when will my child be done with speech language therapy

When Will My Child Be Done With Speech-Language Therapy?

Society as a whole is goal-oriented; as human beings we want to have a plan for the future. The unknown is anxiety-provoking, and people want straight answers. Therefore it is no surprise that a common question when a child is first recommended for speech-language therapy is how long will my child need speech-language therapy? The tough answer to this challenging question is there is no scientific way to determine a child’s timeline for speech-language therapy. However, there are a several components to speech-language therapy that can facilitate greater progress in therapy, possibly resulting in faster discharge.

These Components Will Help Determine How Long a Child Will Need Speech-Language Therapy:

  • Early identification is a key component for success in intervention. It is highly recognized that when speech and language disorders when will my child be done with speech language therapyare identified and treated as early as possible, there is a better prognosis. Developmental milestones can be helpful in identifying children who may be in need of speech-language intervention.
  • With any speech-language disorder there is a spectrum of severity that can occur. Often with a more severe speech-language disorder, therapy will be more intensive and may require a longer treatment period. Looking at the percentile ranking of your child’s score on a standardized test is helpful at determining where your child’s skills are in relation to the typical population.
  • There are several components of a therapy plan which can affect the rate of progress. Receiving consistent and frequent therapy can both positively impact a child’s progress. The greater amount of time a child is spent working on a skill, the faster that skill is likely to improve. Additionally, completing home programs or home activities given by your child’s therapist will facilitate carryover of the child’s targeted skills into other environments.
  • Lastly, every child is different in their areas of need for speech-language therapy. Therefore, each child’s therapy approach will be unique to him or her. A child’s diagnosis will ultimately affect what skills will be targeted and how many target areas there will be. Concomitant issues may also affect a child’s therapeutic approach, resulting in additional goal areas to target through therapy. The presence of multiple diagnoses does not necessarily mean slow progress, but may correlate with the reality that there may be more goals to be met before discharge.

This list is by no means all-encompassing of components which could facilitate faster progress in speech-language therapy. Overall, it is important that the child, family and clinician become a team to target that child’s speech and language needs. Then as a team, goals can be addressed positively in a variety of environments and communication situations.

Click here for more help understanding a speech-language evaluation.




a recipe for speech and language

A Holiday Cookie Recipe for Better Speech and Language

It is largely recognized that the holiday season is a lovely, yet chaotic time of year. During this busy time, being with family often takes precedent over the speech and language homework sent home by your child’s speech-language therapist. Why not combine a holiday tradition with speech-language homework?

Use this recipe for extra language and speech reinforcement while decorating cookies this holiday season:

  • 2 cups of basic concepts: While adding ingredients give directions emphasizing the understanding of a recipe for speech and languagequantitative concepts, such as all, some, one, both. For example, “Add both cups of flour” or “Put on some red sprinkles and some green sprinkles.” If this is too advanced, you can always get extra practice with counting. You can count the cups of ingredients or the number of cookies.
  • 1 teaspoon of adjectives: Adjectives or descriptive words can easily be targeted during baking. You can talk about ways to describe the cookies that you are making, e.g., “Look! You made a big cookie and your sister made a small cookie,” or you can give directions including adjectives, e.g., “Decorate the long tree cookie and I’ll decorate the short tree cookie.”
  • 2 tablespoons of vocabulary: Like with any activity throughout your day, it is good to try to introduce your children to new vocabulary or reinforce the vocabulary they are already using. Vocabulary categories that are easily targeted during cookie decorating are: colors, shapes and nouns. For example, “Do you want to make the tree, snowman or ornament?” or “What colors did you use on your cookie?”.
  • Mix in turn taking: Turn taking is a great social skill to practice at home with siblings or friends. Take turns putting in ingredients, mixing or putting on candies to decorate. Appropriate turn taking can be used by kids when playing games with peers and during conversations.
  • Stir in requesting: Have your child exercise his or her expressive language skills by requesting for items. Depending on their skill level a carrier phrase could be used, “I want ______” or the request could be in question form, “Can I have the _______, please?”. Once your child is successful at making simple requests, work towards expanding the utterance, making the request longer, (e.g, “I want the red frosting”).
  • Bake for following directions: Baking holiday cookies makes for the perfect set up for your child to practice following directions. First start with simple one step directions, “Put on white frosting”. To continue to improve your child’s receptive language you can advance to first/then directions, “First put on white frosting, then put on green sprinkles”.
  • Let it cool with articulation practice: Throughout the whole baking/decorating process, articulation (speech sounds) can also be targeted. As an adult model, you can provide the correct productions for your child emphasizing the target sound. (e.g., What cookie do you like?, Look at my cookie!”). If your child is at the stage in speech therapy where they can practice saying their target sounds, work on using them during the activity. For instance, if you were working on “s” or s-clusters you could practice using the sound to describe what you see “I see a reindeer” or when taking about the steps to baking “Stir in the flour”.

Throughout your cooking baking experience keep in mind that the activity should remain fun, keeping the speech-language practice with in your child’s abilities in order to keep frustration low. Enjoy this recipe for ideas of ways to target speech and language! Happy Holidays!




bowleg child when to worry

Bowleg (Genu Varum) in Children: When to Worry

Genu Varum, or bowleg, is defined as an outward bowing of the knee in relation to the thigh. This results in one or both of the knees being more lateral than the hips and ankles. A parent may first notice this abnormal posturing at birth or when the child begins walking. This can be a scary time for most parents.

It is important to first note that the most common cause of bowleg is idiopathic physiologic genu varum. While this long and confusing name may sound scary, it simply means that the cause is due to normal genetic variations and nothing more serious. Many children grow out of this type of genu varum by the age of 2 without treatment. In cases where the genu varum angles worsen over time or persist after the age of 2, treatment options include bracing, orthoses, or surgical correction.

When a child presents with severe genu varum presentation, genu varum worsening over time, or genu varum persisting past 4 years of age, more serious causes of genu varum must be ruled out. Below is a brief description of several of these causes of genu varum.

Causes of Genu Varum (Bowleg)[1]:bowleg child when to worry

  • Blount’s Disease: This disease is manifested by failure of inner part of tibia (shin bone) to develop, resulting in progressive deformity without treatment. Diagnosis is made through physical exam and x-rays.
  • Rickets: Rickets is caused by insufficient vitamin D, leading to softened bones. Posture and gait abnormalities may be most pronounced following growth spurts or during winter months, when sunlight is low. Diagnosis is made through physical exam, x-rays, and blood work.
  • Osteochondroma: Benign bone tumor found usually near the growth plates of long bones. Mass grows with skeletal growth. Increased pressure and mass on lateral part of knee result in appearance of genu varum. Diagnosis is made through physical exam, x-rays, and biopsy.
  • Osteogensis Imperfecta: Abnormal Collagen, in amount or quality, result in easily fractured bones and shorted stature. Genu varum results from repeated trauma to inner part of tibia restricting growth. Diagnosis is made through x-ray and genetic testing.
  • Pathologic Anterolateral Bow of the Tibia: Results from failure of tibia and fibula to unite. This places the limb at a greater risk for fracture during the first year of life. Diagnosis is made through x-ray.

Consult a physical therapist or orthotist if you have concerns about bowleg in your child.

[1] Leach, J. (2006). Orthopedic Conditions. In Campbell, SK, Vander Linden DW, and Palisano RJ (Eds.), Physical Therapy for Children (481-515). St. Louis: Saunders Elsevier.

 

night splints

The Quick Guide to Night Splints for Children

 

 

 

For many children who are idiopathic toe-walkers, physical therapists often take the conservative approach. We have many things in our arsenal to help children improve without undergoing costly and painful surgery. Outside of stretching and strengthening exercises, we might recommend ankle foot orthoses (AFOs) for day time and/or night time wear. Depending on the child’s range of motion measurements, walking mechanics, and underlying pathology, different types of orthotics might be recommended. We often work closely with orthotists (professionals who design medical supportive devices such as braces) to make sure each child receives the individualized care and equipment he needs to gain full function and optimal alignment.

Here are reasons why your physical therapist might have recommended night splints for your child:

  1. The main goals of physical therapy interventions for toe-walkers are to increase ankle dorsiflexion range of motion and to decrease possible contractures that are associated with the condition. Physical therapy exercise programs include stretching the calf muscles, strengthening the trunk muscles, manual therapy, treadmill training, balance training, and ankle mobility training. Sometimes, in stubborn cases of toe-walking, orthotics are needed to maintain the range of motion gained throughout daily exercise sessions.
  2.  If you’ve ever tried to stretch your pre-schooler’s muscles, you know that children can be active and fidgety. They don’t tolerate passive stretches as well as adults and might complain of boredom, pain, or ticklishness. The most effective stretches are those held for a prolonged period of time at a joint’s end range. Night splints allow for increased stretch time at the ankle joint, because the child is sleeping or resting when they are in place.
  3. The best time to gain range is when a child is relaxed. Since children relax more during sleep, even more range can be gained through passive stretching using a night time AFO.
  4. This is where the night-time splint comes in. While the daytime AFO is a rigid orthosis that keeps your child’s ankles from plantarflexing (pointing down) past neutral while he walks, the night time AFO is a much more dynamic system. Night splints can be adjusted as the ankles gain more range into dorsiflexion. They provide a low-load, prolonged-duration stretch that helps with contracture reduction and counters high tone.
  5. In the literature, night splints have been found to be effective for contractures at a variety of joints, and can be useful in brachial plexus injuries, cerebral palsy, and muscular dystrophy.

As pediatric physical therapists, we rarely recommend over-the-counter orthotics for your child’s orthopedic needs. By consulting with an orthotist, we make sure each child is fitted to the most comfortable and developmentally appropriate custom foot wear for his condition. Usually, children who adhere to a strict physical therapy program and who receive the right orthoses can see a complete change to their posture and gait mechanics in as short as 6 months’ time.

Click here to view our gross motor milestones infographic!

References:
Cincinnati Children’s Hospital Medical Center. Evidence-based care guideline for management of idiopathic toe walking in children and young adults ages 2 through 21 years. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 2011 Feb 15. 17 p. [49 references]

Picky Eater vs. Problem Feeder

Eating. What’s not to love? Whether it’s a gooey, cheesy slice of pizza or a warm cookie fresh out of the oven (yum!), let’s face it -humans love to eat.  Little humans, ehh not so much. Little ones can be incredibly stubborn when it comes to eating, especially when they’re toddlers. What three year old didn’t go through a phase of just eating her go-to; whether it was mac-and-cheese, hot dogs, or PB&J. Many parents have said the words “picky eater” in reference to their child’s eating habits, but it’s important to know the differences between your run-of-the-mill picky eater versus your problem feeder.

Problem feeding is not a normal part of child development. Feeding problems are estimated to occur in up to 25% of normally developing children and in up to 35% of children with neurodevelopmental disabilities. A common definition for feeding problems is “the refusal or inability to eat certain foods.” Feeding problems can lead to serious medical issues such as malnutrition, dehydration, and impaired intellectual, emotional and academic development. Because of these potential impacts on the child’s development, early recognition and management are critical.

The table below can help you determine if your child’s eating skills are following a normal trajectory or further evaluation is needed:

Picky Eater

Problem Feeder

Eats a decreased variety of foods, usually around 30 foods Eats a restricted variety of food, usually 20 or fewer foods
Foods lost due to “burn out” (i.e. one too many hot dogs = refusal) are typically incorporated back into the child’s diet after about 2 weeks Will eat food over and over again like a picky eater but once they burn out, they will not incorporate that food back into their diet
Can tolerate new foods on their plate, will touch or taste a new food even if they aren’t really excited about it Crying/screaming/melt-down mode if a new food is on their plate and will not tolerate touching or tasting
Eats at least one food from most food group textures (e.g. crunchy, soft, puree, etc.) Refuses entire categories of food textures
Will eat a food after being exposed to it at least 10 times Will not try a new food after 10 or more exposures
Sometimes reported as a “picky eater” at pediatric wellness visits Persistently reported as a “picky eater” at pediatric wellness visits

What to do if you suspect your child is a picky eater:

  • Always eat with your child. Eating is a social experience! If your child is expected to eat alone he may feel left out or neglected. (“Why do I have to eat if no one else is?”)
  • Stick to a routine. Give your child three meals and two snacks at the same time each day (or about the same time each day, let’s be realistic here).  Offer juice or milk with his meals, not in between, to avoid filling up his tummy and decreasing his appetite. Offer water in between meals to quench his thirst.
  • At meal times, always offer him one to two preferred foods (i.e. hot dog, chicken nugget) and one new food. When he sees his preferred food, he will feel more comfortable with his plate. Try to make the new food something you’re eating as well.
  • Always talk positively about food! Even if you don’t like something, do your very best not to talk negatively about it. For example, “Mmm, these sweet potatoes are so yummy!” NOT “Ugh, these potatoes are mushy and gross!”
  • Make it fun! Get some different dips out for his chicken nuggets – ranch, BBQ sauce, ketchup, mustard! Cut sandwiches out with a cookie cutter. Use food coloring. Serve breakfast, for dinner!
  • Have your child help! Let him pick things out at the grocery store. Have him wash the vegetables or fruit. Let him mix up the batter.

What to do if you suspect your child is a problem feeder:

Works Cited:

  1. Sisson LA, Van Hasselt VB. Feeding disorders. In: Luiselli JK, editor. Behavioral Medicine and Developmental Disabilities. New York: Springer-Verlag; 1989. pp. 45–73.
  2. Palmer S, Horn S. Feeding problems in children. In: Palmer S, Ekvall S, editors. Pediatric Nutrition in Developmental Disorders. Vol. 13. Springfield: Charles C Thomas; 1978. p. 107–129.
  3. Feeding problems in infancy and early childhood: Identification and management
  4. Debby Arts-Rodas, Diane Benoit
  5. Paediatr Child Health. 1998 Jan-Feb; 3(1): 21–27.
  6. Toomey, Kay. Copyright 2000/2010. Picky Eaters versus Problem Feeders.

What is Co-Treating?

You may have heard your therapist say, “I think a co-treat would be a great option for your child!” But what does that really entail? Will your child still be getting a full treatment session? Will his current and most important goals be worked on? Will he benefit as much as a one-on-one session? When a co-treatment session is appropriate, the answer to all of those questions is…YES!

What is a co-treatment session?

Co-treatment sessions are when two therapists from different disciplines (Speech Therapy (SLP), Occupational Therapy (OT), Physical Therapy (PT), etc.) work together with your child to maximize therapeutic goals and progress.

When is a co-treatment session appropriate?

When the two disciplines share complimentary or similar goals.

EXAMPLE: Maintaining attention to task, executive functioning, pragmatics, etc. Playing a game where the child needs to interact with and attend to multiple people while sitting on a stability ball for balance. [all disciplines]
*When children have difficulty sustaining attention and arousal needed to participate in back-to-back therapy sessions.
EXAMPLE: Working on endurance/strength/coordination while simultaneously addressing language skills. Obstacle courses through the gym while working on verbal sequencing and following directions. [SLP + PT or OT]
*When activities within the co-treatment session can address goals of both disciplines.
EXAMPLE: Art projects can address fine motor functioning as well as language tasks like sequencing, verbal reasoning, and categorizing.
*When a child needs motivations or distractions. [OT + SLP]
EXAMPLE: Research has shown that physical activity increases expressive output. Playing catch while naming items in category or earning “tickets” for the swing by practicing speech sounds.  [PT or OT + SLP]
EXAMPLE: PT’s need distraction for some of their little clients who are working on standing or walking and working on language through play during these activities works well. [PT + SLP]

Why co-treat?

  • Allows therapists to create cohesive treatment plans that work towards both discipline’s goal in a shorter amount of time.
  • Allows for therapists to use similar strategies to encourage participation and good behavior in their one-on-one sessions with the child.
  • Allows for therapists to collaborate and discuss the child’s goals, treatment, and progress throughout the therapy process. Together, they can consistently update and generate plans and goals as the child succeeds.
  • Aids in generalization of skills to different environments, contexts, and communication partners.
  • Allows for problem-solving to take place in the moment. For example, an extra set of hands to teach or demonstrate a skill or utilizing a strategy to address a negative behavior.

Co-treatments sessions can be extremely beneficial for a child. There are endless ways therapists can work together to promote progress and success towards a child’s therapeutic goals.. However, co-treatments may not always be appropriate and are only done when the decision to do so is made collaboratively with the therapists and the parents.

Contact us for more information on the benefits of co-treating in therapy sessions.

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.

Can Technology Replace Therapy?

With the changes in science and technology, there has been major changes and adaptations with pediatric therapy.  There are many applications available that provide therapists and children with technological support.  These applications can be found on a variety of sources such as, but not limited to, the iPad, Kinect, Wii, Kindle, etc.  There has been much support for such technology as evident by a New York Times article on on physical therapists using Wii Golf to help enhance the benefits of the therapy.

Now the question that should be asked is why bother with therapy when a parent can spend a lot less money and time by buying applications and video games?

The applications must be considered only one aspect of developmental therapy. They are tools that help with the therapy; however, by no means supplement the benefits of the therapy itself.  Developmental therapists have specific training on developmental therapy and how to help children develop to their potential at the quickest and most efficient manner possible.

So although there have been major breakthroughs with technology and software; I will never foresee a time in which the technology will replace the therapist.

Learning Disabilities Demystified

Learning concerns are one of the most common neurological issues with which children and adolescents present.  It has been estimated that approximately six percent of the general population meet the clinical criteria for a diagnosis of a learning disability.  The Diagnostic and Statistical Manual, Fifth Edition (American Psychiatric Association, 2013), which is the guide book for psychologists and psychiatrists that provides information regarding diagnostic information, indicates that there are several essential features of specific learning disabilities in children.

5 Features of Learning Disabilities in Children:

  1. Persistent difficulties learning basic foundational academic skills with onset during the early elementary years.  The manual indicates that these foundation academic skills include: reading of single words accurately and fluently, reading comprehension, written expression and spelling, arithmetic computation, and mathematical reasoning.
  2. A child’s performance is well below average for his or her age.
  3. Learning difficulties are readily apparent in the early school years in most individuals.  That being said, there are some instances in which the concerns are not fully evident until later in the individual’s academic life.
  4. The learning disorder is specific in that it is not attributed to other factors such as intellectual disability, socio-economic status, medical conditions, or environmental factors.
  5. The deficit may be restricted only one academic skill or domain.

Prior studies have indicated that learning disorders are more common in males than females.  There are several long-term consequences associated with learning disorders in which the individual never receives any intervention, including:  lower academic achievement, higher rates of high school dropout, higher levels of psychological distress, higher rates of unemployment, and lower incomes.
Data has indicated that children with learning disabilities are often at risk for a variety of co-existing conditions including ADHD and social-emotional concerns.  Click here for more information on learning disabilities.


The Hidden Benefits of Sledding

Looking for fun winter activities to do with the kids this season? Sledding is one of the easiest snow-day experiences to learn, especiallythe hidden benefits of sledding for young children. With minimal equipment required, there are numerous fitness benefits of sledding. So find the closest hilltop and take that toboggan or flying saucer for a spin!

Find the right hill:

Look for snow-covered hills right outside your home and in your neighborhood parks. Make sure the hills are easy to climb back up, without rocks, trees, or other obstructions that might make the downhill ride dangerous.  In the city, make sure you stay clear of roads or areas with cars. Read more