Educate! Educate! Educate!

As pediatric occupational and physical therapists we always need to remember that one of the most important, if not the MOST important, aspect of our job is to educate.  We need to let students, teachers, school staff and parents know what we do and why we do it.  Without buy in from all team members goals can not be reached.  In addition, in order for therapeutic activities to be carried out all day long we need to educate people how to make that happen.  A 30 minute pull out therapy session may be beneficial but even better is to train someone else who is with that child all day, every day, on how to do what you do during a therapy session.

Hang up this sign in your therapy room or toss it into your folder to remind you to educate!  You can download it at http://yourtherapysource.com/freeeducate.html

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5 Ways for Pediatric Therapists to Snap Out of a Funk

 

[caption id="attachment_1271" align="aligncenter" width="400"] Photo from Flickr Hannah K[/caption]

Ever have the blues at your job?  Feeling like you are stuck in a rut?  Here are 5 ways to snap out of a funk as a pediatric occupational or physical therapist:

1. Remember why you chose this profession - to help others.

2. Connect with other therapists to ask for help establish a professional learning network or monthly team meetings with colleagues to ask for suggestions or to vent.  Need activity suggestions to mix things up a bit?  Check out all the free ideas at YourTherapySource.

3. Have other interests - don't obsess over your job. Try to leave it at work and go home for your own leisure activities.

4. You are not alone - all therapists go through phases where you feel like you are spinning your wheels.

5. Realize you may not always be right - sometimes the parent or teacher would like a different end result than you would for a child. If you always insist on your way or the highway your job will be very tough. Compromise and try to move on - you will feel happier!

Do you have any tips or suggestions to add to the list?

End of Year Lists for Students by the Students

Have you ever considered having the children you currently work with create a list of advice or tips for other children for the next school year?  You could ask the children to submit tips and suggestions that make functional tasks easier for them.  This activity will hopefully empower the children to see that they can help others.  It may also allow them to think about different aspects of functional tasks possibly leading to goal setting for the following school year. 

Perhaps they could answer questions such as:

1.  What do you do to be more organized at school?

2.  What is your favorite physical education activity to participate in?

3.  If an activity has to be adapted for you to participate in gym class or recess, what have you found to be the most helpful adaptation?

4.  Is there anything that makes getting dressed easier for you?

5.  Is there a certain entrance to the school you find easiest to enter in at?

6.  Is there a staircase that is easier to navigate than others?

7.  Is there a bathroom at the school that is easier to use than others?

You don't even need to suggest these questions.  Maybe just throw it out there to the students from now until the end of the school year.  Set up an easel in the therapy room or carry a note pad.  When a student thinks of a tip write it down.  Once all the suggestions have been gathered, organize them into categories.  Then next school year hand out your tip sheet to all the students on your caseload. 

Want to take it one step further?  Ask parents for their tips and suggestions to complete functional skills for a successful school year.  Make this information available to parents the following school year. 

Punch Cards for OT/PT

Check out our latest freebie - Reward Punch Cards for Occupational, Physical and Speech Therapy.

You can download these business cards to encourage children to achieve their goals in therapy whether it be functional or behavioral. After 10 holes are punched, the child earns a reward.

Download the punch cards here.

Are You the Best Person for the Job?

Do you ever ask yourself if you are the best person for the job? For any children who receive related services, hopefully this question is asked frequently. When teachers create class lists for the following school year, they usually make a recommendation based on the student and the teacher's style. The students move from grade level to grade level with different instructors. Does this get done for therapy services as well? When a new skill needs to be taught do you ever consider changing therapists? Or perhaps a goal is not being accomplished - do you ever consider it may be the therapist and not the child?

For some reason in the "therapy world", occupational, physical or speech therapists may see the same child for years. For some children this is beneficial. For example, children who are medically fragile and their families may benefit from the continuity of the same therapist from year to year. Perhaps families feel comfortable with the same therapist since a bond has been created between the therapist and the child.

Many times the therapist's experience is taken into consideration when creating caseloads. For young children with cerebral palsy, a part of therapy is usually neurodevelomental treatment. Using their hands, the therapist attempts to facilitate proper movement patterns while inhibiting abnormal muscle tone. One therapist may be able to facilitate a child's movement patterns very differently than another. Perhaps ones hand placement is just slightly different or hand size is significantly different this can influence neurodevelopmental treatment. Many time parents or teachers will say "I don't seem to do it as good as you". Therefore, something to consider when a child is not reaching a specific goal is to think about changing therapists. It is not to say that the current one is not good, but you never know what a different set of hands may illicit. If you do not want to change completely, another idea is to ask for another therapist to consult on the child. Maybe the therapists could do one cotreatment session to see if a different set of hands can help the child to achieve the goal.

What about different diagnoses? Some therapists work very well with children with certain diagnoses. Just like some teachers prefer to teach math over reading, some therapists prefer to work with children with autism instead of cerebral palsy or ambulatory children versus non ambulatory children. Therapists should look closely at what type of child they work best with and offer to help if that is their "niche".

What about the goal? If the goal requires a significant amount of assistance who might be best for the job? A small therapist may not be a good match. If the goal requires a significant amount of patience like learning to ride a bicycle, an individual with a short fuse may not be a good fit. If the goal is climbing the jungle gym to the highest point (see yesterday's blog post on this topic), a nervous individual may not be the best person for that job.

What about carry over at home or in the classroom? It is not always possible to have a choice of which adult can help, but if it is possible consider the adults' strengths and weaknesses. When teaching a skill like toilet training patience is a virtue. Teaching a child to do the monkey bars or a to use a fire pole, requires some strength and is not for the faint at heart.

Therefore, when a child is learning a new skill consider the therapist's style and experience in addition to the child's goals and diagnoses to create the best fit possible.

Part 4 - Exercise Participation: Asthma

Asthma is a common chronic disease is the pediatric population. Having this condition, does not indicate that children should avoid exercise or sports participation. Although exercise and emotions can trigger bronchospasm with mild inflammation. Statistics show that almost 90% of asthmatics and 40% of people with allergic rhinitis suffer from exercise induced bronchospasm (EIB). This bronchocontriction typically occurs after 8-15 minutes of physical activity and clears up with 60 minutes. The usual triggers for EIB are running and other cardiovascular activities excluding swimming.

Some of the benefits of exercising for asthmatics are the following:
1. improves aerobic capacity (although does not change pulmonary function tests)
2. swimming can decrease asthma morbidity
3. potential for decrease in EIB severity (exercise may increase the threshold for triggering bronchospasm

There are possible risks to asthmatics with exercise such as:
1. high intensity exercise can trigger EIB
2. bronchial changes with endurance athletes
3. any sports or recreational activities that expose the athlete to dry, cool air, allergens or pollutants could trigger asthma (winter sports exacerbate symptoms more)
4. scuba diving may be dangerous

When children with asthma exercise the following tips are recommended:
1. asthmatic children can participate is any physical activity is symptoms are controlled. A lower risk activity to trigger symptoms is swimming.
2. keep a log of physical activity, triggers and symptoms
3. should be followed by a medical doctor to diagnosis EIB, prescribe proper medications and when to take the medications prior to exercise
4. avoid scuba diving is asthma symptoms are present or abnormal pulmonary function tests
5. for major competitions may need documentation from physician to use certain medications.

Reference: Philpott, John F MD, Dip Sport Med; Houghton, Kristin MD, Dip Sport Med; Luke, Anthony MD, MPH, Dip Sport Med Physical Activity Recommendations for Children With Specific Chronic Health Conditions: Juvenile Idiopathic Arthritis, Hemophilia, Asthma, and Cystic Fibrosis Clinical Journal of Sport Medicine: May 2010 - Volume 20 - Issue 3 - pp 167-172 doi: 10.1097/JSM.0b013e3181d2eddd

Part 3 - Exercise Participation: Cerebral Palsy

When recommending exercise and sports participation for children with cerebral palsy, there are many factors to consider. Research is constantly being collected and analyzed on the benefits of physical activity for people with cerebral palsy. One topic is the use of muscle strengthening exercises. Some current research states that progressive resistance exercises has been shown to improve muscle strength and function. Some research has concluded that muscle strengthening does not increase muscle spasticity.

Regarding cardiovascular health, children with cerebral palsy:
1. have 2-3 times higher energy expenditure rates while walking
2. may have poor cardiovascular health
3. take many less steps per day than their typically developing peers

With these statistics in mind, aerobic exercise can be beneficial for children with cerebral palsy. Some examples of research studies indicating this are the following:
1. lower limb cycling (3x/week, 20 min sessions for 1.5 - 16 months) resulted in improved aerobic fitness
2. a community fitness program of aerobics, strength training, and stretching (3x/week for 10 weeks) resulted in increased muscle strength and improved perception of physical appearance
3. a systemic review of research indicated that short-term cardiorespiratory training (i.e. 2–4 months) increased aerobic fitness by 18–22% and long-term training (i.e. 8–9 months) by 26–41%. Short-term training (i.e. 2–4 months) increased activity by 0–13%, and long-term training (i.e. 8–9 months) by 2–9%. Aerobic activity provided little carry over into activity.

When deciding what sports or recreational activities are suitable for children with cerebral palsy, each child would have to be evaluated individually. Basically, once a child is thoroughly evaluated, a pediatric therapist can help to suggest recreational activities such as boccie ball, fishing, horseback riding and more. For formal sports such as swimming, wheelchair basketball, soccer or baseball, the therapist can help to suggest which sport would make a good fit for a particular child based on functional levels. In addition, any adaptations or modifications to the sports or recreational activity should be considered. For more information on sports and leisure activities for people with cerebral palsy visit the United Cerebral Palsy website.

References:
Darrah, Johanna PhD, PT; Wessel, Jean PhD, PT; Nearingburg, Patricia PhD, PE; O'Connor, Marjorie BEd, PE Evaluation of a Community Fitness Program for Adolescents with Cerebral Palsy Pediatric Physical Therapy Spring 1999 - Volume 11 - Issue 1


Butler, Jane M.; Scianni, Aline; Ada, Louise Effect of cardiorespiratory training on aerobic fitness and carryover to activity in children with cerebral palsy: a systematic review International Journal of Rehabilitation Research:
June 2010 - Volume 33 - Issue 2 - pp 97-103 doi: 10.1097/MRR.0b013e328331c555