What’s In A Breathe?
Breathing; It sounds so simple, but are we doing it right?
Common breath holding patterns (not good) include:
Chest Breathing
Reverse Breathing/Paradoxical Breathing
Collapsed Breathing
Hyperventilation
Dyspnea.
This could lead to:
Chronic tension in upper body, neck, shoulders, back, and jaw
Anxiety, increased stress response (heart disease, hypertension)
Lack of circulation in abdominal area leading to indigestion, heartburn and bloating
Greater difficulty learning movement because basic pattern of breathing (movement) can be upside down
Confused or disoriented state of mind
Learning breathing techniques can assist with energy throughout the day, a calmer state for focusing, managing pain, and easier movement for the body.
Nose Breathing Versus Mouth Breathing:
Through the Nose: air is warmed and humidified, cleaned of dust particles, and cleaned of bacteria
Through the Mouth: more air in during intense physical activity, when trying to inhale quickly, for techniques requiring the deepest exhalation possible, greater ability to vary air flow
What is Normal Respiratory Rate?
Neonatal 30-60
Early Childhood 20-40
Late Childhood 15-25
Adult 12-16
Hyperventilation:
we may not recognize we’re doing it unless it’s in the extreme form. It can be subtle and chronic, and usually happens with chest breathing. As a result, you lose too much CO2...which is necessary for maintaining the right mixture of acid and alkaline, an essential balance for proper cell metabolism (respiratory alkalosis). That can cause marked alterations in the rates of chemical reactions in cells.
Conditions that may be related to hyperventilation:
fatigue
exhaustion
heart palpitations
rapid pulse
dizziness
visual disturbances
numbness
tingling in the limbs
SOB
yawning
chest pain
stomach pain
muscle pain
cramps
stiffness
anxiety
insomnia
nightmares
impaired concentration and memory
Diaphragmatic Breathing, Restorative Yoga, and Meditation are great ways to incorporate good quality breathing. Want to know more? Email us!
Pelvic Organ Prolapse
What is Pelvic Organ Prolapse?
“a departure from normal sensation, structure, or function, experienced by the woman in reference to the position of her pelvic organs”
-The International Urogynecology Association (IUGA) and the International Continence Society (ICS)
Descent or herniation of pelvic organs from normal attachment sites or normal position in the pelvis into the vagina or beyond.
Isolated or global
Muscular, ligament and fascia weaknesses
Stages:
“Prolapse stage ≥2 has been demonstrated among 37% of women presenting for annual gynecologic examinations. It seems to make little sense to define something as stage 1 or 2 of a disease process that is very common, benign, and not predictive of symptoms or progression.”
-Dietz & Mann 2014
Etiology:
POP can be acquired by Trauma, abdominal pressures, pregnancy. It can also be congenital secondary to connective tissue defect, or neurologic defect. It may also be a part of the aging process due to loss of hormones.
It is estimated that POP is associated with Stress Urinary Incontinence (leakage of urine) in 40% of the cases.
Risk Factors:
Obesity BMI > 25
Hysterectomy
Previous prolapse surgery
Defective connective tissue
Denervation
Myopathy leading to wide levator ani hiatus
Increasing age
Chronic cough (allergies/asthma/smoking)
Constipation and straining § Family history of POP
Signs of a connective tissue disorder (hemorrhoids, hernias)
Heavy occupational
Vaginal delivery (especially forceps delivery)
Treatment:
Pessaries- Prosthetic devices to help assist internal structure
Behavioral: Weight Loss, Smoking Cessation, Decrease straining with activity modification
Pelvic Floor Rehabilitation uses exercises and evidence based methods
Surgeries to restoration normal anatomy
To get treated by a professional that has advanced training in this field, ask if your healthcare professional (nurse, PA, MD, OT, PT, or NP) is BCIA Board Certified.
To ask us more questions, email us at smplytherapy@gmail.com
Helping Kids Regulate Behaviors
Long story short; Occupational Therapists help people recover and regulate. Among the psychosocial conditions, anxiety disorder is the third prevalent mental disorder affecting children aged 3-17 years (CDC, 2019). So our mindset is built around evaluating the situation and helping people adapt. Here are some tips to help those little ones (and even adults) regulate:
Sleep is Key
Keep a night routine to keep consistent
Comfortable bedding. This may include a weighted blanket at first, but we don’t recommend weighted blankets all night.
Calming Music/Lights
Having the child sleep in their own bed, a tent over the bed may make it more fun.
Body pillows can help with giving your child some comfort.
Nutrition
Eating healthy is important for function.
If you have major concerns about your child’s limited food repertoire or “picky eating” seek out a therapist who is trained.
Children are recommended to have 10 sources of protein, 10 fruits/veggies and 10 other/starches
Making a total of about 30 different foods
Helping Regulate You Child
It sounds simple; but watch their facial expressions and body language.
Try not to overwhelm with an activity, possibly ending up in a shutdown.
On the other hand, also try to pay attention to their arousal level. Limit an activity that’s getting them so wound up that it’s hard to get them back down.
If they’re at a meltdown, try calming activities that seem to work for them.
Where does OT Play a part?
OT’s are a great resource for therapy for implementing evidence-based mental health promotion for: Emotional Regulation, Executive Functioning, Mindfulness, Yoga and more!
If you have questions, please feel free to reach out to us at smplytherapy@gmail.com
Guest Post: Strategies for Forming a New Habit
Today, we really have a treat. We have a guest post by: Vincent Balestrieri from the Autism Movement Project
BJ Fogg is a Stanford professor who studies habit formation. People have difficulty developing new, healthy habits for a variety of reasons. One strategy that I've found particularly useful is to pair a new habit with a specific time and location. In the winter of 2019 I decided that I wanted to practice yoga and meditation daily as opposed to a few times a week which I had been doing for years prior. It's now been two years and I've been extremely consistent in my practice, missing only a few days each year. One strategy that helped me get into the habit and also remain consistent is pairing my practice with a specific time and location. I practice every night before bed (time) and my mat stays rolled out on the floor in my room (location). Keeping the mat rolled out also minimizes the effort required to engage in the behavior and is an environmental cue to practice. It's difficult to form a new habit when too much effort is required. It is also difficult to form new habits when a task is perceived as too difficult. For that reason, I shifted my daily practice to 30 minutes as opposed to the 90 minute classes I was taking 2-3 times weekly prior to that. I knew that 90 minutes daily was an unrealistic expectation and would likely lead to me giving up on daily practice. These concepts are not only simple, but they're also generalizable and applicable to many habits. Think about how you might employ some of these strategies to a new behavior or habit you'd like to engage in. In my experience, a well thought out strategy with an environment set up for success trumps motivation or determination.
What is Pediatric Teletherapy?
I still remember the first time I heard about Teletherapy (sessions via video); It was about 5 years ago and a coworker was talking about doing it part time for speech therapy. My first instinct was, how does that help kids?!
Many things that happened in 2020 seemed unimaginable to our 2015 selves, but here we are! There are many pros to teletherapy, I can’t say it’s for everyone but for many families it allowed for a closer educational relationship with the therapist. A huge part of Occupational Therapy focuses on training parents and families to assist their child progression, and doing teletherapy facilitated that.
So let’s go though some activities for great (middle school aged) teletherapy sessions!
Meme writing: You can share a funny picture to start. They can work on typing or writing, and it also works on executive functioning.
Online Games:
Bamboozle.com
https://jeopardylabs.com/
Escape Room: You can share a google doc, powerpoint or a word document. Some activities can be solving trivia, gross motor activities, fine motor activities, locating items.
Fantasy Sports Team: This is great for kids that are into sports, they can choose players. Names and stats can be listed on a shared word document. They can also add mascot, colors, uniforms, stadium name if they like.
Virtual Field Trip: The student can choose country, landmark or venue to tour. They can add pictures and videos to a google slide or power point and present to Field Trip Participants (OT, teacher, family members).
Newsletter: On a shared document, the student can research a topic (ex: sports trivia, gaming tips, recipes) and write a report.
If you need more ideas or you would like to schedule a consult, please email us at smplytherapy@gmail.com.
OT for Newborns
Believe it or not… Occupational Therapy can start the day that a child is born! In hospital settings, many children that are born prematurely end up receiving services due to their early start out of the womb. There are NICU OT’s that work in hospitals to help parents with NICU babies connect and care for their little ones, and we also provide services once their home.
SMPLY OT doesn’t have NICU services just yet, but we do often see little ones that are younger than three. As with most of the age category of children 0-3, this age group treatment comes with a “parent training” model. This just means that a lot of our treatment will include education with the parents, teaching different techniques and exercises to get their child’s development accelerated!
The sooner the better.
With Occupational Therapy; The sooner you seek treatment, the better. It may be a minor delay in physical development that the pediatrician refers to OT for. But as time goes on, our little ones get bigger, with a larger spectrum of developmental milestones to reach. So that little 4 mo old may only need to work on tummy time and adaptive positions to be taught by the OT to reach their developmental level; But once they turn one and they are having trouble standing or taking side-steps, it may be more hurdles to meet to get up to speed.
Tummy Time ASAP!
One of the first exercises your child experiences. And you can start the day you bring your baby home from the hospital. Neck muscles that are addressed during tummy time are necessary for your baby to sit upright for play, and eventually start crawling, standing and walking. Once they can hold their head up, the other pieces of development start falling into place.
Some Great Toys for Tummy Time:
Mirrors - It can be a little one from the toy department, or it can be a long mirror you already have at home to help motivate that little one to hold their head up.
Rattle - It’s a classic and is great for newborns, the auditory and colorful stimuli really gets babies engaged.
Colorful ball - You can use this for your baby to watch go from one side to another. This may be good for babies who are able to lift up their chest a little and are almost starting to reach.
If you need more ideas, you can always reach out to us at smplytherapy@gmail.com!
Valentine's Day and Chinese New Year Activities
Even if you’re not the most spirited person to celebrate; these activities are just another way to get creative with your little one! We have a couple holidays this week- Lunar New Year and Valentine’s Day. Two very different celebrations but we figured we’d give you some ideas to have fun this week.
For Valentine’s Day Celebrations
Celery Heart Stamps: Use the ends of the celery stick as a stamp to dip into red or pink paint for a heart felt painting.
Ribbon Valentine: Something about Valentine’s always makes me flash back to Billy Madison getting one from Principal Anderson. Since kids are less likely to be able to pass it along to classmates, make ones at home for family members! You can use pieces of already used ribbon from Christmas to paste onto a heart, for a striped design.
Valentine Name Puzzle: This is a double task; they can make the valentine with their name displayed across it. Then if you draw jagged lines across or even in squares, they can put it back together like a puzzle!
Paper Heart Mobile: Use different colored construction paper to cut outlines of hearts, then attach them upright onto a string hanging from the ceiling.
Valentine Collages: if you have colored tissue paper, and a paper plate- make a collage! Add your own design by cutting the tissue paper into pieces that you can glue onto the paper plate. Then cut out a hearth to display on the window sill.
For the Lunar New Year Celebrations
Red Envelopes: This might be for the older kids, or adult assistance. https://www.firstpalette.com/craft/chinese-red-envelope.html
Paper Fans: You’ll need 3 5X8 inch pieces of paper, two craft sticks and an tiny hairband. Here are some instructions with pictures: https://www.littlepassports.com/craft-diy/chinese-new-year-craft/
Paper Lanterns: This is another activity that will require some adult assistance if for the younger kids. Here is a great how-to site https://www.firstpalette.com/craft/paper-lantern.html.
Printable Chinese Zodiac Animals: Here’s a Free Printable! https://funcraftskids.com/wp-content/uploads/2020/12/12-Chinese-Zodiac-Coloring-Pages.pdf
For more fun ideas, you can always email us at smplytherapy@gmail.com!
Let’s Talk About Tennis Elbow (Lateral Epicondylitis)
This isn’t just for tennis players. But if you’ve ever swung a tennis racket, you’ll understand the motion that limits people with this condition. It’s that back-swinging motion when your elbow straightens and the arm extends; aka a backhand
Usually it stems from overuse due to repetitive motion, and other trauma to the upper extremity; typically from the work setting. Ergonomics and physical demands of your workspace is highlighted on this topic because many of our injuries that are more insidious, are probably from micro-injuries over time.
It’s one thing if you got into a bike accident and have pain from a traumatic event; that would be pretty clear on how/when you got injured. But many people have pain that come and go, with conditions that worsen over time and unsure exactly when it started. Lateral Epicondylitis is typically more like the latter set of symptoms. Hence, the nickname… tennis players have a very similar swing that repeats when playing, and the repetitive movement over time causes the appearance of the injury.
However, not all those that play tennis get tennis elbow, and not all that have tennis elbow play tennis. For anyone like me who has never picked up a tennis racket, it probably stems from an activity that you spend a lot of time doing with repetitive motions, like working at a desk.
If a person is experiencing pain in their elbow, they can contact their doctor who will then refer out to an Occupational Therapist. We do a series of assessments to evaluate how you’re affected by this condition functionally, strength, and pain severity. For treatment we will be giving a home program of exercises, provision of protective equipment or orthotics to facilitate healing, and clinic exercises/modalities.
What I appreciate about the Occupational Therapy profession is that we treat the patient as a whole, and want to incorporate good habits to speed up your healing. We don’t just look at your strength and give rote exercise, and send you on your way. We will educate you on what is happening in your body, give suggestions for sleep positions, body mechanics for work to reduce strain on your body. We can also recommend pain management techniques without medication treatment.
If you have questions, or may need Occupational Therapy Intervention contact us at (201) 777-0856 or book a free consult with us.
What is Sensory Diet?
A sensory diet is a set of activities that make up a sensory strategy and are appropriate for an individual’s needs. These are specific and individualized activities that are scheduled into a child’s day and are used to assist with regulation of activity levels, attention, and adaptive responses. It has nothing to do with food!
Why use a sensory diet?
It can be very motivating for a child and help them participate in activities. It's a means to adjust sensory input in relation to an individual’s needs. Based on the the child, we will prescribe some activities to incorporate into your routine. As we evaluate what activities are meaningful and motivating for your child, we will curate a child centered approach that is unique to your child.
Just as a healthy diet consists of a spectrum of foods, a sensory diet is a balanced set of sensory information that allows an individual to function. A person cannot survive on broccoli alone. Similarly, a child cannot thrive with only one type of sensory activity.
This goes for adults and children alike; we all need different types of input in order to feel balanced; part of the reason quarantine restrictions are not great for most individuals. Our bodies and minds instinctively know that varying sensory input allows us to function appropriately. However; children may have a harder time regulating and identifying what their bodies need. That's when OT's come in.
Studies support the use of active participation in multi-sensory activities for at least 90 minutes per week to improve occupational performance (Fazlioglu &Baran, 2008; Thompson, 2011; Woo & Leon, 2013; Wuang, Wang, Huang, & Su2010).
GOALS OF A SENSORY DIET ARE TO:
Provide the child with predictable sensory information which helps organize the central nervous system. Support social engagement, self-regulation, behavior organization, perceived competence, self-esteem, and self-confidence. Inhibit and/or improve modulation of sensation within daily routines and environments. Assist the child in processing a more organized response to sensory stimuli.
If you want to learn more, schedule a free consult with us here
Trigger finger
This new lifestyle of staying at home has it’s pro’s and con’s. I have saved some mileage on my car lease, and gas money has gone towards take-out food (support small businesses!). I have also been able to take many more continuing education courses online throughout the year, helping me understand different diagnoses and the new research that has come out since I’ve been in school; This week I wanted to talk about a lesser known diagnosis called Trigger Finger.
It’s something that affects 2-3% of the general population, and most common in middle aged women. What happens is, there may be a stiffness, triggering, clicking or catching of the finger when extending a digit; limiting the use of your finger. It usually affects the dominant hand, ring and long fingers most commonly, and there’s an increased incidence with comorbidities like Rheumatoid Arthritis, Diabetes, and Carpal Tunnel Syndrome.
There are stages to Trigger Finger, so if not addressed with your doctor or Occupational Therapist, it can worsen. Early stages result in the clicking or catching of the finger, then patients may find it hard to open (extend) the finger as it progresses. The reason that your finger may be locking/clicking is because there is inflammation or a nodule preventing your finger from moving freely through the tendon sheath ( tunnel for your tendon to run through).
An Occupational Therapist will treat those with this condition to improve their use of hand. We will evaluate your hand, strength, and how it affects your daily activities. After evaluation, we will build a plan of care to improve your condition with activity modifications, orthotic management and other techniques to treat your unique injury. Orthotic management is a large part of this treatment; research shows that it is 73-93% effective for Trigger Finger, with a wearing schedule for about 3-12 weeks depending on your severity. Your Occupational Therapist will work with you to provide the best orthosis for your lifestyle, and your budget.
If you have any questions about Occupational Therapy services, and would like to speak to us; contact us here for more information.
Why Virtual?
Going all in for holiday decor has been my go-to coping strategy for this second wave, and I don’t think I’m the only one. I've seen a lot more houses lit up this year, and I could hardly find Christmas lights (in November?!). It doesn’t completely make up for the darkness at 4 PM, but it helps stay positive and appreciate having something to look forward to! As we enter a new phase of COVID-19, many of us are spending the holidays a little differently to keep our families safe. So I wanted to take some time out to talk about how virtual (teletherapy) Occupational Therapy is still a great way to keep families in a healthy routine.
I know; why would I pay (or use my insurance for) my child when you (the parent) have to do all the work? Many of you that have participated in Occupational Therapy can understand that sessions have great outcomes when the child not only shows up to their sessions, but when the families take a role in supporting the OT’s efforts. We are not miracle workers; and our sessions are not the only time that families work on Occupational Therapy goals. It’s like going to the doctor; they see you with the understanding of underlying issues that may be causing your complaint- give you a recommendation whether it's medication, going for more testing, and you follow through with the treatment. Your infection won’t improve unless you contact your pharmacist for antibiotics, and your child won’t experience improvements without parental assistance. Occupational therapists are however the specialists in understanding many factors that go into difficulty with adverse behaviors, sensory processing, or difficulty with meeting developmental milestones.
What does virtual treatment look like?
Depending on your child’s difficulties, we customize an evaluation and plan of care to help you and your family. We use different sources and materials at home; we have gotten very creative with household products to make treatment fun and manageable. We don’t want families to feel anymore stressed than necessary, so let us know what you have available at your home and we’ll make it work! We also take the time to educate you about your child’s condition and how to target specific skills that may need improving. The families that I see the most improvement with are the ones that are motivated to learn about their child, that’s one of the most important things. Virtual or not. We will guide you the rest of the way.
Let us know if you have any concerns with child behavior, we’re happy to talk to you directly and we are taking insurances. Book your OT consultation here.
Cryo/Cold Therapy - How Does It Really Work?
As an evidenced based practice, we want to take some time today to report on the new research behind those cryo/cold therapy techniques! You may have started to hear about cold water immersion or athletes that jump into ice baths after intense training; but how does it hold up in research?
Occupational Therapy practices in outpatient and acute settings (hospitals and clinics) may use these modalities to help with musculoskeletal injuries for decreasing inflammation and helping with pain. The cryotherapy body of evidence is large with moderate to weak evidence supporting most of the treatments. However, there are some studies that reported inconclusive results. Here are some recent (within the past 6 years) reviews of research regarding cryotherapy.
Note: The review of studies report information found in research, this is not a recommendation for treatment intervention without the guidance from a professional healthcare practitioner.
Cryotherapy
Q: Does cryotherapy alter tissue healing and repair?
A (+): Cryotherapy does not alter tissue healing and repair
Three research studies support that it does not alter tissue healing and repair. (2020- Peake et al. Frontier in Physiol, 2017- Singh et al. Frontier in Physiol, 2016- Vieira et al. Sci Rep)
A (-): Cryotherapy negatively alters tissue healing and repair
2020- Fuchs et al. J Physiol.
2020- Chaillou et al. J Physiol.
Q: Should athletes return to activity after cryotherapy?
A (-): Cryotherapy can adversely affect performance if athletes immediately return to activity. Progressive warmup is warranted.
2014- Prichard and Saliba. J Athl Train 60 09/10/20 Cryotherapy
Q: Does cryotherapy improve joint range of motion (ROM), strength, and neuromuscular control among healthy individuals?
A (+): Cryotherapy had positive results for all outcomes
2020- Kalli et al. J Bodw Mov Ther (review)
Q: Does cryotherapy decrease pain and increase function after musculoskeletal injury or pathology?
A (+): Cryotherapy had positive results for all outcomes
2019- Hsu et al. J Orthop Trauma (review)
2019- Sari et al. Pain Res Manag
2015- Malanga et al. Postgrad Me
A (-): Cryotherapy had inconclusive results
2019- Dantas et al. J Physiother
2019- Dantas et al. Clin Rehab (review) 61 09/10/20 Cryotherapy
Q: Does cryotherapy effect postural stability?
A (-): Cryotherapy adversely affects posture stability at the ankle.
2015- Fullan et al. J Athl Train
A (+): Cryotherapy does not effect posture stability at the knee.
2019- Fullan et al. J Sport Rehabil
Q: Does cryotherapy reduce pain and improve function after surgery?
A (+): Cryotherapy had positive results for all outcomes
2019- Larsen et al. J Oral Rehabil (review) (oral)
2019- Karaduman et al. Medicina (TKA) 62 09/10/20 Cryotherapy
Q: Does cryo-compression reduce pain and improve function after surgery?
A (+): Cryo-compression had positive results for all outcomes
2018- Nabiyev et al. Neurspine (spine)
2016- Secrist et al. AM J Sports Med (review) (ACL)
Cold Water Immersion
Q: Does cold water immersion (CWI) improve post-exercise muscle adaptation and muscle contractility?
A (-): CWI delays post-exercise adaptations
2020- Earp et al. Pharmaceutics
A (-): CWI delays muscle contractility after treatment
2020- Mur Gimeno et al. Sensors
Q: Does CWI enhance post-exercise recovery?
A (+): CWI enhances post-exercise recovery
2020- Gimeno et al. Sensors
2019- An et al. Int J Environ Res Public Health (review)
2018- Futado et al. Braz J Med Biol Res
2017- Higgins et al. J Strength Cond Res (review) 64 09/10/20 Cold Water Immersion
Q: Is CWI better than whole body cryotherapy (WBC) for post-exercise recovery?
A (+): CWI is better that WBS for recovery
2017- Abaidia et al. Int J Sports Physiol Perform
2017- Mawhinney et al. Med Sci Sports Exerc
Q: Is CWI better than contrast for post-exercise recovery?
A (+): CWI is better that contrast for post-exercise recovery
2017- Higgins et al. J Strength Cond Res (review)
Q: Is CWI better than ice cups for post-exercise recovery?
A (+): CWI is better that ice cup massage for post-exercise recovery
2016- Adamczyk et al. J Therm Biol
Other Cryotherapies
Q: Does WBC enhance post-exercise recovery?
A (+): WBC may have positive short-term recovery effects
2020- Louis et al. Eur J Appl Physiol
2020- Sliwicka et al. Sci Rep
2017- Mawhinney et al. Med Sci Sports Exerc
2017- Russel et al. J Strength Cond Res
A (-): WBC has no benefits for post-exercise recovery
2019- Broatch et al. Sci Rep
Q: Does Vapocoolent spray work?
A (+): Vapocoolent spray and stretch shows positive effects
2020- Koole et al. J Prosthet Dent
2008- Kostopoulos & Rizopoulos. J Bodw Mov Ther 66 09/10/20
Bottom Line
Occupational Therapist Considerations
Cryotherapy may:
Delay tissue healing and post-exercise recovery
Delay muscle contractility and impair postural stability
Improve pain, ROM, and function after strenuous exercise, injury, or surgery.
CWI seems to have the strongest evidence followed by the emerging WBC
Want to learn more about Cryo / Cold Therapy? Email Us!
References:
Abaïdia AE, Lamblin J, Delecroix B, et al. Recovery From Exercise-Induced Muscle Damage: Cold-Water Immersion Versus Whole-Body Cryotherapy. Int J Sports Physiol Perform. 2017;12(3):402-409.
Adamczyk JG, Krasowska I, Boguszewski D, et al. The use of thermal imaging to assess the effectiveness of ice massage and cold-water immersion as methods for supporting post-exercise recovery. J Therm Biol. 2016;60:20-25. An J, Lee I, Yi Y. The Thermal Effects of Water Immersion on Health Outcomes: An Integrative Review. Int J Environ Res Public Health. 2019;16(7).
Babaei-Ghazani A, Shahrami B, Fallah E, et al. Continuous shortwave diathermy with exercise reduces pain and improves function in Lateral Epicondylitis more than sham diathermy: A randomized controlled trial. J Bodyw Mov Ther. 2020;24(1):69-76.
Block JE. Cold and compression in the management of musculoskeletal injuries and orthopedic operative procedures: a narrative review. Open Access J Sports Med. 2010;1:105-113.
Broatch JR, Poignard M, Hausswirth C, et al. Whole-body cryotherapy does not augment adaptations to high-intensity interval training. Sci Rep. 2019;9(1):12013.
Cameron MH, Sutkus A. Physical Agents in Rehabilitation - E Book: An Evidence-Based Approach to Practice. Elsevier Health Sciences; 2017.
Chaillou T, Treigyte V. Cold water immersion puts the chill on muscle protein synthesis after resistance exercise. J Physiol. 2020;598(6):1123-1124.
Cho YS, Choi YH, Yoon C, et al. Factors affecting the depth of burns occurring in medical institutions. Burns. 2015;41(3):604-608.
Dantas LO, Breda CC, da Silva Serrao PRM, et al. Short-term cryotherapy did not substantially reduce pain and had unclear effects on physical function and quality of life in people with knee osteoarthritis: a randomised trial. J Physiother. 2019;65(4):215-221.
Dantas LO, Moreira RFC, Norde FM, et al. The effects of cryotherapy on pain and function in individuals with knee osteoarthritis: a systematic review of randomized controlled trials. Clin Rehabil. 2019;33(8):1310-1319.
Dehghan M, Farahbod F. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. Journal of clinical and diagnostic research : JCDR. 2014;8(9):LC01-LC04.
Devrimsel G, Turkyilmaz AK, Yildirim M, et al. The effects of whirlpool bath and neuromuscular electrical stimulation on complex regional pain syndrome. J Phys Ther Sci. 2015;27(1):27-30.
Earp JE, Hatfield DL, Sherman A, et al. Cold-water immersion blunts and delays increases in circulating testosterone and cytokines post-resistance exercise. Eur J Appl Physiol. 2019;119(8):1901-1907.
Engelhard D, Hofer P, Annaheim S. Evaluation of the effect of cooling strategies on recovery after surgical intervention. BMJ Open Sport Exerc Med. 2019;5(1):e000527.
Fu T, Lineaweaver WC, Zhang F, et al. Role of shortwave and microwave diathermy in peripheral neuropathy. J Int Med Res. 2019;47(8):3569-3579.
Fuchs CJ, Kouw IWK, Churchward-Venne TA, et al. Postexercise cooling impairs muscle protein synthesis rates in recreational athletes. J Physiol. 2020;598(4):755-772. 102 09/10/20
Fullam K, Caulfield B, Coughlan GF, et al. Dynamic Postural-Stability Deficits After Cryotherapy to the Ankle Joint. J Athl Train. 2015;50(9):893-904.
Furtado ABV, Hartmann DD, Martins RP, et al. Cryotherapy: biochemical alterations involved in reduction of damage induced by exhaustive exercise. Braz J Med Biol Res. 2018;51(11):e7702.
Garra G, Singer AJ, Leno R, et al. Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy. Acad Emerg Med. 2010;17(5):484-489.
Harrison LE, Pate JW, Richardson PA, et al. Best-Evidence for the Rehabilitation of Chronic Pain Part 1: Pediatric Pain. J Clin Med. 2019;8(9).
Hawkins SW, Hawkins JR. CLINICAL APPLICATIONS OF CRYOTHERAPY AMONG SPORTS PHYSICAL THERAPISTS. Int J Sports Phys Ther. 2016;11(1):141-148.
Higgins TR, Greene DA, Baker MK. Effects of Cold Water Immersion and Contrast Water Therapy for Recovery From Team Sport: A Systematic Review and Meta-analysis. J Strength Cond Res. 2017;31(5):1443-1460.
Hsu JR, Mir H, Wally MK, et al. Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury. Journal of Orthopaedic Trauma. 2019;33(5):e158-e182.
Im SH, Han EY. Improvement in anxiety and pain after whole body whirlpool hydrotherapy among patients with myofascial pain syndrome. Ann Rehabil Med. 2013;37(4):534-540.
Kalli K, Fousekis K. The effects of cryotherapy on athletes' muscle strength, flexibility, and neuromuscular control: A systematic review of the literature. J Bodyw Mov Ther. 2020;24(2):175-188.
Karaduman ZO, Turhal O, Turhan Y, et al. Evaluation of the Clinical Efficacy of Using Thermal Camera for Cryotherapy in Patients with Total Knee Arthroplasty: A Prospective Study. Medicina (Kaunas). 2019;55(10).
Koole P, Zonnenberg AJJ, Koole R. Spray and stretch technique and its effects on mouth opening. J Prosthet Dent. 2020;123(3):455-460.
Kostopoulos D, Rizopoulos K. Effect of topical aerosol skin refrigerant (spray and stretch technique) on passive and active stretching. J Bodyw Mov Ther. 2008;12(2):96-104.
Kuyucu E, Bülbül M, Kara A, et al. Is cold therapy really efficient after knee arthroplasty? Ann Med Surg (Lond). 2015;4(4):475-478.
Kwiecien SY, O'Hara DJ, McHugh MP, et al. Prolonged cooling with phase change material enhances recovery and does not affect the subsequent repeated bout effect following exercise. Eur J Appl Physiol. 2020;120(2):413-423. FLarsen MK, Kofod T, Starch-Jensen T. Therapeutic efficacy of cryotherapy on facial swelling, pain, trismus and quality of life after surgical removal of mandibular third molars: A systematic review. J Oral Rehabil. 2019;46(6):563-573.
The Importance of Postpartum Ergonomics
Ergonomics is a specialty in the Occupational Therapy practice that’s becoming more widely discussed. For good reason. As we all become more aware of our positioning for work related tasks and become more aware of how the way we sit at a computer desk can result in micro-injuries over time; it makes us better able to handle the workload that comes with a full-time job. What ergonomics is typically related to is work; but not many people relate it to one of the most popular jobs in the world -being a parent!
There’s a huge change in your body post-child birth. There is more of a holistic perspective needed in caring for a new mom and their child during that first year (perinatal period), with “mother-centered” solutions. Improving women’s health will in turn improve infant health, but sometimes it’s hard for moms to seek help.
Physiological Risk Factors:
Soft tissue edema, Ligament laxity – relaxin & estrogen production
Weight gain (+ ligament laxity = joint discomfort)
Weakened core muscles: Abdominals, pelvic floor
Sleep deprivation
Shift in center of gravity
Emotional stress of new role (plus other roles).
Postpartum stress can result in anxiety, fatigue, and decreased self care; which can lead to increased risk of physical and mental illness>impacting the wellness of the whole household. There is a connection between body posture, pain and Postpartum Depression (PPD); mental and physical symptoms & changes are interdependent. To counteract the symptoms of PPD, there’s a connection between exercise/wellness interventions & PPD prevention.
“Using an evidence-based approach, occupational therapy practitioners can contribute to preventing pain, increasing function, and promoting meaningful occupations during pregnancy and the postpartum period.” OT practitioners are seeing women during the perinatal period in clinics with musculoskeletal diagnoses. Women expect pain/discomfort during the perinatal period – but may not talk about it. OT can address issues preventatively via health promotion.
Common Risk Factors are:
Forceful Exertions
Repetitive Activity
Awkward or Static Positioning
Contact Stress
Research Study: Sit et al. (2017) study of 259 Chinese women
57% reported wrist pain after childbirth
Few new mothers had increased risk within first 8 weeks due to lack of experience of demands of childcare tasks
Hypothesis that other factors were baby’s size, breastfeeding, and attending antenatal classes
Wrist/Thumb Positioning Tips
Avoid the “L” position (wrist bent back)
Keep a neutral wrist (not bent, more straight)
Use larger joints/muscles
Loosen your grip
Posture Tips
There are ‘normal’ curves in your back
These curves MUST be maintained (especially the lumbar or low back)
Neutral to anterior pelvic tilt
DO bend at your hips (and knees)
DO NOT bend at your waist
Feeding
Breast or Bottle
Try to get comfortable before baby latches
Choose a comfortable ‘seat’ § Consider footrest
Maintain lumbar curve of spine
Avoid cervical flexion
Neutral or anterior pelvic tilt
General Suggestions
Look at grip and wrist position
Look at environment: height of objects, reach, arrangement of items
Decrease frequency of lift/hold/carry
Encourage independence, get help when available, get cooperation from child
Decrease stress/strain of task
Consider mood/behavior of child
Stretch during the day
Strengthen in preparation for childcare tasks
If you have more questions, I would love to discuss them with you! Please feel free to email me at smplytherapy@gmail.com.
Expressive Art in OT
"Expressive Art is a process by which various art modalities are used as a catalyst for creative expression to enhance personal growth, awareness and healing."
We’re not talking about fine art; and using a piece to necessarily express yourself. Expressive art focuses on the process, and uses the technique for improvement. This includes;
Visual arts
This includes painting, drawing, sculpting, pottery, photography, printmaking, crafts and scrapbooking. There’s supportive evidence that says these types of art increases sensory input. Fingers and hands have tons of nerve endings which transmit to the cerebral cortex, enriching the sensory experience to help children with motor development. It also helps with self of self, self esteem and perception of control over a situation. Helps with perceptual skills, global cognitive function, and helps reduce cognitive decline in older adults with Dementia.
Drama & Storytelling
Projective play with dolls or puppet helps kids with creating a comfortable atmosphere to express feelings of the play subject (kind of like “asking for a friend,” but for kids). There’s also purposeful improvisation; where the child acts out a situation that may be relatable. This will help them with expressing themselves, because the character portrayed is typically themselves. Scripting may be used to help with speech related issues like Aphasia, where a client reads from a script of a favorite movie/show or song. Research shows that drama and storytelling results in improvements in self-worth, overcoming self-imposed limitations, and in self-advocacy. Props are less antagonistic and threatening, and can aid in communication. Multi-sensory storytelling can be used to improve retention and recall for individuals with intellectual disability.
Dance and Movement
Improves strength, balance, and proprioception with kinesthetic activity
Reduces depressive symptoms
Slows cognitive decline
Activates motor neurological brain regions to improve muscle memory
Reduces fall risk
Stimulates communicative capacities through shared experiences in dance
Music and Singing
Increase neuroplasticity
Enhance alertness, leading to improved attention and memory
Decrease depressive symptoms and improve motivation
Activate multiple parts of the brain, fostering dendritic sprouting and synaptic plasticity
The way Occupational Therapists can blend this into practice is to use some of the visual arts for table top activities, role play different situations (short story), role playing, using a mirror to show dance movements, expressive writing. Contact us for creative occupational therapy sessions!
References
Dunphy, K., Baker, F. A., Dumaresq, E., Carroll-Haskins, K., Eickholt, J., Ercole, M., Kaimal, G., Meyer, K., Sajnani, N., Shamir, O., & Wosch, T. 2019. Creative Arts Interventions to Address Depression in Older Adults: A Systemic Review of Outcomes, Processes, and Mechanisms. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2018.02655 2. Malyn, B. O., Thomas, Z., & Ramsey-Wade, C.E. (2020) Reading and writing for well-being: A qualitative exploration of the therapeutic experience of older adult participants in a bibliotherapy and creative writing group. Counseling and Psychotherapy Research. https://doi.org/10.1002/capr.12304 3. Masika, G., Yu, D.S.F., & Li, P. W. C. (2020) Visual art therapy as a treatment option for cognitive decline among older adults. A systemic review and meta-analysis. JAN, https://doi.org/10.1111/jan.14362 4. Matos, A., Rocha, T., Cabral, L., & Bessa, M. (2015). Multi-sensory storytelling to support learning for people with intellectual disability: an exploratory didactic study. Procedia Computer Science, 67. 12-18. doi: 10.1016/j.procs. 2015.09.244 5. Morris, J., Toma, M., Kelly, C., Joice, S., Kroll, T., Mead, G., & Williams, B. (2015). Social context, art making processes and creative output: a qualitative study exploring how psychosocial benefits of art participation during stroke rehabilitation occur. Disability and Rehabilitation, 38(7), 661-672. https://doi.org/10.3109/09638288.2015.1055383 6. Nguyen, M.A, Truong, T.K.O, & Le, T.H.D. (2016). Art therapy in combination with Occupational therapy in supporting children with special needs. The Vietnamese Journal of Education, 50-52. ISSN: 2354 0753 7. Osman, S. E., Tischler, V., & Schneider, J. ‘Singing for the Brain’: A qualitative study exploring the health and well-being benefits of singing for people with dementia and their carers. Dementia, 15(6), 1326-1339. DOI: 10.1177/1471301214556291
Roswiyani, R, Kwakkenbos, L, Spijker, J., & Witteman, C. L. M. 2017. The Effectiveness of Combining Visual Art Activities and Physical Exercise for Older Adults on Well-Being or Quality of Life and Mood: A Scoping Review. Journal of Applied Gerontology, 38(12), 1784-1804. 9. Schlaug, G. 2016. Chapter 81 – Melodic Intonation Therapy. Neurobiology of Language, 1015-1023. https://doi.org/10.1016/B978-0-12-407794-2.00081-X 10. Skidmore ER, Butters M, Whyte E, Grattan E, Shen J, Terhorst L. Guided Training Relative to Direct Skill Training for Individuals With Cognitive Impairments After Stroke: A Pilot Randomized Trial. Arch Phys Med Rehabil. 2017;98(4): 673-680. doi:10.1016/j.apmr.2016.10.004 11. Vik, B., Skeie, G., & Specht, K. (2019). Neuroplastic Effects in Patients With Traumatic Brain Injury After MusicSupported Therapy. Frontiers In Human Neuroscience, 13. https://doi.org/10.3389/fnhum.2019.00177 12. Whale, Rosann. "ARTs Story." https://www.arts-story.com/expressive-arts/ 13. Yuen, H. K., Mueller, K., Mayor, E., & Azuero, A. 2011. Impact of Participation in a Theatre Programme on Quality of Life among Older Adults with Chronic Conditions: A Pilot Study. Occupational Therapy International, 18(4), 201-208. https://doi.org/10.1002/oti.327
Primitive Reflexes in Child Development - Part 2
We’ve discussed Primitive Reflexes in previous blogs, today I’m going to get a bit more in depth. Before we talk about Primitive Reflexes, let's go back to neuro 101. The brain has different parts called the brain stem (kind of like the stem of a flower), the cerebellum, and the cortex (the large part). The lower structures develop first (brain stem), then the higher structures (cerebellum and cortex). When a baby is born, the brain is immature. The brainstem is the most mature, and regulates most of the baby’s functioning with almost automatic functions. This includes breathing, heart rate, and primitive reflexes. It’s like the baby’s functioning is on auto-pilot early on. As the baby learns about his or her environment and develops during the first year; the brain stem starts relinquishing more and more control to the other parts of the brain. Within the first year, the brain stem fully matures.
Movement!
The prefrontal cortex matures much later, not until a person is in their mid 20’s does it fully mature through movement and interaction with the environment. It’s also a use it or lose it type phenomenon; which makes it so important for children to receive information from the environment to their senses to react and move. This exchange of information creates changes in the brain and in the body systems. As your baby learns how to be in control of their bodies, the brain stem gives up some control to higher parts of your brain (cerebellum and cortex).
Think of your brain as a theater:
The upper level of the brain is the stage. You only notice what’s on stage during a performance; similar to your learning, planning, rational thinking.
The brain stem and cerebellum is like the backstage crew. Working behind the scene to make sure everything runs smoothly.
Primitive Reflexes
Develop in utero
Assist the birth process
Disappear (typically) within the first year, and replaced by adult reflexes
Are a test to the maturity of your central nervous system
Are strong, may interfere with development and function of the rest of the brain
Children have these reflexes for a reason, to help them through the birth canal and to help them adjust to a totally new environment (outside the womb). Reflexes are for survival until they learn to adjust. Unfortunately, they can interfere with development and function of the rest of the brain past a certain age.
We’ll go through each Primitive Reflex, starting with...
Moro
The Moro reflex is one of the more common, and have a large affect on child development. It has to do with when the baby or child loses head support, they go into fight-or-flight mode. This helps for the baby to take their first breath, protecting their airway, and alerts caregiver to a possible danger. The downfall to this is that if the stimulation to the nervous system continues upon the change in head position, releasing stress hormones, cortisol and adrenaline; it affects their arousal, sensory, immune and digestive system. With this adrenaline rush, it might present as that their really excited but that’s what happens when this reflex gets elicited. They might be at their stress limit more than usual due to this reflex that still persists. Result: This might be the child that has a hard time tuning out irrelevant information to continue their school work. They also may react more sensitively to auditory information.
Symptoms include: overreactive, hypersensitive, anxiety, hyperactive, visual-perceptual problems, poor impulse control, emotional immaturity, motion sickness, immune issues, stimulus bound, controlling behavior, dislike of changes.
Asymmetric Tonic Neck Reflex (ATNR)
This is a reflex that gets elicited when a child’s head turns right or left, and their limbs flex/extend in response. This reflex is for encouraging movement in the womb, assists with the birth, helps keep baby’s airway clear, early visual hand-eye training, and helps break up the two sides of the body. If not integrated, it makes it difficult for kids to coordinate both sides of the body, especially for reading and visual motor development.
Symptoms: poor balance and coordination, avoiding crossing midline, poor hand-eye coordination, difficulty with visual tracking, difficulty with reading and writing.
Tonic-Labyrinthine Reflex (TLR)
This is elicited when the neck is extended or flexed. This is another reflex that helps the baby get into a good position for birth, helps develop muscle tone, elicited by the vestibular system.
Symptoms: poor balance and coordination, visual perceptual problems, motion sickness, over or underdeveloped muscle tone, poor posture, toe walking, poor spatial skills, vestibular problems.
Spinal Galant Reflex
This is when a baby’s hips rotate towards stimulated side. It increases movement and flexibility in the womb, and promotes hip flexibility. As children get older with this retained reflex, sitting in a chair may be uncomfortable.
Symptoms: difficulty sitting still, hypersensitivity in the lumbar region (tags, waisbands), some connection to bedwetting.
Symmetric Tonic Neck Reflex (STNR)
STNR helps babies move from crawling on the floor to standing, spine alignment, and visual skills that allow them to focus on things close up and alternate to something far away. This might be the reason your child is uncomfortable sitting in a chair, needs to move in different positions to copy from the board, they may even sit on their feet. It may present as though they are students that don’t want to do their work, but it’s the difficulty they have with an immature postural system that is preventing them from sitting comfortably. This may also affect their attention and concentration, as well as hand-eye coordination.
Symptoms: helps the infant defy gravity (move from floor to standing), helps spine alignment, and visual accommodation (alternating visual focus for something close to something far).
Reasons for Retained Primitive Reflexes
This might be due to damage to higher levels of the brain, Pathology (Alzheimer’s and Parkinson’s), or maybe they never properly developed or withdrew during pregnancy, birth and infancy. In pediatrics, it’s usually the third case. This includes; complications with pregnancy, complications with labor and birth, or problems in infancy. It could also have to do with complications with pregnancy; medical problems, sickness, injury requiring bed rest, extreme stress, or alcohol/drug use. These are just risk factors, and it doesn’t mean that if one of these cases relates to your family- that your child will end up with a retained primitive reflex.
Treatment through Occupational Therapy
The way we treat a person with neurodevelopmental delay (retained primitive reflexes), is through movement and interaction with the environment. Special exercises are performed that stimulate the nervous system, and different parts of the brain stem. This is not a quick fix, it requires months of the program, but it is made manageable with the help of family and an Occupational Therapist to make an individualized and tailored treatment plan for your child’s needs.
Want to know more? Set up a free 30 minute consultation!
How Sign Language (ASL) Aids in Early Childhood Communication
This might sound either odd, or over ambitious for families to think about using sign language in their own household. Cue in a scene from Meet the Fockers with Little Jack signing a full sentence; Grandpa Jack wasn’t too far off...
So if there are no family members with hearing problems or people with communication disorders; why would you use it?
Did you know American Sign Language (ASL) is the third most studied language in the US? Outnumbered by only Spanish and French. So why would people use ASL? It’s something I’ve used in practice with children because even before a child can really start verbalizing, they want to communicate! There might be a misconception that if you teach your child sign language, they won’t be as motivated to verbalize or speak, or that it somehow hinders their speech development. Research says just about the opposite; and once kids develop speech, they’ll want to say it! ASL can help kids communicate sooner, possibly as soon as 6 months. Plus, it’s been shown that it can actually accelerate verbalizations and language by being able to put 2 words together sooner than children that didn’t use sign language.
It helps their basic understanding of language. ASL reinforces verbalizations and language by adding a visual cue with a kinesthetic movement to the auditory speech; targeting different senses for understanding and development of language. Signing also helps books become more interactive; kids thrive on learning through interaction, so when language comes to life (or signing) it makes it more interesting to kids. Babies have a natural tendency to use gestures and their hands, signing also reinforces motor development as they learn new skills.
For those in bilingual households, ASL can serve as a language bridge for children and adults who speak different languages.
Looking at the developmental milestones: at 6-7 months typically developing children start improving gross motor skills (bigger movements of the body), and sit independently. Somewhere between 10-14 months, the average baby says their first word. Signing builds upon those earlier developing gross/fine motor skills so that the baby can communicate before saying their first words. It also builds on a baby’s natural tendency to point and start to gesture with their hands to communicate.
Signing with Special Needs
For those with communication difficulties that continue through the years, sign language increases their opportunity to express themselves and connect with others. Some diagnoses that may benefit are Down Syndrome, Autism Spectrum Disorder, Cerebral Palsy, Expressive language difficulties like Aphasia/Apraxia, Learning Disabilities, Delays secondary to Premature birth, tracheomitized children, short term illnesses, Post-surgical conditions that inhibit speech.
OT Tips
Start with 3-5 signs at first. What do they need most?
Create the sign at the same time that you verbalize it.
Make eye contact, and create the sign as close to your face as possible.
REPETITION IS KEY. Exaggerated motions might also help, kids are drawn to movement and visual aids.
Be patient. Signing back may not happen for a while, it may take a few months.
Once they do sign back, celebrate! Confirm their accomplishment and encourage them to do it more.
It may not look perfect at first, accept approximations.
Let this become a part of your daily routine, to use in everyday context and their routines.
There are also some “made up” signs that might work for your family, which aren’t technically ASL signage, but will help your child communicate.
Whatever works for your family to help the little ones communicate, and hopefully reduce meltdowns. If you have any other questions, or you want to talk about your child’s development, contact us or schedule a free 30-minute consult!
Value of OT in Acute COVID-19
Finally! We have some educational courses for COVID-10 patients and how Occupational Therapy can help with getting people better. It’s a little detour to our usual pediatric topics but I think this is an important conversation with the way our world is going. I don’t know about you, but the only way I can settle my nerves about the unknown is to learn more about it, make it less strange and more understandable. I have some parts of this particular blog for my fellow Occupational Therapists in acute care, but there’s good information for everyone. The information below is based on a great course I took called “The Value of Occupational Thearpy in the Acute Care Management of Patients with COVID-19,” if anyone else is interested.
A little background
The virus is called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS- Cov 2). Along with the same guidelines as HIV/AIDS; HIV is the virus that causes the AIDS disease, SARS-Cov-2 causes COVID-19.
CDC Guidelines: Contact/droplet precautions except during aerosolizing procedures. Examples for when to take airborne precautions are; Tracheostomy, Intubation, CPR, High flow O2.
Illness Severity
Mild to moderate: 81% of patients have mild symptoms up to mild pneumonia
Severe: 14% with dyspnea (difficulty breathing), hypoxia (oxygen deprivation), or >50% lung involvement on imaging
Critical: 5% includes those with respiratory failure, shock, or multiorgan system dysfunction
The clinical presentation for those going to the hospital include generalized weakness, dyspnea, delirium, upper extremity plexopathies, fatigue, anxiety. Other considerations include social isolation, occupational deprivation, stigma, and caregiver exposure/illness risk.
With increased survival rates of ICU admissions, patients are left with what is a new concept called Post-Intensive Care Syndrome. Basically in 2010, The Society of Critical Care Medicine found that with medical advancements there is an increase in survival rate of ICU patients However, those that were leaving the ICU were left with very profound neuromuscular physical deficits as well as psychological and cognitive deficits. Due to the pandemic and influx of critically ill patients, we can reflect some of the research for Post-Intensive Care Syndrome to understand how we can treat COVID-19 patients.
Numbers
As we have heard on the news, the severity of COVID-19 cases have risk factors for neuromuscular impairments including; multiorgan failure, prolonged bed rest, possibly month long intubation and ICU stay. 85-95% of ICU survivors will experience persistent weakness at hospital discharge, possibly resulting in atrophy, sensory loss, foot drop.
Regarding patients 1 year post ICU discharge; 50% experience deficits in ADL’s (ex: bathing, hygiene tasks, feeding, toileting, dressing activities), and 70% with deficits in IADL’s (ex: driving, cooking, cleaning, shopping). Other risk factors include increased need of caregiver support, less likely to go back to work. From a psychological perspective, 1 in 3 experience Depression, 60% experience PTSD. Younger age is correlated with higher rates of depression, anxiety, and post-traumatic stress syndrome, as well as with lower level of education. And importantly, that impairment in executive functioning is associated with higher rates of depression.
Risk of Cognitive deficits secondary to prolonged periods of sedation, decreased memory due to hypoxia common with acute respiratory distress syndrome (a symptom with COVID-19).
With an all hands on deck approach to stabilize the patient medically, and precautions for limited use of PPE, making patient isolation harder to keep track or assess delirium (confusion).
Occupational Therapy Assessments
How can OT help? Recent article that showed in COVID-19 survivors that lower grip strength equated to higher rates of intubation, and it also correlated with respiratory muscle strength. -MMT or Dynamometer for measurement of strength
Assessment for Physical Function
-ICU Mobility Scale is a zero to 10, Functional Status Score for the ICU, FSS-ICU (it has a really high 99% inter-rater reliability. It has five features including rolling, supine to sit transfer, sitting edge of bed, sit to stand transfer, and walking), AM-PAC for ADLs (6 ADLs with a scale of one to four grading level of independence), Katz Independence 10 of ADLs includes six ADLs (not great for scaling), Barthel (10 ADLs and mobility tasks including grading it from independent, needs help, and dependent. So here, you only get three ways to identify patient's progress, so not as sensitive but is supported by literature.)
Assessment for Delirium
-CAM assessment method for ICU and the Intensive Care Delirium Screening Checklist are both high inter-rater reliability, high specificity (gold standard), Confusion Assessment Method – Severity (CAM-S), Intensive Care Delirium Screening Checklist (ICDSC), Brief Confusion Assessment Method (bCAM).
Cognition Assessments
-Richmond Agitation Sedation Scale (RASS), The Orientation Log (O-Log), Montreal Cognitive Assessment (MoCA)
Psychological Assessments
Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale – Revised (IES-R)
Intervention!
-Prone Positioning has been shown to improve gas exchange efficiency, increase perfusion and recruitment of dorsal lung, mobilizes secretion. Link: https://www.ficm.ac.uk/sites/default/files/prone_position_in_adult_critical_care_2019.pdf
Repositional strategy to mobilize the lungs, goal is to prolong or prevent intubation, can be done while conscious or when sedated with proper guidelines and precautions.
In order to prevent Brachial Plexopathy, proper prone positioning and nursing education is encouraged. Early Mobilization; the therapy team will assess and treat within safety limitations.
Teamwork; Co-treating with other healthcare professional and Cluster care is great for patient progression. Billing may take a back seat for the benefit of the patient.
Delirium management:
Giving patients the tools they need to interact within their environment, regulating sensory input with hearing aids/dentures/glasses, modify environment; turning on lights, clock visible, collaboration with speech therapy for adaptive strategies, communication, reorientation strategies are all going to help regulate patients.
Early mobility with engagement in ADL’s, modifications with DME (tools to help with activities of daily living) as needed, energy conservation. Preservation of independence and encouragement to continue doing activities will help with recovery. Your OT will also help patients learn breathing techniques, identify this is your breaking point in terms of safety for your fatigue level and then how to manage it.
Management of Mental Health
We learned that deficits and executive functioning are independently linked with increased rates of depression (super important to address). Social engagement with facetimes, calls for those without smart devices can help patients in the ICU. Routines make cluster care easier but also helps patients with mental health. ICU Diaries are also used in OT for improving orientation, memory, psych component of mental health. Mindfulness breathing exercises have shown to reduce anxiety, and patients report improvement.
Resources on
Facebook- COVIDRehab4OT Group (general COVID), COVID4CCOT Group (critical care)
Royal College of Occupational Therapists: www.rcot.co.uk
Hospital Elder Life Program www.hospitalelderlifeprogram.org § https://help.agscocare.org/products
Johns Hopkins University: Everybody Moves Campaign
Rehabilitative Care Alliance: http://rehabcarealliance.ca/
Resources
Alvarez, E.A., Garrido, M.A., Tobar, E.A., Prieto, S.A., Vergara, S.O., Briceno, C.D., & Gonzalez, F.J. (2017). Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit: A pilot randomized clinical trial. Journal of Critical Care, 37. § American Occupational Therapy Association (2020). The role of occupational therapy: Providing care in a pandemic. Retrieved May 13, 2020 from https://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/News/2020/OT-Pandemic.aspx. § Bamford, P., Bentley, A., Dean, J., Whitemore, D., & Wilson-Baag, N. (n.d.). Guidance for Conscious Proning. Retrieved May 14, 2020, from https://www.ics.ac.uk/ICS/Pdfs/COVID-19/Guidance_for_conscious_proning.aspxCampbell, C. (2014). The role of occupational therapy in an early mobility program in the intensive care unit. Special Interest Section Quarterly: Physical Disabilities, 37(1). § Centers for Disease Control and Prevention (2020). Interim clinical guidance for management of patients with confirmed coronavirus disease (COVID-19). Retrieved May 13, 2020 from https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical- guidance-management-patients.html. § Clancy, O., Edington, T., Casarin, A., & Vizcaychipi, M.P. (2015). The psychological and neurocognitive consequences of critical illness. A pragmatic review of current evidence. Journal of the Intensive Care Society, 16(3), 226-233. § Costigan, F.A., Duffet, M., Harris, J.E., Baptiste, S., & Kho, M.F. (2019). Occupational therapy in the ICU: A scoping review of 221 documents. Critical Care Medicine, 47(12), 1014-1021. § Desai, S.V., Law, T.J., Needham, D.M. (2011). Long-term complications of critical care. Critical Care Medicine, 39(2). doi: 10.1097/CCM.0b013e3181fd66e5 § Esbrook, C., Jordan, K., Robinson, M., and Wilcox, J. (2020). Occupational therapy in hospitals & inpatient care: Responding to a pandemic. Retrieved from https://myaota.aota.org/shop_aota/product/OL8102 § Karnatovskaia, L.V., Johnson, M.M., Benzo, R.P., & Gajic, O. (2015). The spectrum of psychocognitive morbidity in the critically ill: A review of the literature and call for improvement. Journal of Critical Care, 30, 130-137. § Kho, M.E., Brooks, D., Namasivayam-MacDonald, A., Sandrar, R., & Vrkljan, B. (2020). Rehabilitation for patients with COVID- 19. Guidance for occupational therapists, physical therapists, speech-language pathologists and assistants. School of Rehabilitation, McMaster University. http://srs-mcmaster.ca/covid-19/ § Kofis, K., Roberson, S.W., Wilson, J.E., Pun, B.T., Ely, E.W., Jezowka, I., Jezierska, M., & Dabrowksi, W. (2020). COVID-19: What do we need to know about ICU delirium during the SARS-CoV-2 pandemic? Anesthesiology Intensive Therapy, 52(2). § Intensive Care Society (2019). Guidance: Prone Positioning in Adult Critical Care. Retrieved May 16, 2020, from https://ficm.ac.uk/sites/default/files/prone_position_in_adult_critical_care_2019.pdf 5/29/20 16 References continued § Parker, A., Sricharoenchai, T. & Needham, D.M. (2013). Early rehabilitation in the intensive care unit: Preventing physical and mental health impairments. Current Physical Medicine and Rehabilitation Reports, 1(4), 307-314. § Quick, T., & Brown, H. (2020). A Commentary on Prone Positioning Plexopathy during COVID 19 Pandemic. The Transient Journal of Trauma, Orthopaedics and the Coronavirus. Retrieved from https://www.boa.ac.uk/policy-engagement/journal-oftrauma-orthopaedics/journal-of-trauma-orthopaedics-and-coronavirus/a-commentary-on-prone-position-plexopathy.html § Schweickert, W.D., Pohlman, M.C., Pohlman, A.S., Nigos, C., Pawlik, A.J., Esbrook, C.L. … & Kress, J.P. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomized controlled trial. Lancet, 373, 1874-1882. § Wilcox, M.E., Brummel, N.E., Archer, K., Ely, E.W., Jackson, J.C., & Hopkins, R.O. (2013). Cognitive dysfunction in ICU patients: Risk factors, predictors, and rehabilitation interventions. Critical Care Medicine, 41, S81-S98. § World Health Organization (2020). Infection prevention and control during health care when novel coronavirus infection is suspected. Retrieved from: https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when- novel-coronavirus-(ncov)-infection-is-suspected-20200125
Take It Outside
Play is so important in Occupational Therapy Treatment, strong evidence supports play as a huge factor for health, development, and well being (Lester & Russell, 2010). We’re not just talking about playing on a soccer team, or participating in a group art class; we’re talking about intrinsically motivated play that’s child driven. It’s about how the child engages with others naturally and the experience of play as the driver of learning. It also shouldn’t stop at primary school.
Children today spend far less time outdoors than prior generations did. This is affecting children’s healthy sensory development, restricting movement opportunities.
Impacts of Less Play Time
Many teachers have reported decreased attention.
Posture is changing; Physical Therapists and Chiropractors are seeing preadolescent posturing with rounded curvature, and back problems. This may be due to different factors; limited core strength and back strength to keep body upright, kids are spending more time seated, which affects gait and posture, they’re also looking at screens more often.
Another thing teachers are reporting; kids falling out of chairs, clumsiness and bumping into other kids. Shedding light on possibly reduces body awareness and coordination.
Also, a rise in anxiety and depression.
There used to be more imaginative play, now it’s more structured, making it difficult to play outdoors, and access nature. Outdoor play is becoming more of a priority due to covid related limitations, and hopefully this opens new doors to making it more accessible for kids.
Why the Outdoors is Great
Nature is a great sensory experience; once you step outside, the wind is blowing, the sun, rain, or snow all stimulate different senses. Even reflecting on the ground; walking indoors is flat (predictable), outdoors the ground is uneven (unpredictable). Adjusting your body and how you process sensory stimulation is important for development. It allows for a calm but alert state for optimal organization of the sensory system. Even the environment is naturally calming; blue, green, brown in nature, which are scientifically proven to help feed at ease. Sounds typically played at a spa or are water, wind, things that calm us down. Some smells of trees will actually reduce cortisol levels in your brain, inducing calm. Being outdoors, constantly assessing your environment, creates a calming but alert state. Classrooms and clinics are typically filled with posters, many children in one place, and it may be disorganizing, this might provide some respite for children to learn. On average parents report 4-6 hours playing outside about 30 years ago, digging in dirt, playing with friends. Research shows that 48 mins is now the time for average outdoor play.
Biophysical Reactions to Play
Vestibular system: Research in the US says children sit 9 hours a day in a constant seated upright position (that’s Pre-pandemic). Children need to move frequently throughout the day to help move fluid in the inner ear, to stimulate the vestibular system; helping kids know their body in space. It makes them safer to have a well developed vestibular system. Climbing rocks or spinning shouldn’t be limited, it may reduce development and integration of the vestibular system. Behavioral optometrists support this; reporting movement helps with visual skills for reading and writing. It’s as if stimulation of the vestibular system turns the brain on for learning. Go upside down and climb trees, challenge the vestibular system to support activity regulation for learning in the classroom. Roll up and down the hills! Sledding! Mudslides! Tree climbing! Spinning/swings!
Proprioceptive system: This system is suffering for children when on devices. Resistance to joints and muscles are not being stimulated. This is how we develop understanding on how to hold a baby chick gently, use of appropriate pressure for writing, or playing tag without pushing too hard on other children. Shoveling, building dams, digging in dirt, carrying heavy buckets all give stimulation. Building fort is a favorite; kids love building a space for themselves.
Warning: This may not be natural at first. You may send your kids outside to play and the result may only be using the stick for digging, then coming back inside. But the next time they might realize they can write with the stick in dirt, and also use it for building a fort like they saw another kid did. This develops over time, but they may benefit from making it child driven, building on their ideas with increased creativity and using a different skill. Use the environment as inspiration, but allow the child to initiate play.
Additional Thoughts...
If a child relies on adults for ideas, it may result in not being an independent problem solver. Instead, allow the child to interact with others and get creative on their own for a more interactive play. Outside has a more full body engagement of the senses. Nature provides unpredictable sensory challenges to provide more learning and adaptability for changes in sensory experiences.
Children learn best through play; for social skills, emotional regulation. Child directed play allows for children to learn how to solve their own problems without help, and allows for socioemotional learning to build relationships. Let them dive deep into play; 20 minute recess doesn’t allow for it and there needs to be more opportunities for self-directed play.
Home Ideas: Promote outdoor play with setting up loose parts stones, tree cookies, bricks, fabric, logs, wood planks, gutters, pallets, baskets, egg crates, tires, dishware, tarps, buckets, junk in your basement, stainless steel bowls and plates, sleds, boxes, duct tape. How many parents have seen a child open a new toy, and play with the new box more? Let them be creative with a budget friendly option!
If you have additional questions or want to know more on how to implement more play, schedule a time for a free 30 minute consultation.
References:
Hanscom, A. (2016). Balanced and barefoot: How unrestricted outdoor play makes for strong, confident, and capable children. New Harbinger Publications, Inc.
Lester, S. and Russell, W. (2010). Children’s right to play: An examination of the importance of play in the lives of children worldwide. The Hague: Bernard van Leer Foundation
Mielonen, A., & Paterson, W. (2009). Developing literacy through play. Journal of Inquiry & Action in Education, 3 (1), 2009.
Savina, E. (2014). Does play promote self-regulation in children? Early Child Development and Care, 184:11, 1692-1705
Schunk, D. H. (1987). Peer models and children's behavioral change. Review of Educational Research, 57, 149-174. 3
The Therapeutic Benefits of Outdoor Play Recorded June 4, 2020 Presenter: Angela Hanscom, MOT, OTR/L OccupationalTherapy.com Course #4756
Terrible twos? Or Astoundingly Autonomous?
Did you know that the “terrible twos” is not universal? In some developing countries, it’s viewed as “relatively smooth and harmonious (Mosier & Rogoff, 2003; Box 6-2).” It’s a well-known phrase that’s coming up more and more as I become close to starting a family. But, thinking back to my childhood; I’m not sure if it’s something my parents or family used growing up in an immigrant household. For good reason. In the United States, this stage is a normal sign for drive for autonomy. Toddlers are testing their limits as individuals, that they have control over the world, almost like new magical powers. It’s a trial and error of sorts, seeing how their ideas come into existence, making their own decisions. But this typically comes with the repercussions of a toddler yelling, “no!” Just for the sake of resisting authority. Almost all U.S. kids show some negativism to some degree, usually starting at age 2, peaking around 3.5/4 years old, and declining by about 6. If caregivers view this new found self-will as normal, and healthy for learning independence (not focusing on the stubbornness), it can help with teaching the child self-control and contributes to their sense of competence, avoiding excessive conflict. Easier said than done, but education and understanding of their development will help your child learn about themselves.
Here are some research based guidelines that can help parents of toddlers discourage negativism and encourage socially acceptable behavior:
Be Flexible. Learn the child's natural rhythm’s and special likes and dislikes
Think of yourself as a safe harbor. With safe limits, from which a child can set out and discover the world, to which your toddler can come back to for support.
Make your home child friendly
With unbreakable objects that are safe to explore.
Avoid physical punishment. It’s often ineffective, and may result in more damage.
Offer a choice
Even a limited choice can help, allow them some control. For example, “Would you like your bath now or after we read a book?”
Be consistent in enforcing necessary requests
Don't interrupt an activity unless absolutely necessary. Try to wait until the child's attention has shifted. If interruption is necessary, give warning. (“We have to go to the playground soon.”)
Suggest alternative activities when behavior becomes objectionable
For example, when a child is throwing sand in someone's face, say, “Look the swing is open!”
Suggest, don’t command
Accompany requests with smiles or hugs, not criticism, threats or physical restraint.
Link requests with pleasurable activities
(“It’s time to stop playing so that you can go to the store with me.”)
Remind the child of what you expect
For example, “when we go to the playground, we never go outside the gate.” Wait a few moments before repeating a request when a child doesn’t comply immediately.
Use a time-out to end conflicts
In a non-punitive way, remove either yourself or the child from a situation.
Expect less self-control during times of stress
(illness, divorce, the birth of a sibling, or a move to a new home).
Expect it to be harder for toddlers to comply with “do’s” than with “don’ts”
(“Clean up your room.” takes more effort than “Don’t write on furniture.”)
Keep the atmosphere as positive as possible
Make your child want to cooperate.
If you have any questions, book a free consultation with me and I will be happy to review with you!
Sources:
Haswell, Hock, & Wenar, 1981; Kochanska & Askan, 1995; Kopp, 1982; Kuczynski & Kochanska, 1995; Power & Chapieski 1986.
References:
Mosier, C.E., & Rogoff, B. (2003). Privileged treatment of toddlers: Cultural aspects of individual choice and responsibility. Developmental Psychology, 39, 1047-1060.
What's the Best Pre-K?
With this new school year starting, many families are concerned with education and how it may affect their children. As each family is making a careful decision, I want to shed some light into how kids may benefit from learning. It’s a unique time, with concern for child safety; But I hope to help parents understand what research has shown in terms of efficacy of different learning techniques, and some resources to help their decision.
Early Childhood Education
When it comes to education, there are usually a few different trains of thought. In other countries, they may apply an academic preparatory theory for schools. While the U.S. sticks to a more child centered philosophy following a social and emotional growth in line with developmental needs, and strong cognitive emphasis with Piaget and Maria Montessori Theories. You may have heard more about Montessori based schools; letting children learn naturally in a child driven, thoughtfully prepared environment. Piaget is a Child Developmental Psychologist that introduced a cognitive development model that determined stages of how children represent and reason with the world; helping us understand how our children learn best at different ages.
How do we improve education?
There is a debate on how to improve education, with pressure for instruction in academic skills as early as Pre-K in the U.S. Supporters of developmental theories and approaches report that the push for academic skills neglects child need for exploration and free play. This disrupts the self-initiated learning by relying too much on teacher initiated learning. I think we all learn best in environments that motivates and interests us, the approach to learning can make all the difference.
What’s best for our kiddos?
U.S. Studies support child centered, developmental approach. One study (Marcon, 1999) had 721 4-5 year olds that had three types of class; Child Initiated, Academic Directed, and Middle of the Road (blend of the two). The Child Initiated group actively directed their own learning, and excelled in basic academic skills, more advanced motor skills (compared to the two other groups), and scored higher than the Middle of the Road group in behavior and communication skills. This suggests that one philosophy for education can work better than a blend (like the Middle of the Road group), and child centered learning is more effective than Academic Directed. This doesn’t necessarily apply to 100% of kiddos, everyone learns differently, but we want to report the majority of the findings to better understand what may work best.
How can Occupational Therapy help?
Occupational Therapy practice is a child centered approach that creates goals and a treatment plan to make sure the child is getting the most effective treatment. We use theories, similar to Piaget and Maria Montessori to help guide their learning and make it effective for learning. If your child is having trouble with the upcoming school year, and you find them falling behind on certain skills, we may be able to help you with specific skills necessary for school tasks. Give us a call and schedule your consultation on our home page, we’re happy to talk to you!