Therapist with child

Essential Competencies of a Pediatric Physical Therapist

Perhaps you just met your baby’s physical therapist (PT) for the first time. Or you are considering a physical therapy evaluation for your pre-adolescent and you are on the fence about whether an adult PT is better suited for him. Are you curious what sets pediatric physical therapists apart from others in the field? Or what today’s employers are looking for in entry level physical therapists?

While physical therapy has been around since the late 19th century, the field of pediatric physical therapy has experienced considerable changes since the 1970s.  Of the 200 plus institutions across the nation that offer doctoral physical therapy education and training, there is great variability in how pediatric instruction is provided. Between 2011 and 2012, the Section on Pediatrics (SoP) of the American Physical Therapy Association (APTA) worked extensively to set up a framework to guide curriculum development of all entry-level Doctor of Physical Therapy (DPT) education programs.  This framework focused on the most important aspects of working with children.  The core competencies described below outline the knowledge, skills, and abilities therapists need to be successful in this field. They also help clinical instructors, such as myself, create teaching strategies and learning objectives for future students.  Before any graduate of an entry-level DPT program could be considered a pediatric professional, she must demonstrate these 5 Essential Core Competencies:

1)      Human Development – The knowledge of development (especially motor development) across the lifespan is key in being able to analyze the growth and movement of children.  Not only do pediatric PTs know about typical and atypical movement at each age, they are also aware of the maturation process/transition between skills levels.  Orthopedic and neurological information specific to the pediatric population must be integrated throughout all clinical decision making for a pediatric therapist.  In order to effectively interact with children across their lifespan, knowledge of psychosocial, cognitive, and communication developmental levels are also essential.

2)      Therapist with childAAge-appropriate patient/client management – Along the line of being an effective clinician for children across different age groups, a pediatric physical therapist must accurately select appropriate tests and measures based on the child’s age, history, play activities, family structure, parent interview, endurance level, attention span, and numerous other factors.  Treatment planning and interpretation of examination results rely heavily on knowledge of developmentally appropriate interventions and goals. Needless to say, the rehabilitation process between a 2 year old and a 10 year old are very different, even if they have the same mechanism of injury.

 

3)      Family-centered care for all patient/client and family interactions – One key difference between treating children and treating adults is the level of family involvement during the course of therapy.  The pediatric therapist not only addresses the needs of the child, but the entire family as well. A child with special needs means a family with special needs. Pediatric therapists in various settings (hospitals, schools, clinics, doctor’s offices, and in the home) all must consider the priorities and goals of the family, as well as how they influence the child.

4)      Health promotion and safety – Going back to the idea that humans have different needs across the lifespan, special considerations must be given to the pediatric population.  Parents may not be aware of environmental factors that affect development, safety concerns for specific ages, or the appropriate health care professionals for each stage of a child’s development. Pediatric physical therapists are here for that health and wellness promotion, both for typically developing children and children with special needs.

5)      Legislation, policy, and systems – Lastly, pediatric practitioners must understand public health programs and legislative policies that are appropriate for each age group and setting of pediatric clinical practice, such as Medicaid, Individuals with Disabilities Education Act (IDEA), and other state and federal regulations.

Reference:

Essential competencies in entry-level pediatric physical therapy education.Rapport MJ, Furze J, Martin K, Schreiber J, Dannemiller LA, Dibiasio PA, Moerchen VA. Pediatr Phys Ther. 2014 Spring; 26(1):7-18

What Is the Difference Between Occupational and Physical Therapy for Children?

Many of the parents I meet often ask why very few occupational therapist work with infants, or why an occupational therapist (OT) is seeing their child for toe-walking as opposed to a physical therapist (PT). They often wonder why one child who has balance or coordination issues would see a physical therapist while another with similar limitations would see an occupational therapist instead. Some parents think that occupational therapists only work on fine motor skills while physical therapists only work on gross motor skills.  Physical and occupational therapists work in a variety of settings, including hospitals, neonatal intensive care units, skilled nursing homes, outpatient clinics, schools, rehabilitation centers, and doctor’s offices.  Physical therapist and occupational therapist roles differ depending on the setting they work in and the medical diagnoses they work with.

In the outpatient clinic, some of these roles may overlap.  While there are some similarities between PTs and OTs in each setting, there are a few fundamental differences between OTs and PTs in the pediatric setting.

Pediatric Physical Therapy:

In the pediatric outpatient setting, physical therapists are often musculoskeletal and movement specialists. Parents can seek out evaluations when their babies are as young as 1 month old. Physical therapists have in-depth knowledge about human musculoskeletal, neuromuscular, integumentary, and cardiovascular systems. Based on our background in stages of development and biomechanics, we help children with mobility difficulties; whether they are behind on their gross motor milestones, recovering from injury/surgery, or not keeping up with other children.

Through all kinds of hands-on or play techniques, pediatric physical therapist work with children on the following:

  • Gross motor skills
  • Strength
  • Endurance
  • Balance and coordination
  • Motor control and motor planning
  • Body awareness
  • Pain relief
  • Flexibility
  • Gait mechanics
  • Orthotics training
  • Wound care

Our focus is for children to be as mobile and as independent as possible, while training their caregivers on all aspects of a child’s physical development. This includes anything that may affect a child’s quality of movement, posture, alignment, and safety.

Pediatric Occupational Therapy

Outpatient pediatric occupational therapists are trained to improve the quality of children’s participation in their daily functional tasks.  A child’s job is to play and take part in activities at school and at home. These include important endeavors such as paying attention in class, hand writing, dressing, feeding and grooming themselves, and being able to engage in age-appropriate games. Occupational therapists are also trained to help children organize and interpret information from the environment so that they can just be kids. This may include taste aversions that limit their food intake, or texture aversions that affect their clothing tolerance, or sound aversions that affect their mood.

OTs work with children on the following skills:

  • Sensory integration
  • Cognitive endurance
  • Fine motor skills
  • Hand function
  • Visual-spatial awareness
  • Hand-eye coordination
  • Attention
  • Social skills
  • Body awareness

Occupational therapists often educate parents and teachers on the best techniques to ensure children participate in learning, self-care, and play tasks.

Why do some children need both disciplines and some only need one?

So many factors can affect a child’s ability to participate in her daily life. A child may be experiencing frequent falls or may have trouble jumping due to a number of reasons.  No matter the diagnosis or underlying medical condition, any child who is having a hard time keeping up with his peers can benefit from a comprehensive evaluation by a pediatric specialist.

Signs at the Playground Your Child May Need Physical Therapy

The playground is one of the most basic, yet most wonderful, forums for young children to begin to develop gross motorskills.  For most kids, the playground is a place where physical feats and skills come alive.  However, the many options at the playground also provide an excellent spot for parents to see if a child is lagging in an area of his gross motor development and may need physical therapy.  Read on for 5 signs this may be the case.

Signs at the Playground Your Child May Need Physical Therapy:

  • He is afraid to climb certain structures, for example a rock wall or a chain ladder.
  • He has difficulty keeping up with peers during running games.
  • He runs into objects or people/falls down often.
  • He leads with one leg only when climbing.
  • He demonstrates an inability to ride a bike independently by 7 years of age.

If you feel your child presents with any of these signs, a consultation with a physical therapist may be needed.  Remember, every child develops at his own pace.

Make the Most of Pediatric Therapy Sessions

Parents often ask how they can help their child make optimal progress while in therapy.  Attending therapy once or multiple times a week is a large commitment, both financially and time-wise.  Therefore, it’s important to make the most of your child’s time in therapy and to ensure you optimize your resources to help your child progress as much as possible.

5 Things parents can do to make the most of pediatric therapy sessions:

  1. Communicate with your child’s therapist.  If you don’t know what your child is working on in therapy, then there is a problem.  Your therapist should continually inform you what specific goals your child is working on and why.  Your therapist should also give you specific ways to address these goals at home.  If you feel unsatisfied with the communication between you and your therapist, talk to him or her about it.  Troubleshoot ideas to open the lines of communication, whether it’s talking at the end of treatment sessions, planning periodic phone meetings, or receiving e-mail updates.
  2. Check-in about the big picture.  In addition to weekly communication with your child’s therapist, schedule time every so often for a more thorough “check-in” meeting about your child’s progress and to collaborate on a plan moving forward.  This might be a face-to-face meeting or a phone conference.  These are best done without the distraction of your child or other siblings present.  Discuss your child’s progress, ask your questions, and get an idea of where things are going from here.  Is your child making progress?  If not, why?  Should therapy be increased to twice a week?  Will your child benefit from additional support from another therapeutic discipline? Read more

5 Top Chicago and North Shore Gyms for Children After They Graduate from Physical Therapy

My Gym

my gym logo
My Gym offers programs and classes to that are designed to help children that are 6 weeks through 13 years of age to develop physically, cognitively and emotionally.  They offer structured weekly classes that incorporate music, dance, relays, games, special rides, gymnastics, sports and more. Children will gain strength, balance, coordination, agility and flexibility while developing social skills, confidence and self-esteem. Classes are separated by ages: “Little Bundles” (6 weeks- 6 months), “Tiny Tykes” (7-13 months), “Waddlers” (14-22 months), “Gymsters” (23 Months – 2.5 years) and etc. Programs include Camp, Parents’ Night Out, Fit & Fun Days, Karate/Martial Arts and Free Play.

Little Gym little gym logo

The Little Gym of Chicago takes a holistic “Three-Dimensional Learning” approach to skill development. Their philosophy is based upon three core tenets: “Get Moving” to foster flexibility, strength, balance and coordination; “Brain Boost” to nurture listening skills, concentration and decision making; and “Citizen Kid” to promote sharing, teamwork, cooperation and leadership abilities. They offer programs and classes that are categorized by age: Parent/Child Classes for 4 months-3 years, Gymnastics for 4-6 years, Gymnastics for 6-12 years, Sports Skills for 3-6 years, Karate for 4-12 years and Dance for 3-12 years. There is also a WonderKids Club for 3-4 year olds that focuses on learning and development.

Bubbles Academy bubbles academy logo

Bubbles Academy offers events, programs, classes and play opportunities for children as well as their parents. Their class curriculum focuses on Motor Skills, Language, Attention, Self Expression, Socialization, Empathy and Confidence. The Bubbles Academy offers a free trial class. Their play-based enrichment courses include music, creative movement, art, yoga, independence, imagination, swimming, cooking and dance. Our educational series is progressive, including preschool preparation, gentle separation and an alternative preschool option. Programs are categorized based upon age groups and milestones: Babies (including Newborns, Bubble Music and Aqua Bubbles), Crawlers, Walkers, 2-3 years, 3-5 years, Family, Adult Fitness, Sibling Care and various camps.

Gymboree gymboree logo

Gymboree Play & Music has been fostering creativity and confidence in children of ages 0-5 for over 30 years. The play-type activities are designed to help develop the cognitive, physical and social skills of children. The class curriculum is based on a balanced whole-child approach with activities to support what your child is mastering currently and what he or she will aspire to master later. Classes are designed in 6-month increments in order to meet a child’s unique interests and abilities. Gymboree classes include Play & Learn, Music, Art, Sports, Family Fun and Social Skills.

Little Beans Cafe little beans

At Little Beans, kids have the freedom to play, learn, imagine and create in a custom interactive indoor playground. The premise of Little Beans Café is to provide families with a place to play together. It provides parents with a café atmosphere while providing kids with an interactive indoor village to explore and socialize. Little Beans have free-play, supervised play, classes, events, parties, camps and play groups.

When is Stiffness Problematic in Infants?

If your child seems stiff or rigid, he/she may have what is described as “high muscle tone” (hypertonia). This means that the muscles baby in towelare chronically contracted. Stiffness can become problematic in an infant when it limits the movements and acquisition of a child’s gross motor skills.

Signs of Stiffness in Infants:

  • Your child might hold his/her hands in tight fists or may seem unable to relax certain muscles.
  • He/She may have difficulty letting go of an object or difficulty moving from one position to another.
  • The legs or trunk of the child might cross or stiffen when you pick the child up as well.

How Can A Physical Therapist Help?

While limb stiffness is a sign of abnormal signals that are being sent from the brain to the body that over-activate certain muscle groups, some of these movement/coordination disorders are mild and can be treated with physical therapy. The physical therapist will help the child break out of her stiff positions, stretch out the tight muscles, strengthen the weak muscles and develop efficient movement patterns.

At times, limb stiffness is a symptom of spastic cerebral palsy; however, parents should not focus on a medical diagnosis within babies. Regardless of the medical diagnosis, the focus of therapy will be to stretch the tight, overactive muscles and guide the child to acquire motor skills and perform functional tasks in a more efficient manner.

How Can A Parent Help?

Parents should set up the environment to be motivating and organize activities so that the child can practice in a variety of ways. Both massage and Yoga can help to improve muscle length and flexibility. While Botulinum Toxin (commonly known by the brand name “Botox”) can help, it is not used in children that are younger than 18 months. This toxin is injected directly into a child’s muscles and temporarily paralyzes the muscle’s activity, giving the child the opportunity to stretch the tight muscle and strengthen the opposing muscle. Muscle relaxants may be prescribed for adults that have cerebral palsy, but they’re rarely used for toddlers as they cause drowsiness.

If you are concerned about the stiffness in your baby or if your child’s rigidity is keeping him/her from interacting with toys, contact your doctor and schedule an evaluation with a physical therapist.

10 Signs at School Suggesting a Student May Benefit from Physical Therapy

Children develop and improve their gross motor skills significantly during their early school years, between three and ten years of age. A lot of gross motor development occurs at school while playing at recess or doing activities in gym class. School offers the opportunity to recognize if a child needs extra assistance from a physical therapist in expanding or improving their gross motor skills.

Physical therapist treats child

Here are some tips for teachers that will help determine if a child would benefit from physical therapy:

  1. The child prefers to sit and play instead of run or participate in gross motor activities during recess or gym class.
  2. The child has difficulty jumping, skipping, or galloping when compared to their peers.
  3. The child has an atypical gait pattern (for example, they walk on their toes or they are “knock-kneed”)
  4. The child prefers to w-sit (with their knees bent, feet by their bottom, and bottom on the floor) instead of crossed-legged on the floor.
  5. The child frequently trips, falls, or bumps into objects.
  6. When walking up and down the stairs, the child does not alternate their feet, instead placing both feet on each step.
  7. The child is unable to kick a soccer ball.
  8. The child is unable to catch or throw a playground ball.
  9. The child runs significantly slower than his peers or has difficulty running for more than one minute.
  10. The child complains of pain or tightness in their ankles, knees, hips, or back.

If you see any of these characteristics in children at school, they may benefit from a physical therapy evaluation. Without fully developed gross motor skills, a child is going to have difficulties keeping up with their peers during recess or gym class. It will also affect their ability to participate in gross motor games and sports. Also, it is important to note that many children will exhibit the above behaviors and may or may not require physical therapy (PT) intervention therefore it is important to consult with a PT first.

Preparing for Pediatric Physical Therapy Evaluation

Coming to a physical therapist for your child for the first time can be an overwhelming and confusing experience – but it doesn’t have to be! Here at North Shore Pediatric Therapy we have outlined the most important information to know before you go to the pediatric physical therapist for the first time.Pediatric physical therapist smiling

Paperwork: Although no one enjoys filling out form after form, this information is essential to the therapist and office staff. Please remember to bring the following with you at your first appointment. This information will be emailed to you by the family-child advocate before you come in.

  • Copy of your physician’s prescription for physical therapy. It is imperative that we have this on file before any ongoing treatment sessions.
  • Insurance Card 
  • Your child’s past medical history. We will ask questions concerning his or her gross motor milestones and at what ages these were achieved, as well as birth history, pertinent family health history, educational history and general information about your child’s motor, language and social skills. Also if your child has visited a therapist before and you have documentation from these visits, we would be happy to make a copy of those as well.
  • A clear picture of your availability for future appointments. We will do our very best to make all future treatment appointments at the initial evaluation.

Equipment: It would be helpful to us and your child if you bring a few things along with you.

For infants and younger children:

  • A toy that he or she responds to and enjoys can be used during treatment. This helps us transition the child to the new environment and is good for tracking skills.
  • A onesie to wear during the treatment sessions. At the evaluation we will observe the child moving without clothes on (except for the diaper) to observe his or her muscles and general tone.
  • A blanket can be more comfortable for the children to move around on. If you don’t have one don’t worry, our treatment mat is soft and secure.
  • A pacifier can help to soothe your child
  • A bottle or source of food might help if the child becomes hungry. He or she will be working hard and might become hungrier than normal.
  • A change of diapers is never a bad idea!

For toddlers and older children:

  • Dress your child in comfortable clothes that are easy to climb, jump, roll, crawl and move in.
  • Wear athletic shoes and socks to the appointment. We will complete most exercises without shoes on in order to accurately assess balance and movement skills. However, it is helpful for the therapist to see what footwear the child wears and if additional recommendations are warranted.

What do we do?

  • Strength and range of motion testing.
  • Assess gross motor milestones (i.e. rolling, crawling, running, jumping, skipping)
  • Discuss treatment plan and what you should expect out of therapy.
  • Plan functional short term and long term goals for your child.
  • Standardized testing is usually completed in order to get a baseline measurement for your child. These tests allow us to measure your child against his or her peers, and create realistic projections for what we can expect to achieve through therapy.

The physical therapist working with your child will be able to answer all of your questions pertaining to his or her diagnosis at the first appointment. Any questions that come up after that initial evaluation can be answered before, during or after future appointments via email, phone, or in-person conversations. Thank you for taking the time to read this and be prepared. We look forward to meeting you and your child!

* This article was also written by Adele Nathan, Student Physical Therapist at North Shore Pediatric Therapy

3 At home Exercises For Torticollis | Pediatric Therapy Tv

Here our Pediatric Physical Therapist gives viewers 3 examples of exercises that parents can perform at home with their child who has torticollis.  For more blogs by experts on Torticollis, click here

In This Video You Will Learn:

  • 3 great exercises a parent can do at home with their child who has Torticollis
  • A great alternative to Tummy Time
  • How to get your child to actively move around
  • How to perform an easy pull to sit exercise and why that helps

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide
audience, this is Pediatric Therapy TV, where we provide experience and
innovation to maximize your child’s potential. Now, your host, here’s
Robyn.

Robyn: Hello and welcome to Pediatric Therapy TV. I am your host,
Robyn Ackerman, and today I am sitting here with Jesse Coffelt,
who is a pediatric physical therapist. Jesse, can you please let
us know three exercises that we can do with a baby who has been
diagnosed with torticollis?

Jesse: Absolutely. There are three great exercises, and obviously
tummy time is going to be hugely important for these kiddos.
This is a great carry I like to do with babies, where my hand is
supporting the baby’s chest here. It can be comfortable. You can
carry the child here. You can put your hand on her, and she’s
always got to lift up her head to be looking around. So she’s
getting that tummy time equivalent.

Another one that’s really good is you can hold the baby up like
this. Again, you can be engaging with your child, and you can
kind of just be tipping her side to side, looking at her, really
getting her to actively move around.

The third one, if I could just place the doll right here, it’s
like a pull-to-sit exercise. What you’re doing is you’re going
to grasp the child by her hands and just gently and slowly lift
her up. What you’re looking for is making sure that she is
lifting her neck up and she’s actively engaging her abdominals.
You can come up here to sitting, and then slowly take her back
down to laying on the ground. The slower you move, the more
she’s got to actively work and strengthen those muscles.

Robyn: All right, great. Thank you so much, Jesse, and thank you to
our viewers. And remember, keep on blossoming.

Announcer: This has been Pediatric Therapy TV, where we bring peace of
mind to your family with the best in educational programming. To
subscribe to our broadcast, read our blogs, or learn more, visit
our website at LearnMore.me. That’s LearnMore.me.

How to get your Child to do PT Exercise without Feeling like “The Bad Guy”

Wow, you are sitting down to read this. You are lucky to take the minute between gift shopping, cleaning for your relatives to girl doing physical therapyvisit, packing for your own vacation to get away from your relatives, and the 13th version of the Nutcracker ballet that you have seen since January. I say that you are in luck, as I have hidden the winning lottery numbers in the text of this blog.

With the excitement of the holidays, and the variety of directions that children and parents are pulled these days, I have a lot of parents looking to advocate for their children and wanting strategies on how to best support their child’s growth towards his physical therapy goals. In that vein, I reached out to Beth Chung, MSMFT, AMFT, one of North Shore Pediatric Therapy’s brilliant Marriage
and Family Therapists. I asked her several of the questions I am frequently asked:

“My child won’t do their PT ‘homework'”

“Work towards a goal.”  Beth answers.  You can help motivate your child by creating a star chart. These charts work for behavior as well as exercises. This chart can track your child’s progress with his/her exercises, and gives you something physical you can use to motivate him/her throughout the week (“Let’s look at your star chart. Look! You did such a wonderful job yesterday of doing all your leg exercises. I know you can do it again today!”). It can also allow your child to work toward a goal (ex. 5 days of completed exercises can lead to a reward.) Some of the best rewards for this can involve spending time with the family, and possibly something physically active. You can find active family-friendly places here. But don’t forget that walking through the Lincoln Park Zoo, the Chicago Botanical Gardens, any of these museums, or even through a park near home can be just as entertaining.

“Break it down.” You utilize immediate rewards. This works great for privileges the kids already get, such as time on the computer (for non-homework activities) or time with video games. For example, 15 minutes of a PT exercise can correlate to a certain amount of time with electronics.

“Dive in with them.” Most of the exercises you can do right along-side them. [Quick note, as long as you do not have a condition that would worsen if you performed them.]

“My child doesn’t believe me when I say that it’s important”

“Go to the source.” Set up a meeting with your child and the clinician she is working with. That clinician has experience, education, and research to back-up the activities she suggests. When the child can see that her parents and PT or OT are a team, it reinforces what they each say.

“Encourage your child’s questions.” Getting your child to “buy-in” to her exercise routine is essential, or it will be a struggle every day. Use what you know is important to your child (ex. Playing on the soccer team next year or feeling physically strong). Explain to your child how engaging in homework exercises can meet these goals, and praise your child throughout the process (ex. “I noticed that you ran faster today than I’ve ever seen you run! Those exercises must really be helping!”).

“Can’t we just take a couple of weeks off of exercise?”

“No.” This time of year is stressful for almost everyone. Finding creative ways to incorporate exercises into your routine is the key to success. Taking just a few days off of exercises can be a big set-back, and slow progress towards your goals. Here is a link to some fun movement activities.

“Explore your own feelings and thoughts as parents.” It may feel tempting to allow your child to take time off from the exercise, especially during the busy holiday season. Something to keep in mind, however, is that PT or OT occurs one hour out of your week and that, as clinicians, we rely on parents to continue to encourage your children to practice various exercises during the week. One way to think about it is that your PT or OT is your consultant, who can give you strategies and exercises, and that you are the coach to empower your child in his daily life!

To reiterate Beth’s point, we as clinicians see your kids for 1/168th of the week, or approximately 0.6% of the week. You are the expert on your child, and you are her primary influence. So it is essential that parents and clinicians work together to fully facilitate the homework program and maintain consistency with the exercises.

Enjoy your time with your kids and, when you win the lottery, remember who provided you with those numbers.