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/

 

 

Child Physical Therapy: Treatment for Toe Walking

As children learn to navigate walking, they may initially learn to walk on their toes while cruising along furniture. Toe walking is developmentally appropriate until the age of three. If your child persistently walks on their toes in the absence of any underlying neuromuscular or orthopedic condition, it is considered idiopathic toe walking. 

Kristal Kraft

Kristal Kraft

Idiopathic toe walking is defined as habitual toe walking with no known cause. Idiopathic toe walking may lead to tightened calf muscles, decreased range of motion of ankles, and eventually, shortened Achilles tendon. 

 

What is the treatment for toe walking?

            Treatment options vary on the degree and duration of toe walking. It also depends on the flexibility of the Achilles tendon. As with any habit, the longer it persists, the harder it is to break. In extreme instances, surgery to lengthen the Achilles tendon may be most appropriate. For most cases, ankle foot orthosis (AFO) and/or physical therapy are recommended. AFOs are removable braces worn during day and night to help maintain the foot at 90-degree angle. 

Physical therapy creates a program designed for your child’s needs by incorporating a combination of stretches and strengthening. In order to increase the effectiveness of physical therapy, daily home exercises are crucial. Below are a list of at-home stretches and activities you can incorporate into your weekly routine. 

 

At-home Stretches: 

·     Manual calf stretch: This stretch requires help from an adult. Your child will sit on the floor with his/her knees straight. The adult will cuff the child’s heel with their hand as the foot rests on the adult’s forearm. Slowly apply pressure on the child’s foot so their foot points up and towards the child’s body. Hold for 30 seconds on each side. 

·     Wall stretch:  The child is standing for this stretch. They should place their hands on a wall and point both feet at the wall one behind the other. Lean into the wall as the front leg is bent and the back leg is straight. Hold both feet on the ground flat for 30 seconds.  

 

Activities to strengthen muscles: 

·     Sit to stand: While your child sits on a chair or bench, place your hands below their knees with moderate pressure downward to provide tactile cues to keep heels on the floor. With the steady pressure, your child will stand up with heels remaining on the ground. Complete 5 repetitions. 

·     Basketball stretch: Encourage your child to sit on a small ball such as basketball while keeping both heels on the ground. Practice squatting by standing and sitting back down on the ball while keep heels down. 

·     Bear walks: Animal walking is great for stretching and strengthening leg muscles. For a bear walk, place hands and feet on the floor while hips aim towards the air. As one foot moves towards the hands, the other leg stays back while actively pushing the heel to ground. 

·     Penguin walk: Pretend to walk like a penguin by keeping the toes in the air and walking only on the heels! 

·     Crab walk: Start in the bridge position and propel forward by using hands and feet. Keep feet flat on the floor! 

·     Bozo Buckets: Line up three buckets in a row to play bozo buckets. Instead of throwing the beanbags into the buckets, place the beanbag on top of the feet and fling the bean bag by kicking. 

·     Scooter races: Race a friend or sibling on the driveway! Sit on the scooter with feet in front and use the heels to propel forward. 

·     Slide: With parent supervision, have your child climb up the slide. Climbing up a playground slide targets range of motion, strength and weight bearing. 

 

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References:
Beazley, Elizabeth, et al. “Activities for Children Who Walk on Their Toes.” University of Rochester Medical Center, www.urmc.rochester.edu/MediaLibraries/URMCMedia/childrens-hospital/developmental-disabilities/ndbp-site/documents/toe-walking-guide.pdf.
SickKids hospital staff. “Toe Walking, Idiopathic .” AboutKidsHealth, 11 Apr. 2011, www.aboutkidshealth.ca/Article?contentid=946.
“Toe Walking in Children.” DINOSAUR PHYSICAL THERAPY, 5 May 2018, blog.dinopt.com/toe-walking/.
“Toe Walking in Children.” Mid-Maryland Musculoskeletal Institute, 8 Oct. 2015, mmidocs.com/media/blog/2015/10/idiopathic-toe-walking/46.
http://blog.dinopt.com/toe-walking/

Child Speech Therapy: Autism and Social Skills

Socials skills (turn taking, initiating conversation, and staying on topic) are necessary to create meaningful relationships with peers. Children with autism spectrum disorder need to be explicitly taught the social skills that may come naturally to other children. Children with ASD want to have meaningful relationships with other children, but require extra help to build relationships. 

            Impairments in social functioning is a distinct feature of ASD, and may include deficits in the following:

  • Initiating interactions
  • Responding to the initiation of others
  • Taking on another person’s perspective

            Speech-language pathologists assist children with autism develop important social skills to communicate wants and needs, socialize with others, and participate in activities. Incorporating your child’s speech goals at home can reinforce and generalize social skills in everyday activities and interactions. Below are some tips and strategies to help your child improve social skills. 

1.    One skill at a time. 

Don’t try to teach all the social skills in one bundle. Children with ASD benefit from learning social skills in smaller segments and practicing one skill at a time. For instance, introduce greetings (hello, what’s up, how are you) first, and provide opportunities to greet members in the community. 

2.    Model social interactions.

Social interactions occur frequently throughout the day. After modeling appropriate social behaviors, explain the situation after the interaction. As mentioned before, children with ASD benefit from explicit instruction regarding social interaction. Explain the difference between greeting your sister versus greeting an unfamiliar communication partner. You may hug your sister but shake the hand of the unfamiliar person. 

3.    Visuals and social stories.

Visuals in the form of a comic strip can help introduce a new social skill. Children can bring the comic strip to school for a visual reminder when presented with a social interaction. Social stories present social concepts through a brief and engaging story format. Social stories through video may work best. Research has shown that children with ASD respond well to instruction via technology.

4.   Role-play.

Once the child is presented the skill, role-play different scenarios the child may be expected to use the specific skill. The more comfortable the child feels using the new skill, the more often they will implement it during everyday interactions. 

5.   Practice, practice, practice!

During childhood, many interactions revolve around play. For children with autism, learning the rules of card and board games may be challenging. Ask your child’s teacher if there are specific games children like to play during recess. Practice playing the games at home, and eventually use the game to initiate interaction with peers at school.

6.   Celebrate strengths. 

Children with ASD frequently have specific interests in hobbies that may include music, technology, or rote memorization skills. Encourage your child to use these interests and strengths to their advantage when interacting with others.   

7.   Social Group. 

Social groups are an excellent way for children to apply their social skill goals in a functional, but supportive setting.  Lumiere Children’s therapy offers social groups for all ages. Learn more here

 

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Resources:
Bellini, Scott. “Indiana University Bloomington.” IIDC - The Indiana Institute on Disability and Community at Indiana University, www.iidc.indiana.edu/pages/Making-and-Keeping-Friends-A-Model-for-Social-Skills-Instruction.
“Helping Your Child with Autism Improve Social Skills.” Psychology Today, Sussex Publishers, 16 June 2017, www.psychologytoday.com/us/blog/socioemotional-success/201706/helping-your-child-autism-improve-social-skills.
“Social Skills and Autism.” Autism Speaks, 25 July 2012, www.autismspeaks.org/family-services/community-connections/social-skills-and-autism.

 

Child Physical Therapy: Autism and Physical Therapy

Children with autism spectrum disorder present with challenges related to social skills, repetitive behaviors, speech and language, and sensory processing. Speech, behavior, and occupational therapy is recommended to improve communication, behavior, and sensory deficits in children with autism spectrum disorder. Along with these disciplines, physical therapy is a crucial component of an autism treatment team. Physical therapists focus on improving a child’s balance, posture, and incoordination to improve engagement and participation in everyday activities.

Jake Guild - Flickr

Jake Guild - Flickr

What is physical therapy?

Pediatric physical therapists help guide children through physical milestones. Areas of intervention include gross motor skills, balance/coordination skills, strengthening, and functional mobility. 

What are common physical deficits in ASD?

Children with autism spectrum disorder may experience some of the following physical challenges:

·      Decreased eye-hand coordination

·      Difficulty controlling posture

·      Lack of Coordination

·      Poor balance and instability

·      Low muscle tone

Research has shown that children with autism may also demonstrate toe-walking ankle stiffness, and motor apraxia.

Physical Therapy treatment for ASD

Pediatric physical therapy utilizes play and therapy techniques to improve balance and posture in children with autism. Improving posture in sitting, standing, and walking can build endurance and increase attention during school-time activities. Once a child feels secured and balanced, they can focus on other areas such as socializing, interacting, and playing. Physical therapists improve the lives of Children with ASD by improving their day-to-day functioning.

 

Learn more about Autism on our blog: Autism and Sensory Integration, Autism Awareness, Art and Autism, and many more articles!

 

LUMIERE THERAPY TEAM🖐️

 

Resources:

“Autism Spectrum Disorder.” American Physical Therapy Association, 31 Oct. 2014, www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=a6482e75-65c6-4c1f-be36-5f4a847b2042.

“The Role of the Pediatric Physical Therapist for Children with Autism Spectrum Disorder.”Center for Autism Research, www.carautismroadmap.org/the-role-of-the-pediatric-physical-therapist-for-children-with-autism-spectrum-disorder/.

Wang, Judy. “Physical Therapy for Children with Autism.” North Shore Pediatric Therapy, Judy Wang, PT, DPT Http://nspt4kids.Com/Wp-Content/Uploads/2016/05/nspt_2-Color-logo_noclaims.Png, 13 Jan. 2015, nspt4kids.com/autism/physical-therapy-children-autism/.