EDU Healthcare Blog
5 Tips for Articulation Carryover in the Classroom...August 16, 2017 11:44 AM
As school based speech-language pathologists, our end goal for articulation treatment focuses on helping students use clear speech in the general education classroom. Ultimately, this carryover of skills during classroom activities affects our students’ academic success.
As the start of the school year draws near—or has already arrived of some of us—I offer five tips on articulation carryover that I always share with teachers and other faculty. These easy approaches will help teachers—and also families—support generalization of articulation skills:
- Model clear articulation: The more the student hears a sound correctly, the more likely they’ll say it correctly. Look for opportunities to model target sounds, especially during small group activities. When modeling for a student, say the sound clearly and naturally.
- Focus on speech sounds: Emphasize the sound a letter makes rather than the letter itself. For example, remind a student to say the “shh” sound, rather the “s” “h” sound.
- Give specific feedback: Give students’ specific feedback for saying sounds correctly. For example, “Wow! I heard TWO sounds when you said the word “spot!” I heard “ssssss” and “puh”! Avoid criticizing a student for saying a sound incorrectly in front of other students. Speaking with confidence is important and providing too much negative feedback—especially in a large group—can make them overly self-conscious.
- Ask for repetition: Asking a student to repeat teaches them that speaking clearly is important without putting them on the spot to say a specific sound correctly. For example: “I didn’t understand, can you say that again?” “What you have to say is important, can you repeat that?” If you still can’t understand the student, encourage them to use a communication strategy like saying the word in a sentence to give context or writing it down. Honor the communication even if articulation is incorrect.
- Highlight target sounds: Underline or highlight the target sound in advance for read aloud or homework activities to reinforce the student’s awareness of the sound in context. This is also a great carryover activity for older students to complete independently.
Everyone at some point needs to work on clear articulation and speaking. It takes practice for children and adults to use precise language in academic and professional settings.
Physical Therapist's Guide to Traumatic Brain Injury...August 16, 2017 8:09 AM
Traumatic brain injury (TBI) occurs when an injury disrupts the way the brain functions. The most common causes of TBI are falls, car crashes, and blows to the head. There are 2.8 million cases of TBI diagnosed each year in the United States. Concussion, which is a mild TBI, makes up approximately 80% of all diagnosed TBIs. Traumatic brain injury can happen to anyone; however, some people are at higher risk than others. Children under the age of 4 are at risk of injury from falls and child abuse. Adolescents aged 15 to 19 are at an increased risk due to sports injuries and car crashes. People aged 75 years and older are at risk from falls.
CAUTION: If you have experienced a head injury, seek medical help immediately.
Physical therapists help people with TBI regain their physical function, relearn daily tasks, and restore their fitness and wellness.
What is Traumatic Brain Injury?
TBI occurs as a result of forces exerted on brain tissue. Common causes of TBI are falls, car accidents, blows to the head, and battlefield injuries. Movement of the brain that causes damage even though the skull is intact is called a closed injury. Damage caused by a wound that breaks through the skull, such as a gunshot or a puncture by a sharp object, is called a penetrating injury.
Those who sustain moderate-to-severe TBI require specialized hospital and rehabilitative care to address the serious physical, cognitive, and emotional changes that result from injury to the brain. Nearly half (43%) of those who need hospitalization for TBI will have some form of disability 1 year after the injury.
Severe TBI often causes a period of unconsciousness, called coma. During this time, the person may not be responsive to outside stimulation. Consciousness may gradually improve, but many brain functions can be affected by the injury, including those guiding thought, movement, sensation, and behavior.
Signs and Symptoms
Because the brain controls our ability to move, think, sense, and socialize, the symptoms that result from TBI can vary widely. They may include:
- Physical symptoms, such as weakness or difficulty moving the arms, legs, body, and head. The affected person may have difficulty sitting, standing, balancing, walking, or lying down and changing position in bed.
- Cognitive symptoms, which can include difficulty remembering, paying attention, or solving problems. The affected person may have a reduced awareness of these difficulties, which can cause safety concerns.
- Sensory symptoms, which can include changes in vision, hearing, or the sense of touch. Balance senses that are aided by the inner ear may also be impaired.
- Emotional and behavioral symptoms, which can include difficulty in controlling emotions, or a change in personality. If cognitive deficits are significant, the affected person's inability to understand what has happened may result in significant emotional agitation.
How Is It Diagnosed?
Upon the individual’s arrival at the hospital, an attending physician will diagnose the level of TBI by assessing factors such as the ability to open the eyes, to speak, and to move in response to a command.
Imaging studies will be conducted (eg, MRI, CT scan) to determine what parts of the brain are injured or if there is any bleeding or fluid that could be pressing on the brain tissue. A physical therapist often works with the medical team to understand what areas of the brain are injured, so the physical therapy evaluation can focus on potential problem areas.
With a severe injury, a person may arrive at the hospital by ambulance and may be on life support and/or in a coma (the eyes are shut and there is no response to external stimuli). Over time, the individual will likely be able to open his or her eyes. Sometimes eye opening is accompanied by rapid recovery of other abilities, such as talking and physical movement. For other people, recovery is slower.
How Can a Physical Therapist Help?
The physical therapist will work with the patient, family, and other health care providers to develop goals and an individualized treatment plan to address the challenges and functional limitations associated with the injury. Depending on the severity of the injury, the patient’s level of consciousness, and the problems the patient has the treatment plan will widely vary.
When a person is said to be in a vegetative state, some basic brain functions resume, such as eye-opening on a regular sleep/wake cycle, breathing, and digestive functions, but they are unaware of surrounding activity. During this phase, the physical therapist will help with positioning and equipment that will ensure proper posture and flexibility, reduce the likelihood of any problems, such as bed sores, and encourage the individual’s responsiveness to the environment.
When a person is said to be in a minimally conscious state, they show beginning signs of awareness (the ability to do purposeful things), but these responses are often not consistent. During this phase, a physical therapist will help with stretching, positioning, and equipment use while working with the individual to increase consistent responses to commands for movement and communication.
As the person becomes more conscious and is able to more actively participate in physical therapy, the physical therapist will use a combination of exercise, task-specific training, patient and family education, and different types of equipment to help the patient improve, including:
- The ability to maintain alertness and follow commands
- Muscle and joint flexibility that may be reduced after inactivity
- The ability to move around in bed, to sit without support, and to stand up
- The ability to balance safely when sitting, standing, or walking
- The ability to move by strengthening and the practicing of functional activities
- Balance and coordination
- Strength and energy, reducing any feelings of fatigue that occur from inactivity or injury to the brain itself
- A return to sports and fitness activities
If limitations prevent the return to preinjury activities, a physical therapist can help an individual improve mobility and master the use of equipment, such as an ankle brace, a walker, or a wheelchair.
Can this Injury or Condition be Prevented?
Traumatic brain injuries can be prevented by taking steps to protect the head when engaged in risky activities, and by lessening participation in those activities. Awareness of the signs and symptoms of injury can help quicken response time should a TBI occur. To lower the risk of sustaining a TBI:
- Always wear an appropriate helmet when taking part in activities that increase the risk of falling, such as biking, rock climbing, motorcycling, skateboarding, skiing, or skating.
- Always use your car's seatbelts; infants must be secured in an appropriate car seat, according to safety requirements and instructions.
For small children:
- Provide appropriate adult supervision in fall-prone areas like playgrounds.
- Use child barriers to prevent home-based falls around areas such as stairs and second-story windows.
- Educate teens about the many factors associated with death and brain injury in car crashes, including the use of alcohol or other substances, speeding, or texting or phone use while driving.
- Educate teens about mild TBI or severe injuries related to sports.
For older adults:
- Educate older loved ones about the risk of falls in the home related to daily mobility and housework activities that carry a greater risk of brain injury, such as using a ladder or footstool, walking on a wet floor, or vacuuming stairs.
Real Life Experiences
Ryan is a 20-year-old college engineering student at a local university. He has many friends, but doesn’t own a car. He often relies on a friend to drive him to meetings or social events.
Just last week, Ryan sustained a severe brain injury with facial wounds and a broken left arm when the car in which he was a passenger rolled over in an accident. He was unresponsive at the scene of the accident and was taken by ambulance to the nearest trauma center. On the way to the hospital, Ryan needed help breathing. His initial diagnosis showed a severe injury: he was not opening his eyes, could not speak, and was unable to move his arms or legs. His parents rushed to be by his side in the hospital.
Ryan remained in a coma for several days, but eventually resumed breathing on his own, opened his eyes, and moved the right side of his body. Although groggy and confused, he was able to begin physical therapy. Ryan's physical therapist worked with him each day on sitting and moving in bed, standing at the side of the bed, and taking a few steps with the help of a walker. His left-sided weakness was an important focus, so strengthening and coordination exercises were part of his routine.
With focused medical care and work with his physical therapist, Ryan began to recover some of his faculties. After his condition improved, Ryan was transferred to a rehabilitation center. Ryan clearly still had problems with important skills such as paying attention, memory, and the ability to plan and problem-solve.
At the rehabilitation center, Ryan’s physical therapist’s main focus was on helping him improve control of the left side of his body in order to perform important skills safely and independently. At first, he needed physical help to stand up, walk more than a short distance, and climb stairs. As he progressed in physical therapy, Ryan began to walk with a cane and build his endurance by exercising on a treadmill. He and his physical therapist developed a fitness workout that was similar to what he used to do at the college fitness facility.
During rehabilitation, Ryan's speech-language pathologist and neuropsychologist completed specific testing to determine the extent of his cognitive problems. While his ability to pay attention, remember, and problem-solve improved gradually, upon leaving the rehabilitation center, Ryan still wasn’t ready to go back to the cognitive challenges of college. Further outpatient therapy was planned in speech pathology to address the goals he had yet to achieve.
After his discharge from the rehabilitation center, Ryan continued to see a physical therapist on an outpatient basis to work more on the remaining weakness in his left ankle that affected his endurance, balance, and ability to jump and run. Ryan's goal was to resume playing intramural basketball.
After a few more months of hard work, Ryan was able to return to the university. This week, his physical therapist informed his coach that, with careful guidance, Ryan was ready to rejoin his intramural basketball team for modified practices.
This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat TBI. However, you may want to consider:
- A physical therapist who is experienced in treating people with neurological conditions/injuries. You may find these physical therapists affiliated with rehabilitation centers that commonly serve individuals with stroke, brain injury, and spinal cord injury.
- A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in neurologic physical therapy and uses the designation NCS (board-certified clinical specialist in neurologic physical therapy). This physical therapist has advanced knowledge, experience, and skills that may apply to this condition.
- Sometimes physical therapists with a strong interest in brain injury have the credential of Certified Brain Injury Specialist (CBIS), from the Brain Injury Association of America.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have traumatic brain injury.
- During your first visit with the physical therapist, be prepared to describe the physical issues and symptoms that are causing the most difficulty following the brain injury.
- Plan to talk about what goals are most important to help increase the patient's independence performing daily activities, and ensure a healthy future.
Tips to Ease the Transition to Full-Day School...August 15, 2017 3:43 PM
I’ve had my share of unrealistic expectations of mothering, so I shouldn’t have been surprised that when my older son began full-day school, it was far from what I’d imagined. I expected my son’s first full day of school to be a smooth and happy experience; however, like many children, he had to transition emotionally, physically and mentally to being “on” for a whole day. He spent the first weeks—which turned into months—coming home, as we deemed it, a grumposaurus.
When I started talking to some mommy friends, I found solace in the fact that I was not alone. Here are tips to help you and your child survive the transition to full-day school:
Practice the school routine prior to school starting.
To help your child adjust, plan to shift their schedule from summer to school mode before school starts. Shares Lee Nodes, a mom from Mount Pleasant, South Carolina, who has worked as a counselor and special education teacher, says, “Routine, especially at home, is so important. We start the early-to-bed routine several days before school starts in the summer to get the kids used to it, so it isn’t a shock.”
Also adjust their lunch schedule to their school’s timing. Sarah Sheridan, a fifth-grade teacher in Rockford, Illinois, suggests, “You can contact your school to find out when your child will be eating lunch. A child who is used to eating at 11 a.m. can get hungry if their scheduled lunchtime isn’t until noon.”
Reduce morning stress on school days.
Reducing stress in the morning can help make the whole day turn out better. Be sure to lay out school clothes at night and give your kids plenty of time to eat a healthy breakfast.
Helping them with their morning routines can prevent stress too. “Give kids a pictorial checklist. You can download great pictures to match your child’s list of things to do … down to the exact backpack they will be heading off to school with,” suggests Jennifer Bailey, a teacher and autism consultant who is mom to two elementary-aged boys.
Refresh and encourage your child while they are at school.
No, you can’t attend school alongside your child, but don’t underestimate the value of a note or other reminder in their lunchbox.
Sheridan reminds parents, “For the youngest students, missing their parents can be a real concern. Family photos can be a reminder for the nonreaders that their parents will be waiting for them at the end of the day. Whether it’s a photo taped in a lunchbox or a small photo on a yarn necklace, it can be a real comfort.”
Create a home environment that allows after-school downtime and sharing.
Whether you pick them up at school or they arrive home on a bus, children coming home from full-day school will most likely be ravenous and needing to relax. Bailey’s advice to parents is simple: “No trying to ‘talk’ about [their day] until we have their basic needs met—hydrate them, snack them, rest time.”
Allow your son or daughter some time to play outside or in their rooms, before talking about their day. But then, whether during dinner or at bedtime, allow them to unload. Nodes finds with her family that “Right before bedtime is the best time to talk to them. … They seem to be an open book at that time of night.”
The first week of full-day school may be a big shock for your whole family, but be patient, as the tiredness and grumpiness may linger beyond that week. Sheridan explains, “For younger grades it takes much longer, around winter break, for students to slip into their schedule, whereas upper-elementary students take a few weeks to fall back into their routines.”
Bailey agrees. “It takes our whole family a good month to get into the groove of the school year. … Try to limit overscheduling.”
Lastly, if your efforts don’t seem to working, be flexible. Nodes concludes, “Adjust routines if needed. Are they getting enough sleep, food, et cetera? Anything else going on at school?” By keeping your patience, you will help ease the transition to full-day school for your child and, perhaps just as important, yourself!
12 Speech & Language Considerations For Children With He...August 15, 2017 1:46 PM
1. What is the child hearing?
The starting place for evaluation and service is the determination of the child’s residual hearingability. If the child is a consistent hearing aid wearer, then consider the SPLogram or aided audiogram. If the child does not wear hearing aid(s) daily, then use the unaided audiogram.
2. What speech sounds can the child hear consistently?
Plot the child’s hearing thresholds on the Speech Spectrum Audiogram for Consonants to estimate his or her speech perception abilities when detecting sound from a close distance in a very quiet setting. A child cannot be expected to discriminate and comprehend sounds if they are not consistently perceived. Only thresholds representing the best hearing should be plotted, since that is the ear that will be used primarily to detect and discriminate soft sounds. This can be considered the child’s “hearing line.” Identify the speech sounds that will be: (a) most likely audible to the child (sounds above the hearing line), (b) detected in consistently by the child (on or very close to the hearing line), or (c) inaudible to the child (below the hearing line on the audiogram).
If the child’s audiogram is not available or is unreliable or you want to confirm the accuracy of these sound perception estimates, stand 4-6 feet from the child and ask him/her to repeat or signal when you say the Ling sounds at a typical conversational level. The child’s ability to repeat these sounds should generally reflect the hearing ability for the different pitch ranges and should agree with the sound audiogram. Clinically, the Ling sounds were chosen because /oo/ as in “moon” approximates 250 Hz, /a/ as in “mop” at 500 Hz, /ee/ as in “meat” at 1000 Hz, /sh/ at 2000 Hz and /s/ at 4000 Hz (Ling, 1989).
3. What is the child’s range of hearing in different situations?
Hearing is a distal sense that is affected by background noise and reverberation in the environment. It is important to consider the effect of distance on speech perception. Another way to think of this is to consider the size of the child’s “listening bubble” or their range of hearing in different listening situations. If the child is very close to the speaker, is using an FM system, or it is very quiet, he or she may be able to detect more sounds than those suggested by the audiogram. If the listening environment is noisy or the child is at a distance greater than 4-6 feet, then most likely, he or she will not be able to perceive sounds as well as suggested by the audiogram. To estimate the child’s ability to perceive sound in a 1:1 listening situation, you can produce the Ling sounds (in quiet or with background noise) at 2-3 feet. Improvement in listening through the use of an FM system can be estimated by having the child repeat the Ling sounds in quiet from a distance of 4- 6 inches. Be careful not to let the child feel the air stream as you produce the sounds.
4. Where is the child on the hierarchy of development of auditory skills?
Speech perception ability and the level of auditory skills will determine the degree to which spontaneous speech and language can be expected to emerge in the absence of a manual communication system. A child who does not perceive speech sufficiently to spontaneously develop age appropriate auditory skills will likely have speech and language delays. Consider the child’s level of auditory skills (detection, identification, discrimination, comprehension). Listening Skills Develop Over Time may help you understand the various auditory skills. The majority of children who are hard-of-hearing will have sufficient residual hearing to detect most, if not all, speech sounds when amplified. Some sounds may be heard inconsistently and will be difficult to discriminate. Listening skills are developmental, based on consistent exposure and experience with sound.
5. Which speech sounds are the best targets for habilitation?
When analyzing the sound productions of children with hearing loss, first, be sure that the speech sounds are developmentally appropriate for the child’s age, then differentiate between sounds that are within the child’s speech perception ability and sounds that are not. Elicit connected speech to determine a child’s speech proficiency. Emerging or misarticulated audible sounds would be the initial articulation targets chosen for habilitation (sounds above the hearing line on the sound audiogram). Speech sounds that are inconsistently audible would be the next articulation targets (sounds on or very near the hearing line). Inaudible speech sounds may be approached more efficiently through practice with computerized programs that monitor production, provide visual cues, and target prosody and loudness as well as phonology. The inaudible sounds are more challenging to the child and mentor since they must be approached through visual and proprioceptive feedback—systems that are less efficient than the auditory system for learning speech. However, many children with hearing loss have learned to articulate inaudible sounds as part of auditory-oral methods that capitalize on skills other than primarily audition.
6. Tap into higher order language skills, not just vocabulary.
Language gaps often occur due to lack of language stimulation or fragmented perception of verbal communication. Evaluation of language ability is not necessarily straightforward. Children who are hard-of-hearing may do quite well on a vocabulary test— (e.g., Peabody Picture Vocabulary Test; Dunn & Dunn, 1981) and still have significant gaps in their word understanding due to a life time of hearing fragmented speech and missing incidental language. Therefore, traditional vocabulary tests tend to under estimate the significance of a language deficit in this population. Higher order language tasks, such as problem solving, following age appropriate multi-step directions, repeating the critical elements of a story, or using specific words or concepts meaningfully, can reveal gaps in receptive language ability. Careful observations of the student within the active educational setting may provide the most critical information about the child’s daily language usage and comprehension. It is important to recognize that even if a test has been standardized on a population with hearing impairment, it still may lack relevance to the language tasks required of mainstreamed students with hearing impairments. Information on pragmatics and children with hearing loss to appear on a future SSCHL webpage.
7. Gaps in language relate to the complexity of meaningfulness.
Due to gaps in receptive language, the test performance of children with hearing loss could be inaccurately interpreted as a language processing disorder. This problem can be compared to one’s learning a second language as an adult, but not developing a robust vocabulary and sophisticated grammar. You could process the conversational language that you had learned quite well, but the vocabulary or grammar you did not know could potentially sabotage your comprehension. The speed and accuracy of processing any conversation depends upon your world knowledge, which guides your expectations; your facility with the vocabulary, grammar, and conversational conventions of the language; and your ability to use context to infer meaning. Because the overriding concern in language learning is “meaningfulness,” simple vocabulary drills of isolated words are not effective in meeting a child’s needs to become a fluent communicator for social, as well as educational reasons.
8. Vocabulary is only useful in the larger context of life and learning.
The acquisition of vocabulary and its nuances is a slow and additive process. The child must become a word mason, using known words as a foundation and building walls of vocabulary by adding new, similar words that intersect across content areas or by recognizing the multiple meanings of words that need to fit into more than one wall. Between each of these word bricks is a mortar, made up of syntactic forms and pragmatic functions. Meaning exists in context. Acquisition and comprehension of the richness of vocabulary is more reliant upon context than upon a single definition or an isolated sentence. The language of peers is ever changing and often produced in quick conversations in noisy environments. The acquisition of figurative language, idioms, and slang helps students become participating members in their peer groups. This vocabulary is a prime target for habilitation. To identify these popular words, talk with and listen to children on the playground and in the halls. Role-play with the child with hearing loss to illustrate the meaning and appropriate context of these new words. Figurative language is especially important to school-aged children. Idioms, slang, metaphors, and other forms of figurative language add to the richness of our conversations and stories, and their usage often identifies the social status of the user.
9. Simply missing endings may not be simple.
Due to the tendency for children with hearing loss not to perceive word endings (morphology) and unstressed words or syllables, errors in the use of syntax and morphology are sometimes evident in writing and speaking (Speech Production Characteristics article). These forms may be emerging and relatively easy to address through direct teaching of syntax forms (e.g., plural, past tense, possessives) or, they may involve more serious deficits or confusion that require lengthy and repetitive habituation methods. Morphological differences can be approached through contrastive procedures that underscore when and when not to use the endings. The use of contrastive procedures helps to add meaningfulness by providing context for the use of the endings.
10. Differentiate between sound-based and language-based reading problems.
Reading skills appear to be significantly related to phonemic awareness. Many, if not most, children who are hard-of-hearing develop some level of phonemic awareness, which allows relatively age appropriate word recognition or oral reading performance (i.e., one year delay). Reading comprehension tasks reflect an individual’s higher order language and cognitive abilities. If a child performs within the normal range on standard receptive language measures, but is subsequently found to perform poorly on language-based reading tasks (i.e., reading comprehension delays of 2+ years), this deficit should be an indication of the need for further investigation of language skills. Therefore, a low reading comprehension score could be a reflection of deficiencies in language, rather than a reading disorder.
11. Hearing loss can be an acoustic and comprehension barrier to accessing verbal instruction.
If a child is havingllowing directions, take the time to clarify whether he or she under stands the concepts and vocabulary of directions or is having difficulty following directions because these words are not perceived across the distance of a noisy classroom. A personal ear-level FM system or a desktop FM system improves ease of listening and increases understanding of teacher instruction. A glossary does not replace the experience of learning words naturally in incidental exposure. Consider how much of the vocabulary taught during an academic content unit may have been learned by class peers through overhearing in a variety of situations, rather than at school. Words should be used in many different ways and concepts should be described using many different words. In addition, some children can benefit from visually presenting word relationships via webs or highlighting words with similar meanings in paragraphs. Comparing and contrasting a child’s base of understanding with unknown language can make them feel empowered by how much they do know, and assist them in making connections between concepts.
12. A child’s needs are more complex than curriculums.
Finally, language is alive and interactive; it is the connection that makes us peers and friends. Helping a child develop the skills to recognize his or her gaps, infer meaning, and feel okay about not knowing all the word possibilities is a task that cannot be instilled through drill, worksheets, or pluck-off-the-shelf curriculums. Flexibility, encouragement, caring, and using language from the child’s own world is the ticket for success with children who are hard-of-hearing.
Occupational Therapy's Role in Mental Health in Childre...August 15, 2017 8:08 AM
According to the Substance Abuse and Mental Health Administration (SAMHSA), recovery is defined as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential” (SAMHSA, 2012).
The recovery model requires a shared decision-making process that is person centered and client driven. The client–provider partnership supports shared decision making from the time the individual first engages in services, through developing intervention plans, and in all other aspects of the therapeutic process. A primary goal of the recovery model is to facilitate resiliency, health, and wellness in the community of the individual’s choice, rather than to manage symptoms. SAMHSA (2012) identified 10 guiding principles of recovery: (1) hope, (2) person-driven, (3) many pathways, (4) holistic, (5) peer support, (6) relational, (7) culture, (8) addresses trauma, (9) strengths/responsibility, and (10) respect. These fundamental recovery principles are in full alignment with the philosophy of occupational therapy practice, which is inherently client centered, collaborative, and focused on supporting resiliency, full participation, health promotion, and a wellness lifestyle.
Occupational therapy practitioners work collaboratively with people in a manner that helps to foster hope, motivation, and empowerment, as well as system change. Educated in the scientific understanding of neurophysiology, psychosocial development, activity and environmental analysis, and group dynamics, occupational therapy practitioners work to empower each individual to fully participate and be successful and satisfied in his or her self-selected occupations. Occupational therapy practitioners assume a variety of roles such as direct care therapists, consultants, academic educators, managers, and administrators. They may also work in state and national mental health organizations to help assist in local, state, and national transformation efforts.
The following are examples of how the knowledge and skill base of occupational therapy is used in the process of assisting individuals in all phases of mental health recovery:
- Teach and support the active use of coping strategies to help manage the effect of symptoms of illness on one’s life, including being more organized and able to engage in activities of choice
- Help to identify and implement healthy habits, rituals, and routines to support a wellness lifestyle by addressing barriers and building on existing abilities
- Support the identification of personal values, needs, and goals to enable informed, realistic decision making, such as when considering housing and employment options
- Support the creation and use of a wellness recovery action plan in group or individual sessions
- Provide information to increase awareness of community-based resources, such as peer-facilitated groups and other support options
- Provide information on how to monitor physical health concerns (e.g., diabetes management, smoking cessation), develop strategies to control chronic symptoms, and recognize and respond to acute changes in mental health status
- Support the ability to engage in long-term planning (e.g., budget for major purchases, prepare advanced medical and mental health directives) that leads to meeting personal recovery goals
Occupational therapy practitioners are also teaming with individuals, families and caregivers, interdisciplinary professionals, and other mental health stakeholders, including behavioral health organizations, payers, and communities, to help transform the culture of mental health care through the promotion and active implementation of recovery-based principles and practices. Together, these teams are designing innovative agency and community-based supportive programming based on these recovery principles. The “Recovery to Practice” federal initiative “helps behavioral health and general health care practitioners improve delivery of recovery-oriented services, supports, and treatment” (SAMHSA, 2015).
Where Are Occupational Therapy Mental Health Recovery Services Provided?
Occupational therapy practitioners provide mental health services in the following settings:
- acute and long-term-care facilities
- private and public hospitals
- military installations
- forensic and juvenile justice centers
- employment programs
- residential and day programs
- private practice
- skilled nursing facilities
- outpatient clinics
- community-based mental health centers
The practice of occupational therapy, like the recovery model, is based on the philosophy and evidence that individuals diagnosed with mental health conditions can and do recover and lead meaningful, satisfying, and productive lives. It is the profession’s emphasis on a holistic approach to function, participation, and partnership that is used to help support people with mental illness to develop skills, engage in activities of interest, and meet individual recovery goals.
How to Improve Driving Skills of Teens With ADHD...August 14, 2017 2:44 PM
A study published in the June issue of JAMA Pediatrics found that teens with attention deficit hyperactivity disorder are about one-third more likely to be involved in a car accident than people without ADHD. They're also more likely to obtain their driver's license at a later time.
One of the study's researchers, Dr. Flaura Winston, professor of pediatrics at the University of Pennsylvania in Philadelphia who serves as the scientific director of the Center for Injury Research and Prevention at The Children's Hospital of Philadelphia, says that while this finding is important, it's not necessarily cause for alarm. In fact, she calls the study's relatively low increase in risk encouraging, saying that the statistics illustrate "that it's a manageable risk." Winston also stresses that getting a driver's license later doesn't necessarily equate to a significantly longer period of time. It may just be by a few months later, although it varies by individual. "It just may take them a little longer," she says.
Consider Getting a License Later
Getting a license a bit later is fine with Amanda Plourde, a certified occupational therapy assistant, certified driving instructor and certified driver rehabilitation specialist at Northeast Rehabilitation Hospital Network in Salem, New Hampshire. She says that ADHD teens who choose to delay obtaining their license demonstrate maturity, one of the traits she evaluates when assessing driver readiness among this age bracket.
"It's a mature statement for them to realize this," says Winston, who is also the vice president of the New England Traffic Safety Education Association.
But Don't Wait Too Much Later
Ann Shanahan, an ADHD and executive functioning coach at Shanahan Sweeney Coaching in Chicago, warns of waiting too long to drive. Shanahan, who offers driver education to driving instructors, parents and teens through the program Behind the Wheel With ADHD, explains that individuals with ADHD typically have a maturational lag of three to five years compared to people without the disorder.
Therefore, many parents may feel it's logical to have their child wait a few years beyond the minimum age requirement in their particular state.
However, she says that when a child turns 18, all that's required in most states is six hours of class instruction, which doesn't allow the teen with ADHD to fully understand and experience the intricacies of driving.
Encourage Sports and Exercise Involvement
Interestingly, Plourde thinks activities like biking or skiing can improve an ADHD teen's driving skills because they allow a person to develop fast reflex times.
"I encourage parents to get their child involved in enhancing gross motor expression," she says of such activities. "Driving is a complex social skill that requires reading other drivers and making timely, quick decisions."
Talk to Your Child About the Seriousness of Driving
Winston says that the first time on the road presents the highest accident risk ever in a person's life. For teens, whether they have ADHD or not, this experience brings the most likely chance of having a motor vehicle accident, which is the leading cause of death among this demographic. She explains that the transition of learning to drive with parents in the car to suddenly being alone or with a distracting passenger ups this risk. But she also says distraction transcends having a friend in the car. It also encompasses everything from hearing a cellphone ring to seeing billboards or a person across the street.
Therefore, Winston suggests that parents "start the conversation early about driving" and assess their child's readiness to drive. She says this is essential for any child, but especially those with ADHD. "Parents may want to consider a driving rehabilitation specialist, which is typically an occupational therapist that specializes in driving."
Plourde suggests limiting the number of passengers because "the more there are, the more distractions may arise which can increase the odds of an accident." She explains that she may recommend not having any passengers for one year, but that if the teen has a good driving record during that time, parents should consider allowing them to have one passenger such as a best friend or sibling as a reward.
Take Medication Properly
It's also important to have a conversation with a teen's primary care provider and behavioral specialist. Winston says this helps ensure that ADHD medication is an active, necessary prescription that should be taken as recommended and used for an appropriate duration.
Plourde adds that an ADHD teen should "make sure meds are consistent in their system." She also suggests staying in tune to the body's reaction to these medications, saying that if they tend to wear off after a certain time, then driving beyond that point should be reconsidered.
Consider Helpful Apps and Resources
To help teens with ADHD and their parents, Shanahan says she developed a pre-trip app that's compatible with iPhones as well as Android devices. It acts as a self-checking system by asking the teen a series of short, easy questions in a checklist format. Responses about the destination and whether the adolescent has passengers, sufficient gas and medication are then sent to the parent via a text message. The teen's phone is shut down until he or she arrives at the planned location, at which time another text is sent to inform parents.
Shanahan is also involved in driving instructor webinars as well as parent webinars. Instructors sign up at designated dates and times, while parents can take one at any time. "I encourage parents to take a webinar as soon as possible, not just when their child is about to learn to drive," she says.
Winston suggests turning to readily available resources from the Children's Hospital of Philadelphia's Center for Management of ADHD.
Ask About Individualized Driving Plans
Shanahan says that in some education systems Individualized Education Programs exist. "IEPs have been successful in the academic environment," she says, "so I developed the phrase 'IDP,' or 'Individualized Driving Plan.'" Shanahan explains that while teachers are required to obtain continuing education, that's often not the case for driving instructors, which was a large part of the impetus behind her IDP concept. "This gives instructors the opportunity to remain educated on an ongoing basis," she adds.
She strongly suggests that parents look into IDPs or similar programs when a teen begins driving. She holds meetings to reinforce the importance of spending more time learning driver education and gaining experience while also making sure the teen truly understands everything about his or her brain differences and driving habits compared to the non-ADHD adolescent.
"Parents can make sure schools as well as driving instructors understand the importance of IDPs," she says.
Many tips to help an ADHD teen improve their driving skills are steeped in common sense.
Plourde says it's beneficial to avoid rush hour, take a slower route as opposed to a highway and limit radio use.
Winston agrees, adding that starting with familiar routes and daylight hours is ideal. She explains that parents should still be involved in the driving process even after their child has been on the road for a bit, especially to help review a new route. Another good practice for any individual, she says, is to always wear seat belts.
"It's incumbent on parents, schools and the teenager to focus on the seriousness behind driving, especially when ADHD is involved," Winston says. "Don't ignore it, but manage it like anything else. Their safe mobility is essential."
10 Back To School Tips For School Based Therapists...August 14, 2017 8:15 AM
It is that time of year again – back to school. Here are 10 tips to help you get started on the right “foot” (for the PTs) or “write path” (for the OTs). Get it hahahaha! Ok, I know lame joke but I couldn’t resist. Here we go:
#1: Get organized. Here are a few specific tips to help –
1. Try using one color folder per school. For example, for every student at school XYZ use a red folder. For each student at school ABC use a blue folder.
2. In each student’s file, keep an general information page including goals.
3. Keep a binder for all your daily notes. Using file folder dividers with tabs, write the student’s name on the file folder tab. Try to keep it in alphabetical order to quickly find a student’s name.
4. Keep a file folder with your most popular hand outs in your bag. When teachers or parents need extra information on a popular topic you will have it all at your fingertips.
5. Keep a pack of sticky notes ready to jot down a note or reminders. At the end of the day transfer any information on the sticky note to the proper location.
6. Schedule a meeting with yourself at the end of the week to stay organized. Create a time slot in your schedule at the end of the day (or at home) to sit down go through all the important papers from the week and re-organize to get ready for the upcoming week. It will be a time saver in the long run.
#2: Set up your therapy space. This can mean so many different things to different therapists. Perhaps you are lucky enough to actually have a therapy room. Design your space with universal design principles to set a good example and help all children that come to the therapy room. If your therapy space is a hallway or small closet start setting up your car. Clean it and organize it so that you have space for all your equipment as your travel.
#3: Learn about the students’ curriculum. This may sound like a huge undertaking but at least start out by understanding what is expected of the students on your caseload. Things have changed so much over the last several years about what is expected of children to learn. As school based therapists our job is to help students achieve their educational goals. That job is impossible if we do not fully understand what they need to learn.
#4: Check current goals. Learn about each of your students. It can be hard to get a clear picture of a student’s skill based on what you read on paper. If you had the student previously, have any skills changed over the summer? If a decline is observed, be sure to collect some data to help justify services over the next summer if needed. If the student has improved, check if goals needs to be adjusted.
#5: Observe your students in the educational environment. Observe the student in the classroom, on the bus, in the cafeteria, etc. Can the student physically access all the materials? Are there certain modifications that need to be made to the environment to make it easier for the student? Sometimes as therapists, we focus on what we can do to help with specific therapeutic interventions to help a student improve his/her skills. We need to remember the quick fixes that can be done to the environment around the student to help achieve goals.
#6: Collaborate with teachers, parents, students and other school staff. Introduce yourself to all of the team members, Explain how you can offer help in certain areas for students and encourage the team members to contact you if they have any questions. Don’t forget to collaborate with the most important team member – the student!
#7: Communicate. Communication is different than collaboration. Inform students, parents and school staff what you are working on with the student and offer suggestions of how they can help.
#8: Establish goals for yourself. Keep it nice and simple and try filling out this worksheet on how you can improve this school year –
#9: Don’t judge. If you have new students on your caseload, do not judge them solely on what you read on paper especially their motor skills. Don’t assume that a child can not achieve a certain skill. Take the time to get to know each student (see tip #5).
#10: Be prepared. Children tend to exhibit inappropriate behavior when they become complacent during unstructured times. It is critical to plan out in advance exactly what goals you will be addressing during the session and design an activity keeping those goals as the focus. Always have in mind a few extra activities. Some activities that you may think will take 20 minutes may take 5 minutes leaving you with a chunk of unstructured time. Make sure that students can complete the tasks you will be using while being challenged.
Backpacks Could Cause Back Problems if Not Careful...August 12, 2017 12:27 PM
Here at home, school is starting this week for some local counties. Doctors are warning that heavy backpacks can cause back problems for students.
Less is more when it comes to the way kids like to pack their backpacks for the first day of school. A few parents we spoke with didn’t think the weight of a backpack now, could lead to big problems later. Carrying too much weight in a backpack or wearing it the wrong way can lead to pain and strain.
“Anytime a child or anyone is wearing something kinda heavy on their back for a prolonged period of time, if its not worn properly it can cause injury or pain or discomfort,” said Kellie Collins, a Physical Therapist at Children’s Hospital of Georgia.
Physical therapist, Kellie Collins, says anybody who wears a backpack can be affected, but her main concern is kids from 5th grade through high school.
“As the books get heavier the school requirements get a little more, they’re carrying more things to and from school,” said Kellie Collins, a Physical Therapist at Children’s Hospital of Georgia.
“When you’re walking with it you book bag kind of gets hard on your shoulder and it kind of makes it hurt a little bit,” said Matao Gonzalez, who is going to the sixth grade.
After talking with a few parents, some say they never really thought about backpacks causing back problems until now while sharing advice on what they would do to prevent it.
“They would probably need to have rolling book bags just because of the books that’s in their bags when they have to carry them from class to class, they’ll probably be a whole lot better for them,” Lakita Brooks, Richmond County parent.
“Leave the unnecessary things that they wont need at home that day at home,” Patti Youngblood, Columbia County parent.
The American Occupational Therapy site recommends:
- Packing the heavier items closer to the back.
- Practice putting on the backpack by bending and lifting in the knees.
- Adjust both shoulder straps to prevent any muscle straining.
Students also expressed how they felt to side effects like these..
“Kinda nervous… because when you grow up you don’t want your back to hurt a lot,” said Matao Gonzalez, who is going to the sixth grade.
- Arrange books and materials so they won’t slide around in the backpack.
- Check what your child carries to school and brings home. Makes sure the items are necessary for the day’s activities.
- Consider using a book bag on wheels if your child’s school allows it.
- Distribute weight evenly by using both straps.
- Wearing a pack slung over one shoulder can cause a child to lean to one side, curving the spine and causing pain.
Speech & Language Therapy for Children & Adolescents...August 10, 2017 7:28 PM
Children with Down syndrome have strengths and challenges in development of communication skills, including receptive (understanding) language and expressive (speaking and composing sentences) language skills and reading. It takes a team to help children and adolescents progress well in speech and language; that team typically includes speech-language pathologists, physicians, classroom teachers, special educators and families. Speech-language pathologists have information and expertise to help address the speech and language problems faced by many children with Down syndrome. Physicians treat ear, nose and throat conditions and metabolic and hormonal concerns that may affect respiration, hearing, voice and articulation. School learning is language based, so classroom teachers, special educatos and speech-language pathologists help in modifying language and curriculum to help children learn. Parents play an important role in their child's speech and language development because home and daily activities are the core of communication.
What Are the Language Characteristics of Children and Adolescents with Down Syndrome?
Research and clinical experience demonstrate that some areas of language are generally more difficult for children with Down syndrome while other areas are relatively easier. Children with Down syndrome have strengths in the area of vocabulary and pragmatics (social interactive language). They often develop a rich and varied vocabulary as they mature. They have good social interactive skills and use gestures and facial expressions effectively to help themselves communicate. They generally have the desire to communicate and interact with people. Syntax and morphology (including grammar, verb tenses, word roots, suffixes and prefixes) are more difficult areas, possibly because of their complex and abstract nature. Children with Down syndrome frequently have difficulty with grammar, tenses and word endings and use shorter sentences to communicate.
Most children with Down syndrome are able to understand much more than they can express. As a result, their test scores for receptive language are higher than for expressive language. This is known as the receptive-expressive gap.
Children with Down syndrome learn well through visual means, so often reading and the use of computer programs focusing on language skills can help them learn. Seeing words and images associated with sounds and being able to read words can help speech and language develop. For some children, the written word can provide helpful cues when using expressive language.
What Are the Speech Characteristics of Children and Adolescents with Down Syndrome?
There are a wide range of abilities that children with Down syndrome demonstrate when using speech. Speech intelligibility (speech that can be easily understood) is one of the most difficult areas for people with Down syndrome at all ages. Many children have difficulty with the strength, timing and coordination of muscle movements for speech. Speech involves coordinating breathing (respiration), voice (phonation), and the production of speech sounds (articulation). Factors that can contribute to speech intelligibility problems include: articulation problems with specific sounds, low oral-facial muscle tone, difficulty with sensory processing and oral tactile feedback, use of phonological processes (e.g. leaving off final sounds in words) and difficulties in motor planning for speech.
What Does a Speech-Language Pathologist Do?
A speech-language pathologist (SLP) can provide evaluation and treatment for the speech and language difficulties experienced by children and adolescents with Down syndrome. They can help develop a comprehensive treatment plan to address all of the areas in which the child may be experiencing difficulty, including receptive and expressive language, semantics (vocabulary), syntax (grammar), pragmatics (uses of language and social and conversational skills) classroom language skills, speech, oral motor planning and oral motor strengthening. SLPs can work with families and teachers to design and implement an effective school, home and community program to help children develop stronger communication skills.
What Language Skills Are Needed for School?
Parents can help by working as a team with their school personnel to develop an individualized treatment program. In school settings in the United States, the plan will be part of the IEP (Individualized Education Program). Speech and language IEPs may include diagnosis and evaluation, individual therapy sessions, group therapy sessions, classroom-based therapy sessions and/or outcome goals. The IEP may also include provisions for information, consultation and guidance to parents and classroom teachers.
When children are in inclusive settings, the speech-language pathologist may consult with the teacher to provide information about a child's speech and language needs, and may suggest modifications, such as providing the student with written rather than verbal instructions or including fewer items on a class worksheet. Accommodations such as preferential seating to help problems in hearing and listening may be used. Certain skills may also help prepare a child to get the most out of classroom learning; children who have learned to follow directions, have a good grasp of classroom routine and have basic subject knowlege are well prepared for a successful educational experience. Other communication skills needed include the ability to talk and interact with other children, teachers, custodians, cafeteria staff and other school personnel such as school bus drivers.
It is difficult for children in school when their speech and language can't be understood by the teacher or other children in the class. Behavior problems are sometimes related to frustration in not being understood and the relationship between communication and behavior should be explored. In the schools, a child can be referred for a Functional Behavioral Analysis. Based on the findings, a Positive Behavior Intervention Program can be developed.
What Can Parents Do to Help Their Child's Speech?
Parents can provide practice in speech and language skills at home and in the community. Varied and inclusive home and community experiences help children and adolescents with Down syndrome continue to acquire and use new communication skills. Activities that involve social interaction, such as scouting or participating in youth groups, can help young people with Down syndrome develop and practice speech and language skills. When a child has more opportunities to communicate, his or her skills will expand.
The speech-language pathologist can provide information and can design a home activities program to help the child practice the communication skills being addressed in therapy. It is important that parents stay in regular contact with the speech-language pathologist so that their child can practice speech and language skills. Regular phone or e-mail contact, a journal or audiotapes can provide that continuous contact. Parents can also seek additional services as needed. Books, workshops, conferences and newsletters can provide state-of-the-art information.
How Can I Get Help for My Child?
Parents are often frustrated because they feel that their child needs more speech and language therapy than is being provided by the school. School systems are the major provider of speech-language services, but they have guidelines that determine whether a child is eligible for their services. Sometimes eligibility depends on whether a child's test scores are below those for his or her age; other criteria include the relationship between cognitive and language levels. Parents should make sure they are aware of the eligibility criteria, as well as the federal, state or local legislation and policies that apply to service delivery in speech and language.
Although most children receive speech and language services through their local educational system, speech-language pathology services are also available in hospitals, rehabilitation centers, university clinics and private practices. Parents should seek additional help for their children when needed.
How Can I Find a Qualified Speech-Language Pathologist (SLP)?
Qualified SLPs are certified by the American Speech-Language-Hearing Association and licensed by the state. After professionals have been certified, they can use CCC-SLP (Certificate of Clinical Competence in Speech-Language Pathology) following their names. This means they have completed a master's degree in an accredited program, completed required hours of clinical practice internship and passed a national certification examination. The American Speech-Language-Hearing Association or a specific state's Speech-Language-Hearing Association can refer parents to local SLPs. Members of Down syndrome support groups can also often refer parents to local speech-language pathologists who have experience working with children with Down syndrome.
The Only 5 Things You Need to Bring to a Job Interview...August 10, 2017 4:26 PM
The interview process is stressful enough. You don't want to complicate things by showing up unprepared.
We asked a few career experts and hiring managers what they expect candidates to bring on the big day. Here are the five essentials to show up with:
1. Copies of your résumé
Despite the transition from the traditional paper résumé to more dynamic social media templates, such as LinkedIn, many hiring managers still expect candidates to arrive with a few hard copies.
Amanda Augustine, a career management expert and spokesperson at The Ladders, an online job-matching service for professionals, says if you happen to know the exact number of people you'll be meeting with, bring at least one copy for each of them, plus a few extra to be safe. "You'll need one for you to reference while you talk, and one copy for each interviewer, just in case they aren’t prepared," she says.
2. Pen and notepad
Each career expert and hiring manager emphasized the importance of bringing a pen and paper.
Jotting down a few notes during the interview can come in handy as you write your post-interview thank you note later that day. (But remember to listen closely to the hiring manager, and don't get distracted by your note-taking!)
Also, if you're interviewing for a consulting, finance, or engineering position, you will likely have to answer impossible brainteaser questions. It can be helpful to have a pen and paper as you attempt to work through these questions.
You're not the only one in the hot seat on the big day. In nearly every interview you will have the chance to ask your own questions.
Use this part of the interview to your advantage. Ask smart questions to impress the hiring manager and to figure out if this place is a perfect fit for you. The career experts recommend having a few written down ahead of time rather than having to come up with them on the spot.
While questions may vary depending on the company you're interviewing with, here are some impressive ones that will work in any situation:
- How do you see this position evolving in the next three years?
- What can I help to clarify that would make hiring me an easy decision?
- How will the work I'll be doing contribute to the organization's mission?
4. Portfolio of sample work
Depending on the job you're applying for, it is a good idea to bring samples of your work. "The medium needs to match up. You should not bring a binder of print material to a digital publication," explains Business Insider's director of talent, Stephanie Fogle. "And be prepared to talk about it."
5. A positive attitude
"Most importantly, come with your A game," Augustine says. "Confidence, a positive attitude, and a genuine interest in the role and the company will set you apart from the competition. When you and another candidate have comparable skill sets, the only thing that will set you apart is your passion."
How Does Speech Therapy Help Children with Cerebral Palsy?...August 10, 2017 1:42 PM
Children’s speech and language development typically follows a pattern. Those with cerebral palsy may not progress as predictably – calling for speech therapy intervention. Speech problems include:
- Articulation disorders – Cerebral palsy patients may experience poor oral-motor control and muscle weakness in the head, neck, face and throat. These conditions interfere with a child’s ability to make sounds, form syllables, and say words. Pronounced articulation problems can make it difficult or impossible for others to understand a child’s speech.
- Fluency disorders – Interruptions, such as stuttering, break the flow of speech, impeding communication and frustrating individuals affected by fluency disorders.
- Voice disorders – Resonance problems and other voice disorders occur when cerebral palsy patients experience irregular pitch, volume control and voice quality. The condition makes it hard for children to interact, and may also cause pain or discomfort as a child speaks.
- Dysarthria disorders – Cerebral palsy patients sometimes experience impaired movement of muscles that are used for speech production. These areas include the tongue, lips, and vocal folds. Some signs of Dysarthria include:
- “Slurred” or “mumbled” speech which can be difficult to understand
- Delayed rate of speech
- Limited facial movement
- Abnormal pitch or rhythmic speaking
- Dysphagia disorders – Difficulty swallowing or digesting food from your mouth to stomach. Symptoms of Dysphagia include:
- Having trouble swallowing or digesting food
- Frequent Heartburn
- Coughing and Gagging
- Aphasia disorders – Referring to damage to the part of the brain that affects language and speech. Aphasia causes problems with speaking, writing, articulating, and listening. Symptoms of Aphasia disorders include:
- Difficulty speaking
- Difficulty understanding communication
- Trouble reading or writing
- Using other words for the intended word
In addition to problems producing sounds, syllables and phrases, cerebral palsy patients may face language difficulties, such as:
- Receptive struggles – Processing and understanding language poses challenges for some cerebral palsy patients. Speech and language therapy reinforces cognitive and interpretive skills required to draw meaning from language and communication.
- Expressive disorders – Difficulty putting words together to convey ideas may interfere with some patients’ ability to communicate effectively. Expressive disorders may also result in limited vocabulary and inappropriate use of language in social settings.
- Cognitive-communication disorders – Language problems experienced by children with CP may include difficulty with communication skills involving, perception, memory, organization, problem solving and other cognitive functions.
Benefits of Speech Therapy
Speech therapy has widespread benefits for cerebral palsy patients. Not only does the process improve communication interactions, but speech therapy can also be used to strengthen and improve facial and oral muscle control.
Dysphagia and oral feeding difficulties affect cerebral palsy patients in several ways. The condition can include problems chewing, swallowing, gagging, coughing and drinking. Maintaining healthy body weight and nutrition may present challenges for children with CP, including hydration concerns and questions about long-term physical development.
Feeding and swallowing therapy, conducted by trained speech and language pathologists, ensures physical challenges do not interfere with a child’s nutritional intake.
In addition to the needs on the patient, speech therapy accounts for parents, family members and caregivers. Symptoms of cerebral palsy are not consistent, so each family faces unique challenges; therapists seek their input before developing speech and language treatment plans. Successful therapy contributes to ease of care and reduces stress on caregivers.
Communication is the essential bridge linking patients and caregivers. Unfortunately, cerebral palsy sometimes interrupts a child’s ability to process, understand and respond in conventional ways. Speech and language therapy repairs the disconnect, helping patients express their needs more clearly and easing pressure experienced by parents, teachers and family members.
Speech therapy supports development in these areas:
- Producing sounds, words and syllables
- Regulating voice volume
- Articulation and pronunciation
- Understanding and comprehension
- Voice quality
- Chewing and swallowing
As communication skills improve, cerebral palsy patients gain confidence and participate in a wider range of activities. Effective therapy supports cognitive and emotional development; reinforcing social skills and helping children with CP interact in diverse settings. Speech therapy may lead to progress in these areas:
- Confidence and self esteem
- Desire to interact socially
- Learning and communicating at school
- Expressing thoughts and ideas
- Overall quality of life
Speech and Language Therapy Expectations
Speech-language pathologists (SLP) are credentialed medical professionals with special communication training. The clinicians, informally referred-to as speech therapists, are concerned with language development, human communication and related disorders.
Before recommending speech and language exercises, an SLP conducts an assessment of each patient’s abilities and limitations. Drawing from various therapeutic techniques, a course of treatment is then constructed, with clear therapy goals in mind. Once appropriate intervention is undertaken, periodic review and testing furnish vital feedback – enabling speech pathologists to make adjustments to therapy.
Speech Therapy Exercises
Speech therapy employs various methods to address swallowing problems, increase oral-motor function, enhance understanding, and facilitate communication. Techniques are recommended according to the unique needs of each patient. Therapy may include:
- Swallowing exercises – Swallowing and feeding therapy is designed to enhance oral-motor control. Speech therapists use various techniques to assist with swallowing, including facial massage and lip, tongue and jaw exercises. Therapy strengthens face and jaw muscles used for eating, drinking and swallowing, and increases perceptive abilities.
- Jaw, lip and tongue exercises – Muscle weakness and poor oral-motor coordination interferes with communication and feeding, posing socialization and nutrition issues for cerebral palsy patients. Assorted exercises strengthen lip, jaw and tongue muscles. Lollipops and tongue depressors are used to create resistance, developing strength and control. And eating extra-chewy foods may also be recommended, to build strength and train facial muscles.
- Articulation therapy – Demonstrating proper technique is a big part of this type of speech therapy. Through repetitive exercises, speech pathologists show how the mouth and tongue work together, producing sounds, syllables and words. Mirrors are often used to help a child learn facial control and visually illustrate progress.
- Blowing and breathing exercises – Blowing on whistles helps train mouth muscles to form shapes needed for producing particular sounds. Blowing activities also strengthen abdominal muscles and help CP patients control breathing.
- Language and word association – Speech therapists use pictures, books and objects to stimulate language development. While playing and talking with a child, for example, therapists model correct language and association patterns, prompting the child to build vocabulary and grammar skills.
- Swallowing exercises – Swallowing and feeding therapy is designed to enhance oral-motor control. Speech therapists use various techniques to assist with swallowing, including facial massage and lip, tongue and jaw exercises. Therapy strengthens face and jaw muscles used for eating, drinking and swallowing, and increases perceptive abilities.
- Using Flash Cards – This fun and interactive game can help children and therapists focus on the sounds that they may have trouble with. Providing entertaining games helps keep patients involved and excited while learning.
- Mirror Exercises – This form of therapy helps children understand how movements of the mouth should be for certain sounding letters. This helps to improve this issue.
Here's How Schools Can Support Students' Mental He...August 9, 2017 8:57 PM
About one in five children in the United States shows signs of a mental health disorder — anything from ADHD to eating disorders to suicide.
And yet, as we've been reporting this month, many schools aren't prepared to work with these students. Often, there's been too little training in recognizing the problems, the staff who are trained are overworked, and there just isn't enough money.
When there are enough people to handle the job, how should all the different roles fit together?
Many experts point to one model. It's got a bureaucratic name — the "multi-tiered system of supports" — but when you picture it, just imagine an upside-down pyramid, or maybe a funnel. It starts with support for everyone and moves on to more and more specialized help.
Here, everyone in the school has a part to play. The collective mission is broad: Create a school environment of general well-being, and a climate where mental health isn't stigmatized.
It takes a lot of planning — with big decisions often coming from the top. Just ask Amanda Aiken.
She is now the Senior Director of Schools at New Orleans College Prep, a charter school network. But before that she was a principal at one of their schools, Lawrence D. Crocker College Prep.
In that role, she made a point to stand outside her New Orleans school every morning. When the buses drove in, she was at each door. Other staff were stationed at the front and back entrances.
Every student, from preschool to eighth grade, shook at least two hands before they even get inside the building.
Every student, every day?
Sometimes, Aiken conceded, it was a hug rather than a handshake.
"They hear a lot of good-mornings and a lot of how-are-you-doings," says Aiken. "I require that human touch."
Now her successor carries on that tradition.
But Aiken wasn't just being nice. It was strategic.
Many students at Crocker, part of a charter school network, have a higher risk for mental health problems. Most students receive free or reduced-price lunches, and Aiken estimates as many as 70 percent have experienced some form of trauma in the last two years: violence in their neighborhoods, family troubles, the daily stress of living in poverty.
"We need to make sure what we're doing is not retraumatizing," she says. "I see the principal as the leader in setting the tone and the culture of how school will support students and families."
That starts in the morning, but extends far beyond. Crocker is a "trauma-informed" school, which means all staff are trained on how to work with, and identify, students who have gone through trauma.
It also means they have a focus on structure, so students know what to expect. They also have a social-emotional curriculum, yoga after school and a focus on keeping suspension rates low through restorative justice.
"They aren't going to be prepared for college if they're suffering," Aiken says.
As principal, she tried to prevent crises, rather than addressing them as they come up.
"If you have everyone trained and take an 'it takes a village' approach, you can do a lot of preventative measures to reduce the risk significantly," says Aiken.
But, she adds, a healthy school environment isn't enough.
"Teachers are trained to teach. We have all taken a child psychology class, but we're not trained to work with kids with mental health needs," she says.
That's where other professionals come in.
The First Responders
When a student does show signs of trouble, one of the first steps is to talk with them. That conversation will dictate what happens next, but getting students to open up? It's easier said than done.
School social worker Ana Bonilla-Galdamez is a pro at that. Her office at Charles Barrett Elementary School in Alexandria, Va., is a testament to the different strategies she uses to unleash the gift of gab in even the most guarded of students.
There's a lot going on in there. First, there's her bookshelf, with titles like: Growing Good Kids, The Special Education Treatment Planner, Small Group Counseling.
And then there's everything else. She has a lot of board games: Candyland, Operation and her favorite, Uno. She also has art supplies, balls, a dollhouse and a sand box. A Superman doll sits in her chair, because even Superman has a weakness.
These are her tools. They help students open up, and they also help build the skills those kids will need throughout life, like managing emotions.
Although now at an elementary school, Bonilla-Galdamez spent most of her 20-year career at the high school level, working largely in what she describes as "crisis mode."
"We would think, 'Man, if we just had met this kid before,' " she says. A few years ago, a job opened up in the elementary school and she decided to apply.
"I thought, this is my chance to see where this starts," she says.
Early intervention for the child — and education for the parent — is key, she says. That's where the games in her office and the phone calls home come in.
"My job is to dig," she says, "For me to do that, I need to build the trust of the parent and the child."
She tells the story of the time a young mom came in, worried about her kindergarten son. He had been telling her he wanted to die. In her office, Bonilla-Galdamez let the boy choose whatever game he wanted. As he grew comfortable, she asked him about life at home.
"He had witnessed people being killed," she says. "He had witnessed a lot of violence."
What to do next all depends on what that child needs. That kindergartner might have ended up in a small group, working on coping skills or managing his emotions. But, in this case that wasn't the answer: She had also learned that the young boy had run out into traffic when he was upset.
"The threat was imminent, so I referred him to emergency services," says Bonilla-Galdamez. "Our environment isn't suited to clinical interventions."
At that point, Bonilla-Galdamez continued working with the family, but she also helped them connect to more specialized help, and the kindergartner moved on to the third level for more support.
At this level, a doctor or therapist may get involved for the first time. Often, school plays a vital role in connecting the student to a clinic.
Vital, but not necessarily easy. When school psychologists Monique Leopold and Danielle Palmer refer students to a mental health clinic, they know that a lot of the time, the appointment never happens.
The two women have a handful of high-quality programs that they rely on for referrals near their schools — a network of public charter schools in the nation's capital called DC Prep. Sometimes though, families can't get an appointment for months. And when they do, with so many living in poverty, getting there is one more complication in already chaotic lives.
"It's not that [those families] don't love their kids, it's that they don't have the capacity," says Palmer.
And even when the students do get professional treatment or medication, sometimes prescriptions lapse before the child could be seen again.
"Triggers are brought from the community into school," says Leopold, "They go to school without what they need."
To try and meet those needs, DC Prep started a partnership with Children's National Health System. Now, a psychiatrist visits the schools once or twice each month.
"I told a family this morning, 'Listen, we have a doctor here,' " Leopold says, "and the mom's eyes lit up."
Lisa Cullins, one of those psychiatrists who visits, says school is a logical place for students to get clinical mental health care.
"At school, they're going to be there anyway. It's something they do everyday," she says. The partnership isn't just easy on families. It's also easier on her.
"To know our patients, we have to know their school setting," she says. "When I walk in, I have a comprehensive packet of information on how the child has been doing since the beginning of the year."
3 Benefits of a Sensory Gym for Your Child with Special Need...August 9, 2017 5:54 PM
The joys of parenting hold true no matter what your child’s abilities are. But when your child has a sensory processing disorder (SPD), you face a set of challenges most parents do not. Everyday settings often don’t accommodate children with SPD. A child who is over-sensitive might find stimuli like light, physical touch, or food overwhelming. Children who are under-sensitive, on the other hand, might crave so much stimulation it’s hard to meet their needs.
For kids on either end of the spectrum, sudden changes in their environment or new settings can lead to tantrums that are difficult to come down from. It’s understandable that behaving appropriately under such distress is challenging for them.
The goal of any parent who copes with these challenges is to improve the child’s sensory integration, and sensory gyms — safe play areas that encourage sensory development — make achieving that goal easier. Sensory gyms provide these children with the space and resources they need to feel secure while playing and to grow at their own pace.
Here are just a few of the ways sensory gyms can aid in your child’s development.
1. Amplifying Therapy
Sensory gyms are not meant to be the end of the line for treating sensory disorders, rather another tool in a therapist’s or parent’s kit — a highly useful tool. When combined with medicine and behavioral therapy, sensory gyms can increase independence, ease stress in social situations, and raise tolerance to new stimuli.
A therapist can guide a child through activities involving brightly colored pillows, swings, ball pits, bubble fans, or tunnels to cultivate appropriate responses to stimuli. Eventually, these reactions become more natural for the child, which helps her participate in more typical activities both academically and socially.
Through guided play on equipment that meets their needs, children with sensory processing disorders improve fine motor skills, body awareness, cause-and-effect reasoning, and social skills. One study demonstrates that gyms help children exercise independence, communicate better, and strengthen their self-care habits and attention spans.
2. Bringing Sensory Development Home
One of the best ways to reap the benefits of a sensory gym is to create one at home. If you can dedicate an entire room to the cause, that’s wonderful, but setting up even a small gym in part of a room will facilitate growth.
You can often use items you already have on hand, so it doesn’t have to be an expensive project. Use a fan for exploring the sensation of air on skin or beanbags for tactile stimulation. Decorate with brightly colored paper or tape, donate old kitchen items for auditory and visual stimuli, or fill bins with sand, gravel, or dry pasta for tactile stimulation. If your child is able, ask her to help you prepare the space — she’ll enjoy the gym even more if she helped bring it together.
Having a sensory gym at home is ideal because it’s always available, even on Christmas Day and at 5 a.m. Plus, it fits your child’s needs. Ask your therapist to help you design a personalized home gym with the most beneficial elements for your child. You might even see siblings enjoying the space as much as your child with special needs.
3. Creating Fun
Sensory gyms help with developmental improvements largely because they’re fun. If your little one doesn’t process an environment like most children, school and play centers can be stressful and overwhelming. That’s hard on both kids and their parents — what parent doesn’t want her child to play freely?
But these gyms are designed specifically for kids with sensory processing disorders, meaning these children can play without stress. The risk-free activities in a sensory gym foster calmness. Learning becomes enjoyable, not taxing. While parents and therapists aim for developmental improvements, the child just sees fun.
There’s no doubt parenting a child with special needs has its challenges. Sometimes the process of making your child healthier and happier feels like one step forward, two steps back. But whether they’re at a large facility or in your living room, sensory gyms can create more steps forward in caring for your child.
Sports, Exercise, and the Benefits of Physical Activity for ...August 9, 2017 12:15 PM
Autism is a complex neurobiological, developmental disorder that is typically diagnosed in childhood and often lasts throughout a person's lifetime. The hallmark characteristics of autism include an impaired ability to communicate and relate to others socially, a restricted range of activities, and repetitive behaviors such as following very specific routines. While the causes of autism are unknown and preventative measures have yet to be discovered, there does exist effective behavioral therapy that can result in significant improvements for many young children with autism. The most widely used behavioral intervention programs focus on developing communication, social, and cognitive skills. However, new research and anecdotal evidence suggest that some alternative therapeutic choices that include sports, exercise, and other physical activities can be a useful adjunct to traditional behavioral interventions, leading to improvement in symptoms, behaviors, and quality of life for individuals with autism.
Physical activity is important for children with and without disabilities alike as it promotes a healthy lifestyle, but can benefit individuals with autism in unique ways. In the U.S., 16% of children ages 2-19 are overweight, whereas the prevalence of overweight among children with ASD is increased to 19% with an additional 36% at risk for being overweight.1 This means that more than half of all children with ASD are either overweight or at risk. Being overweight can put children at increased risk for numerous health problems, both in childhood and as adults, including diabetes, cardiovascular disease, bone and joint problems, and even depression. The effects of these conditions may take an even greater toll on individuals with autism in combination with common autism symptoms and some highly co-morbid conditions such as gastrointestinal problems as well as depression and anxiety.
It has been suggested that decreased physical activity is the primary reason for the increased rate of overweight in children with autism, while unusual dietary patterns and the use of antipsychotic prescription drugs that can lead weight gain may also contribute. Participation in physical activity may be challenging for individuals with autism because of reasons such as limited motor functioning, low motivation, difficulty in planning, and difficulty in self-monitoring. Increased auditory, visual, and tactile stimuli may too prove challenging for affected individuals. Furthermore, physical activity involving social interaction such as team sports can present a difficult situation for someone with autism. However, if implemented appropriately, the addition of physical activity to an autism intervention program can help overcome many of these challenges and improve ones overall quality of life.
It is not surprising to discover that physical activity has been shown to improve fitness levels and general motor function of individuals with autism. A study of a 9-month treadmill walking program on weight reduction in adolescents with severe autism revealed that the program significantly decreased body mass index among the participants. Additionally, as time progressed through the study, the frequency, duration, speed, and elevation of the treadmill walking all increased, indicating a general rise in exercise capacity and physical fitness. In a study of swimming training and water exercise among children with autism, ten weeks of hydrotherapy which included three, 60-minute sessions per week, resulted in significant increases in fitness levels indicated by changes in balance, speed, agility, strength, flexibility, and endurance.
Research has also demonstrated that increased aerobic exercise can significantly decrease the frequency of negative, self-stimulating behaviors that are common among individuals with autism, while not decreasing other positive behaviors. Behaviors such as body rocking, spinning, head-nodding, hand flapping, object-tapping, and light gazing, that have been shown to interfere with positive social behavior and learning, can thus be controlled by the use of exercise. Additionally, exercise can discourage aggressive and self-injurious behavior while improving attention span. In this study, aerobic exercise included 20 minutes of mildly strenuous jogging, however the aforementioned swimming and water exercise study also revealed a significant decrease in stereotypical behaviors in children with autism following a 60 minute session in the pool. One theory behind these findings is that the highly structured routines, or repetitive behaviors involved in running or swimming, may be similar to and/or distract from those self-stimulating, repetitive behaviors associated with autism.
Besides improving fitness, motor function, and behavior in individuals with autism, among the most important advantages of physical activity are the social implications of participating in sports and exercise. Physical activity can promote self-esteem, increase general levels of happiness, and can lead to positive social outcomes, all highly beneficial outcomes for individuals with autism. For those with autism who are able to participate in team sports, this presents an opportunity to develop social relationships among teammates and learn how to recognize the social cues required for successful performance on the field or court. However, individuals that prefer individual sports such as running or swimming that do not rely as heavily on social cues may still benefit from the positive attributes of physical activity while forming social relationships with coaches or trainers. In all cases, participating in sports provides individuals with autism with a role in society that may not have existed otherwise.
While there is evidence to support the role of physical activity in improving autism symptoms, behaviors and life-outcomes, sports and exercise should not replace proven behavioral interventions, but may be effective supplements to these therapies and potentially enhance the benefits. In fact, many of the key components of a successful physical activity program for individuals with autism mirror those that make up some of the most common treatments and behavioral interventions. For instance teaching new skills to children by breaking them down into smaller, organized tasks and then rewarding them for successful achievement is a core component of proven interventions such as ABA and TEACCH. This technique can be readily implemented in teaching physical education to children with autism.
There is increasing interest in establishing program guidelines for enhancing physical activity among individuals with autism. A major reason for this is because research suggests that autism prevalence is increasing and has reached an all-time high. This means that there will be an increasing number of children with autism in schools, physical education classes, and on sports teams. While different individuals with autism may face different challenges in participating in physical activity, these children should still be given the opportunity to experience the benefits of physical activity, and while the results may vary, based on all the available research and that which has been presented in this paper, the potential behavioral, physiological, emotional, and social benefits of physical activity for individuals with autism are numerous and should be further explored.
11 Tips for Adjusting to a New School...August 8, 2017 7:34 PM
Whether your child is moving to a new neighborhood or making the leap to middle or high school, the first few weeks may be filled with anxiety as well as excitement. These 11 tips will help your child make a smooth transition to his or her new school.
1. Make it a team effort.
If you’re choosing between a few schools, talk with your child about what each one has to offer. When it comes time to select specific classes, make sure your child is part of the process.
2. Keep a positive focus.
As the first day draws near, begin talking to your child about her expectations, hopes, and fears for the upcoming school year. Reassure her that other children are having the same feelings and that she’s sure to have a great year. Present school as a place where she’ll learn new things and make friends.
3. Encourage school involvement.
Though you don’t want your teenager to become over-committed, it’s important to encourage participation in one or two activities that particularly interest him. He’s more likely to engaged academically if he feels connected through a school activity, club, or sport. Talk to him about his goals for the school year and how he might like to be involved in school outside of the classroom.
4. Get enough z’s.
If your child has enjoyed a vacation of late nights and lazy mornings, getting him up for school on the first day can be difficult. Help make this transition easier by starting his school-year sleep routine a week or two in advance.
5. Take a trial run.
Take some time before the start of school to make sure you and your child know where to go and what to do on that first morning. Show your child where the bus stop is, or, if she walks, map out the safest route to school, avoiding vacant lots and places where there aren’t a lot of people. Warn your child to always walk with a friend and scout out safe houses to go to in case of emergency. If you can find out what classroom your child will be in, visit the classroom ahead of time so she knows exactly where to go in the morning. You may even want to call the school in advance to find out about any special first-day procedures.
6. Stock up on supplies.
On or before the first day of school, make sure you or your child finds out what school supplies and materials are required. Most schools should provide a handy list for the lower grades, but if not, take it upon yourself to ask and then purchase the items as soon as possible. Middle and high school students should bring a notebook and pen or pencil on the first day.
7. Prepare the night before.
To avoid the morning rush, organize what you can the night before. Lay out clothes, make a lunch and assemble any supplies your child may need. Be sure to get everyone up extra early so you’ll have plenty of time to calmly get ready and get out the door on time.
8. Get a healthy start.
Encourage your child to eat a good breakfast and pack a healthy snack to help her get through the day.
9. Accompany your little one.
Even if your elementary school child will be riding the bus regularly or walking to school, you may want to take him yourself on the first day, particularly if he seems nervous.
10. Introduce yourselves.
Young children are often shy with a new teacher. If you take your child to school on the first day, you might want to go into the classroom and introduce your child to the teacher. Let the teacher know about any special interests or challenges that your child has.
11. Read up about school.
Reading books together about school is a good way to establish the reading habit and to start conversations about school excitement and fears.
How To Know If Your Child’s Making Progress Toward IEP Goa...August 8, 2017 3:55 PM
By the time “Mrs. Bailey” contacted a professional to evaluate her son, she had been receiving quarterly progress reports from his public school for five years, telling her that Kevin was making progress toward achieving the academic goals listed in his Individualized Education Program (IEP). However, her observations of Kevin’s homework and the graded school work that came home didn’t match the school’s evaluation, and she wanted a psychologist to provide a “second opinion.” The outside evaluation confirmed his mother’s concerns — he had deficits in math calculation and written expression skills. In fact, Kevin’s written expression skills were severely delayed and fell in the first percentile — meaning that 99 percent of students his age performed better on the test. Naturally, Mrs. Bailey felt astonished, frustrated, and guilty about not realizing Kevin’s lack of progress sooner in his schooling.
Parents of children with learning disabilities (LD) who are receiving special education services receive regular reports of progress on their children’s IEP goals, as mandated by the Individuals with Disabilities Education Act of 2004 (IDEA). Often these progress reports don’t really provide parents specific information, based on assessment data, as to whether their child is making progress or not.
There are several key factors that can have a positive impact on determining whether or not a child makes real, measurable progress.
- a comprehensive evaluation that identifies a child’s strengths and weaknesses; and appropriately identifies a child’s educational needs
- explicitly stated present levels of performance
- appropriate and measurable goals/objectives
- effective instructional methods, and
- continuous progress monitoring
Ask a parent how their child’s progress toward goals and objectives is being monitored and reported to them, and most often the response is “I’m not sure” or “I don’t know.” As in Mrs. Bailey’s case, it can be years before parents realize that their child is not making progress — or that the achievement gap between their child and his peers has actually widened while receiving special education services. So, how can you really know if your child is making progress? What should you do if you don’t think your child is “making expected progress” toward IEP goals and objectives?
To help you play a proactive role in monitoring your child’s IEP, this article will provide detailed information about each of these key factors as it relates to your child’s special education services.
A comprehensive evaluation should include assessments tailored to the problems for which the child was referred for evaluation. The “reason for referral,” part of the evaluation documents for the IEP, describes the child’s learning problems, as well as any factors contributing to academic performance difficulties. To get a complete picture of a child’s abilities and skills in the home and school environments, evaluation procedures should include all of the following:
- individually administered standardized tests, such as IQ and achievement tests
- curriculum-based assessments (e.g., Curriculum-Based Measurement)
- current classroom-based, local, or state assessments
- work samples indicative of the child’s learning difficulties
- interviews (with teacher, parent, and child)
- observational data
- review of records
- rating scales (if appropriate)
The evaluation should identify specific points where a child’s learning processes break down, and how that impacts his classroom learning. In Kevin’s case, his last reevaluation had just been conducted six months prior to the outside evaluation — when he was in 7th grade. At that time the school administered a brief IQ test, a standardized achievement test, and a speech/language evaluation. The examiner reported that Kevin no longer demonstrated the processing deficits that were identified in his initial evaluation, and that he was compensating for his difficulties. However, further investigation — specifically of data in Kevin’s cumulative file — revealed that he did not meet state standards in reading, math, or writing!
Typically, a school district evaluation will identify an area of unexpected academic weakness and determine whether the weakness is severe enough that the child requires special education services in order to benefit from the general education program. A comprehensive psychoeducational evaluation — most often conducted by a private professional, but sometimes by a school district — typically looks at a fuller range of academic strengths and weaknesses, and at how a child processes information in several areas. In my experience, the better you understand your child’s learning problems, the greater the chances that you can persuade the school to conduct a more comprehensive evaluation. And, of course, if you disagree with the school evaluation, you always have the legal right to request that an Independent Educational Evaluation (IEE) be conducted at district expense.
Explicitly stated “present levels of performance”
Results of a comprehensive evaluation should concretely identify your child’s strengths and weaknesses which can then be used to develop your child’s IEP. Present Levels of Performance(PLOP) should provide you baseline data in very specific terms about what your child can and cannot do in a particular academic or functional area. For example, a statement of a child’s present level of performance in reading might be: “Julia can read words, both in isolation and in context, containing short vowels and silent ‘e.’ However, she is only able to read words containing vowel teams (i.e. /ai/, /ea/, /oa/, /ee/) and dipthongs (i.e. /oi/, /oy/, /oo/, /au/) in isolation with 30% accuracy.”
Goals and objectives would then be written to increase Julia’s accuracy in reading words with vowel teams and dipthongs. Baseline data provide a starting point for determining whether the child makes the expected improvement in learning over a given period of time. In addition, IDEA requires that, in order for a child to be eligible for special education services under the Specific Learning Disability category, school districts must have “data-based documentation of repeated assessments of achievement, at reasonable intervals, reflecting formal assessment of student progress during instruction, which was provided to the child’s parents.” This documentation is very helpful when identifying a child’s present level of performance.
A word of caution:Results of achievement tests are often reported where there is supposed to be a statement of the child’s present level of performance. For example, you may see “WIAT-II Word Reading SS 80” for present level of performance on IEP goal pages. However, achievement tests are designed to measure the performance of many children at a single point in time, rather than to document a single child’s progress over time, as PLOP requires. The PLOP sets the starting point for your particular child’s work toward goals.
Appropriate, measurable goals and benchmarks
Annual goals and benchmarks in your child’s IEP should be measurable and linked to your child’s present levels of performance, as well as to your state’s academic content standards. (Note: “Benchmarks” are measurable steps toward a child’s IEP goals. Although IDEA 2004 eliminated the legal requirement for benchmarks, regular progress reports are still mandated by law, and many schools continue to use the term “benchmarks.”) Many times parents say that when goals are reviewed during IEP meetings, they are unsure as to whether their child’s goals are either appropriate or measurable. Here are a few questions you can ask to find out:
- How will progress toward these goals be measured?
- How will you monitor my child’s progress?
- How will you document my child’s progress?
- How will you communicate with me regarding my child’s progress?
Many parents report that IEP goals and benchmarks often lack specificity. For example, it is very common for special educators to write goals in terms of grade-level attainment, which is very confusing for parents if they don’t know what the curriculum standards are. To illustrate, here is an annual goal created by the school for one student: “‘Danny’ will increase his written expression skills to the beginning fourth-grade level.” After a discussion in the IEP meeting about third-grade and beginning fourth-grade writing expectations (based on grade-level curriculum), the special education teacher changed Danny’s annual goal and added benchmarks that specifically identified a sequence of writing skills for the child to master over the next year.
Here is Danny’s revised annual goal: “Danny will write two to three paragraphs on a given topic, using correct mechanics (capitalization, ending punctuation), spelling, grammar, sentence structure, and organization.” His benchmarks were:
- “Danny will generate his ideas in correct sequence to formulate two to three paragraphs, using and completing graphic organizers before writing.
- Danny will write complete sentences containing correct grammar with 80% accuracy.
- Danny will write a four- to five-sentence paragraph that contains a topic sentence, two to three supporting details, and a concluding sentence.
- Danny will be able to correct 80% of his errors using a proofreading checklist with the specific number of errors for each proofreading area (spelling, capitalization, punctuation, grammar, and sentence structure) with progressively fewer adult cues.”
When goals are written this way, you can monitor your child’s school work to make sure he is progressing toward these goals, confident that they are based on grade-level and state content standards.
Technology Helps Advance Physical Therapy...August 8, 2017 12:18 PM
The world of physical therapy has changed dramatically over the last few years with the advent of technological breakthroughs and new laws that make rehabilitation more accessible.
Tim Goldberg, interim manager of rehab therapies at Scripps Health in Encinitas, said patients are often referred to physical therapy by doctors to reduce or eliminate pain, assist with walking and improve strength and conditioning.
Physical therapy can also be used to help with dizziness and balance issues and to gain or regain function and independence with activities related to daily living, leisure and vocational activities.
Additionally, physical therapists find themselves working with those who underwent recent surgeries or those suffering from brain or spinal cord injuries or a range of orthopedic and neurological conditions.
Like many aspects of health care, physical therapy has changed over the years. Here’s a glimpse at some of what’s new in the world of physical therapy
Farshid Farajzadeh, of San Diego’s Ocean Physical Therapy, said that as of January in California, many insurances companies will let a patient get physical therapy without a doctor’s referral – a move that he said is covered by many insurance plans and saves patients time and co-pay money that was required when getting a referral from a physician.
The catch, he said, is that if a patient still has symptoms after 45 days, the physical therapist is required to send the patient to a doctor.
“It gives the public the right to choose where they want to go and a little bit of freedom,” he said of the change.
Goldberg said he believes more and more people use PT as “pre-hab,” or for prevention instead of using it for rehab after an injury or surgery.
“As more emphasis continues to be placed on keeping individuals healthy and out of the hospital, I think we will see more focus on prevention rather than strictly on rehab or treating the patient after they become ill or injured,” he said.
With the advent of smartphones, apps can be used to track a home exercise program to help teach patients about their posture and body mechanics, Goldberg said.
Additionally, Michael Ryder, manager of rehab services for Sharp Rees-Stealy, said there are computer programs that allow those in physical therapy to watch personalized videos at home so they can do physical therapy exercises off-site between sessions. Patients can also keep an online diary that their therapist can check to make sure they are complying.
Darshan David, a doctor of physical therapy and orthopedic clinical specialist at Kaiser Permanente San Diego, said those in physical therapy are also now using video to analyze normal versus abnormal movement patterns in activities such as walking and running.
“This type of research can help with evaluating and treating people with movement impairments,” he said.
In addition, the use of video games and virtual reality as an adjunct to PT is on the rise, and Goldberg expects to see growth in telemedicine in physical therapy as well over the next few years.
The increase in technology over time has led to advances in equipment. For instance, Scripps, Sharp and other health care systems are utilizing robotics and anti-gravity treadmills to assist with ambulation.
Ryder said the bonus of these types of treadmills is that they lessen the amount of body weight that’s placed on the patient’s lower body, allowing them to get exercise and work on their gait without pain and with less pressure on the bones and joints.
Other facilities, such as Tri-City Medical Center, use new equipment such as underwater treadmills with cameras that help with gait and recovery.
The rehabilitation program at Scripps Memorial Hospital Encinitas was the first in the county to put a wearable robot to use with rehab patients. The exoskeleton suit, made by Ekso Bionics in Northern California, assists patients with walking disabilities.
Goldberg said in recent years there’s been a strong push for evidence-based practices and increased research by the American Physical Therapy Association, its members and the medical community.
He said the demand for advanced medical research — along with data to support PT treatment approaches — is greater than ever. He said this is important because as surgical procedures change and advance, many patients are starting rehab earlier.
“They are getting out of their hospital bed and asked to participate in therapy the day they undergo a total knee or total hip replacement ... and they are returning to playing sports, their profession or the battlefield sooner than in years past.”
Goldberg said that having more data and evidence available to the medical community benefits physical therapists.
“We now have access to chat rooms and online courses, and the Internet allows us to search for the best technology, procedures and the strongest supporting evidence in real time,” he said. “As we see more research and acceptance of the use of stem cells, changes in how we rehabilitate patients or restore their health will likely to change as well.”
Changing attitudes toward health
Many of those in the PT profession said that in recent years, it seems people are taking more responsibility for their own health and well-being than in the past.
Patients are also appearing to be more open to conservative treatment and holistic approaches versus simply turning to drugs or surgery.
“Individuals are having to pay more out-of-pocket for their health care these days and some may be realizing that it pays to be proactive,” Goldberg said. “Investing in your health can save you a lot of money and pain in the long run.”
Activities for Behavior Modification...August 4, 2017 4:09 PM
Kids learn bad behavior by mimicking others. Children also learn from poor examples presented in media. The results of poor behavior influence your child's ability to do well in school and participate as a constructive member of the family. Activities that modify behavior help children avoid specific actions and learn constructive ways to substitute positive for negative behavior. The success of the modification activities depends on the child, parents and the amount of time spent teaching kids alternative ways to handle family, school and social situations.
Gaming allows kids to explore different behavior, and when played with family members or an adult, games teach appropriate actions. Commercially manufactured games offer a way to review specific behavior changes, but parent-made games can focus on targeting specific ways to change. The American Academy of Pediatrics says children frequently exhibit undesirable behavior when they are under stress or are angry or frustrated. Games introduce children to the behavior options available and allow kids to select from several appropriate behaviors. Children can see through gaming that there are several options to try before resorting to bad behavior.
Help Kids Build Critical Skills With Fun Worksheet Activities.
Modeling activities teach children the correct behavior and reactions. Children sometimes behave badly in new or unfamiliar situations. It's not that the child intends to be bad, according to the AAP. Children don't always understand how to demonstrate appropriate actions. Modeling creates imaginary situations that show the child new behaviors that fit the event or situation. Parents can create a fun demonstration by incorporating simple rewards for modeling the correct actions. Fictional scenarios at home allow children to practice appropriate behavior before moving into real world situations.
Formal charts keep track of behavior over a period of time. Once children learn a new behavior, charts help monitor the use of the new information. Formal charts also set reasonable expectations for families, teachers and children, according to the New Mexico Public Education Department. Parents and teachers use charts, along with positive reinforcement, to help children change behavior. Charts offer concrete proof of modifications. Positive reinforcement doesn't need to include food or cash, positive words of praise also give children reinforcement to continue to follow new behavior. Tracking appropriate behavior helps focus on the positive, rather than monitoring mistakes and punishing bad actions.
Watching films and television programs and reading books help introduce and change behavior. These activities also introduce concepts for parents and children to discuss at home about poor behavior. Age-appropriate media encourages children to identify with the book character or movie or show actor. Previewing media helps parents direct the discussion to topics that tie directly into home behavior problems. Monitoring regular viewing controls the types of programming children see, and this helps avoid kids tuning into shows that feature negative behaviors.
Problems at School: Why Does Mental Health Matter in Schools...August 4, 2017 1:09 PM
Children and youth with mental health challenges sometimes experience difficulty at school for a variety of reasons. ACMH receives frequent calls from parents whose kids are struggling to be successful or sometimes not even being allowed to stay at school due to un-addressed mental health needs. Accessing the services that children and youth may need to help them better manage and support their mental health needs at school can be quite challenging. We hope this section will help.
Why Does Mental Health Matter in Schools?
Addressing mental health needs in school is critically important because 1 in 5 children and youth have a diagnosable emotional, behavioral or mental health disorder and 1 in 10 young people have a mental health challenge that is severe enough to impair how they function at home, school or in the community.1
Many estimates show that even though mental illness affects so many of our kids aged 6-17 at least one-half and many estimate as many as 80% of them do not receive the mental health care they need.2
Being able to recognize and support kids mental health in schools matters because:
- Mental health problems are common and often develop during childhood and adolescence
- They are treatable!
- Early detection and intervention strategies work. They can help improve resilience and the ability to succeed in school & life.
In addition, youth with emotional and behavioral disorders have the worst graduation rate of all students with disabilities. Nationally, only 40 percent of students with emotional, behavioral and mental health disorders graduate from high school, compared to the national average of 76 percent; 3 and, Over 50% of students with emotional and behavioral disabilities ages 14 and older, drop out of high school. This is the highest drop out rate of any disability group!
How Do Mental Health Disorders Affect Children and Youth at School?
Mental Health Disorders can affect classroom learning and social interactions, both of which are critical to the success of students. However, if appropriate services are put in place to support a young person’s mental health needs we can often maximize success and minimize negative impacts for students.
One of the problems that families frequently run in to is getting the school to recognize the role of mental health disorders in relationship to the difficulty their child is having. Getting agreement to put strategies in place to address mental health issues and help the youth to better manage his or her mental health symptoms at school is sometimes equally as challenging.
Children’s mental health can affect young people in a variety of ways to varying degrees in the school environment. One child’s symptoms may be really hard to manage at school while another child with the same condition may not have much difficulty. In addition, like all of us, kids with mental health challenges have good days and bad, as well as, times periods when they are doing really well and times when their mental health symptoms become more difficult to manage.
When figuring out the types of supports and services to put in place, it is important to keep in mind that all kids are unique with differing needs and coping mechanisms. The mental health interventions that are chosen need to be based on the individual needs of each child and be able to flex in order to provide more or less support as needed.
Children with mental health needs often need a variety of types of supports in school for them to be successful. For example, a child with hyperactivity may benefit from working some activity into their daily classroom routine. A child with Oppositional Defiant Disorder might benefit from their teachers being trained to interact with them in a certain way. A young person who struggles with disorganization might be helped by being taught planning skills. Children who may become aggressive and those who get overly anxious may benefit from exploring what things lead up to those feelings and being taught strategies to recognize when it is happening and things to do to avoid the problem from escalating.
Sometimes meeting mental health needs in schools may require special instruction and/or practice. For example, if your child needs help for difficulties with social interactions or communication difficulties it may help to teach them new skills and have them practice using them by role-playing or trying them out in small groups.
It is also helpful to look at how mental health symptoms may affect a child in the classroom and the accommodations that may help. For example, children and youth with anxiety disorders may often struggle in school because they are so pre-occupied with their ‘worries’ that it makes it hard for them to pay attention. They may have physical complaints like stomach and headaches and may be frequently absent. They may also have trouble starting or completing their work because they are worried that it won’t be right. Sometimes their fear of being embarrassed, or getting something wrong or their fear of having to interact with others may lead them to them to avoid group and social activities and perhaps school all-together.
Possible accommodations or strategies that may help include:
- Allowing flexible deadlines or letting the student have an option to re-do work so they feel more confident turning it in.
- Helping the teacher to recognize escalating anxiety in a child and equipping them with the tools to intervene and help the child to implement strategies that help manage their anxiety.
- Pre-planning for group discussions to help reduce their anxiety about what they will share or say.
- Make plan for what to do when they are unable to focus due to worries.
- Allow for breaks or opportunities to de-stress.
How to Navigate Problems At School:
How you, as a parent, go about navigating problems at school for your child will depend on a variety of factors including the nature of the problem itself and whether or not your child needs or receives special services.
One strategy that is always helpful no matter how you attempt to solve problems is to work to build a strong working relationship with your child’s school and the people in it. This can sometimes feel challenging at first, especially if you feel the school is not yet willing to do what you think your child needs to be successful. But try to keep in mind that you and the professionals at school really do have a common goal in mind and that is to help your child be successful at school.
Whether or not your child receives special education services you can work with the school to try to get some supports in place to meet their needs.
If your child is having trouble in their classroom it might be best to first meet with the teacher and let them know your concerns. They may have some ideas and be willing to put some strategies in place to help your child.
If that doesn’t resolve the problem you may also want to try to include other school staff such as the principle, social worker, etc. In addition, if your child receives private or public mental health services it may be helpful to ask your child’s therapist to be a part of the meeting as well, as they may be able to provide some much needed insight about what might help your child.
Before any of these meetings take place it is always helpful to take the time to prepare by listing your concerns, including the things that you think your child is struggling with at school and the things you think will help them. It can also be helpful for you to think about the things that might make your child worse or aggravate their mental health condition.
When you meet and share your concerns, whether informally or in a formal meeting the professionals at your school will be able to offer suggestions about strategies they think may help. Again it can be helpful for you to review possible accommodations prior to the meeting with the school and select some to share that you think might be especially helpful for your child.
After the meeting with the school where you discussed your child’s needs the school may want to do some classroom observations to better understand your child needs. Then you can work with the school to agree to put some strategies in place to help your child be more successful. It is important to keep in mind that the first try isn’t always a success. You and the school may find out you need to go back to the drawing board and come up with new strategies.
If you are unable to get the school to put strategies in place or adjust them if they are not working, pleas feel free to call ACMH for help.
Behavioral Issues at School
If your child does not receive special education you can still work with the school to put a plan in place to address behavior issues.
Often if you can get the school to consider providing some of the accommodations or modifications discussed above to support your child when their mental health symptoms affect them at school this alone can help to reduce behavior problems.
Sometimes though some children and youth have ongoing behavioral challenges that may need additional support. You can work with the school to come up with a plan to support your child and teach them new skills in an effort to reduce behavior problems and help your child and the school cope with them when they do.
Plans should be focused on helping kids to recognize the things that can trigger behavioral issues and also teaching new behaviors and skills and allowing opportunities for the student to practice them.
Occupational Therapy Helps Every Day be Independence Day...August 3, 2017 8:21 PM
Merriam Webster defines “independence” as the state of being independent or self-sufficient.
As Americans, we celebrate Independence Day on July 4, but as occupational therapists, we like to consider every day Independence Day. Occupational therapy celebrates 100 years as a profession this year.
Despite occupational therapy’s being around for a while, many people still have not heard of OT or recognize its important role in recovery. Occupational therapy helps people of all ages become as independent as possible.
OT specializes in whatever it is that is important to our clients. While recovering from an illness or disease, many people just want to feel like themselves again. This could include being able to sit up or walk as well as they have before, but it often also means being able to get up and go to the bathroom, or feed or groom themselves, or even put on their clothes without someone helping. These kinds of tasks are known as “Activities of Daily Living” or ADL and are a large focus of OT. We work with clients to make them stronger or even introduce them to new ways of doing their normal tasks. We can also provide patients with equipment that would allow them to perform their ADL without help.
Clients include people of all ages, from children to older adults. Occupational therapists work with children with a variety of disabilities to encourage independence. We can help someone return home after a hip or knee surgery or other injury. OTs can help someone recover after a stroke, strengthening them or teaching them new ways to perform their self-care, independently. We can treat patients with a variety of diagnoses and in a variety of settings: hospitals, outpatient clinics, nursing homes or even in-home with home health.
Other areas that occupational therapists could address include home evaluations, work training and driving evaluations. With a home evaluation, therapists go into their patient’s home, suggesting changes to make the home safer or allow wheelchairs or other types of equipment someone may need to move around by themselves. OTs can recommend equipment that would make tasks easier, like ramps, shower benches or adaptive bathing equipment. Work training would involve preparing a client to perform tasks specific to their job, including lifting or other fine motor tasks. Driving evaluations are an important part of recovery from a stroke, traumatic brain injury or other event, and these would include assessing vision, coordination and other factors that would determine if someone is able to return to driving.
It takes teamwork between the therapist and client to develop a plan and set goals the client wants to be able to achieve to become more independent. It is a special privilege and awesome responsibility to be an OT, to help our clients become independent and to celebrate independence every day.