Original Article By Eric Ries | July 2018
Synopsis/Review by Athena Bellio, PT, DPT, CMT, HHP for Oceanside Therapy Group
Physical therapy services have been a widely accepted form of treatment for decades across multiple populations. However, the role of a physical therapist (PT) in the lives of our children with Autism or Autism Spectrum Disorder (ASD) has not always been emphasized or well-known. In fact, within the last two decades, treatment options for this population of children and families were not as readily available. But, as the treatment paradigm is constantly evolving to encompass the whole child, so is the importance and role of physical therapy in their daily lives.
In this article, written by Eric Ries, he presents the experiences of pediatric PTs working with this wonderful population and how they approached treating and caring for these kids.
Karen Tartick, a school-based PT and parent of a child with Autism, explains her take on the importance of physical therapy in the life of a child with Autism. She shares her own experience with her now adult son, and his limited experience with physical therapy treatment growing up. Tartick goes on to describe that when they first received her son Eric’s diagnosis in 1993, there was less of an emphasis placed on his physical activity during his therapeutic care. She attributes that limited exposure in his youth, in part, to the current challenges Eric faces with poor physical health and limited exercise tolerance. Tartick explains how “tapping into whatever is motivating to the child” is key to having them understand the importance of movement and exercise outside of the therapy world.
Physical therapist, Liliane Savard, also describes her experiences working with children with ASD, claiming that, “most if not all, children with autism have movement difficulty.” She goes on to explain that because PTs are considered movement system experts, they are very adept in figuring out how to design interventions to help these kids participate more in appropriate movement patterns that will allow them to engage in life. Savard emphasizes three main cornerstones to promoting motor learning including: positive expectancy, autonomy support and external focus. In short, if we help our kids to believe they can do something, allow them the freedom and opportunity to make appropriate decisions, and channel their attention and focus to specific elements of a task, we can achieve growth and progress.
The “whole-child approach” is also emphasized in today’s physical therapy treatments. Anjana Bhat, PT, PhD, MS, emphasizes this in her practice with the belief that motor play encourages communication and engagement in a child’s environment as well as with his or her peers. By providing creative play environments, there is, what Bhat calls a “cascading effect” in which PTs help to promote productive solutions and preferred outlets to dealing with maladaptive behaviors. Physical therapists not only treat a movement pattern dysfunction, but also take part in the larger discussion of advocating for children with ASD by enabling and empowering them to “participate in their world.” Bhat goes on to applaud the families and parents of these children, whose determination in empowering their child is inspiring to her as a PT working in this field. She goes on to describe the complexities of this diagnosis with the understanding that our knowledge of best practice for PT and ASD is constantly expanding.
Jan McElroy, PT, PhD, describes the role of a PT best. In a population that is so often misrepresented or “narrowly seen as minimally expressive, behaviorally difficult, and challenging to engage”, PTs bring the fun to these children and families whose lives can often feel stressful. PTs work to address the whole child, find what is salient to him or her and encourage social connections and movement patterns to gain confidence in their newfound independence.
For access to the full article, please see the attached link.
Our OTG family is made up of talented and creative therapists and staff, all working together to facilitate progress and life skills across all disciplines (occupational therapy, speech language therapy and physical therapy). Please contact our PT department for more information on how we can help you and your child reach their gross motor and functional movement goals.
Source: Ries, Eric. “Physical Therapy for People With Autism.” APTA, 2018, www.apta.org/PTinMotion/2018/7/Feature/Autism/.
Q & A with OTG Physical Therapists
Question 1: What's the average length of therapy a child will receive for PT?
KC: The average length of physical therapy will vary child to child. We can possibly see a kiddo for a month or many years. The great thing about physical therapy is that we work on so many areas of the body that a child's sessions are constantly changing and evolving based on what the child is doing.
Chris: Time will vary. Orthopedic-based conditions tend to be weeks/months and developmental-based can be months/years.
Question 2: What's your favorite part about being a PT?
KC: My favorite part of being a PT is helping children and families reach their goals through movement. Improving how a child moves can help them improve social interactions, increase attention, and open up new environments for them to explore. Activity and movement is great for all members of the family and I love helping everyone lead healthy, active, lifestyles!
Chris: I definitely echo the creativity/spontaneous aspect to peds, it's very motivating. Diversity and the apparent need within the peds specialty were specific draws for me coming out of PT school. The diversity in population/background and different family structures we serve are motivating.
Athena: The BEST part about being a PT for me is that it calls for creativity and flexibility with each treatment -- every kiddo is different and special in their own way, which encourages new avenues for exercises and activities. I'm constantly learning from each child and family we treat. Plus, I have yet to find another profession in which busting out in random (Disney) songs is considered appropriate, if not encouraged :)
Question 3: What are your favorite exercises/activities in therapy, what conditions do they treat?
KC: My favorite exercises are SQUATS!!!! Squats are awesome for children with any and all conditions. Working on the gluteal musculature (aka the booty muscles) helps with stability, single leg balance, jumping, running, and walking.
A Final Word from Our PTs
Physical therapists are always here to answer any questions! Don't be afraid to ask anything, even if it seems like a silly question. If we don't know the answer we will do the research and look it up! Our PT team loves to solve any puzzle and are happy to help you with anything for your child's development. Physical therapists are trained and matriculate at a clinical Doctoral level. They are experts in assessing/treating movement-based disorders/pathology in order to restore and maximize function and quality of life.
Written by: Natalie Shilling & the PT Dept. at Oceanside Therapy Group
An exercise ball is a fun piece of equipment that we frequently use in physical therapy for strengthening and balance exercises. It comes in a wide ranges of sizes and can be easy and quick to purchase for home. Here are some fun activities you can do at home with use of an exercise ball...
Trunk Strengthening in Sitting
This is a great exercise for kids of all ages! Help your child to sit on the exercise ball and stabilize them at their hips. Gently bounce them up and down. This is great for bringing about body awareness, as well as teaching your child to engage their core muscles to maintain their sitting posture. You can also rock your child forward and back, side to side, or along a diagonal for them to work on their balance and core strength.
If you have an older child you can have them sit on the ball while performing school work or any table time activity. Just make sure their feet are planted on the floor while on the therapy ball. Give cues to have them sit up tall in order to increase core strength and improve posture.
Prone Walk Outs
With a smaller sized ball, have your child lay on their tummy on the ball. Then have them walk out forward on their hands so that the ball rolls toward their knees, then have them walk their hands back. Try having them complete a puzzle or a game in this position by walking their hands forward to obtain a piece and then walking their hands back to put the piece into the puzzle.
Having your child lay on their back and propped up on their arms (make sure their arms are on the floor). Encourage your child to bring both legs up to 90 degrees in the ready position. Stand in front of them with a medium sized therapy ball. Lightly toss the ball towards their feet and have them kick it back to you. This will help their core and leg strength.
On a smaller sized ball, have your child lean the ball against the wall with their back. Have them sit down and pretend they are sitting in a chair. Repeat this movement for leg strengthening and balance. This can be incorporated with a throwing and catching activity in which the child catches the ball in sitting and throws when standing.
With medium sized ball, stand about 5 feet away from your child. Encourage them to use both hands and lift the therapy ball above their head then throw it forward and bounce on the ground one time. You can play throw-and-catch and see who can make the louder noise! Make sure to watch your child’s posture and encourage them to stand up tall without leaning back or arching their back in order to engage their abdominals and increase their core strength.
For Questions & More Information
If you have any questions on ball sizing or need more information about any of these exercises feel free to ask one of your friendly OTG Physical Therapists. You can work with your child and their therapist to think up more fun games to play at home with the therapy ball.
Written by: The Physical Therapy Dept. at Oceanside Therapy Group
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Physical Therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility. Physical Therapists teach patients how to prevent or manage their condition utilizing treatment techniques to restore function and prevent disability. Importantly, physical therapists work with individuals to prevent loss of mobility before it occurs by developing wellness-oriented programs supporting healthier and more active lives.
Common Exercises in Physical Therapy
Physical Therapy treatment and fitness-related programming/education are critical for conservative management of pain per recent CDC guidelines. Walking, step-ups/downs, and sit-to-stand-go (Up n Go’s) are good functional activities that address strength, balance, coordination, and cardiovascular function. Please join OTG Fit Families and join our collaborative step program! It is fun, exciting, and rewarding!
A balance disc/tilt board/Bosu ball can be used strategically to address balance and sensory impairments. Many variations and uses of these tools can greatly assist restoration in function.
Treatment and prevention of strains/sprains. Theraband will provide resistance in specified ranges of motion as prescribed by your physical therapist to strengthen weakened muscles.
Walking and physical activity such as biking, swimming, and running have been shown to significantly improve physical, emotional, and social health for all ages. With our busy schedules and increased screen-time the challenge is finding the time and meaningful motivation to achieve a balanced lifestyle to stay active.
How many steps are recommended for children? Why is it important? What are some strategies to stay motivated as a family? Where can these ideas be implemented?
HOW MUCH WALKING IS RECOMMENDED FOR MY CHILD?
A systematic review from 2011 indicated that elementary school aged boys should be taking 13,000-15,000 steps/day and girls 11,000-12,000 steps/day. A pedometer is a portable device, such as a FitBit, that counts steps. This will give the most accurate reading of actual steps taken. The correlation of steps is in accordance to evidence-based recommendations of 60 minutes per day of moderate to vigorous activity for children.
WHY IS WALKING SO IMPORTANT?
Increasing physical activity can lead to improved cardiovascular fitness, improved metabolism, and an increase in caloric expenditure, which can decrease the risk for obesity, improving the overall health of our children and families.
WHAT CAN FAMILIES DO?
OTHER FUN WAYS TO STAY ACTIVE
Written by: The PT Dept. for Oceanside Therapy Group
Source: Tudor-Locke C, Craig C, Beets M, Belton S, et al: How many steps/day are enough? For children and adolescents. International Journal of Behavioral Nutrition and Physical Activity. 2011, 8:78.
Core Muscle Strengthening
On a day-to-day basis, whether our children are at school, physical therapy, occupational therapy, or speech therapy we are told that they need to “strengthen their core.” But what are core muscles? How do we strengthen them? Why do some children “W” sit? What can we do to help?
What are core muscles?
Core muscles are a group of muscles in your stomach, back, pelvis, and trunk that help provide stability and create movement. When these muscles are not working properly they can cause back pain, decrease balance, cause difficulty with coordination and poor posture.
The muscles of the core are as follows...
-Pelvic Floor Muscles
All of these muscles work together to compress the abdomen, provide trunk rotation and movement, and help create upright posture and support your spine. These muscles help provide your child with stability, balance, body awareness, and the ability to move around in space, which impacts bilateral coordination, stair climbing, balance, navigating obstacles, and upright sitting and standing, and more!
How can I tell if my child has a weak core?
A weak core can have effects that trickle down to many other developmental skills from balance to posture to pencil grip and more.
Signs of a Weak Core
-Sitting: slumping, fidgeting, leaning on one hand, difficulty with fine motor tasks, W-sitting.
-Transitions: difficulty rolling, crawling, moving from lying down to sitting, and moving from sitting to standing.
-Balance: Difficulty with balance and unsupported sitting, frequent falls, and difficulty with one leg standing.
-Coordination: Difficulty running, performing jumping jacks, crossing midline, and ball skills.
Why is W-sitting bad?
W-sitting is when a child sits on their bottom with their knees bent and feet positioned outside of their hips and this makes a "W" shape.
When W-sitting is a child’s go-to sitting position they are at risk for...
-Lack of cross body movements
-No hand preference
-Increased muscle tightness
-Limited core strengthening
What can I do to help my child’s core strength?
There are many ways to help children of any age strengthen their core muscles.
-No W-Sitting: Make sure that your child is not sitting in W-sitting position and correct with “fix your feet”. Sitting on the floor in long sit, side sit, or legs crossed sitting helps increase core strength and improve trunk mobility.
-Play Time: Encourage your child to play in unstructured, spontaneous play where they are running, climbing, lifting, rolling, pushing, pulling, moving, and engaging in whole body movements.
-Planks: Have your child get into a push up position and hold. Make sure that their body is making a straight line from head to toe. Encourage by having a contest with family members!
-Bridges: Have your child lie on their back with knees bent and feet flat on the floor. Have them suck their belly button into their spine and push through their feet to raise their bottom up off the floor. Encourage by rolling a ball or cars under the bridge.
-Super Hero: Have your child lie on their stomach on the floor and try to lift their arms, upper chest, and legs off the floor like they are a flying super hero.
-Wheelbarrow Walks: Hold your child’s feet and legs and have them walk forward on their hands towards a target. Try to have a relay race with friends!
For more ideas about core strengthening at home or with any questions about core strength or W-sitting, make sure to talk with a physical therapist!
Written by: "KC" Karen Albiston, PT, DPT for Oceanside Therapy Group
Drobnjak, L., Heffron, C. (2015). The Core Strengthening Handbook. The Inspired Treehouse, LLC.
What Is W-Sitting? (Copyright © Pathways.org) Pathways.org. Retrieved June 2, 2017 from https://pathways.org/blog/what-is-w-sitting/
Core Exercises: Guidelines and Examples. (Copyright © 2010 American Academy of Pediatrics). Healthychildren.org. Retrieved June 2, 2017 from https://www.healthychildren.org/English/healthy-living/fitness/Pages/Core-Exercises-Guidelines-and-Examples.aspx
Frequency, length, and duration of therapy will vary according to the needs of each child. In order to achieve therapy goals, consistency is the key. It can be difficult to incorporate a therapy schedule into your weekly routine on top of all the other responsibilities and commitments you may already have. However, the more regular your child's attendance, the more likely he/she will make therapeutic progress.
Having the ability to communicate with your child's therapist regularly will help you to carryover a successful home program. Your pediatric therapist can give recommendations, tips, tools, and resources for your child's unique needs and personality to empower you, as the parent, to help your child thrive in the outside world with his/her peers. Parental involvement will positively impact your child's therapy progress.
Routine practice with therapeutic activities and exercises are crucial to gaining and maintaining new skills. Regression may become a concern if therapy is inconsistent. As a parent this can be frustrating and disappointing. For your child and therapist, that means more time spent re-teaching previously learned skills. Sticking to your therapy schedule and practicing learned skills at home will give your child the best opportunity to progress. When our children succeed, we all win!
Oceanside Therapy Group, Copyright 2017
How is it Diagnosed?
If you think your child may have ASD, contact a physician with your concerns. Getting an accurate diagnosis is the first step toward receiving needed intervention. The physician may refer your child to a specialist for an in-depth evaluation, including diagnosis. Specialists who typically diagnose ASD (or decide that an individual does not have ASD) include developmental pediatricians, child neurologists, child psychologists, and child psychiatrists.
No specific tests can diagnose ASD, but health care professionals may use assessment tools, such as the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2), and the Autism Diagnostic Interview-Revised (ADI-R) to aid in determining the diagnosis. A child's behavior and development must meet specific criteria to receive a diagnosis of ASD. Individuals diagnosed with ASD have symptoms that cause significant difficulty in important areas of current functioning. Individuals with ASD show symptoms from early childhood, even if those symptoms are not recognized until the child is older when social demands increase. Parents may recall earlier symptoms and realize that they didn’t know what those symptoms meant at that time.
How Can a Physical Therapist Help?
Physical therapists can work with your child, family, and educational team to help your child:
A physical therapist will conduct a thorough evaluation of your child that will typically include a health and developmental history and assessment of:
"Autism Spectrum Disorder." American Physical Therapy Association. American Physical Therapy Association, 31 Oct. 2014. Web. 16 Sept. 2016.
Historically, the field of physical therapy boasts a proud and courageous past. Approximately a century ago, a rich tradition emerges from "young reconstruction aides", people who assisted and implemented the earliest forms of restorative mobility. During WWI and WWII the nationwide polio epidemic catalyzed an important profession.
Today, the profession has produced confident and accomplished practitioners at the cutting edge of promoting movement, rehabilitation, risk-reduction, and preventative services. Physical therapists are experts in restoring and improving motion in people's lives and treat people throughout the lifespan.
Written By: Chris Ackerman, DPT, PCS for Oceanside Therapy Group