The Golden Tread: Movement and Mobility

Report
Sheree York, PT, PCS: CHS
Chantel Jones, PT, DPT: CHSEI
Melissa White, PT, MS: UCP/Hand in Hand
Betty Denton, PT: Tri-County Services
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Assist the family and team in identifying priorities
using routines-based interviews
Assist the family and team in developing
meaningful and measurable outcomes based on
the priorities identified
Provide interventions that will support the family in
helping their child develop movement/mobility
◦ Coaching and teaching positioning and activities that can
be carried out through routines
◦ Identifying and helping access additional resources
◦ Translating information from medical or clinical service
providers for practical application at home
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Collaborate with other team members to address child and
family needs related to movement/mobility skills
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World Health Organization: International
Classification of Functioning, Disability and
Health
OSEP TA Community on Practice: Mission and
Key Principles
Family-centered Practice
Evidence-based Practice
Professional competencies, ethics and
rules/regulations
Health condition
Body Functions
And Structures
Environmental
Factors
Activities
Participation
Personal
Factors
Mission
Part C Early Intervention builds upon and
provides supports and resources to assist
family members and caregivers to enhance
children’s learning and development through
everyday learning opportunities.
1.
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4.
Infants and toddlers learn best through
everyday experiences and interactions with
familiar people in familiar contexts
All families, with the necessary supports and
resources, can enhance their children’s learning
and development
The primary role of a service provider in EI is to
work with and support family members and
caregivers in children’s lives
The EI process, from initial contacts through
transition, must be dynamic and
individualized to reflect the child’s and family
members’ preferences, learning styles and
cultural beliefs
5.
6.
7.
IFSP outcomes must be functional and
based on children’s and families’
needs and family-identified priorities
The family’s priorities, needs and interests
are addressed most appropriately by a
primary provider who represents and
receives team and community
support.
Intervention with young children and
family members must be based on
explicit principles, validated
practices, best available research,
and relevant laws and regulations.
 Families and children are active
participants in identifying functional
outcomes, goals that reflect
needs/desires of individual
 Services are provided within the natural
environment of the child
(Svien, 2006)
WHERE: natural environments
WHEN: routines and activities, convenience
HOW OFTEN: based on family and child needs,
potential for change, support needed for family
to learn strategies for supporting development
through daily routines and activities
HOW: sharing information, modeling, coaching,
identifying and communicating with other
providers
◦ Enhance parent confidence
in roles (increase
competence of child to be I
with their own healthcare
◦ Improve pt/family outcomes
◦ Increase pt/family
satisfaction
◦ Build on child/family
strengths
◦ Increase employee
satisfaction
◦ Decrease healthcare costs
◦ Lead to more effective use
of healthcare resources
(Spearing, 2008)
◦ Respect each child/family
◦ Honor ethnic, racial, cultural, socioeconomic diversity/effect
on family experience and perception of care
◦ Recommend, facilitate and support choice for child/ family
◦ Ensure flexibility in org. policies, procedures, provider
practice (tailor to each child/family, individualize)
◦ Share honest, unbiased info, ongoing
◦ Provide & ensure formal/informal support
◦ Collaborate with families in care of each child
◦ Empower each child/family to discover their own strengths,
build confidence/make healthcare decisions
(Spearing, 2008)
Parents and Therapists:
 Natural environments as location and family
activities and routines
 Learning developmental skills
 Being part of a community
 Role of therapist as teacher: teaching families,
adaptations, supporting and educating families
 Collaboration: meeting families where they are,l
encouraging and confidence building, collaboration
among service providers
Campbell 2009
Implications for practice:
Parents seem to understand natural environments (better than
therapists) as location and way of providing services where
setting, activities, and routines becomes the context for
practicing and learning new skills: a source of opportunities
for learning and a context for gaining acceptance and making
friends.
Therapists seemed to limit this concept to location only,
suggesting that the EI services do not vary whether delivered
at home or in clinic. (?)
OT, PT, and SLP practice frameworks include coordination, consultation, and
collaboration as vital and integral aspects of effective practice
 Therapists serve an important role in helping families and non-health based
team members understand the medical and health status of a child
 Communication across disciplines and settings is often difficult
 Families are often confused by the different approaches of medical and EI
providers
 EI therapists can see how the care and recommendations from other
providers affects the daily lives of families: Opportunity to support social
and emotional needs
 Degree of mistrust across settings: a better understanding of roles,
expectations and challenges could improve care coordination
 Confusion and frustration re: access to services and care coordination to
meet the multiple needs of children and families
Summary
 Need for increased opportunities for teaming and collaboration
 Commitment to family-centered care as common thread between providers
◦ Promoting partnerships between families and service providers
◦ Recognizing families as experts in their children’s care
◦ Strengthening decision-making roles for families
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Become more knowledgeable, skilled and effective in care coordination to
provide families and children with more responsive, sensitive, and
appropriate service
Participate in community services collaborative efforts
Participate within professional associations and government at all levels to
promote regulations that support quality services
Where do you fit?
 Assessment team
 Interviewer
 IFSP development
 Intervention
 Team collaboration
 Family support and education
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Intake
IFSP
ongoing
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Helps identify what matters most to the family (concerns)
Helps us understand where and how the family lives (contexts
and expectations)
Helps us understand what matters most to this family
(priorities)
Helps us identify available and needed resources (eco-map)
Helps us focus on functional and meaningful outcomes
Helps us become more effective professionals
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Listening
Caring
Use of appropriate resources
Partnerships
Effective strategies
Accommodations as needed
Improved communication
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Assessment: delay or disorder?
Coaching/Teaching: routine activities that can be practiced on
a regular/routine basis (motor learning)
Encouraging: family/caregiver competence, child strengths
and abilities
Educating: diagnosis, services, prognosis (sharing information
to guide expectations)
Identifying resources: equipment, clinics, non-EI services,
community based activities
Sharing ideas from experience with other families
Practical, effective strategies
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Family indicates they would like for their child
to sit
Explore when, where, how, for what purpose
Ex: Suzy will sit while playing, eating, while
family eats, without support 4 of 5 times each
day for 3 weeks
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Jay will roll or scoot across the floor to play
with a toy 3 times a day, 5 days a week, for 3
weeks
Scott will walk around the furniture to reach a
toy 5 times a day for 4 weeks
He will progress to pushing a toy or walking
with hands or hips held across the room, 2
times a day for 3 weeks
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Observation
Listening
Teaching
Positioning: boppy, lap, corner of couch, box/basket, other
seats
Handling/facilitation: bounce, tilt, pull-to-sit
Side-propping, pushing to sit, tilt to catch self
Play while sitting
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Observation
Listening
Teaching
Facilitating rolling
◦ Prone to supine: prone to reaching with weight shift
◦ Supine to prone: reaching for toy
◦ Across lap
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Prone propping to pivoting and scooting: motivate with toy,
assisted positioning and weight shift
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Observation
Listening
Teaching
Stand with support at couch to reach for parent or toy
Stand with support against chest
Help practice sit to stand from sitting on parent’s leg or
crossed ankles
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Observation
Listening
Teaching
Motivate to shift weight by placement of toy or parent
Assist with weight shift and stabilizing weight bearing side at
couch or holding hips to dance
Help push rolling toy or box
Hold hands or hips
Hold broomstick or other end of sock or toy
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Observation/Evaluation: muscle tone, flexibility, posture
Listening: typical stiffness or inability to hold upright postures
Teaching: ways to facilitate increased stiffness/balance or reduce stiffness
◦ Positioning and holding
◦ Stretching during routine activities, after bath, etc
◦ Handling in ways that provide opportunities to:
 move or hold positions against gravity
 Relax or stretch “tight” muscles
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Refer to appropriate physician, clinic or outpatient therapist
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Medications
Spasticity management
Orthotics
Outpatient therapy
Medical care to identify or address problems
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Grace is a 6-month-old (corrected age) girl
born at 24 weeks of gestation. At birth she
weighed 1lb, 2oz.
Due to bronchopulmonary dysplasia (BPD)
and other upper respiratory complications,
Grace spent the first 4 months of her life on a
ventilator in the NICU. Additionally, she had
a mild case of necrotizing enterocolitis (NEC).
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At 1-month-old corrected age (5-months
chronological), Grace was discharged home
with her family on 0.25 L of supplemental O2.
When awake, her O2 levels are in the upper
80s. While asleep, they are in the upper 90s.
Physically, Grace has slightly increased
muscle tone in her shoulders and legs.
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Sleeps well through the night
Good head control
Smiles socially
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Both parents employed full-time
Maternal grandmother provides childcare
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When will my baby sit up?
When will she crawl?
How do we get her to gain more weight?
She likes to play with toys when we hold
them. How do we get her to play with her
own toys?
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Sit to play
Sit without falling over
Sit to eat eventually so she can feed herself
Eat more types and enough food to gain weight
Reach and play with toys so she’s happier by herself for short
periods (so we don’t have to hold her all the time)
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Grace will pull to sit from lying on her back
after diaper changes and when waking from a
nap.
Grace will work with nutritionist and OT to
address weight gain and other feeding
concerns.
Grace will play with her toys without adult
assistance when lying on her side, her
tummy, her back, and when sitting in her
high chair.
Continued social smiling
 Sits approximately 5 seconds without support
 Scoots forward on tummy with support at her
feet
 Makes cooing/babbling sounds
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Newly diagnosed with mild spasticity
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How do we keep her from being so stiff?
When will she crawl?
When will she feed herself with her hands?
When will she hold her own cup?
When will she walk?
Should her feet roll in at the ankles like this?
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Grace will feed herself Cheerios.
Grace will hold her own sippy cup.
Grace will crawl forward on her belly to
reach her toys.
Grace will pull herself up to furniture to
stand.
Grace will be referred to MD & outpatient
PT to address foot alignment.
Family will demonstrate comfort and
independence with stretching Grace to
help decrease her stiffness.
Gaines was born at term with hydrocephalus
He had a VP shunt placed immediately
He has “cortical blindness” and seizures
Both parents work: mom is a nurse and has worked in special ed
and hospitals
He attends a home day care
He has a 6 year old sister
Church and work friends are supportive
Extended family lives in Selma and New York
Followed by Neurosurgeon and Ophthalmologist
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Sleeps most of the time
Doesn’t respond to visual stimuli
Poor head control
Stiffness in legs and arms
Family priorities and questions:
Does he or will he see?
Will he develop ok?
What would you do?
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Family did not speak English?
Parents worked during day and day care did not want you to
go there?
Parents are seeking multiple services. What is your role?
MD told mother baby won’t live long
Parents do not understand diagnosis
Parents do not follow-through
How do you develop functional and measurable goals for
these “other” areas?
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Are family-centered?
Are developmentally appropriate?
Provide opportunities to practice and participate in activities
during daily routines?
Occur in the natural environments where the family and child
live, play, participate in activities meaningful to them?
Are collaborative with other providers?
Train/support families to care for their child in ways that
support the development of their child while addressing their
identified concerns?
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World Health Organization. International Classification of
Functioning, Disability, and Health. Geneva, Switzerland:
World Health Organization;2001
AAHBEI (American Association of Home-Based Early
Interventionists)
http://www.aahbei.org
Svien L, Anderson A, Long T. Research in Pediatric Physical Therapy:
An Analysis of Trends in First Fifteen Years of Publication. Pediatr Phys
Ther. 2006: 18: 126-132.
Spearing, E. Providing Family-Centered Care in Pediatric Physical
Therapy. In:. Pediatric Physical Therapy, 4th ed.( Tecklin, J. Ed.).
Baltimore, MD: Lippincott Williams & Wilkins: 2008: 1-11
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Campbell P, Sawyer B, Muhlenhaupt M. The meaning of
natural environments for parents and professionals. Infants &
Young Children. 2009;22(4):264-278
Ideishi R, O’Neil ME, Chiarello LA, Nixon-Cave K.
Perspectives of therapist’s role in care coordination between
medical and early intervention services. Phys & Occup Ther
in Pediatrics. 2010;30(1): 28-42
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AEIS Policy Memos (found on the ADRS website) www.rehab.state.al.us
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AEIS EI Updates disseminated from the state office
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ADRS (Alabama Department of Rehabilitation Services) www.rehab.state.al.us
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AAHBEI (American Association of Home-Based Early Interventionists)
http://www.aahbei.org/
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NEC*TAC (National Early Childhood Technical Assistance Center)
http://www.nectac.org/
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OTHER WEB RESOURCES:
www.mychildwithoutlimits.org
Resources from United Cerebral Palsy
http://pediatrics.aappublications.org/cgi/reprint/104/1/124
Journal article on the role of the pediatrician in Early Intervention
http://www.medicalhomeinfo.org/health/EI.html
American Academy of Pediatrics web page on Early Intervention

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