Congenital muscular Torticollis should be a suspected diagnosis if your infant demonstrates a preferred head position or posture. Infants will present with reduced cervical range of motion, a potential palpable mass in the sternocleidomasoid muscle and/or craniofacial asymmetry.
A diagnosis is made by your pediatrician and can usually be done based on a simple history and physical examination. Physical examination findings may include:
Head tilt to one side
Reduced range of motion
Palpable SCM tightness
Absence of findings associated with non-muscular causes of congenital Torticollis
 Cheng JC, Tang SP, Chen TM, et al. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants–a study of 1,086 cases. J Pediatric Surg 2000; 35:1091.
 Kaplan SL, Coulter C, Fetters L. Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association. Pediatr Phys Ther 2013; 25:348.
As a pediatric physical therapist in the outpatient setting, about 10-25% of my patients are diagnosed with Torticollis. Torticollis is the tightening of one muscle in the neck called the Sternocladeomastoid, or SCM for short. The SCM is the muscle that controls ipsilateral sidebend and contralateral head rotation. This muscle, located on either side of the neck, works to tuck the chin down. When one side works independently, it will work to turn the head to the opposite side and tilt the head towards the direction of the muscle. Torticollis is a serious medical condition, and left untreated, can result in many impairments. I will go over some of the most frequent and serious below.
Possible Results of Untreated Torticollis:
Plagiocephaly – This is the most common consequence of untreated Torticollis. Plagiocephaly is the mishapening of the bones on the skull, usually resulting in a large flat spot on one side of the back of the head and facial assymetries. Early diagnosis and conservative treatment can be successful in decreasing the severity of the Plagiocephaly. However, late diagnosis must be treated by a helmet or craniofacial surgery.
Cervical spine contractures into the preferred head rotation and sidebend – These contractures can become ossified over time, significantly impacting functional mobility and ability to interact with peers. Once a contracture is ossified, surgery is required to lengthen the muscle, followed by several sessions of physical therapy to regain full cervical spine range of motion.
Limited shoulder mobility – Decreased active movement into non-preferred rotation and sidebend can also result in shoulder elevation. This in turn impacts the child’s ability for upper extremity weight-bearing and reaching toward midline with hand.
Cervical Scoliosis – Persistent head tilt in the absence of shoulder elevation can result in a lateral shift of the cervical spine, which leads to cervical scoliosis.
Many times, babies with torticollis will develop plagiocephaly, or misshapen head. Babies develop these flat spots on one or more parts of their heads because they often sleep in the same position for prolonged period of time. Quite a few parents I know like to keep their children in car seats because they sleep better in that cradled position. If you are worried about your baby’s head shape, or if he starts to show a preference for the way he holds his head in the car seat, read on for three tips to help decrease the likelihood of plagiocephaly and improve his torticollis.
3 Tips for Reducing Plagiocephaly and Improving Torticollis in the Car Seat:
Get him out of the car seat as much as possible. It may sound obvious, but car seats are really only to be used in cars. I know it’s easier to carry a sleeping infant in and out of places while they are in a car seat, but the best position for a baby is still on his tummy. Babies with torticollis are going to hate tummy time at first, but they eventually learn to like it (click here for some easy alternatives for tummy time). Even just doing tummy time over a boppy or a towel roll will help get them off their flat spot, strengthen their neck muscles, and help round out their head. Just remember, all tummy time should be supervised, whether the child is asleep or not.
Place objects on the opposite side. If your baby likes to look out the window he’s next to when he’s in the car seat, switch things up and put him near the other window instead. If he likes to look to the right side all the time in the car seat, put dangling toys to the left side. Young infants are attracted to bright lights, yellow or red colors, faces, and rattle sounds. Use toys and mirrors to get him looking the other way.
Try props. Props such as towel rolls and little foam cushions should only be used if they can be separated from the baby by a barrier that prevent babies from wiggling into the towels. Some infant car seats have a little shield between the baby and the soft padding of the carrier. I always recommend propping the towel rolls behind the shield and underneath the side of the head they prefer to lie on. This gets them to turn their head more to the other side. It does the same job as the Tortle hat, and babies tolerate it much better than wearing a beanie.
If you are still having trouble keeping your little one off his flat spot while he is in the car seat, or if you are noticing a head shape change, bring him (and the car seat) in to one of our physical therapy specialists, and we will help turn things around.
A majority of the babies I see in the clinic are those diagnosed with torticollis and plagiocephaly. These babies are often accompanied by bewildered first-time parents with worried looks, scared by those big diagnostic words. The first questions they ask are “could I have prevented this?” and “will he need a corrective helmet?”
What is plagiocephaly and what causes it?
Since the beginning of the “Back to Sleep” program in the 1990s, which kept babies off their tummies to prevent Sudden Infant Death Syndrome, many babies started to develop flat spots on the back of their heads. Plagiocephaly and brachycephaly are two terms used to describe the abnormal head shape, depending on the degree of distortion and location of the flatness. While most parents think they were partially responsible for the flat spot developing in their newborn, an infant’s head is extremely malleable before it reaches cranial maturity. Any prolonged external force leads to some skull shape changes. Plagiocephaly and brachycephaly can be associated with many conditions, from prematurity and twin births, to torticollis (asymmetrically tight neck muscle), to developmental delay. Often times, the asymmetries are resolved with simple repositioning and stretching exercises to encourage the child to look to both sides, physical therapy, as well as nap and play time on the tummy, all with supervision of course.
How do plagiocephaly helmets work and what’s the best time to get one?
Plagiocephaly helmets are cranial orthoses made out of a hard plastic shell with foam lining, custom made to each child, and designed to keep pressure off the flat spots to help the head naturally round itself out. They are meant to be worn for 8-12 weeks for at least 23 hours a day, during sleep and play. Certain hospitals, orthotics companies, and plastic surgeon’s offices design their own version of the helmets, but the concept is still the same.
The earlier a child with torticollis and plagiocephaly starts a repositioning and physical therapy program, the less likely he will need a skull reshaping orthosis. As physical therapists, we usually recommend a helmet evaluation if 1) A baby has been repositioned off his flat spot and participating in physical therapy for 1-2 months without any significant changes noted to his head shape, 2) A baby has spent 1-2 months sitting independently with good head control and playing easily in tummy time, and moderate to severe plagiocephaly is still present, or 3) A baby is over 6 months of age and facial asymmetries are still obvious. Usually, helmets are not expected to be effective for kids over 18 months. What facial asymmetries do we look for as an indication of moderate to severe cranial change? A smaller chin on the affected side, a smaller ear or an ear that’s shifted forward, and a smaller or droopy eye on one side are examples. Of course, every baby develops differently and other factors may be taken into consideration, such as if his abnormal head shape is keeping him from achieving gross motor milestones (rolling, head control, etc).
Do helmets actually help? Aren’t all of our heads a little bit asymmetrical? What happens if my child doesn’t get one?
In its early years, the infant helmet received a bit of scrutiny. The biggest push-back from some insurance companies and doctors against cranial helmets is that asymmetrical head shape in babies appears to be a cosmetic complaint that hardly justifies a costly and bulky orthosis. Parents and practitioners alike question the association between deformational plagiocephaly and long-term functional delay in kids. There has been research over the last two decades on whether helmets alone prevent long-term asymmetries, if cranial asymmetries lead to other medical issues, or if neurodevelopmental delays occur in school-aged children with plagiocephaly. While the literature is still young and long-term research is still in the works, untreated cranial asymmetries have been linked to visual defects, ear infections, middle ear malfunction, jaw bone changes, developmental delay, learning difficulties, and other psychomotor delays.
In a brand new study out of the Netherlands this month, researchers found that helmet therapy alone yields similar results to natural cranial growth. The study, however, focused only on babies with mild plagiocephaly, not torticollis, prematurity, or other associated conditions. Babies with severe plagiocephaly were also not included in the study, which limited the population to a very specific, underrepresented, group in pediatric clinics. Interestingly enough, the study found that by the time their child was 2 years old, parent satisfaction was much higher and parent anxiety was slightly lower in the group who received helmets. Even in this study suggesting the ineffectiveness of helmets, the authors referenced other studies that discussed the long-term implications of letting deformational plagiocephaly go untreated. These included researchers from different fields, such as neurology, child development, physical therapy, orthotics and prosthetics, and plastic surgery. Overall, developmental experts agree, long term consequences of untreated plagiocephaly are multi-faceted and future research is imperative.
Because physical therapists like us have no association with helmet companies, doctors’ offices, or orthotists, our recommendations are purely based on the child and family’s needs. What I always tell anxious parents trying to make this decision of whether or not to try the cranial orthosis helmet with their child is this:
Helmets are not right for every baby with cranial asymmetry. The results you can get out of a helmet depends on the fit, consistency of wear, and the baby’s growth. The most effective time period to make the most changes to a baby’s head is short. Don’t let a medical professional bully you into making a decision you aren’t comfortable with. At the same time, take on a wider perspective when trying to make this decision. Have we done all the necessary exercises and reposition changes? Have we taken into consideration medical advice from all the different health professionals involved in your baby’s care? Did the helmet evaluation (with measurements done by machines for precision) reveal moderate to severe cranial changes? Are you worried about side effects or costly interventions that might be needed down the road? These are great questions to talk out with your pediatrician or physical therapist.
In my clinical experience, I have never had a parent regret the decision they made, whether it was to seek out a helmet evaluation or to forgo helmet therapy. Though often it was a hard decision to make, we were able to work through the questions together to determine the best course of action for their precious little one’s all-important noggin.
Do you still have questions or have experience you want to share? Please let us know!
Kordestani R, Patel S, Bard D. Neurodevelopmental Delays in Children with Deformational Plagiocephaly. Plastic and Reconstructive Surgery 2006;117:1. Available from: www.plasreconsurg.org. [accessed 15 April 2014]
Stevens, P. Beyond Cosmetic Concerns – Functional Deficits Associated with Deformational Plagiocephaly. April 2012. The O&P EDGE. Available from: http://www.oandp.com/articles/2012-04_02.asp [accessed 15 April 2014]
Van Wikl RM, van Vlimmeren LA, Groothuis-Oudshoorn CGM. Helmet therapy in infants with positional skull deformation: randomized controlled trial. BMJ 2014;348:g2741. Available from: http://www.bmj.com. [accessed 12 May 2014]
https://www.nspt4kids.com/wp-content/uploads/2014/05/133910422.jpg338507Judy Wang, PT, DPThttps://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngJudy Wang, PT, DPT2014-05-20 13:46:492015-01-13 17:27:49Babies, Misshapen Heads, and Plagiocephaly Helmets: a Physical Therapist Perspective
As a follow-up question to the importance of tummy time discussion, most parents want to know what their babies should be doing on their tummies for the first year. Are they still working their muscles if they are just resting their cheek or gnawing on the floor mat? What if he is just kicking and screaming with hands fisted? Is he really doing what he should be doing? When he starts sitting independently, why can’t I just let him sit all the time?
Questioning if your 2 months old should be holding his head up when he is on his tummy? Wondering if your 8 months old should be crawling more? Wonder no more.
Here is a month by month guide on what your child should be doing on his tummy the first year of life.
Month 1: Tummy time can start as early as day 1. By the time a baby is a month old, he can most likely lift his head enough to turn his head and rest his cheek to the other side.
Month 2: After 2 months of spending plenty of time on his tummy, a baby is now not as curled up into the fetal position as before. His hips are a little more stretched out and he has the strength to lift his head even higher. He can put weight on the outer edges of his forearms and his shoulders are strong enough to bring his hands out from underneath his chest.
Month 3: By the 3rd month, a baby can put more and more weight through his elbows when he is on his tummy. Because of increased strength in his neck and trunk muscles, he can now lift up his chest and keep his hips down. Weight-bearing through the forearms is so important because it builds strength and stability in the chest and shoulder muscles and joints.
Month 4: The 4th month is a great month for baby development. This is the month of significantly better head control, muscle control, and symmetry. The 4 month old can now push even higher through his forearms, lift his head up to 90 degrees, and hold his head in midline. His neck now looks longer as his neck muscles develop more strength to hold his head up against gravity.
Month 5: Around the 5th month, a baby starts pushing through his hands with the elbows straight. He is learning to shift his weight from one side to the other. Because of this, he might reach with one arm for a toy or accidentally roll over from tummy to back. He is better at using his back muscles against gravity and may look like he is swimming as he kicks his arms and legs up from the floor.
Month 6: At the halfway point of a baby’s first year, a lot of maturation has occurred (Read more about tummy time at 6 months of age here). The baby is able to perform tasks with much more equilibrium and control. The baby is now constantly on the move and loves tummy time because he can do so much and see so much. If you place him on his back, he will most likely roll himself over to his tummy. Place him on his tummy and he won’t fall over accidentally anymore, because of increased motor control.
Month 7: Between all the swimming and pushing off of the floor in the previous months, the 7 month old has developed a lot of trunk strength and shoulder/hip stability. He can now separate his two sides and pivot himself around in a circle to get to toys. He has the control to shift his weight to one elbow and play with the other hand. Some babies may start pushing themselves back into a bear position (hands and feet) or quadruped position (hands and knees). They may rock back and forth in this position, which strengthens their upper and lower bodies to prepare for crawling and standing and improves their sense of balance.
Month 8: The 7th – 8th month is usually when babies start pulling to stand from a quadruped position. Some babies may skip belly crawling all the together, but most babies creep by the 8th or 9th month. An early crawler will show a low-hanging belly close to the floor, but as he practices crawling more and works on his tummy muscles, he will start creeping with all trunk muscles engaged. The typical 8 months old will no longer need his upper body to lift his trunk. He may be seen more and more in a kneeling position so his hands can be free for play.
Month 9: The typically developing 9 months old is now constantly on the move. Crawling is his main method of locomotion. He has enough trunk and muscle control to transition easily between sitting, quadruped, and tummy time. He may start pulling himself into standing though still needs his arms to do most of the work. One thing he may be able to do better is pulling to stand with one foot in front kneeling (half-kneeling).
Month 10: By month 10, a baby will be transitioning to stand via half-kneeling more often. In standing, a 10 month old will have developed the hip/trunk control to rotate his trunk and weight-shift. This is mostly because of the hard work he did on his tummy before! Not only can he transition well by himself, he does so with more control and is much more safe, steady, and efficient.
Month 11: The 11 months old now has more control of his hips and trunk when on his knees. He may be able to play in tall kneeling and half-kneeling positions without falling. His leg and hip muscles are now strong enough that he doesn’t need his hands as much to pull to stand.
Month 12: By a baby’s first birthday, he will have developed full trunk control and ability to use one side independent of the other. This allows for improved weight shifting during standing, increased use of kneeling and half-kneeling, and stability during standing. The 1 year old is able to transition in and out of quadruped position and is now ready to take some independent steps!
It truly amazes me how many new skills babies can acquire in just the first year. Want to know the key gross motor milestones of a baby’s first year? Click here.
https://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.png00Judy Wang, PT, DPThttps://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngJudy Wang, PT, DPT2014-01-22 17:38:332014-06-02 22:20:43Tummy Time the First Year: A Month by Month Primer
Many first-time parents are not told about the importance of tummy time for newborns until their children become toddlers with atypical movement patterns, clumsy gait, or motor delay. With our hectic schedules and fast-paced lifestyle, sometimes it is just easier to pick our children up and get going. But, pediatricians and physical therapists will agree, tummy time is an important aspect of infancy to develop the motor skills children need to actively engage in their environment.
How do you know if your baby is spending enough time on her tummy?
By 6 months, these are the things your growing explorer should be able to do:
Reach for nearby toy while on tummy:
Her gradually improved trunk stability, shoulder girdle mobility, and emergent interest in her surroundings allow your baby to briefly prop on one hand and reach with the other for toys.
Raise entire chest:
Now that your child can props on her hands with arms straight, elbow in front of shoulders, she not only can lift her head up, but her trunk as well.
Extend arms and legs (alternately or together) off a surface, and lift head up against gravity with neck elongated:
At 6 months, a baby’s back muscles are strong, but that strength is also balanced by her chest muscles. Because of this, a baby at 6 months can lift up her head against gravity but also tuck her chin. She may be able to perform swimming motions that eventually lead to belly crawling.
Equilibrium reactions in prone:
What this means is that the muscles on the front and back of her trunk can now adapt to changes in her center of gravity. The equilibrium reactions return her to her tummy when she shifts her weight and prevents her from falling over. The more controlled her movements become, the better equipped she is to start scooting after toys.
For a typically developing child, tummy time should be her most preferred position because of the mobility and freedom she experiences in that position. Tummy time is where a child learns to separate her two sides and use them independently of each other. It is an important place to encourage the initiation of belly crawling and eventually crawling.
Red flags – Signs that warrant a physical therapist evaluation:
Remember, every child develops differently. The tummy time skills listed above are the skills pediatricians and physical therapists look for to make sure a child is on track. If your baby isn’t consistently showing these skills by 6 months, keep putting her on her tummy, play with her, and give her a couple weeks’ time. Some babies just need more input to their hands and abdominals before they build up the strength to do all of the above.
However, consider an evaluation if you still notice the following by the 7th month:
Difficulty lifting her head
Stiffens her legs with little or no movement
Does not roll over
Arches body backwards stiffly in an attempt to roll over, instead of using the abdominals.
Does not sit independently
Does not play with her feet when lying on her back
https://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.png00Judy Wang, PT, DPThttps://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngJudy Wang, PT, DPT2014-01-13 16:34:042014-06-02 22:21:05What Should My Baby Be Doing on Her Tummy by 6 Months?
Every parent knows how important tummy time is for their baby. Most parents also know how difficult it is to get the necessary amount of tummy time into each day. This is only made more difficult when babies dislike tummy time and cry whenever placed on their belly. Here are some simple alternatives to laying your baby flat on their stomach as well as provide the benefits of tummy time and keeping baby and parent happy.
3 Alternatives for Tummy Time:
Front Carry: Hold baby facing away from you, supporting him/her around their rib-cage With their bottom tucked into your belly, tilt their trunk forward so that it is parallel with the ground. This will encourage the baby to look forward, strengthening the muscles in the back of the neck and along the spine. The more horizontal the baby is, the more difficult it will be for them to lift and hold their head. Lift the baby’s trunk up every 30-60 seconds to give them a break.
Baby on Shins: Lay on your back with your legs bent so that your shins are parallel to the ground. Lay the baby on your shins with their head hanging off your knees and holding onto their hands. This is a great alternative as you can look at the baby as well as move your legs to entertain the baby (similar to airplanes). This is also a good core exercise for mommy!
Baby on Lap: Sit on the floor with your legs straight out in front of you (support your back on the wall if necessary) and lay your baby across your legs with their head hanging off one side of your thigh. This is an effective exercise because you can easily move a toy with one hand to encourage them to look around and strengthen the baby’s neck muscles.
https://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.png00Leida Van Osshttps://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngLeida Van Oss2013-03-28 22:23:502014-04-23 19:48:143 Easy Alternatives for Tummy Time
As I mentioned in my previous blog “how to make a large Floor Pillow”, there are several different reasons that therapists use floor pillows during your child’s therapy sessions. Floor pillows are a wonderful tool and provide a relaxation spot for children of all ages. Below are several ways your large floor pillow can be used with your child at home:.
5 Uses For Large Floor Pillow:
Kid sandwich: have your child lay in the middle of the pillow, either on his stomach or on his back. Either fold the pillow in half over your child, or place another pillow on top of your child (if you have two). Apply gentle consistent pressure onto the pillow, to feel like a ‘good squish’. Your child can then request to have harder squishes (more pressure) or softer squishes (less pressure). This is a great calming and self-regulation strategy, which can be useful when your child’s body is moving too quickly (to slow him down) or too slowly (to ‘wake’ him up).
Jumping into the pillow (proprioceptive input): place the pillow at the end of a hallway or across the room, and then have your child run towards the pillow and jump into the pillow (kind of like a ‘cannon ball’). Similarly, you could have your child do an animal walk to get over to the pillow (e.g. bear walk; crab walk; wheelbarrow walk), which would provide more strengthening and proprioceptive input.
Quiet spot: a large pillow can be the perfect place to ‘take a break’. It can be used as a quiet spot for your child to read a book or listen to calming music to relax and unwind. It can also be a designated spot for your child to take some deep breaths when he is feeling frustrated or overwhelmed. Try to work towards having your child recognize when his body needs a break, and have him request some quiet time in a large pillow. This helps to work on body awareness and self-calming.
Pillow mountain: a pillow mountain is a fun way to work on strengthening and balance. It is especially beneficial when using more than one pillow; however, one pillow will work just fine. If using more than one, place the pillows in a line, overlapping each other a little bit to form a ‘mountain’. Have your child climb from one side of the pillow mountain to the next by either walking, crawling or using animal walks. You can also add in a board game by placing the game pieces at one side of the mountain and the game board at the other side. Then have your child cross the mountain in order to retrieve the game pieces; moving back and forth will also help to work on his endurance.
Heavy work (pulling pillow across room): have your child pull the large pillow down a hallway or across a room using both of his hands together. This helps to work on bilateral skills (using both hands together) and also works on upper body strength. Similarly, this type of activity qualifies as ‘heavy work’, meaning that it provides a high amount of input for your child’s body, and can be calming and self-regulating for your child.
While many materials used in the clinic during your child’s therapy session cannot always be replicated at home, a large floor pillow can be integrated into your daily activities! There are several different ways in which you can use a large floor pillow with your child in order to help him with a variety of skills and purposes. Feel free to reach out to your child’s therapist for more ideas or take a peak at the floor pillows used around the gym next time you are at the clinic!
https://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.png00Amanda Mathewshttps://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngAmanda Mathews2012-10-07 15:36:542014-04-26 16:27:025 Uses for a Large Floor Pillow
Supervised time when your child is laying on a firm flat surface on her tummy.
When your child is being in a position where she is face down and has to lift her head up against gravity.
Why does my child need tummy time? Why is it so important?
Studies have shown a link between slowed achievement of developmental milestones and diminished tummy time in babies.
Tummy time builds the muscles in your child that are necessary for advanced movements like crawling, walking and (gulp) running.
My child always cries during tummy time, what should I do?
Lay on the floor with your child. Babies are often frustrated because they have less ability to interact with the world when they are lying on their tummies, and if they can see your face (and your smile), they may calm down. You may also utilize mirrors or toys to distract them when they get frustrated.
Try a “tummy time alternative.” This can be carrying your child face down in a “superman” position or sit with them supporting her trunk and tilt her forward so her shoulders are in front of her hips.
As your child gets stronger (and more able to lift her head and play with toys in this position) she will enjoy tummy time more and more.
What can happen if I don’t give my child tummy time?
If the child is always on their back, it increases the risk of flattening portions of their head, and if they do not move their heads around in all directions, it increases their risk of developing torticollis.
There may be slowed attainment of developmental milestones such as independent sitting, crawling, and walking.
How much tummy time should my child be getting?
The goal is that by 6 months of age, your child should be on their tummy 50% of her play time (not including feeding time, bath time, or sleeping time). Remember that this is a goal to work towards and not to be expected the first day you introduce tummy time.
How old should my child be before I begin tummy time?
You may introduce tummy time on day 1, as long as there are no medical complications whereby your pediatrician would recommend avoiding tummy time.
***Most importantly, babies should always be placed to sleep on their back, and supervised when on their tummy***
One of the most popular questions we hear as pediatric therapists is “how long will treatment take for my child”? Parents like to be able to visualize a plan of action and know that there is an end in sight. Parents want to make sure that their child is not only keeping up with same-aged peers, but fitting in with their peers, and succeeding across environments: at home, at school, and within the community. As therapists, we completely understand this mindset and want to help parents to feel valued and heard. And we want to work as a team to create appropriate goals and treatment ideas to help each child reach their greatest potential by working as a team.
How Pediatric Therapy Sessions Work:
Every child progresses differently, which is why each child has their own individualized set of goals and recommendations. Similarly, one strategy may work quickly for one child and not at all for another. Therefore, treatment strategies are unique to each child.
Consistency and follow through at home is extremely important, as a child is typically only in the clinic for 1-2 hours per week. Whether it is 10 minutes or an hour, finding time to complete your child’s exercises each day makes a huge difference in their progress, skill sets, and success. For example: heavy work activities to help with self-regulation; theraputty to work on hand strength; practicing natural environment skills while at the playground; increasing turn-taking and initiation of conversation during mealtime.
Typically, therapists work with a client for at least 6 months, at which point a re-evaluation can occur to assess progress made since the initial evaluation and revise the goals and plans for the future. Therefore, a date for course completion can not be determined at the initial evaluation. The therapist will continue to assess progress throughout the child’s therapy sessions, and together with the parents will decide on a course completion date when appropriate. Overall, course completion is very case specific.
Treatment may be longer than anticipated to make sure that there is a smooth transition for the child, to make sure all goals have been met, to make sure the child will be successful moving forward (e.g. going into the next school year), and to make sure both the child and the family have the tools and resources to continue to make progress, rather than see regression.
Teamwork is huge. By collaborating with other professionals (e.g. teacher, coach, other therapists), the child will have several advocates working together towards one purpose- his success. Similarly, when everyone works together to meet the child’s wants and needs, there will be greater consistency and, therefore, greater success.
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https://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.png00Amanda Mathewshttps://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngAmanda Mathews2012-04-10 13:08:042014-04-27 12:25:28How Long Will My Child Have To Be In Therapy