Nice article about an important topic. Our society puts tremendous pressure and demand on our young athletes. To be able to be the best, sometimes we need to take a break. PARENTS - good read and try to understand the physical perspective. Don't forget we want your kids to be the best, but you need to understand the physical demands a child can handle.
PLAY SAFE!
http://www.cleveland.com/dman/index.ssf/2013/02/noted_surgeon_dr_james_andrews.html
Monday, August 4, 2014
Saturday, August 2, 2014
Nice Commentary on "Containers" for Infants
This is an article written by a physical therapists addressing the overuse of "containers" in today's society. Therapists it's a good read. Parents it's good info for how to play with your child.
http://www.sentinel-standard.com/article/20140704/NEWS/140709625
http://www.sentinel-standard.com/article/20140704/NEWS/140709625
Wednesday, June 11, 2014
Tone: What is it? How to explain it?
Muscle
Tone: What is it?
As therapists, we are many times asked by parents
“What is muscle tone?” Generally when
parents are asking this, it is because their child likely has high muscle tone
or spasticity. However, muscle tone can
be normal, high or low. So let’s start
with what is normal.
In 1966,
Stolov, defined the tone in the muscle as "the resistance of the muscle to
passive elongation or stretching" (1).
In other
words, it is the state of muscle tension inside a muscle or muscle group
when it is at rest.
Normal
Muscle Tone
Normal
tone means that there is
the right amount of “tension” inside the muscle at rest, and that the muscle is
inherently able to contract on command – we can tell our biceps to contract to
pick up a cup. Do not confuse “tone” with “strength”. Tone is the tension in
the muscle, set by the muscle spindles and the alpha and gamma nerves
associated with them. Strength is the
more of the number of muscle fibers and the ability to contract as a group to
produce a force. Although the two can
are connected, one does not precipitate the other (ie: high tone does not mean
high strength)
Low
Muscle Tone
Low
tone means there is not
enough tension in the muscle when it is at rest. When looking at a child with
low muscle tone, the muscles will not be defined and may have a floppy
feel. In general, because of the low tension,
there is a lack of graded control of the muscle when it is being
used. Graded control means that
just the right amount of movement and effort is used for the specific task.
To use
the coffee example again, when you decide you want to have a sip of coffee,
there is not enough tension in your muscles at rest. So you use a bit extra
momentum, maybe by flinging your arm out! You bump the cup a bit, get your
fingers around the handle and then drag it back, but the cup is heavy, and you
use too much oomph at first (to overcome the lack of “tension” in your muscles)
with the result that the coffee sloshes out!
Children
with low tone may well battle to sit upright at a desk for any period of time,
and may slouch over like the child in this picture. Children with low tone will often lean against any surface they can - walls, chair backs, etc.
They may
also lack endurance for gross and fine motor activities and may struggle with
games that require coordinated, controlled movements.
It is
important to remember that muscle tone is on a continuum – you can have
normal muscle tone that is a bit on the low side or a bit on the high side.
The tone
of the muscles affects postural control and postural stability.
Postural control and postural stability give you the “background” control of
your body that is necessary for helping you to stay upright and to stabilize
you during movement.
Postural
stability needs to develop in 3 main areas:
•
Neck
muscles
A lack of
stability in these areas may have an impact on a child's Fine Motor and Gross Motor Skills.
High
Muscle Tone
High
tone means there is too
much tension in the muscle at rest. In other words, the muscle is tight and
tense even though it is not doing anything. A child with spastic cerebral palsy
has high tone, which causes the arms and legs to be tightly contorted. When the
arms and legs are not regularly stretched and moved through physical therapy,
then “contractures” may occur, which mean less and less range of movement is
possible.
In the everyday example I gave above, if you had increased tone,
you would have to concentrate very hard and expend a lot of effort overcoming
the tension in your biceps in order to stretch out your arm. You may well end
up moving your whole body towards the coffee, as the tension in your arm
muscles is too high to be overcome with ease. Your movements are also likely to
be jerky.
Spasticity
Spasticity (meaning to draw or tug) is involuntary,
velocity-dependent, increased muscle tone that results in resistance to
movement. The condition may occur secondary to a disorder or trauma, such as a
spinal cord injury (SCI), a brain injury, a tumor, a stroke, multiple sclerosis
(MS), or a peripheral nerve injury. The severity of spasticity can change over
time, in different situations, and even with emotion.
Although
many therapeutic and medical interventions can attenuate its effects,
spasticity can be severely debilitating. In spite of the fact that spasticity
may coexist with other conditions, it should not be confused with any of the
following:
• Rigidity - Involuntary, bidirectional,
non – velocity-dependent resistance to movement
• Clonus - Self-sustaining, oscillating
movements secondary to hypertonicity
• Dystonia - Involuntary, sustained
contractions resulting in twisting, abnormal postures
• Athetoid movement - Involuntary,
irregular, confluent writhing movements
• Chorea - Involuntary, abrupt, rapid,
irregular, and unsustained movements
• Ballisms - Involuntary flinging movements
of the limbs or body
• Tremor - Involuntary, rhythmic,
repetitive oscillations that are not self-sustaining
Saw this on the internet, thought it was an interesting way of talking about tone/spasticity
Frequency
Spasticity
is present to some degree in most patients with MS, SCI, cerebral palsy (CP),
and traumatic brain injury (TBI).
Advantages
of spasticity
Spasticity may sound like a completely detrimental
thing, but spasticity can actually help with function for many people.
Substitutes for strength, allowing
standing, walking, gripping (think tenodesis grip)
May improve circulation and prevent
deep venous thrombosis and edema
May reduce the risk of osteoporosis
– although must be careful with this, especially if person is non-weight
bearing
Morbidity/disadvantages
of spasticity
While spasticity does have some advantages, it is
still a very large consideration in the health, functionality, and quality of
life in most people.
Orthopedic deformity, such as hip
dislocation, contractures, or scoliosis
(surgery and botox can help here, but are not always successful)
Impairment of activities of daily
living (eg, dressing, bathing, toileting)
Impairment of mobility (eg,
inability to walk, roll, sit)
Skin breakdown secondary to
positioning difficulties and shearing pressure
Pain or abnormal sensory feedback
Poor weight gain secondary to high
caloric expenditure
Sleep disturbance
Depression secondary to lack of
functional independence
How to
Assess and Measure Spasticity
• Ashworth scale/Modified Ashworth - From
0-4 (normal to rigid tone)
Scoring (taken from Bohannon and Smith, 1987):
0: No increase in muscle tone
1: Slight increase in muscle tone, manifested by a catch and release or by minimal
resistance at the end of the range of motion when the affected part(s) is moved
in flexion or extension
1+: Slight increase in muscle tone, manifested by a catch, followed by minimal
resistance throughout the remainder (less than half) of the ROM
2: More marked increase in muscle tone through most of the ROM, but affected
part(s) easily moved
3: Considerable increase in muscle tone, passive movement difficult
4: Affected
part(s) rigid in flexion or extension
• Physician's rating scale - Gait pattern
and range of motion assessed
- a modified version of the
Physicians Rating Scale, known as the Observational Gait Scale (OGS)
- OGS was found to have acceptable
interrater and intrarater reliability for knee and foot position in mid-stance,
initial foot contact, and heel rise with weighted kappas (wk) ranging from 0.53
to 0.91 (intrarater) and 0.43 to 0.86 (interrater).
- Anna H Mackey, Glenis L Lobb,
Sharon E Walt and N Susan Stott (2003). Reliability and validity of the
Observational Gait Scale in children with spastic diplegia. Developmental
Medicine & Child Neurology, , pp 4-11.
• Penn Spasm Frequency Scale - From 0-4 (no
spasms to >10/h)
Composed of
2-parts; the first is a self report measure with items on 5-point scales
developed to augment clinical ratings of spasticity and provides a more
comprehensive assessment of spasticity.
Spasm
Frequency:
• 0 = No spasm
• 1 = Mild spasms induced by stimulation
• 2 = Infrequent full spasms occurring less
than once per hour
• 3 = Spasms occurring more than once per
hour
• 4 = Spasms occurring more than 10 times
per hour
Spasm
Severity:
1 = Mild
2 = Moderate
3 = Severe
If the
patient indicates no spasms in Part 1, then they do not proceed to Part 2. The
second component of the PSFS is a 3-point scale assessing the severity of
spasms.
Functional
scales such as the Functional Independence Measure or Gross Motor Function
Measure also may be valuable, although they do not measure spasticity directly.
Research-oriented
tools for measurement include the Tardieu scale, surface electromyography, isokinetic
dynamometry, the H reflex, the tonic vibration reflex, the F-wave response, the
flexor reflex response, and transcranial electrical/magnetic stimulation.[1]
*** rehabmeasures.org
has many great assessment
tools with explanations, directions, and norms
***
Below is a movie
for patient explanation of tone:
Resources/References
3.
http://cerebralpalsy.org/about-cerebral-palsy/symptoms/eight-clinical-signs-of-cerebral-palsy/#amt
Wednesday, June 4, 2014
Parenting Essentials
This was just released from the CDC. Nice reference for some behavior problems, and just good parenting advice. Take a look!
http://www.cdc.gov/parents/essentials/index.html
Coming Soon: what is tone and help explaining it to parents...
http://www.cdc.gov/parents/essentials/index.html
Coming Soon: what is tone and help explaining it to parents...
Tuesday, May 13, 2014
29 Symptoms of Undetected Vision Problems
I just got this information from The Vision Therapy Center. Thought it was worth passing along in a short little post. Good for teachers, therapists and parents in the first steps to helping your child.
According to the American Optometric Association, 1 in 4 children have a vision problem that affects their ability to learn. Many of those problems are vision problems which aren’t detected during typical vision screenings performed by schools and pediatricians.
Here are 29 symptoms that your child may have an undetected vision problem.
- Has a crossed or lazy eye
- Tilts the head to one side on a frequent basis, or has one shoulder that is noticeably higher
- Squints, blinks, and/or closes one eye repeatedly
- Holds the book close while reading
- Has poor hand-eye coordination
- Displays signs of emotional or developmental immaturity
- Has a low frustration level, and often doesn’t get along well with others
- Experiences blurry vision
- Complains of nausea or dizziness and motion sickness
- Experiences double vision (you may have to ask – “do you see two of these objects?”)
- Confuses left and right directions on an ongoing basis
- Loses his or her place when reading or copying from the board or paper
- Has difficulty remembering what was read
- Has difficulty remembering, identifying, and reproducing geometric shapes
- Reverses words
- Uses finger to read
- Rubs eyes during or after short periods of reading
- Skips words and/or has to re-read on a regular basis
- Omits small words
- Struggles with handwriting
- Moves head back and forth (instead of moving eyes)
- Appears clumsy, or frequently bumps into or drops things
- Experiences problems catching a ball
- Favors the use of one eye when reading or viewing an object
- Experiences burning or itching eyes, reddened in appearance
- Has frequent headaches in forehead or temples
- Exhibits posture problems
- Has a short attention span and is easily distracted
- Becomes nervous, irritable, or quickly fatigued while reading, looking at books, or doing close work
Sunday, May 4, 2014
Tummy Time
What
is Tummy Time and Why is it important?
Tummy
Time is an
important activity for your baby’s development and is endorsed by the American
Academy of Pediatrics (AAP). Tummy Time is the supervised time your baby spends
while awake on it’s abdomen (belly).
Tummy Time helps to strengthen head, neck and upper body muscles,
provide sensory input to hands and trunk, helps provide and develop appropriate
visual and vestibular input and reactions, and gives baby a different view of
the world.
The
vast majority of babies now sleep on their backs, a recommendation of the AAP,
to help prevent Sudden Infant Death Syndrome (SIDS). This movement is commonly known as the
Back-to-Sleep campaign, and has had good results reducing the risk of SIDS by
40%. HOWEVER, because babies are
back-sleeping and spending increased time in “containers” – car seats,
bouncers, strollers - now, babies are losing vital hours of tummy time and
opportunities to develop their neck and trunk muscles – necessary for further
skills such as reaching, crawling, rolling.
ALL babies benefit from Tummy Time – even newborns!
Because
being prone (on abdomen/belly) is such a crucial position for strengthening the
neck, trunk and eye muscles of babies, the impact of limited Tummy Time is
becoming evident. A survey performed by
Pathways Awareness confirmed “what
early childhood medial professionals have been observing: 2/3 of therapists
reported a rise in early motor delays in infants in the past 6 years, and those
who saw an increase said that lack of tummy time while awake is the number one
contributor to the escalation in cases.”1 Each year more than 400,000 children in
the US are at risk for an early motor delay, and the actual incidence is 1 in
40, a 150% increase from 25 years ago, and a rate even higher than incidences
of other accelerating conditions like autism.2
Just a little Tummy Time everyday can help promote
appropriate motor development in babies!
Benefits (recap)
- strengthens neck muscles, so baby can hold head up
and look around
- strengthens trunk muscles, so baby can develop the
muscles for sitting, crawling, walking
- provides sensory input to hands and front of body;
baby is able to feel different textures and develop the touch sensation
- provides vestibular and visual input for eye and
vision development; baby strengthens eye muscles and sense of space
- helps baby’s head become round instead of developing
flat spots on the back of the head (prevents positional
plagiocephaly)
When
to Start
Tummy
time can begin right after birth or definitely by the time your baby is a month
old. You may want to delay tummy time until the umbilical cord stump falls off,
but as long as your baby is comfortable, baby can safely participate in Tummy
Time.
Remember: When you put your baby on her tummy,
always place baby on a smooth, flat surface with no loose items (toys,
blankets, pillows) which might block the airway.
Babies often complain about being placed on their
tummy, but if tummy time is begun early (even from just a few days old) and
maintained on a consistent schedule, it will become a part of their daily
routine. Tummy time can improved head
control which is needed for the next stages of development. Tummy time is critical for building muscle
strength in the back, neck and shoulders, strength that children also need to
meet their developmental milestones.
Simply holding and soothing baby in a different position can help
infants become accustomed to tummy time.
How
Frequently and for How Long
There really is no set time for how much time each
day baby should do Tummy Time. Some
research says babies should be prone for 1 hour a day (cumulative, not all at
one time), but there did not seem to be a consensus on amount of time just that
Tummy Time was essential for all babies.
Here are some guidelines to help get your Tummy Time
minutes.
-
at least once per day
-
try for 5-10 minutes several times a day
-
incorporate some Tummy Time into the time baby is being held
-
as baby grows, build up Tummy Time (this is where you can aim for 1 cumulative
hour every day)
Many babies often resist Tummy Time initially. This could be because baby does not have good
control of body and head yet and Tummy Time is a workout. Just remember, just as it was hard to run
that first lap on the track when you first started, practice makes
perfect. Your baby will begin to
tolerate Tummy Time – just keep at it!
How to
Make Tummy Time Fun
Here are
some tips for making Tummy Time more fun (for you and baby
-
When your baby can't support her own head yet, put her on your chest tummy
down. Or put her across your lap on her stomach for burping or to settle her
down instead of holding up at your shoulder.
- Enjoy some together time. Lie down and place your baby
“tummy-to-tummy” or “tummy-to-chest.”
-
Get on the floor with your baby. Interact with your baby – funny faces,
talking, singing.
- Encourage
your baby to look up by talking or singing above her head.
- Place
your baby next to a mirror or musical box -- or something else she’ll want to
reach for.
-
Change your position or position of toy/mirror to encourage head turning and
looking up
-
Place your baby's upper body and arms over a nursing pillow (Boppy pillow) or
rolled up towel. This positioning may
be more comfortable to in the beginning.
- When carrying your baby around the house, carry her tummy-down
instead of upright.
-
If your baby starts to fuss, divert her attention. Turn her on her back, then
blow "raspberries" on her tummy. Flip her onto her stomach and make
the same raucous noises on her back. That’s distraction at its silly best.
-
Waiting an hour or so after feeding may be more comfortable for baby –
preventing less spit up and baby may be
less fussy.
Nice table from American Occupational
Therapy Association3
|
If you want to:
|
Consider these activity tips:
|
|
Make
Tummy Time part of your family’s daily routine.
|
Begin
with short intervals, such as 2 to 3 minutes a day, and work up to at least
20 minutes per day. Daily Tummy Time can be done in short increments or all
in one session, depending on your baby’s tolerance and needs.
Pay attention
to signs that your baby is getting tired, such as crying or resting his face
on the surface, and be sure to end Tummy Time before your baby becomes
fatigued.
Incorporate
Tummy Time into the activities you’re already doing with your baby, such as
towel drying after bath time, changing diapers, or applying lotion.
When
burping your baby, try laying her across your lap on her tummy.
It is
never too early to begin to read to your baby, and Tummy Time is a great
opportunity for storytelling.
|
|
Increase
your baby’s ability to reach and play
|
While
your baby is playing on his belly, hold a toy in front of his face to get his
attention. This will encourage your baby to lift his head and reach. Sit or
lie down in front of your baby during Tummy Time for safety and supervision.
During
Tummy Time, arrange toys in a circle around your baby to promote reaching in
many different directions.
Initiate
eye contact and talk, coo, or sing to your baby while she is on her belly,
because this will attract your baby’s interest and motivate her to
participate.
Your baby
will be encouraged to lift her head, reach, and play when she sees your face
and hears your voice. Get your whole family involved.
|
|
Position
your baby to enjoy Tummy Time.
|
Roll up a
thin towel or blanket to make a bolster that will provide extra support
during Tummy Time. Place the bolster under your baby’s chest, and position
his arms over the roll, with his hands stretching out in front of it. Your
baby’s chin should always be positioned in front of the bolster so that the
airway is not blocked.
Always
supervise your baby during bolstering.
Be sure
your baby distributes his weight evenly on both sides of his body while on
his tummy to strengthen muscles equally.
Limit the
time your baby is constrained in swings, exersaucers, and other baby gear,
and encourage active play to strengthen his muscles through Tummy Time.
|
|
Engage
your baby’s senses.
|
Place a
plastic mirror in front of your baby so she will be interested in lifting her
head to look at her own reflection.
Use
blankets or towels with different textures and colors so your baby can
experience different visual and touch sensations (e.g., switching between a
terry-cloth towel and a fleece blanket).
|
|
Consider
alternatives to “typical” Tummy Time.
|
Positions
for Caregiver:
A great
way to carry out Tummy Time is to place your baby on your stomach or chest
while you are awake and in a reclined position on a chair, bed, or floor.
This is also a great way to begin Tummy Time with a newborn.
Positions
for Baby:
Side-lying
is another positioning option. Position your baby on a blanket on his side,
and support his back with your hand or use a small rolled up blanket. Make
sure both of your baby’s arms are in front of him, and slightly bend his hips
and knees so your baby is comfortable. This position can also aid in reaching
and playing.
|
Tummy
Time Trouble
Tummy
Time is hard work! Not every baby is
going to enjoy laying on their stomach.
Remember that even if baby squawks or whines, it does not mean that baby
does not like it.
What if
your baby is just plain angry about tummy time? KEPP TRYING!!! DON’T GIVE UP!!! The more exposure and practice the
better. Baby will get stronger and
hopefully tolerate the position better in time.
Try to
keep the tips above in mind. Start in
small time segments. Interact and play
with baby during Tummy Time. If your
baby likes routine (most of us do!), try doing Tummy Time every time you change
baby – she will come to expect it and may not resist as much.
If you
see that your baby prefers to hold her head to one side, try to do activities
(make faces, sounds, talking) to encourage her to turn her head to the opposite
side. If you are unable to change the
preference, bring this up with your pediatrician or healthcare
professional. Also, if you have done a
lot of Tummy Time and are concerned baby is not meeting her developmental
milestones (remember there are averages for when babies meet milestones, but
these are not hard and fast rules!), you should feel comfortable letting your
pediatrician know!
Resources
1. Pathways Awareness. National
Survey of Pediatric Experts Indicates Increase in Infant Delays; More Tummy
Time is Key. Accessed at: www.pathwaysawareness.org.
2. Statistics compiled by the Pathways Awareness
Medical Round Table from a variety of sources, including the March of Dimes, Pediatrics
Annual Summary of Vital Statistics, and the Centers for Disease Control and
Prevention
en Espanol
en Espanol
For
more research on Tummy Time see the below articles:
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