional/psychological functions, such as self-confidence and regulation, also tend to improve.   The improvements in brain function are based on the premise that our higher brain functions – the “cortical functions” such as language, cognitive skills, socialization – rely and depend upon how well sensory input is received and processed as it enters the central nervous system and is relayed to the upper brain.  iLs improves processing at both the sub-cortical and cortical levels.

The design of iLs programs is based around the listening component.  Each product has a specific listening schedule, into which the balance and visual activities are included.  These “integrating” activities compromise 15-20 minutes of each listening session, and are explained in a Playbook which accompanies each product.  iLs clinic programs are typically 20-40 sessions in length, with a frequency of 3 or more sessions per week.  Each session is 60-80 minutes long with 15-20 minutes allotted for the integration activities.  The balance of each session is spent doing creative and/or relaxing activities such as drawing, puzzles, fine-motor games, or just relaxing in a comfortable chair.  iLs home programs are designed to be flexible with listening sessions at either 30 or 60 minutes in length.  The entire program is typically completed over a 3-month period.

Kinesio Taping® involves the use of a special elastic therapeutic tape that is applied to the skin over a specific muscle or joint.  This taping method is very different than traditional taping methods that often involve rigid tape.  It is Kinesiotapes elastic properties that encourage use of weakened muscle groups and improve circulation.  In the pediatric population, Kinesiotape can be used for a variety of purposes, but its most common use is to encourage the use of proper muscles to perform specific movements over a period of time.  Increased use of a weakened muscle improves strength and the quality of movement improves.  Other therapeutic uses for Kinesiotape include pain management, edema (swelling) management and joint/tendon stabilization. Go to www.kinesiotaping.com for more information or watch this video.
NDT is the primary treatment technique for individuals with central nervous system impairment such as children with cerebral palsy or traumatic brain injury.  NDT trained therapists believe that due to the central nervous system impairment, atypical posture and movement patterns are used by the child for function.  Unfortunately, it is the use of these patterns that lead to secondary impairments and dysfunction.  NDT trained therapists use clinical thinking to evaluate a child’s movement in order to determine the focus of each physical, occupational or speech therapy session.  Therapeutic handling is used to assist in the facilitation of typical movement to gain function.

Reach Therapy is an NDTA Center of Excellence(NDTCOE). As an NDTCOE, Reach partners with NDTA in education dedicated to training as many therapists as possible in the Neuro-Developmental Treatment Approach. In addition to our trained staff, Reach has hosted many NDTA courses including the 8-week pediatric certification course. Because of our dedication and commitment to this treatment philosophy, we have been named one of the first facilities designated as an NDTA “Center of Excellence”.

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Oral-motor patterns must be directly observed.  The individual presents many different patterns at once with varying degrees of severity and skill, making identification of baseline oral motor skills challenging for the therapist.  Different patterns may be observed with different food types and in response to different types of stimuli.  At Reach Therapy, many of our SLPs and OTs are trained in oral motor treatment and assessment.  Over the years, we have hosted oral motor experts such as Debra Beckman CCC-SLP and Gay-Lloyd Pinder, PhD, CCC-SLP, C/NDT.  Many of our staff have taken these training courses, adding to our expertise in the area of feeding and oral motor therapy techniques.

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Sensory Integration involves a trained therapist who generally works with the child in a room specifically designed to stimulate and challenge all of the senses.  During the session, the therapist works closely with the child to encourage movement within the room.  The therapy is driven by four main principles: The Just Right Challenge (the child must be able to meet the challenges through playful activities), Adaptive Response (the child adapts behavior to meet the challenges presented), Engagement (the child will want to participate because the activities are fun) and Child-directed (the child’s preferred activities are used in the session).

Our sensory system is the way we perceive the world around us, and if our sensory system is not working properly it affects us negatively.  Anyone can have sensory dysfunction.  Our senses include touch, hearing sight, taste, smell, gravity, joint and muscle movement.  Sensory Integration is a neurological process that provides us with the ability to combine all of these senses and enables us to appropriately interact with people and the environment.  Sensory integration is a part of normal development for most children through play and everyday activities.  In children who lack the integration, we see development delays, learning deficits, feeding difficulties and behavior problems.  These deficits may occur due to their inability to process sensory information appropriately.  Sensory integration is frequently utilized as a treatment for sensory issues in child autism.

Sensory integration therapy is careful to not provide children with more sensory stimulation than they can cope with.  The therapist looks for signs of distress.  Children with lower sensitivity (hyposensitivity) may be exposed to strong sensations, while children with heightened sensitivity (hypersensitivity) may be exposed to quieter activities.  Treats and rewards may be used to encourage children to tolerate activities they would normally avoid. Go to www.sinetwork.org for more information on Sensory Integration therapy or watch this video.

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At Reach Therapy, we have staff trained in 2 different therapeutic listening programs: Samonas and Integrated Listening Sytems (iLs).

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Samonas Sound Therapy is a scientifically and artistically structured auditory intervention program that uses music, voice and nature sounds to re-map and restore the brain’s ability to process sound.  Ingo Steinbach, a German sound engineer with a broad background in music, physics and electronics, developed this method through 20 years of research.

Used by over 3,000 practitioners worldwide, Samonas Auditory intervention has proven effective in children and adults of all ages.  Because Samonas is a home-based therapy program, it can be done at any time of the day, in the place where your child is most comfortable: your home.  The auditory system is linked to many parts of the mind/body system.  Due to this linking, the effects of sound therapy can be far reaching.  Therapists, parents and educators have witnessed positive change in areas such as learning disabilities, auditory processing, sensory integration, attention and focus, balance/coordination and memory, language and communications.

Samonas is an individualized sound therapy program that combines the essential elements of music, sound and science in specialized recordings.

Go to http://www.samonas.com/H03/H03a.html for more information.

TheraTogs are an exo-muscular system for neuromotor postural and sensory training.  The suit is worn under the patient’s clothes for up to 16 hours a day and provides the patient with body awareness, bone and joint development, sensory input, assists with stability issues, provides joint alignment and assists with motor performance. Go to http://www.theratogs.com for more information or watch this video.

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Visual Perception refers to the brain’s ability to make sense of what the eyes see.  This is not the same as the term visual acuities, which means how clearly a person sees (i.e. “20/20 vision”).  A person can have 20/20 vision and still have problems with visual perceptual processing.  Good visual perceptual skills are needed for reading, writing, cutting, drawing and completing math problems as well as many other skills.  A child who has problems with perceptual processing might have difficulties working puzzles, copying block designs or discriminating shapes, pictures or letters.

Seven “sub-areas” under the term visual perception include visual discrimination, visual memory, visual spatial relationships, visual form constancy, visual sequential memory, visual figure ground and visual closure.  It is important to note that visual perceptual deficits cannot be remediated with practice.  Therapeutic activities are designed to help children compensate for visual perceptual deficits and assist them to capitalize on their visual perceptual strengths.  If you suspect your child has a visual perceptual processing problem, you should request an evaluation by a trained professional such as an occupational therapist.

Assessments include the non-motor test of visual perceptual skills, motor free visual perception test and Beery Test of visual perception (a sub-test of the Beery Test of Visual Motor Integration).

The VitalStim® Therapy System is a non-invasive, external electrical stimulation therapy cleared to market by the Food and Drug Administration in 2002 for the treatment of dysphagia with application on the anterior neck.  The VitalStim® Therapy System is designed as an adjunct modality, meaning a clinician will apply VitalStim® while simultaneously working with the patient on swallowing exercise.  The goals of VitalStim® are to increase spontaneous swallow so that the child can manage oral secretions (saliva), begin feeding trials, advance diet texture, increase efficiency of swallow/oral intake, decrease incidences of aspiration and decrease reliance on tube feeding.  Patients with the following diagnoses may benefit: anoxia, or acquired brain injury, cerebral palsy, recurrent aspiration pneumonia, chronic pulmonary problems, tube-feeding dependent, and other diagnoses deemed appropriate by your therapist and physician. Go to www.vitalstim.com for more information.

Julian’s Mom says…
“Occupational Therapy at Reach has helped my child improve his hand-eye coordination and motor skills. Julien’s therapist has done an excellent job in helping him to improve his quality of life”

Jazlyn’s Mother says…
“The therapists are phenomenal and truly care about a child’s goal. The plans are reasonable in advancing and will state any concerns. “Where we truly Reach for every child’s goal”. April (OT) has grown with our child and their bond is amazing. Ale (SP) has helped us find a helpful communication device. Ogechi (PT) is our new physical therapist and has already improved Jazzy’s core work. All are a blessing and work together for the best interest of my daughter and she knows who they are and loves all just by her smile when she sees them.

Jayden’s Mom says…
“Occupational therapy at Reach has helped Jayden in many ways. Slowly but surely Jayden is becoming more and more comfortable around other people besides his family. The introduction to using sign language and pictures in order to communicate is the best thing that I feel like Reach has taught my son. Jayden’s therapists are great, and very patient with Jayden. Because I know he can be a handful.”