therapeutic preschool

Lumiere Children’s Therapy: Autism and Physical Therapy

Happy Autism Spectrum Disorder (ASD) awareness month! Many recognize speech therapy as an important component of the overall treatment plan for ASD due to difficulty with spoken language, eye contact, facial expressions, and emotional recognition. Although language deficits are a core symptom of autism, children may also demonstrate difficulty with coordination, motor planning, and hand-eye coordination. Therefore, physical therapy can help facilitate gross motor development to increase participation in everyday activities and social activities such as gym class, sports, playing, etc.

Lecates - Flickr

Lecates - Flickr

What are the signs and symptoms of Autism Spectrum Disorder?


  • Social communication challenges

    • Difficulty with social interaction including initiating and maintaining topics during conversation

  • Pragmatic difficulties

    • Children with ASD may present with poor eye contact, difficulty gauging personal space, and decreased facial expressions

  • Difficulty identifying emotions

    • Difficulties may include recognizing one’s own emotions as well as the feelings of others. They experience trouble expressing their emotions during a variety of situations. Also, children may lack knowledge of when to seek emotional support or provide emotional comfort to others.

  • Repetitive behaviors

    • Repetitive behaviors present differently for each individual but some examples may include repetitive body movements (arm flapping, spinning), motions with objects (spinning wheels), staring at lights, and/or ritualistic behaviors (lining up toys in order)

What physical difficulties may a child with autism experience?

Children with ASD may present with the following physical challenges:


  • Developmental Delay:

    A developmental delay is when a child is lacking the age-appropriate skills in one or more of the developmental areas: cognitive, social-emotional, speech and language, fine and gross motor. If a child demonstrates a physical developmental delay, they may have difficulty rolling over, holding up their head, sitting up, crawling, and eventually walking and jumping.


  • Low muscle tone:

    Muscle tone is the amount of tension in muscles used to hold up our bodies while sitting or standing. Low muscle tone is when the muscles require more effort to move properly while doing an activity. They may have difficulty maintaining good posture when standing and sitting, and often affects their overall gross motor development.


  • Difficulty with motor planning.

    Motor planning is the ability to conceive, plan, and then execute the physical skill in the correct sequence. Motor planning assists children in attempting new tasks without the need to consciously learn the steps to each new task. Motor planning arises from organizing sensory input from the body, and having adequate body awareness and environmental perception. Children who have trouble with motor planning may experience difficulty carrying out new tasks, following physical commands when given verbal instructions, and appearing clumsy while executing new tasks.


  • Decreased body awareness.

    Children with ASD may lack awareness of where their bodies are in relation to their environment, causing children to become accident-prone or present clumsy.

Who is a Physical Therapist?

Physical therapists, often referred to as PTs, are professionals that help people gain strength, mobility and gross motor skills. They are experts in motor development, body function, strength, and movement. Pediatric physical therapists can help children with a variety of disorders gain functional physical skills so they can participate in everyday activities.

What does physical therapy target?

  • Basic skills. Physical therapists can help children develop the primary gross motor skills of sitting, rolling, standing and running if they are experiencing a developmental delay.

  • Coordination. Physical therapists focus on the necessary muscles and skills to improve balance and coordination in everyday activities.

  • Improve reciprocal-play skills. Help children use motor planning to coordination throwing and catching a ball, and other activities that involves interacting and reacting to another person.

  • Development of motor imitation skills. In order to learn new skills, a child must be efficient in imitation and following physical directions. PTs can offer strategies and practice of imitating movements.

  • Increasing stamina and fitness. For older children, physical therapy may focus on skills required to participate in play and sports such as kicking, throwing, catching, and running.

  • Parent education. PTs create home exercise programs so that family members can help facilitate building on strength, coordination, and development of specific goals into their natural environments and routines.


Why is physical activity important for children with ASD?

Physical therapy increases a child’s ability to participate in physical activities by improving strength and coordination. Once a child is able to functionally participate in physical activities, they are able to reap the many benefits of daily exercise.


  • Social skills. Gym class, playgrounds, and organized sports teams offer opportunities for children to develop friendships and social skills. For children with ASD, physical activity programs provide a fun, safe environment to develop and practice social interaction skills.

  • Improvement in behaviors. Physical activity may help decrease maladaptive behaviors and aggression. Children with ASD have difficulty expressing and understanding their feelings. Physical activity can aid in reducing stress and frustration in children, often helping them adjust in different activities without aggression.

  • Overall health improvements. Staying active and participating in daily physical activities can decrease the risk of general health problems in individuals with ASD, including obesity.

  • Increase quality of life. Daily activities such as climbing stairs, walking on the sidewalk, and going grocery shopping require the use of gross motor skills. Improving one’s strength and stamina can positively affect their participation in everyday chores and activities.


If your child has Autism Spectrum Disorder, and is experiencing difficulty with coordination, strength, and motor planning, physical therapy might be right for you. Our physical therapists at Lumiere Children’s Therapy can offer evaluations, customized treatment plans, and home exercise programs for carryover into the home.





References:

“Does Physical Activity Have Special Benefits for People with Autism?” Autism Speaks, www.autismspeaks.org/expert-opinion/does-physical-activity-have-special-benefits-people-autism.

Morin, Amanda. “What You Need to Know About Developmental Delays.” Understood.org, www.understood.org/en/learning-attention-issues/treatments-approaches/early-intervention/what-you-need-to-know-about-developmental-delays.

“Motor Planning.” North Shore Pediatric Therapy, nspt4kids.com/healthtopics-and-conditions-database/motor-planning/.

“Physical Deficits.” Mental Help Physical Deficits Comments, www.mentalhelp.net/articles/physical-deficits/.

Rudy, Lisa Jo. “What Can a Physical Therapist Do for a Your Autistic Child?” Verywell Health, 24 July 2018, www.verywellhealth.com/physical-therapy-as-a-treatment-for-autism-260052.

Ries, Eric. “Physical Therapy for People With Autism.” Physical Therapy for People With Autism, www.apta.org/PTinMotion/2018/7/Feature/Autism/.

“What Are the Symptoms of Autism?” Autism Speaks, www.autismspeaks.org/what-are-symptoms-autism.






Lumiere Children’s Therapy: Breathing Difficulties in Children

Examine your breathing for a minute. Are you breathing through your nose or mouth? Is your mouth open or closed? Is your tongue on the bottom or roof of your mouth? Optimal breathing should be effortless and quiet through the nostrils with the tongue suctioned to the roof of the mouth behind the front teeth and the lips should be gently closed. Nasal breathing positively affects swallowing patterns, chewing, speaking, voicing and body posture. If nasal breathing is compromised for any reason, orofacial myofunctional disorders and/or airway function disorders may arise. This article focuses on descriptions of airway function disorders, including pediatric obstructive sleep apnea, and treatment options.

Airway Function Disorders (AFD)

AFD occur when the airway function is obstructed at any level of the airway, affecting a range of human functions. Sleep disorder breathing such as pediatric obstructive sleep apnea, is a collapse at any level of the upper airway resulting in abnormal breathing during sleep. Pediatric sleep apnea will be discussed further in this article. Sleep disordered breathing is initially impacted by daytime breathing specifically in children who mouth breath.

Signs of mouth breathing include the following:

  • Open lips

  • Low or forward tongue posture

  • Short upper lip

  • Forward head posture (protruding from neck)

  • Frequently dry lips

  • Misaligned teeth requiring orthodontics

  • Dry mouth

  • Hyponasal speech (speech that sounds nasal like they have a cold)

  • Drooling

  • Nasal congestion or constant runny nose


Impact of AFD

Airway function disorders may impact a variety of functions in a child’s life. It may interfere with language development, learning and academics, memory, attention, socialization, and self-regulation. Children with AFD may exhibit primary behavior characteristics of excessive fidgeting, hyperactivity, decreased attention and emotional outburst.

airway

AFD may also impact a child’s speech and swallow function. Some children with AFD present with an interdentalized (tongue between teeth) on the following sounds /s, z, t, d, n, l/ as those sounds are produced with tongue elevation.  Children may also experience abnormal swallowing patterns such as tongue-thrust swallows or impaired chewing.


Risk factors of AFD

The following is a list of risk factors associated with AFD:

  • Enlarged tonsils and/or adenoids

  • Mouth breathing

  • Nasal abnormalities such as a deviated septum (Deviated septum is when the thin wall between nasal passages is displaced causing one nasal passage to be smaller)

  • Frequent nasal congestion or allergies

  • Chronic rhinitis: set of symptoms including running nose, itchy nose, post-nasal drip, congestion, and sneezing that persist for months to a year

  • Higher Body Mass Index

  • Gastroesophageal reflux disease (GERD): when stomach acid flows back up irritating the lining of the esophagus

  • Low muscle tone

  • Craniofacial syndromes or growth alteration

  • Prematurity

  • Traumatic birth

  • Gender (Males are two times more likely to have SBD)

  • Ethnicity (African Americans are at a higher risk)

Pediatric Obstructive Sleep Apnea (OSA)

Reflect on your quality of sleep the past few nights. Did you sleep soundly through the night without any disturbances and wake up rejuvenated, or did you toss and turn all night feeling distracted and lethargic in the morning? The quality and effectiveness of a good night’s sleep impacts your mood and productivity the following day. The same holds true for children; if a child experiences disturbances throughout the night, they may demonstrate difficulties in behavior and attention during the school day. Studies have suggested that as many as 25% of children diagnosed with attention-deficit hyperactivity disorder may have symptoms of obstructive sleep apnea.

What is OSA?

OSA is an airway function disorder that is observed during sleep. OSA is when a person has repeated episodes of partial or complete upper-airway obstruction during sleep

How prevalent is OSA in children?

Studies have shown that up to 5% of children are diagnosed with OSA, with a correction between pediatric obesity and OSA.

What are the symptoms of OSA?

The most prevalent symptom of OSA is snoring. Although some children may only demonstrate habitual snoring which consists of vibration of airway tissue with no airway obstruction, studies have found a ratio between 3:1 and 5:1 between symptomatic habitual snoring and obstructive sleep apnea (OSA).

Other symptoms include the following:

  • Agitated sleep

  • Nightmares

  • Mouth breathing or open mouth posture

  • Bedwetting

  • Pauses in breathing or gasping for air during sleep

  • Audible breathing

  • Grinding teeth

  • Sweating

Treatment for Airway Disorders

  1. The first step to treatment of airway disorders is to determine the function of the nasal airway. Determining structural or physiological barriers to nasal breathing is necessary to determine plan of care. An evaluation by an allergist and otolaryngologist (ENT) is necessary to determine if medications such as antihistamines, allergy medicine or surgery is required to be able to safely breath out of the mouth.

  2. Elimination of non-nutritive sucking is important for adequate growth and formation of dental structures. Non-nutritive sucking (e.g. pacifier, finger, and object sucking) is a risk factor for future dental occlusion abnormalities. Orofacial myofunctional therapist can provide strategies to eliminate the use of nonnutritive sucking.

  3. Establishing adequate oral rest posture would be the next step of therapy. Orofacial myofunctional therapy focuses on retraining the muscles to stabilize a normal rest posture between the tongue, lips, teeth and jaw. Orofacial myofunctional therapy uses oral tactile stimulation and resistance activities to help disassociate the tongue from the jaw, improve lip closure and strengthen tongue elevation.

  4. Once the resting posture has been achieved, orthodontics may be recommended for dental stability if the child presents with a malocclusion of crossbite, overjet, or underbite; this might include braces, retainer, or rapid palatal expansion depending on the occlusion.

Pediatric Obstructive Sleep Apnea Treatment

In cases of pediatric sleep apnea, the first treatment step is typically the removal of the adenoids and tonsils. As reported by American Sleep Apnea Association, the removal of the adenoids and tonsils results in complete elimination of pediatric OSA symptoms in 70-90% of uncomplicated cases. As previously mentioned, a dental evaluation should be performed to check for hard palate development to accommodate the child's tongue. If necessary a rapid palatal expander (a non-invasive fixed and/or removable dental device) can be worn for six months to one year, to expand the transverse diameter of the hard palate.The next treatment option to consider is positive airway pressure, or PAP, which is typically used as a palliative treatment for adults with sleep apnea. A PAP machine blows pressurized air into the child’s mouth to counteract the closing of the throat during sleep. The amount of pressure is determined through an overnight sleep study.

If you feel your child exhibits any of the symptoms listed above for an airway function disorder, speak with your primary care physician for adequate referrals to airway specialists. At Lumiere Children’s Therapy, our speech-language pathologist can treat speech sound disorders, swallowing disorders, and oral motor deficits associated with AFD.

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References:

Archambault, N. (n.d.). Healthy Breathing, 'Round the Clock. Retrieved from https://leader.pubs.asha.org/doi/full/10.1044/leader.FTR1.23022018.48


Capdevila, O. S., Kheirandish-Gozal, L., Dayyat, E., & Gozal, D. (2008). Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proceedings of the American Thoracic Society, 5(2), 274-82.

Children's Sleep Apnea. (2017, February 13). Retrieved from https://www.sleepapnea.org/treat/childrens-sleep-apnea/

Deviated septum. (2018, March 03). Retrieved from https://www.mayoclinic.org/diseases-conditions/deviated-septum/symptoms-causes/syc-20351710

Gastroesophageal reflux disease (GERD). (2018, March 09). Retrieved from https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940

Hayes, K. (n.d.). Coping With Chronic Rhinitis. Retrieved from https://www.verywellhealth.com/coping-with-chronic-rhinitis-4160487

Orofacial Myofunctional Disorders: Treatment. (n.d.). Retrieved from https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589943975§ion=Treatment

Positive Airway Pressure Therapy for Sleep Apnea. (2017, February 03). Retrieved from https://www.sleepapnea.org/treat/sleep-apnea-treatment-options/positive-airway-pressure-therapy/


Child Therapy: School Therapy

The beginning of the school year may seem overwhelming for parents, with navigating bus schedules, after-school activities, and new classroom expectations. To make the beginning of the year a little less hectic, we answered all your questions about the IEP process as well as  taking a look at speech therapy services in the school.

What is an IEP?

An IEP, Individualized Education Program, is a legal document for each child in public school who qualifies for special educational services. The IEP documentation process is a team approach consisting of caregivers, classroom teacher, special education teacher, and specialized therapists (speech therapist, occupational therapist, vision therapist, psychologist, etc). The IEP outlines the appropriate and necessary special educational services available to your child to help them become most successful in the classroom.

 

What is included in an IEP?

The Individuals with Disabilities Education Act (IDEA) is a federal law requiring specific information in the IEP, but does not mandate a specific format. Therefore, each IEP may look different depending on the involved professionals and school district. The main purpose of the IEP is to outline the necessary support and services provided to your child inside and outside classroom instruction. It includes the type, amount, and frequency of services. An IEP will include the following information:

 

  • Current performance level. The IEP will outline your child’s strengths and weaknesses academically, socially and behaviorally. If appropriate, it will include an analysis on language and speech development, sensory needs, fine motor development and gross motor development. Standardized assessments will be explained with scores and severity level. Each member of the IEP team will communicate specific information about their area of expertise such as progression with current goals, strengths and weaknesses, and type of support provided.

 

  • Measurable goals. The second piece of information included in an IEP is the goals. Goals are created based on your child’s current needs. Goals are specific, measurable, attainable, realistic and timely. Progress on goals should be observed and documented throughout the year by the attending professional. During annual IEP meetings, goals will be modified, upgraded, and downgraded based on your child’s progress.

 

  • Appropriate services. The final piece of information included in an IEP is the action plan, such as recommended services, start date, location (in classroom or out of classroom), and professionals involved. Services may include extended testing time, reading intervention, speech therapy 1x/week, qualification for a communication device, and so on. The type, frequency, and implementation of services will be specific to your child’s needs.

 

What should you expect in an IEP meeting?

 

IEP meetings occur annually to discuss progress, concerns, and make necessary updates. If necessary, IEP meetings can occur more than once a year to discuss changes or modifications to the current plan. Prior to the annual meeting, team members will re-evaluate skills through standardized and/or non-standardized assessments, observe behaviors and participation in the classroom and analyze data collected on goals.

The new IEP is written with updated goals and services. The annual IEP meeting will be scheduled in advance to ensure each member of the team is present. During the meeting, each team professional will communicate progress and modifications of current goals and services. After each member of the team has discussed their area of specialty, caregivers will be able to discuss current concerns observed at home. In preparation of the meeting, write down noticeable areas of improvement and weaknesses to discuss during the meeting.

The meeting may seem overwhelming with excess amounts of educational jargon, so being prepared with specific questions or concerns will ensure you have all your questions answered. If you feel rushed during the initial or annual meeting, feel free to ask for a copy of the IEP to review at home before signing off on the current plan. Once you are comfortable with the current plan for services, your signature will allow for the IEP to become effective.

 

Speech Therapy in School

 

In order to determine eligibility for speech therapy services through the school, the speech therapist must obey the federal regulations of the Individuals with Disabilities Education Act (IDEA).  Eligibility is determined through a multi-step process including observation, teacher reports, screening, standardized assessments, work samples, and parent reports.

The speech-language pathologist will determine if there is a language or speech disorder. In order for the child to receive services in school, the disability must be adversely affecting educational performance. The following can be used to determine adverse academic impact: teacher’s reports, work samples, grade and therapist’s observations in the classroom. Due to caseload capacities, mild speech and language disorders may not qualify for services in the school. If you are concerned with your child’s speech and language development but your child does not qualify for services in the school, you may obtain services through a private practice.

If your child qualifies for speech therapy services, it is important to establish a good rapport with the speech-language pathologist. Parent involvement is crucial for carryover of skills into the home environment. Below are questions to ask your speech therapist in the beginning of each school year.

 

5 Questions to ask your speech therapist:

 

1. What will be the type of service?

 

There are two types of service methods: push-in or pull-out. Push-in is providing speech services in the classroom. The speech therapist collaborates with the teachers and classroom staff. This method allows the speech therapist to target social interactions within the classroom setting. Therapy in the classroom is most beneficial for children demonstrating difficulty with participation in the classroom. It is a great way to work on social skills, reading comprehension, or other language goals that may be impacting one’s academic success. Benefits include peer models, not missing instructional time, collaboration between classroom staff, and addressing specific academic concerns. Disadvantages include classroom distraction and limited one-on-one instruction.

Pull-out method performs speech therapy in the designated speech room. Services may be conducted in a group or individual setting. Pull-out method is recommended for children with articulation goals or specific language concerns. Advantages of pull-out allows specific instruction and intervention in a small group setting. The lesson can be child-specific and independent from the classroom curriculum of that day. The disadvantages of pull-out is that the child is taken away from peer models and may be pulled out during classroom instruction.

 

2. What will be the group size?

 

Group size varies depending on grade, speech goals and time of day. Most school groups fluctuate between three to five students in a group.

 

3. How will be the groups be divided?

 

Groups can be divided in a variety of ways: grade level, type of speech therapy (articulation, language, social), or ability level. Knowing how the group is divided is important to make sure your child is receiving the adequate amount of personalized instruction.

 

4. What will the weekly schedule be?

 

Each school speech therapist creates their weekly schedule differently. It is important to know how often and the amount of time your child will be receiving services. Will it be once a week for 20-30 minutes or three times a week for 15 minute increments.

 

5. What are the goals of therapy?

 

This is the most important question to ask your speech therapist. The speech therapist will have long term goals for the length of the IEP, as well as short term goals she/he will be targeting during sessions. Ask the therapist what goals to work on at home to facilitate carryover into the home environment.

 

For more information on speech therapy services outside school, contact Lumiere Children’s Therapy at 312.242.1665 or www.lumierechild.com.

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Resources:

School Services Frequently Asked Questions. (n.d.). Retrieved from https://www.asha.org/slp/schools/school-services-Frequently-Asked-questions/#ed2

School-Based Service Delivery in Speech-Language Pathology. (n.d.). Retrieved August 14, 2018, from https://www.asha.org/SLP/schools/School-Based-Service-Delivery-in-Speech-Language-Pathology/

Baumel, J. (n.d.). What is an IEP? Retrieved August 14, 2018, from https://www.greatschools.org/gk/articles/what-is-an-iep/