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Recreation for Children With Disabilities in Sonoma County

Have you ever wanted to try out a whole selection of adapted trikes?  Try a new swimming experience? Enroll in a summer camp?

Participation is defined as anything that involves friends, family, future, fitness, fun, or function.  There are many local activities that promote play,  new friends, and new interests for children and young adults with disabilities.  However,  these opportunities are not always easy to find.  Most suggestions on this list are based in Sonoma County, California.  Some are further away, but could be a fun destination or a special side trip if you are in the mood for adventure!  Additional suggestions are welcome.

Continue reading “Recreation for Children With Disabilities in Sonoma County”

Combining the International Classification of Functioning (ICF) with Standardized Testing: An In-Depth Look at Squatting

Devin likes to go fishing; it’s his favorite hobby.  He is a five-year old boy with a diagnosis of bilateral cerebral palsy, GMFCS level 1.  Devin perches at the river’s edge in a deep squat in order to catch a glimpse of the trout beneath him.

Deep squatting is useful for a variety of reasons, like getting close to the floor to see something clearly, or to rest without getting on knees or bottom.  It requires adequate hip flexion range, ankle range, and postural control.  It is a developmental milestone.

When I look at the drawing of Devin, I wonder why:

  • Devin has an inverted foot position on right.
  • His low back position shows excessive lumbar flexion during a deep squat.
  • His pelvis is posteriorly tilted.
  • He is stabilizing, or limiting his degrees of freedom, by bracing his right elbow on his right knee and resting his chin firmly on his left knee.

Continue reading “Combining the International Classification of Functioning (ICF) with Standardized Testing: An In-Depth Look at Squatting”

Using Core Sets With the International Classification of Functioning-Children & Youth (ICF-CY)

Emil is a seven-year-old  boy with cerebral palsy and medical complexity.  He has lived in a rural region overseas until coming to see you for a physical therapy evaluation.  Thinking of Emil functioning, in the context of his life, what areas should you focus on?  When thinking about the whole child, physical therapy decision-making can become a bit overwhelming.  Is there a list that can help you concentrate on the most relevant areas of body structures/function, activity, and participation for a seven-year-old boy with CP?

I am reading an interesting book that discusses the power of checklists.  It’s called the Checklist Manifesto: How to Get Things Right and it is written by Atul Gawande.  In this he discusses how checklists are most effectively used to assist people as they deal with complex situations.  After reading this, I began to view the ICF core-sets as essential checklists to reduce error and foster team communication. Continue reading “Using Core Sets With the International Classification of Functioning-Children & Youth (ICF-CY)”

Newborn: Beginning Tummy Time

 

“My daughter, Malia, is 5 days old.  Is it too early to start tummy time with her?  She doesn’t seem to like it.”

The American Academy of Pediatrics recommends putting babies on their backs to sleep and their tummies to play.   However, it’s not always the easiest thing to put your newborn in the prone (or tummy time) position in the first few days and weeks.  It seems they either sleep or fuss when placed in that position!  The hips are high in the air, elbows are off the ground and the weight is on the face.  It does not look so comfortable and it can be a bit of a tricky start! Continue reading “Newborn: Beginning Tummy Time”

Using the Gross Motor Function Classification System- Expanded & Revised Version (GMFCS-E&R)

Michaela is a five-year-old girl who loves ballet.  She has a diagnosis of diplegic cerebral palsy,  GMFCS level III.  What does this mean?

GMFCS Level III (Between 4th & 6th Birthday)

Children walk using a hand-held mobility device in most indoor settings. They may climb stairs holding onto a railing with supervision or assistance. Children use wheeled mobility when traveling long distances and may self-propel for shorter distances.

From the GMFCS E&R instruction guide

 

GMFCS-E&R Quick facts:

  • Five-level classification system
  • Based on the child’s self-initiated, regular movement
  • For use with children with cerebral palsy only
  • Used to classify children with CP from 1-18 years
  • Not for use to classify infants under 1 year of age
  • Not for use as an outcome measure

The Gross Motor Function Classification System (GMFCS) levels I-V are gross motor function categories for children with cerebral palsy.    This post describes what GMFCS levels I through V mean, how they are used, and some of the controversy around them. Continue reading “Using the Gross Motor Function Classification System- Expanded & Revised Version (GMFCS-E&R)”

Are You Helping a Child Move Before They are Ready? Thinking About Latency in the Context of Movement.

“Nate,   stand up”.  Nathan is five, has cerebral palsy and takes a while to prepare to move his body.  Thirty seconds or more can pass between the request to move and getting a response.  He is quiet, then there may be a quiver of movement. Sure enough, after some patience, up comes the leg and he rises to standing with only a little assistance.  In the context of the classroom, this extra waiting time is surely difficult.  Nathan either arrives late to an activity or his aide is lifting and initiating for him throughout the day and a behavioral expectation is set up.

Children with motor planning difficulty need extra time to initiate and carry out their movement.  Many of us live in a world where time is scarce and we don’t feel that we have time to wait. On the other hand, starting with the end in mind is crucial and takes a lot of training, repetition and patience.  What have you decided to do when faced with this dilemma?

Continue reading “Are You Helping a Child Move Before They are Ready? Thinking About Latency in the Context of Movement.”

How to Use the Timed Floor to Stand-Natural Test (TFTS-N)

Alina loves going to school and spending time with her classmates. She is a first grader with hemiplegic cerebral palsy (GMFCS level 1).   Alina’s typical school day involves getting up and down from circle time, getting in and out of chairs at various stations, and moving to get supplies.  As a PT coming into the classroom for the first time, you are pleased with the number of activities she joins.  However, her teacher shares concern that Alina struggles to keep up with the movement pace of the classroom.   How can you compare Alina’s classroom mobility to that of her peers?  Is there a test with norms that you can use?

TFTS-N Quick Facts:

  • 5-14 years
  • Stand-alone test for children in school environments
  • Walking at a natural pace
  • Timing begins at “go,” not when movement is initiated
  • Tape 3m apart on floor
  • Face validity:  activity of transitioning to/from floor and walking short distance.
  • Test-retest reliability: 0.871
  • Intertester reliability: 0.988

The Timed Floor to Stand-Natural (TFTS-N) test measures time as a child transitions from floor sitting to standing, walks 3m at a natural pace, turns around, walks back to the starting point and then returns to floor sitting.   The sitting position is tailor (criss-cross).   Continue reading “How to Use the Timed Floor to Stand-Natural Test (TFTS-N)”

1 Month: Starting to Lift the Head

“Jack has had tummy time every day since he was three days old.   At first he didn’t like being on his stomach, but now he is happy to play a while in this position.  He is interested in lifting his head to get his mouth on his hand.  It’s like a game to him.”

In tummy time, we want to see a progression of extension through the baby’s back over the first several months.  I’m always in awe and a little surprised at the slow but steady day-by-day progression, especially in the first month.   In the first days of tummy time the weight is on the baby’s face and it is not the most comfortable looking position, but exciting changes are on the way!

Continue reading “1 Month: Starting to Lift the Head”